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© 2006 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 25:691-699 • 0278-4297

What Does 2-Dimensional Imaging Add to 3- and 4-Dimensional Obstetric Ultrasonography?

Luís F. Gonçalves, MD, Jyh Kae Nien, MD, Jimmy Espinoza, MD, Juan Pedro Kusanovic, MD, Wesley Lee, MD, Betsy Swope, MS, CGC, Eleazar Soto, MD, Marjorie C. Treadwell, 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/Detroit, Michigan USA (L.F.G., J.K.N., J.E., J.P.K., B.S., E.S., R.R.); Department of Obstetrics and Gynecology (L.F.G., J.E., M.C.T.) and Center for Molecular Medicine and Genetics (R.R.), Wayne State University, Detroit, Michigan USA; 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, National Institutes of Health, Department of Health and Human Services, 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 determine whether 2-dimensional (2D) ultrasonography adds diagnostic information to that provided by the examination of 3-dimensional/4-dimensional (3D/4D) volume data sets alone. Methods. Ninety-nine fetuses were examined by 3D/4D volume ultrasonography. Volume data sets were evaluated by a blinded independent examiner who, after establishing an initial diagnostic impression by 3D/4D ultrasonography, performed a 2D ultrasonographic examination. The frequency of agreement and diagnostic accuracy of each modality to detect congenital anomalies were calculated and compared. Results. Fifty-four fetuses with no abnormalities and 45 fetuses with 82 anomalies diagnosed by 2D ultrasonography were examined. Agreement between 3D/4D and 2D ultrasonography occurred for 90.4% of the findings (123/136; intraclass correlation coefficient, 0.834; 95% confidence interval, 0.774–0.879). Six anomalies were missed by 3D/4D ultrasonography when compared to 2D ultrasonography (ventricular septal defect [n = 2], interrupted inferior vena cava with azygous continuation [n = 1], tetralogy of Fallot [n = 1], horseshoe kidney [n = 1], and cystic adenomatoid malformation [n = 1]). There were 2 discordant diagnoses: transposition of the great arteries diagnosed as a double-outlet right ventricle and pulmonary atresia misinterpreted as tricuspid atresia on 3D/4D ultrasonography. One case of occult spinal dysraphism was suspected on 3D ultrasonography but not confirmed by 2D ultrasonography. When compared to diagnoses performed after delivery (n = 106), the sensitivity and specificity of 3D/4D ultrasonography (92.2% [47/51] and 76.4% [42/55], respectively) and 2D ultrasonography (96.1% [49/51] and 72.7% [40/55]) were not significantly different (P = .233). Conclusions. Information provided by 2D ultrasonography is consistent, in most cases, with information provided by the examination of 3D/4D volume data sets alone.

Key Words: accuracy • congenital anomalies • fetus • 4-dimensional ultrasonography • prenatal diagnosis • sonographic tomography • spatiotemporal image correlation • 3-dimensional ultrasonography

Abbreviations: 4D, 4-dimensional • STIC, spatiotemporal image correlation • 3D, 3-dimensional • 2D, 2-dimensional • VSD, ventricular septal defect




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