Standardization of the first-trimester fetal cardiac examination using spatiotemporal image correlation with tomographic ultrasound and color Doppler imaging.
OBJECTIVE
The challenges of the first-trimester examination of the fetal heart may in part be overcome by technical advances in three-dimensional (3D) ultrasound techniques. Our aim was to standardize the first-trimester 3D imaging approach to the cardiac examination to provide the most consistent and accurate display of anatomy.


METHODS
Low-risk women with normal findings on first-trimester screening at 11 to 13 + 6 weeks had cardiac ultrasound using the following sequence: (1) identification of the four-chamber view; (2) four-dimensional (4D) volume acquisition with spatiotemporal image correlation (STIC) and color Doppler imaging (angle = 20 degrees, sweep 10 s); (3) offline, tomographic ultrasound imaging (TUI) analysis with standardized starting plane (four-chamber view), slice number and thickness; (4) assessment of fetal cardiac anatomy (four-chamber view, cardiac axis, size and symmetry, atrioventricular valves, great arteries and descending aorta) with and without color Doppler.


RESULTS
107 consecutive women (age, 16-42 years, body mass index 17.2-50.2 kg/m(2)) were studied. A minimum of three 3D volumes were obtained for each patient, transabdominally in 91.6%. Fetal motion artifact required acquisition of more than three volumes in 20%. The median time for TUI offline analysis was 100 (range, 60-240) s. Individual anatomic landmarks were identified in 89.7-99.1%. Visualization of all structures in one panel was observed in 91 patients (85%).


CONCLUSIONS
Starting from a simple two-dimensional cardiac landmark-the four-chamber view-the standardized STIC-TUI technique enables detailed segmental cardiac evaluation of the normal fetal heart in the first trimester.
Turan
S
S
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD 21201, USA.
Turan
O M
OM
Ty-Torredes
K
K
Harman
C R
CR
Baschat
A A
AA
D000293:Adolescent; D000328:Adult; D002306:Cardiac Volume / Q000502:physiology*; D018618:Echocardiography, Doppler, Color / Q000379:methods / Q000592:standards*; D019561:Echocardiography, Four-Dimensional / Q000379:methods / Q000592:standards; D019560:Echocardiography, Three-Dimensional / Q000379:methods / Q000592:standards; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards*; D055815:Young Adult