Three-dimensional ultrasound STIC-HDlive rendering: new technique to assessing of fetal heart

Assessment of fetus during second trimester ultrasonography using HDlive software: What is its real application in the obstetrics clinical practice?

AIM

To show imaging results from application of four-dimensional (4D) ultrasound lightening technique (HDlive™) in clinical obstetrics practice.

METHODS

Normal and abnormal fetuses at second and third trimester of pregnancy undergoing routine scan with 4D HDlive™ (5DUS) in the rendering mode are described. Realistic features of fetal structures were provided by 5DUS in the rendering mode. Normal anatomy as well as pathology like cleft lip, hypoplastic face, micrognathia, low-set ears, corpus callosum, arthrogryposis, aortic arch, left congenital diaphragmatic hernia are highlighted in this study. Anatomical details of the fetuses were provided by 5DUS with higher quality imaging modality compared to those obtained using conventional 2D/3D ultrasound.

RESULTS

Realistic views of fetal anatomy details were displayed by means of 5DUS in the rendering mode, with high image quality obtained either in low-risk or in high-risk obstetrics population. Corpus callosum, esophagus, and aortic arch were obtained in normal fetuses. Cleft lip, cleft lip and palate, micrognathia, hypoplastic face, low-set ears, arthrogryposis, left congenital diaphragmatic hernia, exomphalos, and clitoris hypertrophy were clearly rendered by 5DUS application.

CONCLUSION

The use of 5DUS in the rendering mode, when clinical available, was diagnostic in a variety of congenital anomalies, aided understanding of the parents-to-be and improved prenatal counseling and perinatal management.

Three- and four-dimensional ultrasound in fetal echocardiography: an up-to-date overview

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.

4D Fetal Echocardiography in Clinical Practice

Spatiotemporal image correlation (STIC) is a technique that acquires the fetal cardiac volumes, and then analyzes it offline in both multiplanar and rendered modes, using both static and moving images from a four-dimensional (4D) cine sequence simulating a full cardiac cycle. Spatiotemporal image correlation makes it possible to evaluate cardiac structures and their vascular connections, is less operator dependent, and allows cardiac volumes to be sent to specialists in tertiary centers for examination. Spatiotemporal image correlation can be combined with other software techniques, such as virtual organ computer-aided analysis (VOCAL) and automatic volume calculation (SonoAVC), to calculate cardiac function parameters. It can also be used in association with Omniview® in order to obtain standard echocardiographic planes using simple targets arterial rendering (STAR) and four-chamber view and swing technique (FAST). Recently, fetal intelligent navigation echocardiography (FINE), acquired from 3D STIC volumes, has made it possible to automatically obtain nine standard echocardiographic planes. In this article, we review the chief applications of 4D echocardiography using STIC technique in clinical practice.

How to cite this article

Araujo Júnior E, Tedesco GD, Carrilho MC, Peixoto AB, Carvalho FHC. 4D Fetal Echocardiography in Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4): 382-396.

The value of 3D and 4D assessments of the fetal heart

The objective of this review was to demonstrate the main tools of three- and four-dimensional ultrasonography, using the spatiotemporal image correlation software and its respective applications for assessing the fetal heart and its vascular connections, along with its potential contribution towards screening for congenital heart diseases. Today, conventional, two-dimensional, echocardiography continues to be the gold standard for diagnosing congenital heart diseases. However, recent studies have demonstrated that spatiotemporal image correlation offers some advantages that boost two-dimensional accuracy in detecting congenital heart diseases, given that the fetal heart assessment can be completed in the absence of the patient (offline) and be discussed by different examiners. Additionally, data volumes can be sent for analysis in reference centers via internet links. Spatiotemporal image correlation also enables direct measurement of heart structures in rendering mode, such as the interventricular septum and the annulus of the atrioventricular valves. Furthermore, it enables assessment of cardiac function when used in association with the virtual organ computer-aided analysis software, thus making it possible to calculate the total systolic function, ejection fraction, and cardiac output.