Quality of 2- and 3-dimensional fast acquisition fetal cardiac imaging at 18 to 22 weeks: ramifications for screening

Assessment of the quality of fetal heart standard views using the FAST, STAR, and FINE four-dimensional ultrasound techniques in the screening of congenital heart diseases

OBJECTIVE

To compare the quality of standard fetal echocardiographic views obtained by four-dimensional ultrasound with those obtained by the simple targeted arterial rendering (STAR) technique, four-chamber view swing technique (FAST), and fetal intelligent navigation echocardiography (FINE/5D Heart^® ) technique.

METHODS

This was a cross-sectional prospective study that included pregnant women between 22 and 34 weeks of gestation, with normal fetuses. Fetal heart volumes were acquired using spatio-temporal image correlation (STIC) with the fetal spine between 2 and 9 o'clock. The FAST/STAR techniques consist of the manipulation of STIC volumes by drawing OmniView^™ lines to obtain echocardiographic views. The FINE/5D Heart® technique uses intelligent navigation to automatically generate echocardiographic views. The quality of the images was classified as excellent, good, acceptable, and unacceptable. The analysis was performed using the Bonferroni multiple comparisons test.

RESULTS

The study included 101 pregnant women aged between 16 and 44 years. There was no mean difference in image quality between the techniques regarding fetal spine position in all echocardiographic views (P > .05). However, in the five-chamber, left ventricular outflow tract, right ventricular outflow tract, ductal arch, superior vena cava/inferior vena cava, and abdomen/stomach views, there was a statistically significant mean difference quality between the techniques, regardless of the spine position (P < .05). The best mean image quality was obtained by the FINE technique (P ≤ .016 for all fetal echocardiographic views).

CONCLUSION

The quality of the echocardiographic views obtained using the FINE technique was superior to that of those generated by the FAST/STAR techniques in normal fetuses.

Sonocubic fine: new three-dimensional ultrasound software to the screening of congenital heart diseases

Congenital heart disease is the most common fetal congenital malformations; however, the prenatal rate detection still is low. The two-dimensional echocardiography is the "gold standard" exam to screening and diagnosis of congenital heart disease during the prenatal; however, this exam is operator-depending and it is realized only in high risk pregnancies. Spatio-temporal image correlation is a three-dimensional ultrasound software that analyses the fetal heart and your connections in the multiplanar and rendering modes; however, spatio-temporal image correlation too is operator-depending and time-consuming. We presenting a new three-dimensional software named Sonocubic fine to the screening of congenital heart disease. This software applies intelligent navigation technology to spatio-temporal image correlation volume datasets to automatically generate nine fetal echocardiography standard views. Thus, this new software tends to be less operator-depending and time-consuming.

Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio-Temporal Image Correlation in the Second and Third Trimesters of Pregnancy

OBJECTIVE

To assess the quality of fetal heart views by three-dimensional/four-dimensional (3D/4D) ultrasonography using spatio-temporal image correlation (STIC) in the second and third trimester of pregnancy.

METHODS

This prospective and cross-sectional study was conducted at a single referral service for the screening of congenital heart diseases (CHDs), with pregnant women at 20-30 weeks' gestation with a normal fetal heart. 3D/4D STIC were obtained from the fetal heart screening in the following views: four-chamber (4C), left and right ventricular outflow tracts (LVOT and RVOT), 3 vessels and trachea (3VT), aortic arch (AA), and ductal arch (DA). We categorized the images as satisfactory or unsatisfactory and performed McNemar's test to evaluate the differences between the two-dimensional (2D) echocardiography and 3D/4D STIC techniques. The inter-observer concordance was obtained by kappa coefficient.

RESULTS

The rate of satisfactory fetal heart views using 3D/4D STIC was 54% by using 4 planes (4C, RVOT, LVOT, and 3VT) and 14% by using 6 planes (4C, RVOT, LVOT, 3VT, AA, and DA). In contrast, 100% of the 2D echocardiography images were satisfactory (McNemar's test, P < 0.001). We observed moderate inter-observer concordance to both 4- and 6 planes (κ = 0.56 and 0.43, respectively).

CONCLUSION

The quality of the main fetal heart views by 3D/4D STIC still present some limitations compared with the 2D echocardiography.

Three-dimensional fast acquisition with sonographically based volume computer-aided analysis for imaging of the fetal heart at 18 to 22 weeks' gestation

OBJECTIVE

The purpose of this study was to determine how frequently cardiac images derived from 3-dimensional (3D) volume sets, acquired by fast acquisition and evaluated with sonographically based volume computer-aided analysis (sonoVCAD), were satisfactory for prenatal screening at 18 to 22 weeks' gestation.

METHODS

A prospective study of 100 women with singleton pregnancies was undertaken. Three fast acquisition 3D volume sets were obtained from each patient. Four reviewers independently evaluated the 4-chamber and 5 extracted VCAD views. Factors contributing to unsatisfactory screening were also evaluated.

RESULTS

The frequency with which adequate views for cardiac screening could be obtained varied widely; some single views, such as that of the stomach, were well seen frequently, whereas others, such as the ductal arch, were well seen significantly less frequently (P < .05). A satisfactory screening examination, defined as a visualized 4-chamber, left ventricular outflow tract, right ventricular outflow tract, and axial stomach view, was obtained for 43% to 65% of patients (dependent on reviewer). Logistic regression revealed that obesity (odds ratio, 3.0; 95% confidence interval, 1.7-5.0) and a fetus with the spine toward the maternal abdomen (odds ratio, 1.7; 95% confidence interval, 1.1-2.5) were independently associated with an unsatisfactory screening examination

CONCLUSIONS

Three-dimensional fast acquisition volumes evaluated with sonoVCAD did not allow a satisfactory fetal cardiac screening examination to be obtained a high percentage of the time in a general obstetric population during the second trimester. Certain patient factors, such as body habitus and fetal position, are associated with unsatisfactory 3D imaging.

Satisfactory visualization rates of standard cardiac views at 18 to 22 weeks' gestation using spatiotemporal image correlation

OBJECTIVE

The purpose of this study was to determine the frequency with which 3 standard screening views of the fetal heart (4-chamber, left ventricular outflow tract [LVOT], and right ventricular outflow tract [RVOT]) can be obtained satisfactorily with the spatiotemporal image correlation (STIC) technique.

METHODS

A prospective study of 111 patients undergoing anatomic surveys at 18 to 22 weeks was performed. Two ultrasound machines with fetal cardiac settings were used. The best volume set that could be obtained from each patient during a 45-minute examination was graded by 2 sonologists with regard to whether the 4-chamber, LVOT, and RVOT images were satisfactory for screening.

RESULTS

All 3 views were judged satisfactory for screening in most patients: 1 sonologist graded the views as satisfactory in 70% of the patients, whereas the other found the views to be satisfactory in 83%. The position of the placenta did not alter the probability of achieving a satisfactory view, but a fetus in the spine anterior position was associated with a significantly lower probability that the views were regarded as satisfactory for screening (odds ratio, 0.28; 95% confidence interval, 0.09-0.70; P < .05).

CONCLUSIONS

This study suggests that STIC may assist with screening for cardiac anomalies at 18 to 22 weeks' gestation.