Application of three‐dimensional ultrasonography in the evaluation of the fetal heart.

Abstract

The objectives of this study were to determine whether three-dimensional ultrasonography can provide more cardiac views than two-dimensional ultrasonography and to develop a standard technique. Eighteen women, 16 to 26 weeks' gestation, were scanned with twodimensional ultrasonography for 10 minutes or less to obtain fetal heart views. Threedimensional ultrasonography was used (≤10 minutes) to obtain up to 4 acquisitions of the fetal heart: 4-chamber view, left parasagittal, transverse, and longitudinal nonstandard. Views were later extracted from saved volume data, comparing the yields of two-and threedimensional ultrasonography. The 4-chamber view was obtained in 15 (93%) of 16 cases on both two-and three-dimensional ultrasonography. On two-dimensional ultrasonography, the left outflow tract was obtained in 68% of the cases; on three-dimensional ultrasonography, the left outflow tract was obtained in 46% from the 4-chamber view acquisition and in 100% from the left parasagittal acquisition. On two-dimensional ultrasonography, the right outflow tract was obtained in 68% of the cases; on three-dimensional ultrasonography, the right outflow tract was obtained in 86% from the 4-chamber view acquisition and in 71% from the left parasagittal acquisition. Aortic and ductal arches were obtained in 12% and 18%, respectively, on two-dimensional ultrasonography. On three-dimensional ultrasonography the aortic and ductal arches were obtained in 66% and 86%, respectively, from the 4-chamber view acquisition and in 57% and 71%, respectively, from the left parasagittal acquisition. Three-dimensional ultrasonography permitted a greater number of cardiac views to be extracted from volume data than did two-dimensional ultrasonography. Key words: three-dimensional ultrasonography; fetal heart screening; fetal echocardiography. Medicine, March 13-17, 1999, San Antonio, TX. Address correspondence and reprint requests to Gjergji Bega, MD, Department of Radiology, Division of Ultrasound, 132 S 10th St, Philadelphia, PA 19107. Abbreviations AA, aortic arch; DA, ductal arch; 4CHV, 4-chamber view; IVC, inferior vena cava; LVOT, left ventricle outflow tract; NSLV, nonstandard longitudinal view; NSTV, nonstandard transverse view; PAB, pulmonary artery and branches; RVOT, right ventricle outflow tract; SVC, superior vena cava; 3D, three-dimensional; 3DUS, threedimensional ultrasonography; 2D, two-dimensional; 2DUS, two-dimensional ultrasonography

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

“…A limitation of the technique described in this study, which utilized a transverse sweep for volume dataset acquisition, is that it does not allow imaging of the aortic and ductal arches. Imaging of the arch vessels is best accomplished when the STIC volume datasets are acquired with a sagittal sweep through the fetal chest [58], using a technique originally described by Bega et al [49] for static three-dimensional volume datasets.…”

“…Three-dimensional [45][46][47][48][49][50][51] and, more recently, four-dimensional ultrasonography of the fetal heart [52][53][54][55][56][57][58] have the potential for making the examination less operator-dependent. Once a volume dataset is acquired, the heart can be examined using multiple planes of section, some of which are unobtainable with two-dimensional ultrasound.…”

Accuracy of the Fetal Echocardiography in the High Risk Pregnancies

“…The shift from the prenatal diagnosis of the structural cardiac anomalies and rhythm disturbances toward the fetal cardiac flow dynamics has been made owing to the development of sophisticated ultrasound techniques in hands of skilled professionals. 27,57 Improvements from the point of view of the public health could be achieved in better screening protocols, broadly performed by more skilled professionals in earlier gestational ages. [58][59][60] Increasing role of 3D or live 3D ultrasonography, and telemedicine are promising fields of the development of fetal echocardiography, with the possibility to improve detection rate and accuracy of prenatal CHD diagnosis.…”

“…As it is well-known, four-chamber view detects up to 77 percent of prenatally developed CHD, while depiction of ventricular outflow tracts increases prenatal detection rate of CHD between 83 and 92 percent. 6,27,35,36 The detection of even major malformations seen in the fourchamber view is less than perfect. Some lesions could be overlooked during the examination, because four-chamber view could be normal, which does not exclude existence of CHD.…”

“…27 More than 90 percent of CHD occurs in low risk population. 27 Prenatal detection rate of CHD in tertiary perinatal centers was 18 percent and 0 percent in non-tertiary centers. 28 Prenatal detection rate of major CHD was 23.4 percent in the United Kingdom.…”