This Article Full Text Full Text (PDF) Videos Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gonçalves, L. F. Articles by Romero, R. Search for Related Content PubMed PubMed Citation Articles by Gonçalves, L. F. Articles by Romero, R.

A New Approach to Fetal Echocardiography

Digital Casts of the Fetal Cardiac Chambers and Great Vessels for Detection of Congenital Heart Disease

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., W.L., J.K.N., J.-S.H., J.S.-F., R.R.); Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan USA (L.F.G., J.E., J.S.-F., R.R.); Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan USA (W.L.); and Department of Obstetrics and Gynecology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel (M.M.).

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 study was to describe a method of 4-dimensional (4D) reconstruction of the cardiac chambers and outflow tracts using a combination of spatiotemporal image correlation, "inversion mode," and "B-flow" imaging. Methods. Spatiotemporal image correlation and the inversion mode were used in the examination of the volume data sets of 23 fetuses with congenital heart anomalies. A subset was also examined with B-flow imaging using the gradient light algorithm. Digital reconstructions from abnormal hearts were compared with a library obtained from fetuses without abnormalities. Results. Rendered images of the 4-chamber view using the inversion mode were characterized by: (1) echogenic chambers; (2) sharp delineation of chamber contours when compared with 2-dimensional (2D) images; and (3) distinct display of the myocardium, interventricular septum, interatrial septum, and mitral and tricuspid valves as anechoic structures. Ventricular septal defects, abnormal differential insertion of the atrioventricular valves, and valve atresia were well visualized with the inversion mode. The application of inversion mode or B-flow imaging to 4D rendering of the outflow tracts resulted in "digital casts" displaying the spatial relationships between the outflow tracts as well as the connections between the great arteries and ventricular chambers. The spatial relationships and communications among cardiac structures cannot be visualized with conventional 2D ultrasonography. Conclusions. The application of spatiotemporal image correlation, inversion mode, and B-flow imaging generates information about the anatomy and pathologic characteristics of the fetal heart (digital casts) that cannot be obtained with 2D fetal echocardiography. We propose that these modalities enhance the information provided by ultrasonographic interrogation of the fetal heart and will improve prenatal diagnosis.

Key Words: congenital heart disease • fetal echocardiography • 4-dimensional ultrasonography • spatiotemporal image correlation • 3-dimensional ultrasonography • 4D • 3D

Abbreviations: 4D, 4-dimensional • STIC, spatiotemporal image correlation • 2D, 2-dimensional • VSD, ventricular septal defect

This article has been cited by other articles:

				J. Espinoza, S. S. Hassan, F. Gotsch, J. P. Kusanovic, W. Lee, O. Erez, L. F. Goncalves, M. L. Schoen, and R. Romero A Systematic Approach to the Use of the Multiplanar Display in Evaluation of Abnormal Vascular Connections to the Fetal Heart Using 4-Dimensional Ultrasonography J. Ultrasound Med., November 1, 2007; 26(11): 1461 - 1467. [Abstract] [Full Text] [PDF]

				J. Espinoza, R. Romero, J. P. Kusanovic, F. Gotsch, O. Erez, W. Lee, L. F. Goncalves, M. L. Schoen, and S. S. Hassan The Role of the Sagittal View of the Ductal Arch in Identification of Fetuses With Conotruncal Anomalies Using 4-Dimensional Ultrasonography J. Ultrasound Med., September 1, 2007; 26(9): 1181 - 1188. [Abstract] [Full Text] [PDF]

				R. H. Wachsberg B-Flow Imaging of the Hepatic Vasculature: Correlation with Color Doppler Sonography Am. J. Roentgenol., June 1, 2007; 188(6): W522 - W533. [Abstract] [Full Text] [PDF]

				N. Tuning Does Spatiotemporal Image Correlation Enhance the Diagnostic Usefulness of 3D and 4D Fetal Cardiac Imaging? A Literature Review Journal of Diagnostic Medical Sonography, March 1, 2007; 23(2): 75 - 84. [PDF]

				J. Espinoza, J. P. Kusanovic, L. F. Goncalves, J. K. Nien, S. Hassan, W. Lee, and R. Romero A Novel Algorithm for Comprehensive Fetal Echocardiography Using 4-Dimensional Ultrasonography and Tomographic Imaging. J. Ultrasound Med., August 1, 2006; 25(8): 947 - 956. [Abstract] [Full Text] [PDF]

				L. F. Goncalves, W. Lee, J. Espinoza, and R. Romero Three- and 4-Dimensional Ultrasound in Obstetric Practice: Does It Help? J. Ultrasound Med., December 1, 2005; 24(12): 1599 - 1624. [Abstract] [Full Text] [PDF]