3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double‐outlet right ventricle

Abstract

Objective To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision‐making and in predicting surgical approach in fetuses with double‐outlet right ventricle (DORV). Methods This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision‐making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken. Results Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single‐stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single‐stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04). Conclusion Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision‐making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Three-Dimensional 3D Ultrasound and Doppler Angiography Imaging in the Prenatal Assessment on Normal and Abnormal Fetal Cardiac Anatomy

“…For example, in the 4-chamber view the anatomy of the heart and great vessels at the moment of acquisition i.e., according to the phase of the cardiac cycle, is contained and stored in volume datasets, the main value of 3D volume is the ability unveil the anatomical information contained i.e., reconstruct 3D spatial images standard planes on a 2D screen in a process called rendering [10]. To obtain volume database during a complete cardiac cycle, temporal dimension information that is present during acquisition has to be incorporated, Spatio-Temporal Image Correlation (STIC) is a new a software modality that unites the spatial and temporal domains resulting in a volume of a complete fetal cardiac cycle displayed in motion by means of a sequence of 3D cineloop that consists of a high number of 2D frames, one behind the other [11,12]. However, extracting and displaying meaningful information from volume datasets is highly expertise-dependent, difficult to perform and require a sound knowledge of fetal anatomy [12].…”

Clinical presentation, conventional/4D spatio‐temporal image correlation imaging findings, pregnancy and early postnatal outcomes in fetuses having anomalies of systemic venous return in the absence of significant intracardiac defects: A retrospective study from two centres in Southern India

“…1 In addition to the standard 2D and color Doppler imaging techniques, we also used 4D spatio-temporal image correlation fetal imaging modalities using standard protocols. 14 Volume datasets were obtained in standard and high-definition color modes in the transverse and sagittal planes of the abdomen and chest for the evaluation of the systemic venous anatomy. The datasets were then processed using multi-planar reconstruction imaging and the images were displayed using various rendering modes using highdefinition color, glass-body (color superimposed on gray scale and silhouette rendering) (Figure 9).…”

“…The evaluation of the umbilico‐portosystemic venous system was done using three imaging planes (lateral transverse, anteroposterior transverse, and longitudinal views of the fetal abdomen 1 . In addition to the standard 2D and color Doppler imaging techniques, we also used 4D spatio‐temporal image correlation fetal imaging modalities using standard protocols 14 . Volume datasets were obtained in standard and high‐definition color modes in the transverse and sagittal planes of the abdomen and chest for the evaluation of the systemic venous anatomy.…”

Prenatal Diagnosis of a Large Left Coronary Artery to Right Ventricle Fistula With 3-Dimensional/4-Dimensional Spatiotemporal Image Correlation Rendering Followed by Successful Neonatal Transcatheter Closure

“…We had previously reported the incremental benefits of 3D/4D STIC technique in predicting the postnatal surgical pathway in fetuses with double outlet right ventricle. 4 There was excellent correlation between the anatomy of the coronary artery fistulas as delineated by prenatal 3D/4D STIC compared with postnatal 256 slice computed tomography based reconstruction (Figure 2). The precise delineation of the anatomy in the prenatal period along with the identification of features of high-volume shunting enabled us to precisely plan the neonatal cardiac care for this baby culminating in a successful trans-catheter closure of the fistula (Figure 3; Video S3).…”