title: What does 2-dimensional imaging add to 3- and 4-dimensional obstetric ultrasonography?
abstract: OBJECTIVE
  The purpose of this study was to determine whether 2-dimensional (2D) ultrasonography adds diagnostic information to that provided by the examination of 3-dimensional/4-dimensional (3D/4D) volume data sets alone.
  
  
  METHODS
  Ninety-nine fetuses were examined by 3D/4D volume ultrasonography. Volume data sets were evaluated by a blinded independent examiner who, after establishing an initial diagnostic impression by 3D/4D ultrasonography, performed a 2D ultrasonographic examination. The frequency of agreement and diagnostic accuracy of each modality to detect congenital anomalies were calculated and compared.
  
  
  RESULTS
  Fifty-four fetuses with no abnormalities and 45 fetuses with 82 anomalies diagnosed by 2D ultrasonography were examined. Agreement between 3D/4D and 2D ultrasonography occurred for 90.4% of the findings (123/136; intraclass correlation coefficient, 0.834; 95% confidence interval, 0.774-0.879). Six anomalies were missed by 3D/4D ultrasonography when compared to 2D ultrasonography (ventricular septal defect [n = 2], interrupted inferior vena cava with azygous continuation [n = 1], tetralogy of Fallot [n = 1], horseshoe kidney [n = 1], and cystic adenomatoid malformation [n = 1]). There were 2 discordant diagnoses: transposition of the great arteries diagnosed as a double-outlet right ventricle and pulmonary atresia misinterpreted as tricuspid atresia on 3D/4D ultrasonography. One case of occult spinal dysraphism was suspected on 3D ultrasonography but not confirmed by 2D ultrasonography. When compared to diagnoses performed after delivery (n = 106), the sensitivity and specificity of 3D/4D ultrasonography (92.2% [47/51] and 76.4% [42/55], respectively) and 2D ultrasonography (96.1% [49/51] and 72.7% [40/55]) were not significantly different (P = .233).
  
  
  CONCLUSIONS
  Information provided by 2D ultrasonography is consistent, in most cases, with information provided by the examination of 3D/4D volume data sets alone.
authors.affiliation: Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
authors.forename: Luís F
authors.initials: LF
authors.lastname: Gonçalves
authors.forename: Jyh Kae
authors.initials: JK
authors.lastname: Nien
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Kusanovic
authors.forename: Wesley
authors.initials: W
authors.lastname: Lee
authors.forename: Betsy
authors.initials: B
authors.lastname: Swope
authors.forename: Eleazar
authors.initials: E
authors.lastname: Soto
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Treadwell
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
mesh_terms: D005260:Female; D005333:Fetus / Q000002:abnormalities*; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal