A Systematic Approach to the Use of the Multiplanar Display in Evaluation of Abnormal Vascular Connections to the Fetal Heart Using 4-Dimensional Ultrasonography

Abstract

Objective. The multiplanar display is a modality that allows the simultaneous visualization of 3 orthogonal planes from volume data sets obtained with 3-and 4-dimensional ultrasonography. Simultaneous display of standard views used in fetal echocardiography and their orthogonal planes may provide novel ultrasonographic views for examination of the fetal heart and its vascular connections. This study was designed to determine the clinical utility of the multiplanar display in the examination of abnormal vascular connections to the fetal heart. Methods. We reviewed 4-dimensional volume data sets, acquired with the spatiotemporal image correlation technique, from patients with abnormal vascular connections to the fetal heart. Multiplanar views of the fetal heart were used to simultaneously display standard planes used in fetal echocardiography and their corresponding orthogonal planes. Results. This study included 4 volume data sets from fetuses with confirmed abnormal vascular connections to the heart, including: (1) an interrupted inferior vena cava with azygos or hemiazygos vein continuation; (2) a persistent left superior vena cava draining into a dilated coronary sinus; and (3) a dilated superior vena cava associated with a thoracic lymphangioma. Simultaneous visualization of orthogonal planes displaying abnormal vascular connections to the fetal heart facilitated identification of the abnormal vessels and their spatial relationships with other vascular structures. Conclusions. Multiplanar imaging can be used to assess abnormal vascular connections to the fetal heart and may provide novel ultrasonographic planes for fetal echocardiography using 3-and 4-dimensional ultrasonography. Key words: congenital heart disease; fetal echocardiography; prenatal diagnosis; spatiotemporal; spatiotemporal image correlation; vascular connections. renatal visualization of abnormal venous connections to the fetal heart with 2-dimensional ultrasonography requires the examiner to continuously scan these vascular structures in multiple ultrasonographic planes. This process also involves simultaneous analysis of anatomic structures through mental reconstruction of their spatial relationships. This process can be facilitated using 3-dimensional (3D) and

Prenatal diagnosis of truncus arteriosus using multiplanar display in 4D ultrasonography

“…[48] It has also been demonstrated that multiplanar display may help in the evaluation of abnormal vascular connections. [49]…”

How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart

“…The end result is a multitude of display modes for STIC volume data sets. Congenital Heart Disease —Prenatal assessment and diagnosis of CHD using conventional 2D sonography require an analysis of anatomic structures through a mental reconstruction of their spatial relationships. Four‐dimensional sonography with STIC can improve the ability to identify such complex intracardiac relationships (Figure 9 and Video 13) and may also shorten the examination time 33 , 43 , 121 . Moreover, fetal cardiac abnormalities undetected during real‐time sonographic examination may be detected at the time of STIC volume review 40 .…”

How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart

“…A solid body of evidence suggests that 4D sonography with STIC facilitates examination of the fetal heart 3 , 4 , 5 , 11 – 37 and may also be used to evaluate fetal cardiac function 18 , 22 , 27 , 30 , 31 , 33 , 38 – 46 . This modality has also been used in the prenatal evaluation and diagnosis of congenital heart disease (CHD) 2 , 20 , 47 – 71 because it improves the ability to identify complex intracardiac relationships and can shorten the examination time 3 , 17 , 72 . These facts are important, since evaluation of the normal and abnormal fetal heart 73 – 75 using 2D sonography is one of the most challenging tasks in prenatal diagnosis.…”