Benefits of a Systematic Approach in the Evaluation of Fetal Facial 3-Dimensional Volumes

Abstract

The benefits of using volume ultrasonography (3-dimensional ultrasonography [3DUS]) have been explored in diagnosing fetal anomalies 1-3 such as cleft lip and palate, 4-11 micrognathia, 12,13 congenital heart diseases, [14][15][16] and skeletal abnormalities. 17,18 However, clinical implementation of this new technology has been challenging for many reasons, including familiarity with the knobology and orientation within a volume of data. Training of physicians to use volume ultrasonography has been limited because of a lack of standardization, display, and manipulation of 3-dimensional (3D) volumes. 19 Abuhamad et al 20 recently showed that the Z technique was a useful method for teaching inexperienced physicians to obtain the coronal plane of the uterus from 3D volGladys A. Ramos, MD, Menashe Kfir, MD, Sujin Lee, MD, Deborah D'Agostini, RDMS, Tanya Wolfson, MA, Anthony Gamst, MD, Dolores H. Pretorius, MD Received November 3, 2010, ORIGINAL RESEARCHObjectives-The purpose of our study was to evaluate the accuracy and efficacy of using a systematic approach to teach maternal-fetal medicine physicians how to display a diagnostic fetal profile and palate using 3-dimensional ultrasonography (3DUS).Methods-Ten maternal-fetal medicine physicians were randomly assigned to 2 groups, A and B, and instructed on basic principles of 3DUS volume manipulation. Physicians in group A were asked to display the fetal profile in 5 volumes, including 1 fetus with abnormalities. Physicians in Group B were asked to display the fetal profile in the same 5 volumes after detailed instruction. The groups were combined, and detailed instruction was repeated. The physicians were asked to review an additional 5 volumes. In a separate session, the physicians were divided into their respective groups, and a similar exercise was repeated. This time, they were asked to display the fetal palate in 3-orthogonal-plane and parallel-plane images. The time required for manipulation was recorded. Images were reviewed for accuracy and clinical utility by 2 blinded experienced sonologists. Data were analyzed with mixed effects models.Results-Fetal profile and parallel-plane palate scores were significantly higher in group B (P < .001) compared to group A. There was no difference between groups in displaying the 3-orthogonal-plane image of the palate or after additional training for either group. The mean times for display did not differ between the groups. The time required for evaluation of the abnormal profiles was longer (P = .02) than that for evaluation of the normal profiles.Conclusions-Detailed instruction in obtaining 3DUS images of fetal profiles and palates improved the image quality obtained by physicians. Teaching physicians in a standardized way may help improve the use of 3DUS in clinical practice.

Assessment of Midfacial Hypoplasia in Down Syndrome Fetuses – Validity of a Two-Line Approach and Introduction of a Novel Angle (Maxilla-Mandible-Nasion Angle)

“…There have been a number of publications dealing with the potential superiority of 3D vs. 2D-based studies on facial integrity in normal and aneuploid fetuses [25][26][27][28]. It has been shown that the facial maxillary angle is significantly larger when assessed via a three-dimensional approach.…”

Prenatal Diagnosis of Congenital Syphilis Using Two- and Three-Dimensional Ultrasonography: Case Report

“…3DUS has been used over the last few years as a prenatal diagnostic technique complementary to 2DUS and has enabled better assessment of fetal surface abnormalities [11]. In our specific case, 3DUS clearly demonstrated the twisting and absence of some toes.…”

Radiological evaluation of the fetal face using three-dimensional ultrasound imaging

“…Ramos et al 92 found that: use of three-dimensional ultrasound for visualization of the profile took about 60 seconds and about 73 seconds for the primary palate; that this period might be shorter in expert hands; and a standardized teaching program might improve the use and accuracy of bi-dimensional 93 and three-dimensional ultrasound. 92 However, there are no statistics permitting a precise comparison of the financial aspects of the two approaches.…”