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A Systematic Approach to the Use of the Multiplanar Display in Evaluation of Abnormal Vascular Connections to the Fetal Heart Using 4-Dimensional Ultrasonography

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., F.G., J.P.K., O.E., L.F.G., R.R.); Department of Obstetrics and Gynecology (J.E., S.S.H., L.F.G., M.L.S.) 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 Jimmy Espinoza, MD, 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: jespinoz{at}med.wayne.edu

Objective. The multiplanar display is a modality that allows the simultaneous visualization of 3 orthogonal planes from volume data sets obtained with 3- and 4-dimensional ultrasonography. Simultaneous display of standard views used in fetal echocardiography and their orthogonal planes may provide novel ultrasonographic views for examination of the fetal heart and its vascular connections. This study was designed to determine the clinical utility of the multiplanar display in the examination of abnormal vascular connections to the fetal heart. Methods. We reviewed 4-dimensional volume data sets, acquired with the spatiotemporal image correlation technique, from patients with abnormal vascular connections to the fetal heart. Multiplanar views of the fetal heart were used to simultaneously display standard planes used in fetal echocardiography and their corresponding orthogonal planes. Results. This study included 4 volume data sets from fetuses with confirmed abnormal vascular connections to the heart, including: (1) an interrupted inferior vena cava with azygos or hemiazygos vein continuation; (2) a persistent left superior vena cava draining into a dilated coronary sinus; and (3) a dilated superior vena cava associated with a thoracic lymphangioma. Simultaneous visualization of orthogonal planes displaying abnormal vascular connections to the fetal heart facilitated identification of the abnormal vessels and their spatial relationships with other vascular structures. Conclusions. Multiplanar imaging can be used to assess abnormal vascular connections to the fetal heart and may provide novel ultrasonographic planes for fetal echocardiography using 3- and 4-dimensional ultrasonography.

Key Words: congenital heart disease • fetal echocardiography • prenatal diagnosis • spatiotemporal • spatiotemporal image correlation • vascular connections

Abbreviations: 4D, 4-dimensional • IVC, inferior vena cava • SVC, superior vena cava • 3D, 3-dimensional

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