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Galliotto F, Veronese P, Cerutti A, Zemin F, Bertelli F, Di Salvo G, Guariento A, Vida VL. Enhancing parental understanding of congenital heart disease through personalized prenatal counseling with 3D printed hearts. Prenat Diagn 2024; 44:725-732. [PMID: 38777748 DOI: 10.1002/pd.6583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/25/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES In addition to a correct prenatal diagnosis of congenital heart disease (CHD), comprehensive parental counseling is crucial to ensure that parents are well-informed about the condition of the fetus. This study aims to investigate whether there is a significant difference in the information acquired by parents through traditional counseling, utilizing 2-dimensional (2D) illustrations and images, compared to an advanced approach utilizing personalized three-dimensional (3D) printed models of the fetal heart developed from 3D ultrasound imaging. METHODS This study, designed as a pilot randomized control trial, enrolled pregnant women with gestational ages greater than 18 weeks, whose fetuses were diagnosed with CHD and referred to our center between November, 2020 and June, 2021. Two groups of patients were included in the study. The first group received standard medical counseling with 2D images and illustrations, while the second group underwent advanced counseling with 3D-printed patient-specific heart models. Both groups were then required to complete the same survey in which the knowledge of the CHD was investigated. The 3D models were created from 3D ultrasound imaging and printed using resin materials in both 1:1 and 5:1 scale. RESULTS A comparison of the scores obtained from the two groups revealed that 3D visualization of the fetus's heart has the potential to increase parental knowledge about CHD and the required surgical procedures. Furthermore, all couples expressed interest in receiving a 1:1 scale model of their baby's heart. CONCLUSION Personalized prenatal counseling with 3D-ultrasound-based heart models positively impacts parents' understanding of CHD. The use of 3D models provides a more comprehensive and accessible representation of the condition, contributing to an increased knowledge gain, and potentially helping to support informed decisions regarding their child's care.
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Affiliation(s)
- Francesco Galliotto
- Pediatric Cardiac Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Paola Veronese
- Maternal Fetal Medicine Division, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Alessia Cerutti
- Pediatric Cardiology Division, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Filippo Zemin
- Maternal Fetal Medicine Division, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Francesco Bertelli
- Pediatric Cardiac Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Division, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Alvise Guariento
- Pediatric Cardiac Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Vladimiro L Vida
- Pediatric Cardiac Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Karmegaraj B. Foramen ovale flap aneurysm in fetuses associated with and without heart defects: Prenatal diagnosis, imaging, in-utero hemodynamics, pregnancy, and postnatal outcomes. Echocardiography 2024; 41:e15743. [PMID: 38284679 DOI: 10.1111/echo.15743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Isolated redundant foramen ovale flap aneurysm (RFOA) in the absence of restrictive foramen ovale is believed to be a cause for pseudocoarctation of aorta since the impediment of blood flow to the left heart can be severe, resembling the picture of left ventricular hypoplasia with retrograde aortic flow. The primary objective of the study is to find whether RFOA is always a benign lesion. The main focus of the study is to share my experience in particular on fetuses having redundant foramen ovale flap aneurysm developing into coarctation of aorta and to study the associated factors. METHODS Retrospective study (January 2020 to June 2023). All fetuses with RFOA associated with and without congenital heart defects were included. Fetuses with restrictive foramen ovale and RFOA with single ventricle hearts were excluded. The imaging, in-utero hemodynamics, pregnancy, and postnatal outcomes with at least 3 months follow-up were presented. RESULTS During the study period, a total of 1499 fetal echocardiography were performed. Twenty-two fetuses with RFOA were included. Fourteen fetuses had isolated RFOA and eight had associated abnormalities [extracardiac (n = 5); intracardiac (n = 2), Both (n = 1)]. Genetic evaluation were performed only in fetuses with associated defects were normal. Postnatally all isolated RFOA fetuses had no aortic arch obstruction. Fetuses with associated aberrant right subclavian artery, isolated left superior vena cava, absent ductus venosus and ventricular septal defects developed aortic arch obstruction after birth. RFOA causes smallish left ventricle in fetuses with tetralogy of Fallot which recovered to normal size postnatally. CONCLUSION Isolated RFOA can be benign, however, if it is associated with cardiac or extracardiac anomalies predominantly resulted in aortic arch obstruction. Though it is a cause for pseudocoarctation of aorta, through postnatal reassessment of aortic arch is mandatory. Careful search for intracardiac and systemic venous anomalies is recommended. It created confusion regarding adequacy of left ventricle when associated with congenital heart defects.
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Affiliation(s)
- Balaganesh Karmegaraj
- Sowmi Pediatric Heart Centre, Swasthik Fetal Heart unit, Tamilnadu, India
- Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kerala, India
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Gembicki M, Welp A, Scharf JL, Dracopoulos C, Weichert J. Application of Semiautomatic Fetal Intelligent Navigation Echocardiography (FINE) in Twin Pregnancies: Half the Work or Twice the Effort? Cureus 2023; 15:e38052. [PMID: 37228519 PMCID: PMC10207972 DOI: 10.7759/cureus.38052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To assess the performance of fetal intelligent navigation echocardiography (FINE, 5D Heart™) for automated volumetric investigation of the fetal heart in twin pregnancies. METHODS Three hundred twenty-eight twin fetuses underwent fetal echocardiography in the second and third trimesters. Spatiotemporal image correlation (STIC) volumes were obtained for a volumetric investigation. The volumes were analyzed using the FINE software, and the data were investigated regarding image quality and many properly reconstructed planes. RESULTS Three hundred and eight volumes underwent final analysis. 55.8% of the included pregnancies were dichorionic twin pregnancies, and 44.2% were monochorionic twin pregnancies. The mean gestational age (GA) was 22.1 weeks, and the mean maternal BMI was 27.3 kg/m2. The STIC-volume acquisition was successful in 100.0% and 95.5% of cases. The overall depiction rates of FINE were 96.5% (twin 1) and 94.7% (twin 2), respectively (p = 0.0849, not significant). In 95.9% (twin 1) and 93.9% (twin 2), at least 7 planes were reconstructed properly (p = 0.6056, not significant). CONCLUSION Our results indicate that the FINE technique used in twin pregnancies is reliable. No significant difference between the depiction rates of twin 1 and twin 2 could be detected. In addition, the depiction rates are as high as those derived from singleton pregnancies. Due to the challenges of fetal echocardiography in twin pregnancies (i.e., greater rates of cardiac anomaly and more difficult scans), the FINE technique might be a valuable tool to improve the quality of medical care in those pregnancies.
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Affiliation(s)
- Michael Gembicki
- Obstetrics and Gynaecology, Universitätsklinikum Schleswig-Holstein, Luebeck, DEU
| | - Amrei Welp
- Obstetrics and Gynaecology, Universitätsklinikum Schleswig-Holstein, Luebeck, DEU
| | - Jann Lennard Scharf
- Obstetrics and Gynaecology, Universitätsklinikum Schleswig-Holstein, Luebeck, DEU
| | | | - Jan Weichert
- Obstetrics and Gynaecology, Universitätsklinikum Schleswig-Holstein, Luebeck, DEU
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Veronese P, Guariento A, Cattapan C, Fedrigo M, Gervasi MT, Angelini A, Riva A, Vida V. Prenatal Diagnosis and Fetopsy Validation of Complete Atrioventricular Septal Defects Using the Fetal Intelligent Navigation Echocardiography Method. Diagnostics (Basel) 2023; 13:diagnostics13030456. [PMID: 36766561 PMCID: PMC9914343 DOI: 10.3390/diagnostics13030456] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
(1) Background: Artificial Intelligence (AI) is a modern tool with numerous applications in the medical field. The case series reported here aimed to investigate the diagnostic performance of the fetal intelligent navigation echocardiography (FINE) method applied for the first time in the prenatal identification of atrioventricular septal defects (AVSD). This congenital heart disease (CHD) is associated with extracardiac anomalies and chromosomal abnormalities. Therefore, an early diagnosis is essential to advise parents and make adequate treatment decisions. (2) Methods: Four fetuses diagnosed with AVSD via two-dimensional (2D) ultrasound examination in the second trimester were enrolled. In all cases, the parents chose to terminate the pregnancy. Since the diagnosis of AVSD with 2D ultrasound may be missed, one or more four-dimensional (4D) spatiotemporal image correlation (STIC) volume datasets were obtained from a four-chamber view. The manual navigation enabled by the software is time-consuming and highly operator-dependent. (3) Results: FINE was applied to these volumes and nine standard fetal echocardiographic views were generated and optimized automatically, using the assistance of the virtual intelligent sonographer (VIS). Here, 100% of the four-chamber views, and after the VISA System application the five-chamber views, of the diagnostic plane showed the atrioventricular septal defect and a common AV valve. The autopsies of the fetuses confirmed the ultrasound results. (4) Conclusions: By applying intelligent navigation technology to the STIC volume datasets, 100% of the AVSD diagnoses were detected.
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Affiliation(s)
- Paola Veronese
- Maternal-Fetal Medicine Unit, Department of Women’s and Children’s Health, University of Padua, 35128 Padova, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Marny Fedrigo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Maria Teresa Gervasi
- Maternal-Fetal Medicine Unit, Department of Women’s and Children’s Health, University of Padua, 35128 Padova, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Arianna Riva
- Maternal-Fetal Medicine Unit, Department of Women’s and Children’s Health, University of Padua, 35128 Padova, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-0498212427
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Swor K, Yeo L, Tarca AL, Jung E, Romero R. Fetal intelligent navigation echocardiography (FINE) has superior performance compared to manual navigation of the fetal heart by non-expert sonologists. J Perinat Med 2022; 51:477-491. [PMID: 36474319 PMCID: PMC10164033 DOI: 10.1515/jpm-2022-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Manual and intelligent navigation (i.e. fetal intelligent navigation echocardiography or FINE) by the operator are two methods to obtain standard fetal cardiac views from spatiotemporal image correlation (STIC) volumes. The objective was to compare the performance between manual and intelligent navigation (FINE) of the fetal heart by non-expert sonologists. METHODS In this prospective observational study, ten sonologists underwent formal training on both navigational methods. Subsequently, they were tested on their ability to obtain nine cardiac views from five STIC volumes of normal fetal hearts (19-28 gestational weeks) using such methods. The following parameters were determined for both methods: (1) success rate of obtaining nine cardiac views; (2) mean time to obtain nine cardiac views per sonologist; and (3) maximum number of cardiac views successfully obtained for each STIC volume. RESULTS All fetal cardiac images obtained from 100 STIC volumes (50 for each navigational method) were reviewed by an expert in fetal echocardiography. Compared to manual navigation, FINE was associated with a significantly: (1) higher success rate of obtaining eight (excluding the abdomen view) appropriate cardiac views (92-100% vs. 56-88%; all p<0.05); (2) shorter mean time (minute:seconds) to obtain nine cardiac views (2:11 ± 0:37 vs. 15:49 ± 7:44; p<0.0001); and (3) higher success rate of obtaining all nine cardiac views for a given STIC volume (86 vs. 14%; p<0.001). CONCLUSIONS When performed by non-expert sonologists, intelligent navigation (FINE) had a superior performance compared to manual navigation of the normal fetal heart. Specifically, FINE obtained appropriate fetal cardiac views in 92-100% of cases.
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Affiliation(s)
- Katie Swor
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Adi L Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Computer Science, College of Engineering, Wayne State University, Detroit, MI, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
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Maximal Reduction of STIC Acquisition Time for Volumetric Assessment of the Fetal Heart—Benefits and Limitations of Semiautomatic Fetal Intelligent Navigation Echocardiography (FINE) Static Mode. J Clin Med 2022; 11:jcm11144062. [PMID: 35887826 PMCID: PMC9320472 DOI: 10.3390/jcm11144062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Objective: To scrutinize the reliability and the clinical value of routinely used fetal intelligent navigation echocardiography (FINE) static mode (5DHeartStatic™) for accelerated semiautomatic volumetric assessment of the normal fetal heart. (2) Methods: In this study, a total of 296 second and third trimester fetuses were examined by targeted ultrasound. Spatiotemporal image correlation (STIC) volumes of the fetal heart were acquired for further volumetric assessment. In addition, all fetal hearts were scanned by a fast acquisition time volume (1 s). The volumes were analyzed using the FINE software. The data were investigated regarding the number of properly reconstructed planes and cardiac axis. (3) Results: A total of 257 volumes were included for final analysis. The mean gestational age (GA) was 23.9 weeks (14.3 to 37.7 weeks). In 96.9 (standard acquisition time, FINE standard mode) and 94.2% (fast acquisition time, FINE static mode) at least seven planes were reconstructed properly (p = 0.0961, not significant). Regarding the overall depiction rate, the standard mode was able to reconstruct 96.9% of the planes properly, whereas the static mode showed 95.2% of the planes (p = 0.0098). Moreover, there was no significant difference between the automatic measurement of the cardiac axis (37.95 + 9.14 vs. 38.00 + 8.92 degrees, p = 0.8827, not significant). (4) Conclusions: Based on our results, the FINE static mode technique is a reliable method. It provides similar information of the cardiac anatomy compared to conventional STIC volumes assessed by the FINE method. The FINE static mode has the potential to minimize the influence of motion artifacts during volume acquisition and might therefore be helpful concerning volumetric cardiac assessment in daily routine.
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Yeo L, Romero R. New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D heart. J Matern Fetal Neonatal Med 2022; 35:1498-1516. [PMID: 32375528 PMCID: PMC10544755 DOI: 10.1080/14767058.2020.1759538] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Congenital heart disease (CHD) is the leading organ-specific birth defect, as well as the leading cause of infant morbidity and mortality from congenital malformations. Therefore, a comprehensive screening examination of the fetal heart should be performed in all women to maximize the detection of CHD. Four-dimensional sonography with spatiotemporal image correlation (STIC) technology displays a cine loop of a complete single cardiac cycle in motion. A novel method known as Fetal Intelligent Navigation Echocardiography (or FINE) was previously developed to interrogate STIC volume datasets using "intelligent navigation" technology. Such method allows the automatic display of nine standard fetal echocardiography views required to diagnose most cardiac defects. FINE considerably simplifies fetal cardiac examinations and reduces operator dependency. It has both high sensitivity and specificity for the detection of CHD. Indeed, FINE has been integrated into several commercially available ultrasound platforms.Recently, eight novel and advanced features have been developed for the FINE method and they will be described herein. Such features can be categorized based upon their broad goals. The first goal is to simplify FINE further, and consists of the following features: (1) Auto fetal positioning (or FINE align); (2) Skip points; (3) Predictive cursor; (4) Static mode volume; and (5) Breech sweep. The second goal is to allow quantitative measurements to be performed on the cardiac views generated by FINE: (6) Automatic cardiac axis; and (7) Cardiac biometry. Finally, the last goal is to improve the success of obtaining fetal echocardiography view(s); and consists of (8) Maestro planar navigation.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
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Karmegaraj B, Kumar S, Srimurugan B, Sudhakar A, Simpson JM, Vaidyanathan B. 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double-outlet right ventricle. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:423-430. [PMID: 32022380 DOI: 10.1002/uog.21988] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision-making and in predicting surgical approach in fetuses with double-outlet right ventricle (DORV). METHODS This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision-making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken. RESULTS Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single-stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single-stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04). CONCLUSION Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision-making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Karmegaraj
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - S Kumar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Srimurugan
- Department of Cardiovascular Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Sudhakar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Vaidyanathan
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Abduljalil K, Pan X, Clayton R, Johnson TN, Jamei M. Fetal Physiologically Based Pharmacokinetic Models: Systems Information on Fetal Cardiac Output and Its Distribution to Different Organs during Development. Clin Pharmacokinet 2021; 60:741-757. [PMID: 33486719 DOI: 10.1007/s40262-020-00973-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Fetal circulation is unique and the parameters describing hemodynamic status during development are critical for constructing a fetal physiologically based pharmacokinetic model. To date, a comprehensive review of circulatory changes during fetal development, with a specific focus on developing these models, has not been reported. The objective of this work was to collate, analyze, and mathematically describe physiological information on fetal cardiac output and tissue blood flows during development. METHODS A comprehensive literature search was carried out to collate and evaluate the changes to fetal cardiac output and fetal tissue blood flows during growth. The collated data were assessed, integrated, and analyzed to establish continuous mathematical functions describing the average parameter changes and variability during development. RESULTS Data were available for fetal cardiac output (14 Doppler studies), blood flow through the fetal umbilical vein (15 studies), ductus venosus (6 studies), liver veins (5 studies), brain (4 studies), lungs (5 studies), and kidneys (2 studies). Fetal cardiac output is described as either an age- or weight-dependent function. The latter is preferred as it generates an individualized cardiac output that is correlated to the fetal body weight. Blood flow as a proportion of fetal cardiac output to the liver, placenta, brain, kidneys, and lungs was age varying, whilst for the adipose, bone, heart, muscle, and skin the blood flow proportions were fixed. The pattern of change (with respect to direction and pace) for each of these parameters was different. CONCLUSIONS Despite limitations in the availability of some values, the collected data provide a useful resource for fetal physiologically based pharmacokinetic modeling. Potential applications of these data include predicting xenobiotic exposure and risk assessment in the fetus following the administration of maternally dosed drugs or unintended exposure to environmental toxicants.
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Affiliation(s)
- Khaled Abduljalil
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK.
| | - Xian Pan
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Ruth Clayton
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Trevor N Johnson
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Masoud Jamei
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
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Gembicki M, Hartge DR, Fernandes T, Weichert J. Feasibility of Semiautomatic Fetal Intelligent Navigation Echocardiography for Different Fetal Spine Positions: A Matter of "Time"? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:91-100. [PMID: 32583930 DOI: 10.1002/jum.15379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We investigated the feasibility of a semiautomatic approach for assessments of the fetal heart (fetal intelligent navigation echocardiography [FINE]) in cases of optimal and unfavorable fetal spine positions. METHODS In this study, a total of 1693 spatiotemporal image correlation volumes of first-, second-, and third-trimester fetuses were evaluated by experts using the FINE approach. The data were analyzed regarding proper reconstruction of the diagnostic cardiac planes depending on the fetal spine position. RESULTS A total of 1531 volumes were included. The volumes were divided into 4 groups depending on the fetal spine position: 5-7 o'clock, 4 + 8 o'clock, 3 + 9 o'clock, and 2 + 10 o'clock. In total, 93.2% of the diagnostic planes were displayed properly. Between 5 and 7 o'clock, 94.9% of the diagnostic planes were displayed properly. The correct depiction rates in the other groups were 92.4% (4 + 8 o'clock; n = 538; P = 0.0027), 88.3% (3 + 9 o'clock; n = 156; P < .0001), and 87.3% (2 + 10 o'clock; n = 41; P = .0139). In total, the highest dropout rates were found in the sagittal planes: ductal arch, 13.9%; aortic arch, 10.5%; and venae cavae, 12.0%. CONCLUSIONS Based on our results, the FINE technique is an effective method, but its feasibility depends on the fetal position. The use of this semiautomatic work flow-based approach supports evaluation of the fetal heart in a standardized manner. Semiautomatic evaluation of the fetal heart might be useful in facilitating the detection of fetal cardiac anomalies.
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Affiliation(s)
- Michael Gembicki
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Schleswig-Holstein, Germany
| | - David R Hartge
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Schleswig-Holstein, Germany
| | - Theresa Fernandes
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Schleswig-Holstein, Germany
| | - Jan Weichert
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Schleswig-Holstein, Germany
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11
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Chaoui R. Evolution of fetal cardiac imaging in 30 years of ISUOG. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:38-42. [PMID: 33387411 DOI: 10.1002/uog.23551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
MESH Headings
- Female
- Fetal Heart/diagnostic imaging
- History, 20th Century
- History, 21st Century
- Humans
- Imaging, Three-Dimensional/history
- Imaging, Three-Dimensional/methods
- Periodicals as Topic/history
- Pregnancy
- Ultrasonography, Doppler, Color/history
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Prenatal/history
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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12
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Valderrama CE, Ketabi N, Marzbanrad F, Rohloff P, Clifford GD. A review of fetal cardiac monitoring, with a focus on low- and middle-income countries. Physiol Meas 2020; 41:11TR01. [PMID: 33105122 PMCID: PMC9216228 DOI: 10.1088/1361-6579/abc4c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is limited evidence regarding the utility of fetal monitoring during pregnancy, particularly during labor and delivery. Developed countries rely on consensus 'best practices' of obstetrics and gynecology professional societies to guide their protocols and policies. Protocols are often driven by the desire to be as safe as possible and avoid litigation, regardless of the cost of downstream treatment. In high-resource settings, there may be a justification for this approach. In low-resource settings, in particular, interventions can be costly and lead to adverse outcomes in subsequent pregnancies. Therefore, it is essential to consider the evidence and cost of different fetal monitoring approaches, particularly in the context of treatment and care in low-to-middle income countries. This article reviews the standard methods used for fetal monitoring, with particular emphasis on fetal cardiac assessment, which is a reliable indicator of fetal well-being. An overview of fetal monitoring practices in low-to-middle income counties, including perinatal care access challenges, is also presented. Finally, an overview of how mobile technology may help reduce barriers to perinatal care access in low-resource settings is provided.
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Affiliation(s)
- Camilo E Valderrama
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nasim Ketabi
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering, Monash University, Clayton, VIC, Australia
| | - Peter Rohloff
- Wuqu' Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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13
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Pepes S, Parthenakis F, Makrigiannakis A, Germanakis I. Electronic versus conventional spatiotemporal image correlation (STIC) fetal echocardiography: a direct comparison. J Matern Fetal Neonatal Med 2020; 35:1310-1317. [PMID: 32295436 DOI: 10.1080/14767058.2020.1752656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives: Recent advances in Spatial Temporal Image Correlation (STIC) 4 D fetal echocardiography include the application of eSTIC based on electronic probe image acquisition. We aimed to directly compare the performance of conventional STIC versus eSTIC technique (B-Mode and color Doppler imaging) during off-line reconstruction of STIC/eSTIC fetal heart volume pairs.Methods: Pairs of B-Mode and Color Doppler STIC volumes were acquired sequentially by firstly conventional (STIC) followed by electronic (eSTIC) probes during 33 consecutive obstetric scans at median 23 (range 13-31) gestational weeks. The resulting 66 fetal heart volume pairs were assessed blindly off-line by a fetal cardiologist who documented feasibility of reconstruction, presence of motion artifacts, subjective image quality on a 4-level scale: 1-best to 4-non-diagnostic and morphological diagnosis, to enable a paired comparison of STIC and eSTIC in the same fetus under similar scanning conditions.Results: eSTIC volumes had higher temporal resolution (37 vs. 24 frames per second, p < .001), less motion during acquisition (12 vs. 20 cases, O.R. 7.0, p = .002) and better average image quality (1.9 vs. 2.2, p = .006) compared to STIC volumes. More diagnostic reconstructions were achieved by eSTIC (n = 55, 86%) than STIC (n = 52, 78.8%), p = .001), in a comparable analysis time (mean 4.96 vs. 4.94 min). During a comparison of image quality of the original acquisition (A) and reconstructed planes (B and C planes) e STIC was superior in 22 (33%), 39 (59%) and 21 (38%) volumes, respectively, with the remaining cases being of similar quality (<10% in each plane in favor of STIC). Imaging mode and gestational age had a similar impact on both eSTIC and STIC performance: diagnostically acceptable studies in 49 (75.8%) vs. 48 (72.2%) by B-Mode, 60 (90.9%) vs. 56 (84.8%) by Color Doppler Mode, 8 (62.5%) vs. 10 (50%) in early scans, 38 (95%) vs. 38 (95%) in mid-gestation scans, and 7 (70%) vs. 6 (60%) in third trimester scans. Eight obstetric scans identified a fetus with a cardiac variant or structural abnormality. Diagnostic concordance of the two STIC approaches was comparable (40/48 concordant interpretations, kappa 0.657) all confirmed by fetal and/or postnatal echocardiography.Conclusions: eSTIC was associated with more effective 4 D fetal heart reconstruction due to reduced motion artifacts and superior image quality in all planes, when compared to STIC. Early gestation reconstructions were not generally successful using either technology. Further study is needed to define the cost-effectiveness and diagnostic impact of eSTIC over conventional STIC and their role over, or in addition to, screening 2 D fetal echocardiography by appropriately trained sonographers.
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Affiliation(s)
- Spiridon Pepes
- School of Medicine, University of Crete, Heraklion, Greece
| | | | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Ioannis Germanakis
- Department of Pediatrics, School of Medicine, University of Crete, Heraklion, Greece
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14
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Gembicki M, Hartge DR, Dracopoulos C, Weichert J. Semiautomatic Fetal Intelligent Navigation Echocardiography Has the Potential to Aid Cardiac Evaluations Even in Less Experienced Hands. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:301-309. [PMID: 31411353 DOI: 10.1002/jum.15105] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To investigate the interobserver and intraobserver variability and corresponding learning curve in a semiautomatic approach for a standardized assessment of the fetal heart (fetal intelligent navigation echocardiography [FINE]). METHODS A total of 30 stored spatiotemporal image correlation volume data sets of second-trimester fetuses were evaluated by 3 physicians with different levels of expertise in fetal echocardiography by using the FINE approach. Data were analyzed regarding the examination time and proper reconstruction of the diagnostic cardiac planes. The completions and numbers of correct depictions of all diagnostic planes were evaluated by a blinded expert (time t0). To determine interobserver and intraobserver variability, the volumes were reassessed after a 4-week training interval (time t1). RESULTS All operators were able to perform the investigation on all 30 volumes. At t0, the interobserver variability between the beginner and both the advanced (P = .0013) and expert (P < .0001) examiners was high. Focusing on intraobserver variability at t1, the beginner showed a marked improvement (P = .0087), whereas in advanced and expert hands, no further improvement regarding proper achievement of all diagnostic planes could be noticed (P > .999; P = .8383). The beginner also showed improvement in the mean investigation time (t0, 82.8 seconds; t1, 73.4 seconds; P = .0895); nevertheless, the advanced and expert examiners were faster in completing the examination (t1, advanced, 20.9 seconds; expert, 28.3 seconds; each P < .0001). CONCLUSIONS Based on our results, the FINE technique is a reliable and easily learned method. The use of this semiautomatic work flow-based approach supports evaluation of the fetal heart in a standardized and time-saving manner. A semiautomatic evaluation of the fetal heart might be useful in facilitating the detection of fetal cardiac anomalies.
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Affiliation(s)
- Michael Gembicki
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - David R Hartge
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christoph Dracopoulos
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Jan Weichert
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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15
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Kolding L, Pedersen LH, Petersen OB, Uldbjerg N, Sandager P. Sertraline use during pregnancy and effect on fetal cardiac function. J Matern Fetal Neonatal Med 2019; 34:3631-3638. [PMID: 31718339 DOI: 10.1080/14767058.2019.1688297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: The objective of this study was to evaluate the fetal cardiac function in human pregnancies exposed to sertraline (a selective serotonin reuptake inhibitor) compared to unexposed pregnancies.Method: We included 44 women in gestational week 25 + 0 days to week 26 + 6 days. Fifteen women used sertraline (50-150 mg per day), and 29 women used no daily medication. We assessed fetal cardiac function by Myocardial Performance Index (MPI), E/A ratios and by tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE) measured by 2D M-mode and by 4D eSTIC M-mode.Results: There were no differences between the sertraline exposed and the unexposed. The mean difference of MPI was 0.03 (95% CI -0.08-0.03), of tricuspid and mitral E/A ratios 0.00 (95% CI -0.03-0.05) and 0.03 (95% CI -0.07-0.01), respectively. The mean difference of TAPSE, by 2D and eSTIC, was 0.07 mm (95% CI -0.56-0.41) and 0.10 mm (95% CI -0.55-0.34). Mean difference of MAPSE, by 2D and eSTIC was 0.16 mm (95% CI -0.22-0.53) and 0.24 mm (95% CI -0.16-0.65), respectively. Serum levels of sertraline in exposed participants ranged from 33-266, median 92 nmol/L.Conclusions: We found no significant differences in fetal cardiac function, assessed by TAPSE, MAPSE, MPI and E/A ratios, in pregnancies exposed to sertraline compared to the unexposed.
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Affiliation(s)
- Line Kolding
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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16
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Tseng JJ, Peng HW, Jan SL. An In-depth Perspective of Aortic Arch Branching in Fetal Vascular Rings Using Spatiotemporal Image Correlation Combined With High-definition Flow Imaging: Report of 4 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2217-2224. [PMID: 30536443 DOI: 10.1002/jum.14891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/29/2018] [Accepted: 11/10/2018] [Indexed: 06/09/2023]
Abstract
On the basis of 2-dimensional fetal echocardiographic findings, we investigated 4 different fetal vascular ring cases using spatiotemporal image correlation (STIC) combined with high-definition (HD) flow imaging. An in-depth 3-dimensional perspective of aortic arch branching (ie, the brachiocephalic arteries) was created by application of glass body and HDlive flow rendering algorithms (GE Healthcare, Zipf, Austria). Additionally, complete (U- or O-shaped) or incomplete (C-shaped) vascular rings were clearly differentiated in utero, and articulations around the trachea and esophagus were more easily imaged. In conclusion, spatiotemporal image correlation combined with HD flow imaging could classify fetal vascular rings with accuracy and facilitate decision making during postnatal management.
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Affiliation(s)
- Jenn-Jhy Tseng
- Divisions of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Hsien-Wen Peng
- Divisions of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shen-Ling Jan
- Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
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17
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Chaoui R, Abuhamad A, Martins J, Heling K. Recent Development in Three and Four Dimension Fetal Echocardiography. Fetal Diagn Ther 2019; 47:345-353. [DOI: 10.1159/000500454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
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18
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Dall'Asta A, Paramasivam G, Basheer SN, Whitby E, Tahir Z, Lees C. How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology. Am J Obstet Gynecol 2019; 220:215-229. [PMID: 30447211 DOI: 10.1016/j.ajog.2018.11.1088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022]
Abstract
The antenatal evaluation of the fetal central nervous system (CNS) is among the most difficult tasks of prenatal ultrasound (US), requiring technical skills in relation to ultrasound and image acquisition as well as knowledge of CNS anatomy and how this changes with gestation. According to the International Guidelines for fetal neurosonology, the basic assessment of fetal CNS is most frequently performed on the axial planes, whereas the coronal and sagittal planes are required for the multiplanar evaluation of the CNS within the context of fetal neurosonology. It can be even more technically challenging to obtain "nonaxial" views with 2-dimensional (2D) US. The modality of 3-dimensional (3D) US has been suggested as a panacea to overcome the technical difficulties of achieving nonaxial views. The lack of familiarity of most sonologists with the use of 3D US and its related processing techniques may preclude its use even where it could play an important role in complementing antenatal 2D US assessment. Furthermore, once a 3D volume has been acquired, proprietary software allows it to be processed in different ways, leading to multiple ways of displaying and analyzing the same anatomical imaging or plane. These are difficult to learn and time consuming in the absence of specific training. In this article, we describe the key steps for volume acquisition of a 3D US volume, manipulation, and processing with reference to images of the fetal CNS, using a newly developed context-preserving rendering technique.
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Affiliation(s)
- Andrea Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Gowrishankar Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sheikh Nigel Basheer
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Sheffield, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Development and Regeneration, KU Leuven, Belgium.
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19
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Yeo L, Luewan S, Romero R. Fetal Intelligent Navigation Echocardiography (FINE) Detects 98% of Congenital Heart Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2577-2593. [PMID: 29603310 PMCID: PMC6165712 DOI: 10.1002/jum.14616] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Fetal intelligent navigation echocardiography (FINE) is a novel method that automatically generates and displays 9 standard fetal echocardiographic views in normal hearts by applying intelligent navigation technology to spatiotemporal image correlation (STIC) volume data sets. The main objective was to determine the sensitivity and specificity of FINE in the prenatal detection of congenital heart disease (CHD). METHODS A case-control study was conducted in 50 fetuses with a broad spectrum of CHD (cases) and 100 fetuses with normal hearts (controls) in the second and third trimesters. Using 4-dimensional ultrasound with STIC technology, volume data sets were acquired. After all identifying information was removed, the data sets were randomly distributed to a different investigator for analysis using FINE. The sensitivity and specificity for the prenatal detection of CHD, as well as positive and negative likelihood ratios were determined. RESULTS The diagnostic performance of FINE for the prenatal detection of CHD was: sensitivity of 98% (49 of 50), specificity of 93% (93 of 100), positive likelihood ratio of 14, and negative likelihood ratio of 0.02. Among cases with confirmed CHD, the diagnosis with use of FINE completely matched the final diagnosis in 74% (37 of 50); minor discrepancies were seen in 12% (6 of 50), and major discrepancies were seen in 14% (7 of 50). CONCLUSIONS This is the first time the sensitivity and specificity of the FINE method in fetuses with normal hearts and CHD in the second and third trimesters has been reported. Because FINE identifies a broad spectrum of CHD with 98% sensitivity, this method could be used prenatally to screen for and diagnose CHD.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of HealthBethesda, Maryland, and DetroitMichiganUSA
- Detroit Medical CenterHutzel Women's HospitalDetroitMichiganUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMichiganUSA
| | - Suchaya Luewan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of HealthBethesda, Maryland, and DetroitMichiganUSA
- Department of Obstetrics and GynecologyChiang Mai UniversityChiang MaiThailand
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of HealthBethesda, Maryland, and DetroitMichiganUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMichiganUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMichiganUSA
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20
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Abstract
With the introduction of the electronic 4-dimensional and spatial-temporal image Correlation (e-STIC), it is now possible to obtain large volume datasets of the fetal heart that are virtually free of artifact. This allows the examiner to use a number of imaging modalities when recording the volumes that include two-dimensional real time, power and color Doppler, and B-flow images. Once the volumes are obtained, manipulation of the volume dataset allows the examiner to recreate views of the fetal heart that enable examination of cardiac anatomy. The value of this technology is that a volume of the fetal heart can be obtained, irrespective of the position of the fetus in utero, and manipulated to render images for interpretation and diagnosis. This article presents a summary of the various imaging techniques and provides clinical examples of its application used for prenatal diagnosis of congenital heart defects and abnormal cardiac function.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, CA, USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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21
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Guasina F, Bellussi F, Morganelli G, Salsi G, Pilu G, Simonazzi G. Electronic spatiotemporal image correlation improves four-dimensional fetal echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:357-360. [PMID: 28337810 DOI: 10.1002/uog.17474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the efficiency of electronic spatiotemporal image correlation (eSTIC) with that of conventional STIC to acquire four-dimensional (4D) fetal cardiac volumes of diagnostic quality. METHODS This was a randomized controlled trial of 100 patients in mid-gestation with normal sonograms. In half of the cases, STIC volumes of the fetal heart were obtained with a conventional mechanical 4D probe and in the remaining cases eSTIC volumes were obtained with an electronic 4D probe. Examinations were kept within the timeframe allotted for a standard examination of fetal anatomy, and a maximum of two attempts were made at obtaining a 4D cardiac volume. Datasets were stored on a computer and subsequently analyzed and categorized as being of optimal, satisfactory or inadequate quality, depending on whether or not it was possible to perform an extended basic cardiac examination, including obtaining a three vessels and trachea view, as well as a clear reconstruction of both the aortic and ductal arches in the sagittal plane. RESULTS The eSTIC volume datasets were more frequently of optimal or satisfactory diagnostic quality compared with conventional STIC (94% vs 76%, P < 0.0001). Failure to obtain an eSTIC volume of adequate quality was in all cases the consequence of an unfavorable position of the fetus. CONCLUSIONS Compared with a standard mechanical probe, the electronic 4D probe facilitates acquisition of sonographic cardiac volumes in mid-trimester fetuses. In our hands, eSTIC volumes of optimal or satisfactory diagnostic quality, allowing a detailed offline evaluation of the fetal heart, were obtained in more than 90% of cases within the time frame of a standard examination of fetal anatomy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Guasina
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - G Morganelli
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - G Simonazzi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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22
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Yeo L, Romero R. Color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE) to evaluate the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:476-491. [PMID: 28809063 PMCID: PMC5656930 DOI: 10.1002/uog.17522] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/23/2017] [Accepted: 03/03/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate the performance of color and bidirectional power Doppler ultrasound combined with Fetal Intelligent Navigation Echocardiography (FINE) in examining the fetal heart. METHODS A prospective cohort study was conducted of fetuses in the second and third trimesters with a normal heart or with congenital heart disease (CHD). One or more spatiotemporal image correlation (STIC) volume datasets, combined with color or bidirectional power Doppler (S-flow) imaging, were acquired in the apical four-chamber view. Each successfully obtained STIC volume was evaluated by STICLoop™ to determine its appropriateness before applying the FINE method. Visualization rates for standard fetal echocardiography views using diagnostic planes and/or Virtual Intelligent Sonographer Assistance (VIS-Assistance®) were calculated for grayscale (removal of Doppler signal), color Doppler and S-flow Doppler. In four cases with CHD (one case each of tetralogy of Fallot, hypoplastic left heart and coarctation of the aorta, interrupted inferior vena cava with azygos vein continuation and asplenia, and coarctation of the aorta with tricuspid regurgitation and hydrops), the diagnostic potential of this new technology was presented. RESULTS A total of 169 STIC volume datasets of the normal fetal heart (color Doppler, n = 78; S-flow Doppler, n = 91) were obtained from 37 patients. Only a single STIC volume of color Doppler and/or a single volume of S-flow Doppler per patient were analyzed using FINE. Therefore, 60 STIC volumes (color Doppler, n = 27; S-flow Doppler, n = 33) comprised the final study group. Median gestational age at sonographic examination was 23 (interquartile range, 21-27.5) weeks. Color Doppler FINE generated nine fetal echocardiography views (grayscale) using (1) diagnostic planes in 73-100% of cases, (2) VIS-Assistance in 100% of cases, and (3) a combination of diagnostic planes and/or VIS-Assistance in 100% of cases. The rate of generating successfully eight fetal echocardiography views with appropriate color and S-flow Doppler information was 89-100% and 91-100% of cases, respectively, using a combination of diagnostic planes and/or VIS-Assistance. However, the success rate for the ninth echocardiography view (i.e. superior and inferior venae cavae) was 33% and 30% for color and S-flow Doppler, respectively. In all four cases of CHD, color Doppler FINE demonstrated evidence of abnormal fetal cardiac anatomy and/or hemodynamic flow. CONCLUSIONS The FINE method applied to STIC volumes of normal fetal hearts acquired with color or bidirectional power Doppler information can generate successfully eight to nine standard fetal echocardiography views (via grayscale, color Doppler or power Doppler) in the second and third trimesters. In cases of CHD, color Doppler FINE demonstrates successfully abnormal anatomy and/or Doppler flow characteristics. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIHBethesdaMD and Detroit, MIUSA
- Detroit Medical CenterHutzel Women's HospitalDetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - R. Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIHBethesdaMD and Detroit, MIUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMIUSA
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Merz E, Pashaj S. Advantages of 3D ultrasound in the assessment of fetal abnormalities. J Perinat Med 2017; 45:643-650. [PMID: 28157693 DOI: 10.1515/jpm-2016-0379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/20/2016] [Indexed: 11/15/2022]
Abstract
Three-/four-dimensional (3D/4D) imaging enables a more detailed survey of the embryo and the fetus compared to two-dimensional (2D) ultrasound. The availability of several display modes and standardized examinations permits the demonstration of both the normal and abnormal fetal anatomy in controlled planes and rendered images from different angles. This allows the demonstration of even subtle fetal defects in an ideal sectional plane in a precisely rendered surface or transparent image viewed from an optimal angle. When counseling the parents, the rendered images can help them understand the severity of an existing malformation or, conversely, ensure them of the absence of any fetal abnormality. This is particularly useful in cases with an increased recurrence risk of a specific fetal malformation.
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Mao YK, Zhao BW, Zheng FH, Wang B, Peng XH, Chen R, Pan M. Z
-scores for fetal left atrial size and left atrium-descending aorta distance in fetuses with isolated total anomalous pulmonary venous connection. Prenat Diagn 2017; 37:992-1000. [PMID: 28753739 DOI: 10.1002/pd.5119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/18/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Yan Kai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Bo Wen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Feng Hua Zheng
- Department of Ultrasonic Medicine; The First People's Hospital of Yuhang District; Hangzhou China
| | - Bei Wang
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Xiao Hui Peng
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
| | - Mei Pan
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital; Zhejiang University College of Medicine; Hangzhou China
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Yeo L, Luewan S, Markush D, Gill N, Romero R. Prenatal Diagnosis of Dextrocardia with Complex Congenital Heart Disease Using Fetal Intelligent Navigation Echocardiography (FINE) and a Literature Review. Fetal Diagn Ther 2017. [PMID: 28641300 DOI: 10.1159/000468929] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fetal dextrocardia is a type of cardiac malposition where the major axis from base to apex points to the right side. This condition is usually associated with a wide spectrum of complex cardiac defects. As a result, dextrocardia is conceptually difficult to understand and diagnose on prenatal ultrasound. The advantage of four-dimensional sonography with spatiotemporal image correlation (STIC) is that this modality can facilitate fetal cardiac examination. A novel method known as fetal intelligent navigation echocardiography (FINE) allows automatic generation of nine standard fetal echocardiography views in normal hearts by applying intelligent navigation technology to STIC volume datasets. In fetuses with congenital heart disease, FINE is also able to demonstrate abnormal cardiac anatomy and relationships when there is normal cardiac axis and position. However, this technology has never been applied to cases of cardiac malposition. We report herein for the first time, a case of fetal dextrocardia and situs solitus with complex congenital heart disease in which the FINE method was invaluable in diagnosing multiple abnormalities and defining complex anatomic relationships. We also review the literature on prenatal sonographic diagnosis of dextrocardia (with an emphasis on situs solitus), as well as tricuspid atresia with its associated cardiac features.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, and Detroit, MI, USA
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26
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Sun X, Zhang Y, Fan M, Wang Y, Wang M, Siddiqui FA, Sun W, Sun F, Zhang D, Lei W, Hu G. Role of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation in detecting fetal pulmonary veins. Echocardiography 2017; 34:906-914. [PMID: 28401632 DOI: 10.1111/echo.13543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Xue Sun
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Ying Zhang
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Miao Fan
- Department of Radiology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Yu Wang
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Meilian Wang
- Department of Microbiology and Parasitology; College of Basic Medical Sciences; China Medical University; Shenyang China
- Department of Entomology; The Pennsylvania State University; University Park PA USA
| | - Faiza Amber Siddiqui
- Department of Entomology; The Pennsylvania State University; University Park PA USA
| | - Wei Sun
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Feifei Sun
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Dongyu Zhang
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Wenjia Lei
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Guyue Hu
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
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27
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Three- and four-dimensional ultrasound in fetal echocardiography: an up-to-date overview. J Perinatol 2016; 36:685-93. [PMID: 26963426 DOI: 10.1038/jp.2016.23] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 12/13/2022]
Abstract
Congenital heart diseases (CHD) are the most commonly overlooked lesions in prenatal screening programs. Real-time two-dimensional ultrasound (2DUS) is the conventionally used tool for fetal echocardiography. Although continuous improvements in the hardware and post-processing software have resulted in a good image quality even in late first trimester, 2DUS still has its limitations. Four-dimensional ultrasound with spatiotemporal image correlation (STIC) is an automated volume acquisition, recording a single three-dimensional (3D) volume throughout a complete cardiac cycle, which results in a four-dimensional (4D) volume. STIC has the potential to increase the detection rate of CHD. The aim of this study is to provide a practical overview of the possibilities and (dis)advantages of STIC. A review of literature and evaluation of the current status and clinical value of 3D/4D ultrasound in prenatal screening and diagnosis of congenital heart disease are presented.
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28
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Tuning N. Does Spatiotemporal Image Correlation Enhance the Diagnostic Usefulness of 3D and 4D Fetal Cardiac Imaging? A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479307299535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicole Tuning
- Department of Diagnostic Ultrasound, Seattle University, Seattle, Washington,
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Veronese P, Bogana G, Cerutti A, Yeo L, Romero R, Gervasi MT. A Prospective Study of the Use of Fetal Intelligent Navigation Echocardiography (FINE) to Obtain Standard Fetal Echocardiography Views. Fetal Diagn Ther 2016; 41:89-99. [PMID: 27309391 DOI: 10.1159/000446982] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/14/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the performance of Fetal Intelligent Navigation Echocardiography (FINE) applied to spatiotemporal image correlation (STIC) volume datasets of the normal fetal heart in generating standard fetal echocardiography views. METHODS In this prospective cohort study of patients with normal fetal hearts (19-30 gestational weeks), one or more STIC volume datasets were obtained of the apical four-chamber view. Each STIC volume successfully obtained was evaluated by STICLoop™ to determine its appropriateness before applying the FINE method. Visualization rates for standard fetal echocardiography views using diagnostic planes and/or Virtual Intelligent Sonographer Assistance (VIS-Assistance®) were calculated. RESULTS One or more STIC volumes (total n = 463) were obtained from 246 patients. A single STIC volume per patient was analyzed using the FINE method. In normal cases, FINE was able to generate nine fetal echocardiography views using: (1) diagnostic planes in 76-100% of the cases, (2) VIS-Assistance® in 96-100% of the cases, and (3) a combination of diagnostic planes and/or VIS-Assistance® in 96-100% of the cases. CONCLUSION FINE applied to STIC volumes can successfully generate nine standard fetal echocardiography views in 96-100% of cases in the 2nd and 3rd trimesters. This suggests that the technology can be used as a method of screening for congenital heart disease.
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Affiliation(s)
- Paola Veronese
- Unit of Maternal Fetal Medicine, Department of Women's and Children's Health, Azienda Ospedaliera di Padova (AOP), Padua, Italy
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30
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Yeo L, Romero R. How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart: Part 2. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1043-66. [PMID: 27091912 PMCID: PMC8475629 DOI: 10.7863/ultra.16.01082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/13/2016] [Indexed: 05/04/2023]
Abstract
The effective performance of fetal cardiac examination using spatiotemporal image correlation (STIC) technology requires 2 essential steps: volume acquisition and postprocessing. An important prerequisite is training sonologists to acquire high-quality volume data sets so that when analyzed, such volumes are informative. This article is part 2 of a series on 4-dimensional sonography with STIC. Part 1 focused on STIC technology and its features, the importance of operator training/experience and acquisition of high-quality STIC volumes, factors that affect STIC volume acquisition rates, and general recommendations on performing 4D sonography with STIC. In part 2, we discuss a detailed and practical stepwise approach for STIC volume acquisition, along with methods to determine whether such volumes are appropriate for analysis.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
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31
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Yeo L, Romero R. How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart: Part 1. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1021-42. [PMID: 27091914 PMCID: PMC8475630 DOI: 10.7863/ultra.16.01081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/29/2016] [Indexed: 05/13/2023]
Abstract
Four-dimensional sonography with spatiotemporal image correlation (STIC) technology allows acquisition of a fetal cardiac volume data set and displays a cine loop of a complete single cardiac cycle in motion. Part 1 of this 2-part article reviews STIC technology and its features, the importance of operator training/experience, and acquisition of high-quality STIC volumes, as well as factors that affect STIC volume acquisition rates. We also propose a detailed and practical stepwise approach to performing 4-dimensional sonography with STIC and begin herein by providing general recommendations. Part 2 will discuss specifics of the approach, along with how to determine whether such volumes are appropriate for analysis.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Molecular Obstetrics and Genetics, Wayne State University, Detroit, MI, USA
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32
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Garcia M, Yeo L, Romero R, Haggerty D, Giardina I, Hassan SS, Chaiworapongsa T, Hernandez-Andrade E. Prospective evaluation of the fetal heart using Fetal Intelligent Navigation Echocardiography (FINE). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:450-9. [PMID: 26278116 PMCID: PMC5898803 DOI: 10.1002/uog.15676] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To evaluate prospectively the performance of Fetal Intelligent Navigation Echocardiography (FINE) applied to spatiotemporal image correlation (STIC) volume datasets of the normal fetal heart. METHODS In all women between 19 and 30 weeks' gestation with a normal fetal heart, an attempt was made to acquire STIC volume datasets of the apical four-chamber view if the following criteria were met: (1) fetal spine located between 5- and 7-o'clock positions; (2) minimal or absent shadowing (including a clearly visible transverse aortic arch); (3) absence of fetal breathing, hiccups, or movement; and (4) adequate image quality. Each STIC volume successfully acquired was evaluated by STICLoop™ to determine its appropriateness before applying the FINE method. Visualization rates of fetal echocardiography views using diagnostic planes and/or Virtual Intelligent Sonographer Assistance (VIS-Assistance®) were calculated. RESULTS One or more STIC volumes (365 in total) were obtained successfully in 72.5% (150/207) of women undergoing ultrasound examination. Of the 365 volumes evaluated by STICLoop, 351 (96.2%) were considered to be appropriate. From the 351 STIC volumes, only one STIC volume per patient (n = 150) was analyzed using the FINE method, and consequently nine fetal echocardiography views were generated in 76-100% of cases using diagnostic planes only, in 98-100% of cases using VIS-Assistance only, and in 98-100% of cases when using a combination of diagnostic planes and/or VIS-Assistance. CONCLUSIONS In women between 19 and 30 weeks' gestation with a normal fetal heart undergoing prospective sonographic examination, STIC volumes can be obtained successfully in 72.5% of cases. The FINE method can be applied to generate nine standard fetal echocardiography views in 98-100% of these cases using a combination of diagnostic planes and/or VIS-Assistance. This suggests that FINE could be implemented in fetal cardiac screening programs. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Maynor Garcia
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Denise Haggerty
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
| | - Irene Giardina
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Sonia S. Hassan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
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Gonçalves LF. Three-dimensional ultrasound of the fetus: how does it help? Pediatr Radiol 2016; 46:177-89. [PMID: 26829949 DOI: 10.1007/s00247-015-3441-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/30/2015] [Accepted: 07/13/2015] [Indexed: 01/20/2023]
Abstract
Three-dimensional ultrasonography (3-D US) was introduced to the field of fetal imaging in the early 1990s. Since then several publications have described potential applications for the diagnosis of congenital malformations as well as organ volumetry. This article reviews basic principles of 3-D US as well as its clinical applicability to prenatal diagnosis of abnormalities involving the face, spine and skeletal system, as well as potential applications of 3-D US for fetal cardiovascular and neuroimaging. Limitations related to motion artifacts, acoustic shadowing and barriers to clinical implementation of 3-D US in clinical practice are addressed.
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Affiliation(s)
- Luis F Gonçalves
- Department of Radiology and Department of Obstetrics & Gynecology, Beaumont Health System,, Divisions of Pediatric Radiology and Fetal Imaging,, 360 W. 13 Mile Road, Royal Oak, MI, 48073, USA.
- Department of Radiology and Department of Obstetrics & Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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34
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Polanski LT, Baumgarten MN, Brosens JJ, Quenby SM, Campbell BK, Martins WP, Raine-Fenning NJ. 4-D Assessment of Endometrial Vascularity Using Spatiotemporal Image Correlation: A Study Comparing Spherical Sampling and Whole-Tissue Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2798-2805. [PMID: 26278634 DOI: 10.1016/j.ultrasmedbio.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 05/06/2015] [Accepted: 06/02/2015] [Indexed: 06/04/2023]
Abstract
Our aim in the study described here was to assess the feasibility of spatiotemporal image correlation power Doppler quantification of the endometrium with two techniques: spherical samples and whole tissue. We scanned 51 women in the midluteal phase of the menstrual cycle: STIC assessment of the whole endometrium was not possible in 10% of cases, whereas spherical analysis was possible in all. The time taken for data set analysis was much longer for the whole endometrium compared with spherical analysis (1478.9 ± 291 s vs. 266.8 ± 39.3 s, p < 0.05). Intra-class correlation coefficients for the vascularization flow index (VFI) were similar for both methods. Volumetric vascularity indices were higher when spherical sampling was conducted. Significant cycle-to-cycle variability in the vascularity indices was present, with coefficients of variation exceeding 20% for both techniques. We found that STIC power Doppler quantification of the whole endometrium is possible in the majority of cases, however, it is time consuming and limited by significant cycle-to-cycle variability.
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Affiliation(s)
- Lukasz T Polanski
- Division of Obstetrics & Gynaecology, School of Medicine, University of Nottingham, United Kingdom
| | - Miriam N Baumgarten
- Division of Obstetrics & Gynaecology, School of Medicine, University of Nottingham, United Kingdom
| | | | | | - Bruce K Campbell
- Division of Obstetrics & Gynaecology, School of Medicine, University of Nottingham, United Kingdom
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
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Tonni G, Martins WP, Guimarães Filho H, Araujo Júnior E. Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1180-1211. [PMID: 25748522 DOI: 10.1016/j.ultrasmedbio.2014.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Italy; Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
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Zhu M, Ashraf M, Zhang Z, Streiff C, Shimada E, Kimura S, Schaller T, Song X, Sahn DJ. Real Time Three-Dimensional Echocardiographic Evaluations of Fetal Left Ventricular Stroke Volume, Mass, and Myocardial Strain: In Vitro and In Vivo Experimental Study. Echocardiography 2015; 32:1697-706. [PMID: 25865121 DOI: 10.1111/echo.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Left ventricular stroke volume, mass, and myocardial strain are valuable indicators of fetal heart function. This study investigated the feasibility of nongated real time three-dimensional echocardiography (RT3DE) to determine fetal stroke volume (SV), left ventricular mass (LVM), and myocardial strain under different conditions. METHODS To evaluate fetal hearts, fetal-sized rabbit hearts were used in this study. The in vitro portion of this study was carried out using a balloon inserted into the LV of eight fresh rabbit hearts and driven by a calibrated pulsatile pump. RT3DE volumes were obtained at various pump-set SVs. The in vivo experiments in this study were performed on open-chest rabbits. RT3DE volumes were acquired at the following conditions: baseline, simulated hypervolemia, inferior vena cava (IVC) ligation, and ascending aorta (AAO) ligation. Displacement values and sonomicrometry data were used as references for RT3DE-derived SV, LVM, longitudinal strain (LS), and circumferential strain (CS). RESULTS Excellent correlations between RT3DE-derived values and reference values were demonstrated and accompanied by high coefficients of determination (R(2) ) for both in vitro and in vivo studies for SV, LVM, LS, and CS (in vitro: SV: R(2) = 0.98; LVM: R(2) = 0.97; LS: R(2) = 0.87, CS: R(2) = 0.80; in vivo: SV: R(2) = 0.92; LVM: R(2) = 0.98; LS: in vivo: R(2) = 0.84; CS: in vivo: R(2) = 0.76; all P < 0.05). CONCLUSIONS RT3DE is capable of quantifying the SV, LVM, and myocardial strain of fetal-sized hearts under different conditions. This nongated RT3DE may aid the evaluation of fetal cardiac function, providing a superior understanding of the progress of fetal heart disorders.
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Affiliation(s)
- Meihua Zhu
- Oregon Health & Science University, Portland, Oregon
| | | | - Zhijun Zhang
- Oregon Health & Science University, Portland, Oregon
| | - Cole Streiff
- Oregon Health & Science University, Portland, Oregon
| | - Eriko Shimada
- Oregon Health & Science University, Portland, Oregon
| | - Sumito Kimura
- Oregon Health & Science University, Portland, Oregon
| | | | - Xubo Song
- Oregon Health & Science University, Portland, Oregon
| | - David J Sahn
- Oregon Health & Science University, Portland, Oregon
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Four-dimensional color Doppler reconstruction of the fetal heart with glass-body rendering mode. Am J Cardiol 2014; 114:1603-6. [PMID: 25242366 DOI: 10.1016/j.amjcard.2014.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/21/2022]
Abstract
The investigators present their experience with normal fetal cardiac structures and congenital heart anomalies reconstructed using 4-dimensional color Doppler with glass-body rendering mode and spatiotemporal image correlation. Two normal fetuses and 6 fetuses with congenital heart anomalies (1 case each of ventricular septal defect, Ebstein's anomaly, hypoplastic left heart syndrome, and ductus arteriosus aneurysm and 2 of double-outlet right ventricle) at 26 to 36 weeks' gestation were studied using 4-dimensional color Doppler with glass-body rendering mode. In normal fetal hearts, blood flow through the 4 cardiac chambers and crisscross arrangements of the pulmonary artery and aorta were clearly recognized. In the fetus with a ventricular septal defect, significant shunt flow through the defect between the left and right ventricles was evident. In the fetus with Ebstein's anomaly, giant tricuspid regurgitant flow was noted. In the fetus with hypoplastic left heart syndrome, large tricuspid regurgitant flow was identified. In the fetuses with double-outlet right ventricles, large aortas and small pulmonary arteries leaving the right ventricles in parallel were clearly shown. In the fetus with a ductus arteriosus aneurysm, an enlarged ductus arteriosus following the pulmonary artery was clearly depicted. In conclusion, fetal 4-dimensional color Doppler may assist in the evaluation of spatial relations between the great vessels and both ventricles and differences in the sizes of the great vessels and cardiac chambers.
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38
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Qin Y, Zhang Y, Zhou X, Wang Y, Sun W, Chen L, Zhao D, Zhan Y, Cai A. Four-dimensional echocardiography with spatiotemporal image correlation and inversion mode for detection of congenital heart disease. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1434-1441. [PMID: 24785438 DOI: 10.1016/j.ultrasmedbio.2014.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/03/2014] [Accepted: 02/04/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to evaluate the use of 4-D echocardiography with inversion mode and spatiotemporal image correlation (IM-STIC) in the detection of normal and abnormal fetal hearts. We retrospectively studied 112 normal fetuses and 16 fetuses with a confirmed diagnosis of congenital heart disease. Two volumes were acquired from each of the fetuses using transverse and sagittal sweeps. Volumes were reconstructed with IM-STIC. In normal fetuses, IM-STIC facilitated visualization of the interior structures of the fetal heart and great vessels. The visualization rates of intended planes obtained from IM-STIC 4D data ranged from 55% to 100%. In 16 fetuses with congenital heart disease, IM-STIC was able to display the cardiac malformations using digital casting. Some of the malformations were suspected during pre-natal 2-D echocardiography, and their pre-natal IM-STIC diagnoses were confirmed by post-natal echocardiography, surgery and/or autopsy. Hence, 4-D IM-STIC allows better visualization of complex congenital heart disease and should be considered a very useful addition to 2-D echocardiography.
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Affiliation(s)
- Yue Qin
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Ying Zhang
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Xiaohang Zhou
- College of Basic Medical Science of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Yu Wang
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Wei Sun
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Lizhu Chen
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Dan Zhao
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Ying Zhan
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China
| | - Ailu Cai
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, People's Republic of China.
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Adriaanse BME, Schats J, Tromp CHN, Uittenbogaard LB, Heymans MW, van Vugt JMG, Haak MC. Differential insertion of the atrioventricular valves: measurement protocol to detect various congenital heart defects. Prenat Diagn 2014; 34:935-9. [PMID: 24760486 DOI: 10.1002/pd.4395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 04/20/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objectives of this study were to develop reference values for the distance between the atrioventricular valves, called differential insertion of the atrioventricular valves (DIAVV), in normal fetuses using four-dimensional ultrasound with spatio-temporal image correlation and to explore if DIAVV measurement can differentiate between normal hearts and hearts with cardiac defects. METHODS The DIAVV was analysed longitudinally following a measurement protocol in 74 fetuses between 15 and 36 weeks gestational age. The DIAVV was measured in an apical four-chamber view of the heart in end-diastole. Furthermore, the DIAVV was measured in 70 fetuses with cardiac defects. RESULTS In total, 337 normal and 70 abnormal spatio-temporal image correlation volumes were examined. Longitudinal regression analysis revealed a positive relationship of the DIAVV with gestational age and fetal biometry (p < 0.0001). The DIAVV of fetuses with double outlet right ventricle, truncus arteriosus, atrioventricular septal defects, Ebstein and tetralogy of Fallot all differed from normal fetuses (p < 0.05). CONCLUSION Measurement of the DIAVV is a promising tool; however, a well-defined measurement protocol should be followed to accomplish the correct plane and exact moment in the cardiac cycle. This study presents new nomograms following this measurement protocol and reports an abnormal DIAVV in a wide spectrum of congenital heart disease.
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Affiliation(s)
- B M E Adriaanse
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
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40
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Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 719] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
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Abstract
Recent ultrasonographic methods applied in the evaluation of fetal thoracic structures and anomalies are presented. Fetal lung volumetric assessment by 3D ultrasonography, analysis of the thoracic wall by 3D-rendered image and 3D skeletal-mode imaging, intrathoracic vessel evaluation by 3D power Doppler ultrasonography, analysis of heart anatomy and abnormalities by 4D spatiotemporal image correlation, identification of normal and abnormal intrathoracic almost isoechogenic structures by volume contrast imaging and evaluation of the heart and great vessels by 3 and 4D inverse mode will be reviewed.
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Affiliation(s)
- Rodrigo Ruano
- Universidade de São Paulo-Brazil, R. Valentim Magalhaes 100 ap. 52, São Paulo, SP, 03184-090, Brazil.
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42
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Ahmed BI. The new 3D/4D based spatio-temporal imaging correlation (STIC) in fetal echocardiography: a promising tool for the future. J Matern Fetal Neonatal Med 2013; 27:1163-8. [PMID: 24059290 DOI: 10.3109/14767058.2013.847423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Congenital heart disease is the commonest congenital anomaly. It is much more common than chromosomal malformations and spinal defects. Its estimated incidence is about 4-13 per 1000 live births. Congenital heart disease is a significant cause of fetal mortality and morbidity. Antenatal diagnosis of congenital heart disease is extremely difficult and requires extensive training and expertise. The detection rate of congenital heart disease is very variable and it ranged from 35 to 86% in most studies. In the light of the above, the introduction of the new 3D/4D based spatio-temporal Image Correlation (STIC) is highly welcomed to improve antenatal detection of congenital heart disease. STIC is an automated device incorporated into the ultrasound probe and has the capacity to perform slow sweep to acquire a single 3-dimensional (3D) volume. This acquired volume is composed of a great number of 2-dimension (2D) frames. This volume can be analyzed and reanalyzed as required to demonstrate all the required cardiac views. It also provides the examiner with the ability to review all images in a looped cine sequence. This technology has the ability to improve our ability to examine the fetal heart in the acquired volume and decrease examination time. Using this technique you can share the information and consult colleagues both at your clinical sitting or remotely using the internet.
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Zidere V, Pushparajah K, Allan LD, Simpson JM. Three-dimensional fetal echocardiography for prediction of postnatal surgical approach in double outlet right ventricle: a pilot study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:421-425. [PMID: 23681839 DOI: 10.1002/uog.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To examine the feasibility of reconstructing three-dimensional (3D) echocardiographic views in fetuses with double outlet right ventricle, which might enhance prognostication with respect to the postnatal surgical approach. METHODS This was a retrospective blinded observational study. Our database was reviewed from January 2007 to June 2011 to identify fetuses with usual atrial arrangement, concordant atrioventricular connections, double outlet right ventricle and relatively balanced left and right ventricular size. Six fetuses, in which there was an intention to treat, were included. RESULTS In all six cases, we identified important features, including location of the ventricular septal defect and its relation to the atrioventricular valves and great arteries. The postnatal surgical approach was predicted accurately in each case. CONCLUSION In this group of fetuses with double outlet right ventricle, detailed evaluation by 3D fetal echocardiography enhanced visualization of the anatomy, leading to accurate prediction of the type of surgical repair. Prospective validation in a large cohort of fetuses is warranted.
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Affiliation(s)
- V Zidere
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK; Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Yeo L, Romero R. Fetal Intelligent Navigation Echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:268-84. [PMID: 24000158 PMCID: PMC9651141 DOI: 10.1002/uog.12563] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/07/2013] [Accepted: 02/13/2013] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To describe a novel method (Fetal Intelligent Navigation Echocardiography (FINE)) for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC) and application of 'intelligent navigation' technology. METHODS We developed a method to: 1) demonstrate nine cardiac diagnostic planes; and 2) spontaneously navigate the anatomy surrounding each of the nine cardiac diagnostic planes (Virtual Intelligent Sonographer Assistance (VIS-Assistance®)). The method consists of marking seven anatomical structures of the fetal heart. The following echocardiography views are then automatically generated: 1) four chamber; 2) five chamber; 3) left ventricular outflow tract; 4) short-axis view of great vessels/right ventricular outflow tract; 5) three vessels and trachea; 6) abdomen/stomach; 7) ductal arch; 8) aortic arch; and 9) superior and inferior vena cava. The FINE method was tested in a separate set of 50 STIC volumes of normal hearts (18.6-37.2 weeks of gestation), and visualization rates for fetal echocardiography views using diagnostic planes and/or VIS-Assistance® were calculated. To examine the feasibility of identifying abnormal cardiac anatomy, we tested the method in four cases with proven congenital heart defects (coarctation of aorta, tetralogy of Fallot, transposition of great vessels and pulmonary atresia with intact ventricular septum). RESULTS In normal cases, the FINE method was able to generate nine fetal echocardiography views using: 1) diagnostic planes in 78-100% of cases; 2) VIS-Assistance® in 98-100% of cases; and 3) a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases. In all four abnormal cases, the FINE method demonstrated evidence of abnormal fetal cardiac anatomy. CONCLUSIONS The FINE method can be used to visualize nine standard fetal echocardiography views in normal hearts by applying 'intelligent navigation' technology to STIC volume datasets. This method can simplify examination of the fetal heart and reduce operator dependency. The observation of abnormal echocardiography views in the diagnostic planes and/or VIS-Assistance® should raise the index of suspicion for congenital heart disease.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, National Institute for Child Health and Human Development-NIH/DHHS, Bethesda, MD 20892, USA.
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El Guindi W, Dreyfus M, Carles G, Lambert V, Herlicoviez M, Benoist G. [Contribution of volume ultrasound in the evaluation and prenatal care of fetal cardiovascular anomalies]. ACTA ACUST UNITED AC 2013; 43:56-65. [PMID: 23978842 DOI: 10.1016/j.jgyn.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/02/2013] [Accepted: 05/15/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To highlight the value of 3D ultrasound in the prenatal assessment of fetal cardiovascular abnormalities. PATIENTS AND METHODS A retrospective offline analysis of volume datasets of fetuses diagnosed with cardiovascular anomalies by 2D ultrasound was performed. RESULTS Thirty-four fetuses with 38 cardiac malformations were evaluated. Mean gestational age at diagnosis was 26 weeks. Isolated cardiovascular malformations were detected in 23 fetuses. Extracardiac abnormalities were identified in eight fetuses. Ten terminations of pregnancy were performed. CONCLUSION Offline analysis of cardiovascular anomalies conferred significant diagnostic advantages over 2D ultrasound. 3D ultrasound is a valuable tool for the prenatal diagnosis and the management of congenital heart diseases.
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Affiliation(s)
- W El Guindi
- Service de gynécologie-obstétrique, centre hospitalier de l'ouest Guyanais, 16, boulevard du Général-Leclerc, BP 245, 94393 Saint-Laurent-du-Maroni, France.
| | - M Dreyfus
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Carles
- Service de gynécologie-obstétrique, centre hospitalier de l'ouest Guyanais, 16, boulevard du Général-Leclerc, BP 245, 94393 Saint-Laurent-du-Maroni, France
| | - V Lambert
- Service de gynécologie-obstétrique, centre hospitalier de l'ouest Guyanais, 16, boulevard du Général-Leclerc, BP 245, 94393 Saint-Laurent-du-Maroni, France
| | - M Herlicoviez
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Benoist
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France
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He Y, Wang J, Gu X, Zhang Y, Han J, Liu X, Li Z. Application of spatio-temporal image correlation technology in the diagnosis of fetal cardiac abnormalities. Exp Ther Med 2013; 5:1637-1642. [PMID: 23837046 PMCID: PMC3702623 DOI: 10.3892/etm.2013.1060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 03/12/2013] [Indexed: 12/11/2022] Open
Abstract
Congenital heart disease is the birth defect with the highest incidence in China. Its timely and accurate prenatal diagnosis is critical for appropriate perinatal and postnatal management and salvage treatment. With improvements in the diagnostic capabilities of ultrasound and clinical manipulation techniques, prenatal diagnosis is conducted increasingly early and with greater accuracy. However, the representations of tiny blood vessels and the determination of abnormal spatial structures in the fetal period continue to cause difficulties in prenatal diagnosis. In theory, spatio-temporal image correlation (STIC) technology is able to compensate for the defects of previous traditional two-dimensional (2D) ultrasound and improve the diagnostic accuracy. The aim of the present study was to investigate the clinical application value of STIC technology combined with traditional 2D ultrasound in the diagnosis of fetal cardiac abnormalities. A total of 1,286 fetuses were subjected to sequential echocardiographic examination, during which STIC technology was used to collect heart volume data and carry out image post-processing and off-line analysis. In addition, the prenatal and postnatal echocardiography results were compared with the pathology results following the induced labor of fetuses with cardiac abnormalities. The sensitivity, specificity, misdiagnosis rate and rate of missed diagnosis for the STIC technology in the diagnosis of prenatal fetal cardiac abnormalities were 97.4, 99.6, 0.4 and 2.6%, respectively. The total coincidence rate was 99.2% and the positive and negative predictive values were 97.9 and 99.4%, respectively; the statistics for the consistency check of the STIC technology in the diagnosis of fetal cardiac abnormalities are κ=0.991, P=0.000. STIC technology combined with fetal echocardiography may be used for the definite diagnosis of fetal heart malformations, with high sensitivity and specificity.
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Affiliation(s)
- Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Hamill N, Romero R, Hassan S, Lee W, Myers SA, Mittal P, Kusanovic JP, Balasubramaniam M, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Goncalves LF, Mazaki-Tovi S, Erez O, Hernandez-Andrade E, Yeo L. The fetal cardiovascular response to increased placental vascular impedance to flow determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis. Am J Obstet Gynecol 2013; 208:153.e1-13. [PMID: 23220270 DOI: 10.1016/j.ajog.2012.11.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/05/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to determine if increased placental vascular impedance to flow is associated with changes in fetal cardiac function using spatiotemporal image correlation and virtual organ computer-aided analysis. STUDY DESIGN A cross-sectional study was performed in fetuses with umbilical artery pulsatility index >95th percentile (abnormal [ABN]). Ventricular volume (end-systole, end-diastole), stroke volume, cardiac output (CO), adjusted CO, and ejection fraction were compared to those of 184 normal fetuses. RESULTS A total of 34 fetuses were evaluated at a median gestational age of 28.3 (range, 20.6-36.9) weeks. Mean ventricular volumes were lower for ABN than normal cases (end-systole, end-diastole) with a proportionally greater decrease for left ventricular volume (vs right). Mean left and right stroke volume, CO, and adjusted CO were lower for ABN (vs normal) cases. Right ventricular volume, stroke volume, CO, and adjusted CO exceeded the left in ABN fetuses. Mean ejection fraction was greater for ABN than normal cases. Median left ejection fraction was greater (vs right) in ABN fetuses. CONCLUSION Increased placental vascular impedance to flow is associated with changes in fetal cardiac function.
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Rolo LC, Nardozza LMM, Araujo Júnior E, Hatanaka AR, Rocha LA, Simioni C, Moron AF. Reference ranges of atrioventricular valve areas by means of four-dimensional ultrasonography using spatiotemporal image correlation in the rendering mode. Prenat Diagn 2012; 33:50-5. [PMID: 23148015 DOI: 10.1002/pd.4009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to determine reference curves for fetal atrioventricular valve areas by means of three-dimensional ultrasound using the spatiotemporal image correlation (STIC) software. METHODS This was a cross-sectional prospective study on 328 normal fetuses between the 18th and the 33rd weeks of pregnancy. In order to obtain valve areas, the four heart chambers plane was used with the fetus in a dorsal posterior position. To construct reference ranges, a linear regression model was used, adjusted according to the coefficient of determination (R(2)). To calculate the reproducibility of the tricuspid valve area, the intraclass coefficient correlation (ICC) was used. RESULTS The mean areas of the tricuspid and mitral valves ranged from 0.19 ± 0.08 and 0.20 ± 0.10 cm(2) in the 18th week to 0.93 ± 0.31 and 1.06 ± 0.39 cm(2) in the 33rd week, respectively. The intra-observer and interobserver reproducibility was excellent with ICC = 0.997 and 0.933, respectively. CONCLUSIONS Reference curves for fetal atrioventricular valve areas were determined and presented good reproducibility.
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Affiliation(s)
- Liliam Cristine Rolo
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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49
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3D ultrasound and Doppler angiography for evaluation of fetal cardiovascular anomalies. Int J Gynaecol Obstet 2012; 120:173-7. [DOI: 10.1016/j.ijgo.2012.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/07/2012] [Accepted: 10/16/2012] [Indexed: 11/22/2022]
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50
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Zhang Y, Ding C, Fan M, Ren W, Guo Y, Sun W, Cai A. Evaluation of normal fetal pulmonary veins using B-flow imaging with spatiotemporal image correlation and by traditional color Doppler echocardiography. Prenat Diagn 2012; 32:1186-91. [PMID: 23044982 DOI: 10.1002/pd.3983] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of our report is to evaluate the use of color Doppler echocardiography (CDE) with four chamber view (4CV), scanning around left atrium, and four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation (4D BF-STIC) in detecting fetal pulmonary veins at 17 to 40 weeks' gestation. METHODS This was a prospective study. Color Doppler echocardiography with 4CV, scanning around left atrium, and 4D BF-STIC were used to detect the pulmonary veins in 460 normal fetuses at 17 to 40 weeks of gestation. Routine prenatal screening was used to confirm that the fetuses were in good health with no cardiac or extra cardiac anomalies. All patients underwent follow up at one year. Twenty-two patients were excluded from the study. The number of pulmonary veins visualized using each method was recorded and then compared in six subgroups according to gestational age. RESULTS Four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation was the best method to detect the greatest number of pulmonary veins between 17 and 31 weeks of gestation. Scanning around left atrium detected more pulmonary veins than the traditional 4CV method throughout the gestational period. CONCLUSIONS The scanning around left atrium method proved to be the most suited for detecting pulmonary veins in clinical practice. 4D BF-STIC was superior in detecting the greatest number of pulmonary veins before 32 gestational weeks, but had limited clinical usage because it was very time-consuming and experience-dependent. The 4D method should be considered as a complement to traditional two-dimensional sonography, because it facilitates understanding of the anatomy and the spatial relationships of the cardiac structures.
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Affiliation(s)
- Ying Zhang
- Department of Sonography, Shengjing Hospital of China Medical University, Heping District, Shenyang, 110004, China.
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