Operator Auditory Perception and Spectral Quantification of Umbilical Artery Doppler Ultrasound Signals

OBJECTIVE: An experienced sonographer can by listening to the Doppler audio signals perceive various timbres that distinguish different types of umbilical artery flow despite an unchanged pulsatility index (PI). Our aim was to develop an objective measure of the Doppler audio signals recorded from fetoplacental circulation in a sheep model. METHODS: Various degrees of pathological flow velocity waveforms in the umbilical artery, similar to those in human complicated pregnancies, were induced by microsphere embolization of the placental bed (embolization model, 7 lamb fetuses, 370 Doppler recordings) or by fetal hemodilution (anemia model, 4 lamb fetuses, 184 recordings). A subjective 11-step operator auditory scale (OAS) was related to conventional Doppler parameters, PI and time average mean velocity (TAM), and to sound frequency analysis of Doppler signals (sound frequency with the maximum energy content [MAX(peak)] and frequency band at maximum level minus 15 dB [MAX(peak-15 dB)] over several heart cycles). RESULTS: We found a negative correlation between the OAS and PI: median Rho −0.73 (range −0.35– −0.94) and −0.68 (range −0.57– −0.78) in the two lamb models, respectively. There was a positive correlation between OAS and TAM in both models: median Rho 0.80 (range 0.58–0.95) and 0.90 (range 0.78–0.95), respectively. A strong correlation was found between TAM and the results of sound spectrum analysis; in the embolization model the median r was 0.91 (range 0.88–0.97) for MAX(peak) and 0.91 (range 0.82–0.98) for MAX(peak-15 dB). In the anemia model, the corresponding values were 0.92 (range 0.78–0.96) and 0.96 (range 0.89–0.98), respectively. CONCLUSION: Audio-spectrum analysis reflects the subjective perception of Doppler sound signals in the umbilical artery and has a strong correlation to TAM-velocity. This information might be of importance for clinical management of complicated pregnancies as an addition to conventional Doppler parameters.