title: Basic as well as detailed neurosonograms can be performed by offline analysis of three-dimensional fetal brain volumes.
abstract: OBJECTIVE
  To evaluate the feasibility and the processing time of offline analysis of three-dimensional (3D) brain volumes to perform a basic, as well as a detailed, targeted, fetal neurosonogram.
  
  
  METHODS
  3D fetal brain volumes were obtained in 103 consecutive healthy fetuses that underwent routine anatomical survey at 20-23 postmenstrual weeks. Transabdominal gray-scale and power Doppler volumes of the fetal brain were acquired by one of three experienced sonographers (an average of seven volumes per fetus). Acquisition was first attempted in the sagittal and coronal planes. When the fetal position did not enable easy and rapid access to these planes, axial acquisition at the level of the biparietal diameter was performed. Offline analysis of each volume was performed by two of the authors in a blinded manner. A systematic technique of 'volume manipulation' was used to identify a list of 25 brain dimensions/structures comprising a complete basic evaluation, intracranial biometry and a detailed targeted fetal neurosonogram. The feasibility and reproducibility of obtaining diagnostic-quality images of the different structures was evaluated, and processing times were recorded, by the two examiners.
  
  
  RESULTS
  Diagnostic-quality visualization was feasible in all of the 25 structures, with an excellent visualization rate (85-100%) reported in 18 structures, a good visualization rate (69-97%) reported in five structures and a low visualization rate (38-54%) reported in two structures, by the two examiners. An average of 4.3 and 5.4 volumes were used to complete the examination by the two examiners, with a mean processing time of 7.2 and 8.8 minutes, respectively. The overall agreement rate for diagnostic visualization of the different brain structures between the two examiners was 89.9%, with a kappa coefficient of 0.5 (P < 0.001).
  
  
  CONCLUSIONS
  In experienced hands, offline analysis of 3D brain volumes is a reproducible modality that can identify all structures necessary to complete both a basic and a detailed second-trimester fetal neurosonogram.
authors.affiliation: Division of Ultrasound in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, New York University School of Medicine, NY 10016, USA. eranbor@yahoo.com
authors.forename: E
authors.initials: E
authors.lastname: Bornstein
authors.forename: A
authors.initials: A
authors.lastname: Monteagudo
authors.forename: R
authors.initials: R
authors.lastname: Santos
authors.forename: I
authors.initials: I
authors.lastname: Strock
authors.forename: T
authors.initials: T
authors.lastname: Tsymbal
authors.forename: E
authors.initials: E
authors.lastname: Lenchner
authors.forename: I E
authors.initials: IE
authors.lastname: Timor-Tritsch
mesh_terms: D001921:Brain / Q000196:embryology*; D002983:Clinical Competence / Q000592:standards; D004453:Echoencephalography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005333:Fetus; D006801:Humans; D021621:Imaging, Three-Dimensional; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D015203:Reproducibility of Results