title: A new approach to fetal echocardiography: digital casts of the fetal cardiac chambers and great vessels for detection of congenital heart disease.
abstract: OBJECTIVE
  The purpose of this study was to describe a method of 4-dimensional (4D) reconstruction of the cardiac chambers and outflow tracts using a combination of spatiotemporal image correlation, "inversion mode," and "B-flow" imaging.
  
  
  METHODS
  Spatiotemporal image correlation and the inversion mode were used in the examination of the volume data sets of 23 fetuses with congenital heart anomalies. A subset was also examined with B-flow imaging using the gradient light algorithm. Digital reconstructions from abnormal hearts were compared with a library obtained from fetuses without abnormalities.
  
  
  RESULTS
  Rendered images of the 4-chamber view using the inversion mode were characterized by: (1) echogenic chambers; (2) sharp delineation of chamber contours when compared with 2-dimensional (2D) images; and (3) distinct display of the myocardium, interventricular septum, interatrial septum, and mitral and tricuspid valves as anechoic structures. Ventricular septal defects, abnormal differential insertion of the atrioventricular valves, and valve atresia were well visualized with the inversion mode. The application of inversion mode or B-flow imaging to 4D rendering of the outflow tracts resulted in "digital casts" displaying the spatial relationships between the outflow tracts as well as the connections between the great arteries and ventricular chambers. The spatial relationships and communications among cardiac structures cannot be visualized with conventional 2D ultrasonography.
  
  
  CONCLUSIONS
  The application of spatiotemporal image correlation, inversion mode, and B-flow imaging generates information about the anatomy and pathologic characteristics of the fetal heart (digital casts) that cannot be obtained with 2D fetal echocardiography. We propose that these modalities enhance the information provided by ultrasonographic interrogation of the fetal heart and will improve prenatal diagnosis.
authors.affiliation: Perinatology Research Branch, National Institute of Child Health and Human Development, Wayne State University/Hutzel Women's Hospital, 3990 John R, Box 4, Detroit, MI 48201, USA.
authors.forename: Luís F
authors.initials: LF
authors.lastname: Gonçalves
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.forename: Wesley
authors.initials: W
authors.lastname: Lee
authors.forename: Jyh Kae
authors.initials: JK
authors.lastname: Nien
authors.forename: Joon-Seok
authors.initials: JS
authors.lastname: Hong
authors.forename: Joaquin
authors.initials: J
authors.lastname: Santolaya-Forgas
authors.forename: Moshe
authors.initials: M
authors.lastname: Mazor
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
mesh_terms: D019561:Echocardiography, Four-Dimensional; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods*