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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:595-601 • 0278-4297

Quality of 2- and 3-Dimensional Fast Acquisition Fetal Cardiac Imaging at 18 to 22 Weeks

Ramifications for Screening

Leeber Cohen, MD, Kristie Mangers, RDMS, Lawrence Platt, MD, Svena Julien, MD, Nina Gotteiner, MD, Jeff Dungan, MD and William Grobman, MD, MBA

Department of Obstetrics and Gynecology, Divisions of Obstetric and Gynecologic Ultrasound (L.C., K.M.), Maternal-Fetal Medicine (S.J., W.G.), and Reproductive Genetics (J.D.). Northwestern University Feinberg School of Medicine, Chicago, Illinois USA; Division of Pediatric Cardiology, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA (N.G.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine, University of California, Los Angeles, California USA (L.P.).

Address correspondence to Leeber Cohen, MD, Northwestern Medical Faculty Foundation, 675 N St Clair, Suite 14-200, Chicago, IL 60611 USA. E-mail lcohen{at}nmff.org

Objective. The purpose of this study was to evaluate the frequency with which 6 different fetal cardiac views taken during a fetal ultrasound examination at 18 to 22 weeks’ gestation can be obtained satisfactorily for cardiac anomaly screening using either a 2-dimensional (2D) static or 3-dimensional (3D) fast acquisition technique. Methods. A prospective study of 100 low-risk women undergoing an anatomic survey was performed. Standard static 2D and 3D fast acquisition volumes were obtained on all patients. The 2D and 3D images were assigned, in a random order, to be independently graded by 3 reviewers. The degree of inter-reviewer agreement was assessed through the use of the Cohen {kappa} statistic. The factors contributing to satisfactory imaging were evaluated by random effects logistic regression. Results. A significant proportion of both 2D and 3D images were judged unsatisfactory for screening purposes. However, 2D images were significantly more likely, for all cardiac views, to be judged satisfactory (P < .05). The odds ratios for the 2D technique’s being more likely than the 3D technique to provide images satisfactory for screening were 2.6 for the 4-chamber view, 2.4 for the right ventricular outflow tract, 4 for the left ventricular outflow tract, 3.2 for the 3-vessel view, 8.6 for the aortic arch, and 2.2 for the ductal arch. Conclusions. In this prospective study, static 2D imaging was significantly more likely than fast acquisition 2D imaging to yield cardiac views of high enough quality to satisfactorily screen for anomalies.

Key Words: congenital heart disease • prenatal screening • 3-dimensional fetal echocardiography

Abbreviations: 4D, 4-dimensional • LVOT, left ventricular outflow tract • RVOT, right ventricular outflow tract • 3D, 3-dimensional • 2D, 2-dimensional

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.