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© 2005 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 24:1599-1624 • 0278-4297

Special Review Article

Three- and 4-Dimensional Ultrasound in Obstetric Practice

Does It Help?

Luís F. Gonçalves, MD, Wesley Lee, MD, Jimmy Espinoza, MD and Roberto Romero, MD

Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland USA (L.F.G., J.E., R.R.); Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan USA (L.F.G., J.E.); and Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan USA (W.L.).

Address correspondence to Roberto Romero, MD, Perinatology Research Branch, National Institute of Child Health and Human Development, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit MI 48201 USA. E-mail: warfiela{at}mail.nih.gov

Objective. The purpose of this article was to review the published literature on 3-dimensional ultrasound (3DUS) and 4-dimensional ultrasound (4DUS) in obstetrics and determine whether 3DUS adds diagnostic information to what is currently provided by 2-dimensional ultrasound (2DUS) and, if so, in what areas. Methods. A PubMed search was conducted for articles reporting on the use of 3DUS or 4DUS in obstetrics. Seven-hundred six articles were identified, and among those, 525 were actually related to the subject of this review. Articles describing technical developments, clinical studies, reviews, editorials, and studies on fetal behavior or maternal-fetal bonding were reviewed. Results. Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, especially facial clefts. There is also evidence that 3DUS provides additional diagnostic information in neural tube defects and skeletal malformations. Large studies comparing 2DUS and 3DUS for the diagnosis of congenital anomalies have not provided conclusive results. Preliminary evidence suggests that sonographic tomography may decrease the examination time of the obstetric ultrasound examination, with minimal impact on the visualization rates of anatomic structures. Conclusions. Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, evaluation of neural tube defects, and skeletal malformations. Additional research is needed to determine the clinical role of 3DUS and 4DUS for the diagnosis of congenital heart disease and central nervous system anomalies. Future studies should determine whether the information contained in the volume data set, by itself, is sufficient to evaluate fetal biometric measurements and diagnose congenital anomalies.

Key Words: 4-dimensional ultrasound • pregnancy • 3-dimensional ultrasound • ultrasound

Abbreviations: CI, confidence interval • CT, computed tomography • 4D, 4-dimensional • 4DUS, 4-dimensional ultrasound • GPV, geometric pyramidal volume • MRI, magnetic resonance imaging • NTT, nuchal translucency thickness • STIC, spatiotemporal image correlation • 3D, 3-dimensional • 3DUS, 3-dimensional ultrasound • 2D, 2-dimensional • 2DUS, 2-dimensional ultrasound • VOCAL, Virtual Organ Computer-Aided Analysis




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