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A Novel Algorithm for Comprehensive Fetal Echocardiography Using 4-Dimensional Ultrasonography and Tomographic Imaging

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 (J.E., J.P.K., L.F.G., J.K.N., R.R.); Department of Obstetrics and Gynecology (J.E., L.F.G., S.H.) and Center for Molecular Medicine and Genetics (R.R.), Wayne State University, Detroit, Michigan USA; and Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan USA (W.L.).

Address correspondence to Roberto Romero, MD, Perinatology Research Branch, NICHD/NIH/DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit MI 48201 USA. E-mail: warfiela{at}mail.nih.gov

Objective. Tomographic ultrasound imaging (TUI) is a new display modality that allows simultaneous visualization of up to 8 parallel anatomic planes. This study was designed to determine the role of a novel algorithm combining spatiotemporal image correlation and TUI to visualize standard fetal echocardiographic planes. Methods. Volume data sets from fetuses with and without congenital heart defects (CHDs) were examined with a novel algorithm that allows simultaneous visualization of the 3-vessel and trachea view, the 4-chamber view, and outflow tracts. Visualization rates for these planes as well as the ductal arch and 5-chamber view were calculated. Results. (1) Two hundred twenty-seven volume data sets from fetuses without (n = 138) and with (n = 14) CHDs were reviewed; (2) among fetuses without CHDs, the 4-chamber view, 5-chamber view, ductal arch, 3-vessel and trachea view, left outflow tract, and short axis of the aorta were visualized in 99% (193/195), 96.9% (189/195), 98.5% (192/195), 88.2% (172/195), 93.3% (182/195), and 87.2% (170/195) of the volume data sets, respectively; (3) these views were visualized in 85% (17/20), 80% (16/20), 65% (13/20), 55% (11/20), 55% (11/20), and 70% (14/20) of the volume data sets, respectively, from fetuses with CHDs; and (4) simultaneous visualization of the short axis of the aorta, 3-vessel and trachea view, left outflow tract, and 4-chamber view was obtained in 78% (152/195) of the volume data sets from fetuses without CHDs and in 40% (8/20) of those with CHDs. Conclusions. The 3-vessel and trachea view, the 4-chamber view, and both outflow tracts can be simultaneously visualized using a novel algorithm combining spatiotemporal image correlation and TUI.

Key Words: algorithm • congenital heart disease • fetal echocardiography • 4-dimensional • prenatal diagnosis • spatiotemporal • spatiotemporal image correlation • 3-dimensional

Abbreviations: CHD, congenital heart defect • 4DUS, 4-dimensional ultrasonography • STIC, spatiotemporal image correlation • 3DUS, 3-dimensional ultrasonography • TUI, tomographic ultrasound imaging

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