Methodological study on real-time three-dimensional echo cardiography and its application in the diagnosis of complex congenital heart disease:

Ultrasound vs MRI in Diagnosis of Fetal and Maternal Complications

Ultrasound is the screening modality of choice for the fetal imaging. However, there are circumstances in which an alternative imaging technique is needed for additional information regarding fetal anatomy and pathology as well as different maternal conditions.

Magnetic resonance imaging (MRI) is being increasingly used as correlative imaging modality in pregnancy because it uses no ionizing radiation, provides excellent soft-tissue contrast, and has multiple planes for reconstruction and large field of view, allowing better depiction of anatomy in fetuses with large or complex anomalies.

In this review, we attempted to identify strengths and weaknesses of each modality both from the literature and our own working experience, and to propose to some practical recommendations on when to use which imaging modality.

Both ultrasonography and MRI are operator-dependant and neither technique obviates the need for thorough knowledge of normal and abnormal anatomy. In early pregnancy, and where repeated assessment is needed, ultrasound has the obvious advantage. In circumstances where ultrasound examination is difficult, as in the obese patient or severe oligohydramnion, better images might be obtained by MRI examination. MRI might also identify early fetal ischemic lesions after an insult, such as maternal trauma or death of a monochorionic co-twin. From the published literature, it would appear that MRI may provide additional diagnostic information to that given by ultrasound in 25 to 55% of cases, which in turn may have influence on parental counseling and/or management of affected pregnancies. Individual circumstances and expertise influence the accuracy of both modalities. Ultrasound and MRI should be performed to the highest possible standard, and the final diagnosis should be made in a multidisciplinary setting.

Impact of three-dimensional echocardiography in complex congenital heart defect cases: the surgical view

Other authors have demonstrated the ability of three-dimensional (3D) echocardiography to produce "en face" views of anomalies such as atrioventricular valve disease and atrial and ventricular septal defects. Few data exist about the usefulness of 3D images for more complex congenital heart defects and the surgical impact of this relatively new technology. This study, covering a period of 8 months and including 43 young patients affected by complex congenital heart defects, demonstrated that the routine use of 3D echocardiography is feasible and valuable for some types of cardiac defects. In fact, 3D images have provided more detailed anatomic definition of interrelations between structures in about one-third (15/43) of our cases, yielding new insight into the anatomy analogous to what can be derived from examining a heart specimen. Our surgeons found the 3D images particularly helpful for providing a realistic and almost specimen-like preview of the surgical anatomy that facilitates planning of the surgical program.

Real-time three-dimensional echocardiography: an update

Real-time three-dimensional echocardiography (RT3DE) is the only on-line 3D method based on real-time volumetric scanning, as compared with other 3D imaging techniques such as computed tomography and magnetic resonance imaging, which are based on post-acquisition reconstruction and not on volumetric scanning. In recent years, several studies have revealed possible advantages of 3DE in daily clinical practice. The aim of this manuscript is to give a brief review of the development of the clinical applications of RT3DE.