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Zabadneh N, Santagati C, Reffo E, Biffanti R, Cerutti A, Maschietto N, Milanesi O. Usefulness of fetal three-dimensional ultrasonography for detecting of congenital heart defects and associated syndromes. Pediatr Cardiol 2011; 32:724-36. [PMID: 21479665 DOI: 10.1007/s00246-011-9977-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 03/22/2011] [Indexed: 11/26/2022]
Abstract
Congenital heart defects (CHDs) occur in 1% of live-born infants and frequently are associated with extracardiac malformations. This study aimed to assess the feasibility and accuracy of three-dimensional ultrasonography (3DUS) in fetuses with CHD and to investigate whether 3DUS can add information about the heart and general fetal morphology that shows other congenital malformations or suggests syndromes. For 30 fetuses affected by CHD, 3DUS was performed using a Sonos 7500 ultrasound machine with a cardiac 3D transducer. In 44% of the exams, 3DUS was completely diagnostic for the CHD, providing additional information in 28% of the exams. Furthermore, 3DUS showed 82% of associated malformations, providing the complete diagnosis in 57% of the cases and helping with recognition of syndromes in others. The diagnostic accuracy of 3DUS was superior, with a higher number of acquisitions per exam. Performance was better in fetuses younger than 24 weeks for general morphologic details and in fetuses older than 24 weeks for the heart morphology.
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Affiliation(s)
- Nadia Zabadneh
- Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy
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Contemporary clinical applications of spatio-temporal image correlation in prenatal diagnosis. Curr Opin Obstet Gynecol 2011; 23:94-102. [PMID: 21178772 DOI: 10.1097/gco.0b013e328342ef38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Four-dimensional fetal echocardiography has the potential to reduce the operator dependency of two-dimensional ultrasonography and increase the detection rate of congenital heart defects (CHDs). This review is intended to summarize recent evidence of the important role that four-dimensional ultrasonography with spatio-temporal image correlation (STIC) may play in the prenatal diagnosis of CHDs. RECENT FINDINGS Four-dimensional ultrasonography with STIC may provide the opportunity for telemedicine in the prenatal diagnosis of CHDs because four-dimensional volume datasets can be remotely acquired and accurately interpreted by different centers. Four-dimensional ultrasonography with STIC is an accurate and reproducible technique for the prenatal diagnosis of CHDs. Different four-dimensional rendering techniques can provide important insight into the spatial relationships of normal and abnormal fetal vascular structures. SUMMARY Four-dimensional fetal echocardiography with STIC may facilitate the examination of the fetal heart and could potentially increase the detection rate of CHDs.
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Espinoza J, Lee W, Comstock C, Romero R, Yeo L, Rizzo G, Paladini D, Viñals F, Achiron R, Gindes L, Abuhamad A, Sinkovskaya E, Russell E, Yagel S. Collaborative study on 4-dimensional echocardiography for the diagnosis of fetal heart defects: the COFEHD study. JOURNAL OF ULTRASOUND IN MEDICINE 2010; 29:1573-80. [PMID: 20966468 DOI: 10.7863/jum.2010.29.11.1573] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Congenital anomalies are the leading cause of infant mortality in the United States, and congenital heart defects (CHDs) are the most common type of birth defects. Recently, 4-dimensional ultrasonography (4DUS) with spatiotemporal image correlation (STIC) has been introduced for fetal echocardiography. Accumulating evidence indicates that 4DUS with STIC may facilitate the examination of the fetal heart. Our objectives were to determine the accuracy of 4DUS for the diagnosis of CHDs and the agreement among centers. METHODS This study included 7 centers with expertise in 4D fetal echocardiography. Fetuses with and without confirmed heart defects were scanned between 18 and 26 weeks, and their volume data sets were uploaded onto a centralized file transfer protocol server. Intercenter agreement was determined using a κ statistic for multiple raters. RESULTS Ninety volume data sets were randomly selected for blinded analysis. Overall, the median (range) sensitivity, specificity, positive and negative predictive values, and false-positive and -negative rates for the identification of fetuses with CHDs were 93% (77%-100%), 96% (84%-100%), 96% (83%-100%), 93% (79%-100%), 4.8% (2.7%-25%), and 6.8% (5%-22%), respectively. The most frequent CHDs were conotruncal anomalies (36%). There was excellent intercenter agreement (κ = 0.97). CONCLUSIONS (1) Four-dimensional volume data sets can be remotely acquired and accurately interpreted by different centers. (2) Among centers with technical expertise, 4DUS is an accurate and reliable method for fetal echocardiography.
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Affiliation(s)
- Jimmy Espinoza
- Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, 3601 W Thirteen Mile Road, Royal Oak, MI 48073 USA.
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Abstract
PURPOSE OF REVIEW Over the last few years, great progress has been made in imaging technology, which is changing the way prenatal visualization of the fetal heart is used for diagnosis and therapy. RECENT FINDINGS This paper reviews recent clinical research using these new techniques, namely dynamic three-dimensional (4D) echocardiography, myocardial Doppler imaging, B-flow ultrasonography, endoscopic ultrasound, and magnetic resonance imaging. Of them, 4D echocardiography is the most significant development and is discussed in greater detail. This includes real-time volumetric data acquisition using matrix-array transducer technology, motion artefact elimination using spatio-temporal image correlation, and various display options. The advantages and limitations of each are also addressed. SUMMARY These techniques can provide (1) sequential assessment of the entire heart using a full 4D dataset, (2) 4D delineation of trabeculation patterns on the ventricular walls, en-face dynamic shapes of ventricular septal defects and spatially complex malformations, (3) derivation of cardiac indices to myocardial contractility and strain rate by Doppler tissue imaging, and/or (4) the use of transoesophageal ultrasound to guide in-utero cardiac intervention. All of these techniques expand our ability to evaluate the morphology and function of the in-utero heart.
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Affiliation(s)
- Jing Deng
- Department of Medical Physics and Bioengineering, University College London, London, UK.
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Espinoza J, Romero R, Kusanovic JP, Gotsch F, Lee W, Gonçalves LF, Hassan S. Standardized views of the fetal heart using four-dimensional sonographic and tomographic imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:233-242. [PMID: 18254137 PMCID: PMC2361149 DOI: 10.1002/uog.5250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Center for Molecular Medicine and Genetics, Detroit, Michigan
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Wesley Lee
- William Beaumont Hospital, Royal Oak, Michigan
| | - Luís F. Gonçalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Sonia Hassan
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
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Espinoza J, Romero R, Kusanovic JP, Gotsch F, Lee W, Gonçalves LF, Schoen ML, Erez O, Hassan SS. The role of the sagittal view of the ductal arch in identification of fetuses with conotruncal anomalies using 4-dimensional ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1181-8; quiz 1189-90. [PMID: 17715312 PMCID: PMC2430072 DOI: 10.7863/jum.2007.26.9.1181] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Conotruncal anomalies represent one fifth of all congenital heart defects (CHDs) detected in the fetus. However, the spatial relationship of the great vessels is incorrectly defined in about 20% of these cases. The sagittal view of the ductal arch is considered a standard ultrasonographic view in fetal echocardiography and can be easily visualized using 4-dimensional (4D) ultrasonography. This study was designed to determine the role of this ultrasonographic plane for the prenatal diagnosis of conotruncal anomalies. METHODS We reviewed 4D volume data sets, acquired with the spatiotemporal image correlation technique, from fetuses with and without confirmed conotruncal anomalies. The visualization rate of the sagittal view of the ductal arch was compared among groups using standardized multiplanar views. RESULTS This study included 183 volume data sets from fetuses in the following groups: (1) normal echocardiographic findings (n = 130); (2) conotruncal anomalies (n = 18); and (3) other CHDs (n = 35). Volumes of poor image quality were excluded from analysis (8.2% [15/183]). The visualization rate of the sagittal view of the ductal arch was significantly lower in fetuses with conotruncal anomalies (5.6% [1/18]) than that in fetuses without abnormalities (93.1% [108/116]) and that in fetuses with other CHDs (79.4% [27/34]; P < .01). Absence of visualization of the sagittal view of the ductal arch was associated with a likelihood ratio of 9.44 (95% confidence interval, 5.8-15.5) to have conotruncal anomalies. CONCLUSIONS The sagittal view of the ductal arch may play an important role in the screening and prenatal diagnosis of conotruncal anomalies in 4D ultrasonography.
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Affiliation(s)
- Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Center for Molecular Medicine and Genetics, Detroit, Michigan
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Wesley Lee
- Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan
| | - Luís F. Gonçalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Mary Lou Schoen
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Offer Erez
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Sonia S. Hassan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
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Espinoza J, Kusanovic JP, Gonçalves LF, Nien JK, Hassan S, Lee W, Romero R. A novel algorithm for comprehensive fetal echocardiography using 4-dimensional ultrasonography and tomographic imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:947-56. [PMID: 16870887 PMCID: PMC1800884 DOI: 10.7863/jum.2006.25.8.947] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Tomographic ultrasound imaging (TUI) is a new display modality that allows simultaneous visualization of up to 8 parallel anatomic planes. This study was designed to determine the role of a novel algorithm combining spatiotemporal image correlation and TUI to visualize standard fetal echocardiographic planes. METHODS Volume data sets from fetuses with and without congenital heart defects (CHDs) were examined with a novel algorithm that allows simultaneous visualization of the 3-vessel and trachea view, the 4-chamber view, and outflow tracts. Visualization rates for these planes as well as the ductal arch and 5-chamber view were calculated. RESULTS (1) Two hundred twenty-seven volume data sets from fetuses without (n = 138) and with (n = 14) CHDs were reviewed; (2) among fetuses without CHDs, the 4-chamber view, 5-chamber view, ductal arch, 3-vessel and trachea view, left outflow tract, and short axis of the aorta were visualized in 99% (193/195), 96.9% (189/195), 98.5% (192/195), 88.2% (172/195), 93.3% (182/195), and 87.2% (170/195) of the volume data sets, respectively; (3) these views were visualized in 85% (17/20), 80% (16/20), 65% (13/20), 55% (11/20), 55% (11/20), and 70% (14/20) of the volume data sets, respectively, from fetuses with CHDs; and (4) simultaneous visualization of the short axis of the aorta, 3-vessel and trachea view, left outflow tract, and 4-chamber view was obtained in 78% (152/195) of the volume data sets from fetuses without CHDs and in 40% (8/20) of those with CHDs. CONCLUSIONS The 3-vessel and trachea view, the 4-chamber view, and both outflow tracts can be simultaneously visualized using a novel algorithm combining spatiotemporal image correlation and TUI.
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Affiliation(s)
- Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Luís F. Gonçalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Jyh Kae Nien
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
| | - Sonia Hassan
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan
| | - Wesley Lee
- William Beaumont Hospital, Royal Oak, Michigan
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan
- Wayne State University, Center for Molecular Medicine and Genetics, Detroit, Michigan
- Address correspondence to: Roberto Romero, M.D., Perinatology Research Branch, NICHD, NIH, DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit, MI 48201, Telephone (313) 993-2700, Fax: (313) 993-2694, e-mail:
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Gonçalves LF, Lee W, Espinoza J, Romero R. Examination of the fetal heart by four-dimensional (4D) ultrasound with spatio-temporal image correlation (STIC). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:336-48. [PMID: 16482611 DOI: 10.1002/uog.2724] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- L F Gonçalves
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD, USA
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9
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Gonçalves LF, Espinoza J, Romero R, Kusanovic JP, Swope B, Nien JK, Erez O, Soto E, Treadwell MC. Four-dimensional ultrasonography of the fetal heart using a novel Tomographic Ultrasound Imaging display. J Perinat Med 2006; 34:39-55. [PMID: 16489885 PMCID: PMC1384859 DOI: 10.1515/jpm.2006.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of examining the fetal heart with Tomographic Ultrasound Imaging (TUI) using four-dimensional (4D) volume datasets acquired with spatiotemporal image correlation (STIC). MATERIAL AND METHODS One hundred and ninety-five fetuses underwent 4D ultrasonography (US) of the fetal heart with STIC. Volume datasets were acquired with B-mode (n=195) and color Doppler imaging (CDI) (n=168), and were reviewed offline using TUI, a new display modality that automatically slices 3D/4D volume datasets, providing simultaneous visualization of up to eight parallel planes in a single screen. Visualization rates for standard transverse planes used to examine the fetal heart were calculated and compared for volumes acquired with B-mode or CDI. Diagnoses by TUI were compared to postnatal diagnoses. RESULTS (1) The four- and five-chamber views and the three-vessel and trachea view were visualized in 97.4% (190/195), 88.2% (172/195), and 79.5% (142/195), respectively, of the volume datasets acquired with B-mode; (2) these views were visualized in 98.2% (165/168), 97.0% (163/168), and 83.6% (145/168), respectively, of the volume datasets acquired with CDI; (3) CDI contributed additional diagnostic information to 12.5% (21/168), 14.2% (24/168) and 10.1% (17/168) of the four- and five-chamber and the three-vessel and trachea views; (4) cardiac anomalies other than isolated ventricular septal defects were identified by TUI in 16 of 195 fetuses (8.2%) and, among these, CDI provided additional diagnostic information in 5 (31.3%); (5) the sensitivity, specificity, positive- and negative-predictive values of TUI to diagnose congenital heart disease in cases where both B-mode and CDI volume datasets were acquired prenatally were 92.9%, 98.8%, 92.9% and 98.8%, respectively. CONCLUSION Standard transverse planes commonly used to examine the fetal heart can be automatically displayed with TUI in the majority of fetuses undergoing 4D US with STIC. Due to the retrospective nature of this study, the results should be interpreted with caution and independently confirmed before this methodology is introduced into clinical practice.
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Affiliation(s)
- Luís F. Gonçalves
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
| | - Jimmy Espinoza
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
| | - Roberto Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Corresponding author: Roberto Romero, MD, Perinatology Research Branch, NICHD, NIH, DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit, MI 48201, Tel: 313-993-2700, Fax: 313-993-2694, e-mail:
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
| | - Betsy Swope
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
| | - Jyh Kae Nien
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
| | - Offer Erez
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
| | - Eleazar Soto
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
| | - Marjorie C. Treadwell
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan USA
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Gonçalves LF, Lee W, Espinoza J, Romero R. Three- and 4-dimensional ultrasound in obstetric practice: does it help? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1599-624. [PMID: 16301717 PMCID: PMC7062383 DOI: 10.7863/jum.2005.24.12.1599] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The purpose of this article was to review the published literature on 3-dimensional ultrasound (3DUS) and 4-dimensional ultrasound (4DUS) in obstetrics and determine whether 3DUS adds diagnostic information to what is currently provided by 2-dimensional ultrasound (2DUS) and, if so, in what areas. METHODS A PubMed search was conducted for articles reporting on the use of 3DUS or 4DUS in obstetrics. Seven-hundred six articles were identified, and among those, 525 were actually related to the subject of this review. Articles describing technical developments, clinical studies, reviews, editorials, and studies on fetal behavior or maternal-fetal bonding were reviewed. RESULTS Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, especially facial clefts. There is also evidence that 3DUS provides additional diagnostic information in neural tube defects and skeletal malformations. Large studies comparing 2DUS and 3DUS for the diagnosis of congenital anomalies have not provided conclusive results. Preliminary evidence suggests that sonographic tomography may decrease the examination time of the obstetric ultrasound examination, with minimal impact on the visualization rates of anatomic structures. CONCLUSIONS Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, evaluation of neural tube defects, and skeletal malformations. Additional research is needed to determine the clinical role of 3DUS and 4DUS for the diagnosis of congenital heart disease and central nervous system anomalies. Future studies should determine whether the information contained in the volume data set, by itself, is sufficient to evaluate fetal biometric measurements and diagnose congenital anomalies.
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Affiliation(s)
- Luís F. Gonçalves
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Wesley Lee
- Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Chaoui R, Heling KS. New developments in fetal heart scanning: three- and four-dimensional fetal echocardiography. Semin Fetal Neonatal Med 2005; 10:567-77. [PMID: 16242390 DOI: 10.1016/j.siny.2005.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the possibilities of three- and four-dimensional (3- and 4D) fetal echocardiography. A volume data set of a fetal heart can be acquired as a static volume, as a real-time 3D volume or as an offline 4D volume cine using spatial and temporal image correlation (STIC) software. STIC is explained and the potentials of this modality are emphasized. The display of a fetal heart volume data set demonstrates the cross-sections of interest, using the multiplanar mode or tomographic multislice imaging, and different volume rendering tools. The latter include: surface, minimum, inversion and glass body modes. This review highlights the potential of acquiring a digital volume data set of a heart cycle for later offline evaluation, either for an offline diagnosis, a second opinion (e.g. via Internet link) or for teaching fetal echocardiography to trainees and sonographers.
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Affiliation(s)
- R Chaoui
- Centre for Prenatal Diagnosis and Human Genetics, Friedrichstr. 147, 10117 Berlin, Germany.
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12
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Franklin RCG, Slavik Z. Real time three-dimensional echocardiography moves towards clinically useful neonatal cardiovascular imaging. Int J Cardiol 2005; 105:306-7. [PMID: 16274773 DOI: 10.1016/j.ijcard.2005.03.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/25/2005] [Indexed: 11/30/2022]
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13
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Herberg U, Goldberg H, Breuer J. Three- and four-dimensional freehand fetal echocardiography: a feasibility study using a hand-held Doppler probe for cardiac gating. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:362-371. [PMID: 15761914 DOI: 10.1002/uog.1839] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the clinical feasibility of the signal from a hand-held Doppler probe as a real-time tracking signal for dynamic three-dimensional (3D) (so-called four-dimensional (4D)) fetal echocardiography in a random patient cohort. METHODS Seventy fetuses, with and without congenital heart disease, at various gestational ages (mean, 25 weeks; range, 18-38 weeks) were investigated using freehand 3D echocardiography. Time gating was achieved concurrently by obtaining a Doppler signal of the fetal heart without further signal averaging. In 10 fetuses, Doppler gating was compared to cardiotocogram (CTG)-gated 3D echo using signal averaging. Gray-scale and color Doppler dynamic 3D displays and multiplanar views were assessed according to their ability to accurately depict cardiac gating and cardiac morphology. RESULTS In 68/70 fetuses, valid Doppler-based trigger signals were obtained. Correct cardiac gating was achieved in 231/275 (84%) 4D datasets. Doppler tracing of the fetal heart allowed beat-to-beat triggering without the necessity for signal averaging. Doppler gating detected rapid changes in the fetal heart rate more reliably than CTG gating, but was more sensitive to acoustic interference between the gating and echo-transducer when color-coded Doppler imaging was used. Image quality was highly dependent on random motion and the acoustic window. A total of 171/231 (74%) correctly gated datasets successfully demonstrated clinically useful 4D images of the fetal heart. The reconstruction of 3D and multiplanar views provided additional views not obtainable by two-dimensional imaging. CONCLUSION These results show that a hand-held Doppler probe can be used as a reliable online gating source for 4D fetal echocardiography.
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MESH Headings
- Adult
- Cardiotocography/methods
- Cohort Studies
- Echocardiography, Doppler/instrumentation
- Echocardiography, Doppler/methods
- Echocardiography, Four-Dimensional/instrumentation
- Echocardiography, Four-Dimensional/methods
- Echocardiography, Three-Dimensional/instrumentation
- Echocardiography, Three-Dimensional/methods
- Feasibility Studies
- Female
- Fetal Heart/diagnostic imaging
- Fetal Heart/physiopathology
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/physiopathology
- Heart Rate, Fetal/physiology
- Humans
- Image Interpretation, Computer-Assisted/methods
- Pregnancy
- Reproducibility of Results
- Ultrasonography, Prenatal/instrumentation
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- U Herberg
- Division of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany.
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14
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Acar P, Dulac Y, Taktak A, Abadir S. Real-time three-dimensional fetal echocardiography using matrix probe. Prenat Diagn 2005; 25:370-5. [PMID: 15906427 DOI: 10.1002/pd.1159] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the feasibility of using real-time three-dimensional echocardiography (3DE) to evaluate the fetal heart. METHODS Sixty fetuses were studied with gestational age between 22 and 34 weeks. The fetal heart was normal in 44 fetuses. In 16 fetuses, the fetal heart had morphologic abnormalities (hypoplastic left ventricle in 4, tetralogy of Fallot in 2, Ebstein anomaly in 2, rhabdomyomes in 2, hypoplastic right ventricle in 1) or myocardial dysfunction (in 5 fetuses). Real-time 3DE was performed with a cardiac matrix probe (2-4 MHz). Two modalities of 3D imaging were performed: Biplane and Live 3D imaging. RESULTS Real-time 3DE was performed successfully in 93%. Biplane imaging allowed a multiplanar scanning of the fetal heart. Using rotation, lateral and vertical tilts, the normal cardiac structures were identified from a unique reference image plane: atria and ventricles, atrioventricular valves, aorta and pulmonary artery. Live 3D imaging allowed surface imaging of the fetal heart. 'En face' view of the foramen ovale from the right atrium was obtained, showing the shape of the orifice. By cropping the pyramidal imaging volume, ascending aorta, aortic arch and ductus arteriosus were depicted from a single dataset. In pathologic fetal hearts, 3DE was helpful for (1) localizing multiple cardiac tumors; (2) estimating size and function of the right and left ventricles; (3) evaluating mechanism of valvular regurgitation and pulmonary obstruction. CONCLUSION Real-time 3DE is a feasible and non-time-consuming method, allowing a multiplanar scanning and new inside 3D views of the fetal heart.
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Affiliation(s)
- Philippe Acar
- Unité de cardiologie pédiatrique et foetale, Hôpital des Enfants, Toulouse, France.
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15
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Gonçalves LF, Espinoza J, Lee W, Mazor M, Romero R. Three- and four-dimensional reconstruction of the aortic and ductal arches using inversion mode: a new rendering algorithm for visualization of fluid-filled anatomical structures. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:696-698. [PMID: 15521086 DOI: 10.1002/uog.1754] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- L F Gonçalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD 20892, USA
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16
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Brekke S, Tegnander E, Torp HG, Eik-Nes SH. Tissue Doppler gated (TDOG) dynamic three-dimensional ultrasound imaging of the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:192-8. [PMID: 15287059 DOI: 10.1002/uog.1094] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Dynamic three-dimensional (3D) ultrasound imaging of the fetal heart is difficult due to the absence of an electrocardiogram (ECG) signal for synchronization between loops. In this study we introduce tissue Doppler gating (TDOG), a technique in which tissue Doppler data are used to calculate a gating signal. We have applied this cardiac gating method to dynamic 3D reconstructions of the heart of eight fetuses aged 20-24 weeks. The gating signal was derived from the amplitude and frequency contents of the tissue Doppler signal. We used this signal as a replacement for ECG in a 3D-volume reconstruction and visualization, utilizing techniques established in ECG-gated 3D echocardiography. The reliability of the TDOG signal for fetal cardiac cycle detection was experimentally investigated. Simultaneous recordings of tissue Doppler of the heart and continuous wave (CW) spectral Doppler of the umbilical artery (UA) were performed using two independent ultrasound systems, and the TDOG signal from one system was compared to the Doppler spectrum data from the other system. Each recording consisted of a two-dimensional (2D) sector scan, transabdominally and slowly tilted by the operator, covering the fetal heart over approximately 40 cardiac cycles. The total angle of the sweep was estimated by recording a separate loop through the center of the heart, in the elevation direction of the sweep.3D reconstruction and visualization were performed with the EchoPAC-3D software (GE Medical Systems). The 3D data were visualized by showing simultaneous cineloops of three 2D slices, as well as by volume projections running in cineloop. Synchronization of B-mode cineloops with the TDOG signal proved to be sufficiently accurate for reconstruction of high-quality dynamic 3D data. We show one example of a B-mode recording with a frame rate of 96 frames/s over 20 seconds. The reconstruction consists of 31 volumes, each with 49 tilted frames. With the fetal heart positioned 5-8 cm from the transducer, the sampling distances were approximately 0.15 mm in the beam direction, 0.33 degrees approximately 0.37 mm azimuth and 0.45 degrees approximately 0.51 mm elevation. From this single dataset we were able to generate a complete set of classical 2D views (such as four-chamber, three-vessel and short-axis views as well as those of the ascending aorta, aortic and ductal arches and inferior and superior venae cavae) with high image quality adequate for clinical use.
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Affiliation(s)
- S Brekke
- Department of Circulation and Diagnostic Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
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17
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Chaoui R, Hoffmann J, Heling KS. Three-dimensional (3D) and 4D color Doppler fetal echocardiography using spatio-temporal image correlation (STIC). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:535-545. [PMID: 15170792 DOI: 10.1002/uog.1075] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Color Doppler echocardiography is used to visualize three transverse planes: the four-chamber, five-chamber, and three vessels and trachea views. Color Doppler spatio-temporal image correlation (STIC) is a new three-dimensional (3D) technique allowing the acquisition of a volume of data from the fetal heart that is displayed as a cineloop of a single cardiac cycle. The aim of the study was to examine the potential of color Doppler STIC to evaluate normal and abnormal fetal hearts. METHODS This prospective study included 35 normal fetuses and 27 fetuses with congenital heart defects (CHD) examined between 18 and 35 weeks of gestation. Volume acquisition was achieved by initiating the image capture sequence from the transverse four-chamber view. Volumes were stored for later offline evaluation using a personal computer-based workstation in a multiplanar mode and as spatial volume rendering. RESULTS Successful acquisition was possible in all 62 cases. The three planes could be demonstrated in 31/35 healthy fetuses and in 24/27 fetuses with CHD. Spatial volume rendering was attempted in 18 fetuses with CHD. In the four normal fetuses with inadequate visualization using color Doppler STIC, the region of interest was perpendicular to the ultrasound beam. In two fetuses with CHD inadequate visualization was related to an enlarged heart in late gestation, in which the entire cardiac volume could not be acquired. The third case was an 18-week fetus with complex CHD and transposed great vessels in which artifacts were related to confluent color signals as a result of low resolution in the reconstructed plane. CONCLUSIONS STIC in combination with color Doppler ultrasound is a promising new tool for multiplanar and 3D/4D rendering of the fetal heart. Limitations may be found later in gestation in fetuses with large hearts and early in gestation as a result of low discrimination of signals. In addition, insonation perpendicular to the structure of interest does not image color Doppler signals and should be avoided during acquisition.
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Affiliation(s)
- R Chaoui
- Unit of Prenatal Diagnosis and Therapy, Charité University Hospital, Berlin, Germany.
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18
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Deng J. Terminology of three-dimensional and four-dimensional ultrasound imaging of the fetal heart and other moving body parts. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:336-344. [PMID: 14528467 DOI: 10.1002/uog.890] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- J Deng
- Department of Medical Physics and Bioengineering, University College London, Shropshire House, 11-20 Capper Street, London WC1E 6JA, UK.
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