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Four-Dimensional Ultrasonography of the Fetal Heart Using Color Doppler Spatiotemporal Image Correlation

Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan USA (L.F.G., R.R., J.E., T.C.); Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA (L.F.G., M.T., T.C.); Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan, USA (W.L.); Division of Cardiology, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan USA (K.C.); and General Electric Medical Systems, Kretztechnik, Zipf, Austria (H.B.).

Address correspondence and reprint requests to Roberto Romero, MD, Perinatology Research Branch, National Institute of Child Health and Human Development, 4707 St Antoine Blvd, Detroit MI 48201 USA. E-mail: warfiela{at}mail.nih.gov.

Objective. To describe clinical and research applications of 4-dimensional imaging of the fetal heart using color Doppler spatiotemporal image correlation. Methods. Forty-four volume data sets were acquired by color Doppler spatiotemporal image correlation. Seven subjects were examined: 4 fetuses without abnormalities, 1 fetus with ventriculomegaly and a hypoplastic cerebellum but normal cardiac anatomy, and 2 fetuses with cardiac anomalies detected by fetal echocardiography (1 case of a ventricular septal defect associated with trisomy 21 and 1 case of a double-inlet right ventricle with a 46,XX karyotype). The median gestational age at the time of examination was 21 3/7 weeks (range, 19 5/7–34 0/7 weeks). Volume data sets were reviewed offline by multiplanar display and volume-rendering methods. Representative images and online video clips illustrating the diagnostic potential of this technology are presented. Results. Color Doppler spatiotemporal image correlation allowed multiplanar visualization of ventricular septal defects, multiplanar display and volume rendering of tricuspid regurgitation, volume rendering of the outflow tracts by color and power Doppler ultrasonography (both in a normal case and in a case of a double-inlet right ventricle with a double-outlet right ventricle), and visualization of venous streams at the level of the foramen ovale. Conclusions. Color Doppler spatiotemporal image correlation has the potential to simplify visualization of the outflow tracts and improve the evaluation of the location and extent of ventricular septal defects. Other applications include 3-dimensional evaluation of regurgitation jets and venous streams at the level of the foramen ovale.

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

Abbreviations: RA, right atrium • STIC, spatiotemporal image correlation • TR, tricuspid regurgitation • VSD, ventricular septal defect