Echocardiography in the fetus--a systematic comparative analysis of standard cardiac views with 2D, 3D reconstructive and 3D real-time echocardiography.
OBJECTIVE
The aim of our study was to assess the feasibility and reliability of fetal three-dimensional reconstructive echocardiography using freehand technique (3DR) and 3D real-time echocardiography using matrix technology (RT-3D) in consecutive series of pregnancies and to compare the findings with the gold standard 2D ultrasound, as well as postnatal findings.


METHODS
Fifty consecutive pregnant women (gestational age 19+3 to 37+0) including 10 fetuses with cardiac malformations were scanned prospectively with 2D, 3DR and RT-3D. 3D data sets were evaluated by a blinded independent examiner. The visualization rates for standard cardiac views and structures were determined and the quality and diagnostic accuracy of each modality were calculated.


RESULTS
In RT-3D, the visualization rate of fetal cardiac views was equivalent to 2D, but was significantly lower for 3DR (4cv: 2D 98%, RT-3D 100%, 3DR 96% RVOT: 2D 96%, RT-3D 98%, 3DR 84%). Short-axis views or views of the complete aortic or ductal arch were more readily identified in RT-3D than in 2D (2D 70%, RT-3D 82%). 3DR was more susceptible than RT-3D to artifacts during acquisition and post-processing. The sensitivity and overall accuracy were significantly higher for 2D and RT-3D than for 3DR, when prenatal data was compared with postnatal findings.


CONCLUSIONS
3D freehand reconstruction has significantly lower visualization rates and overall accuracy compared to 2D and RT-3D. RT-3D echo is a feasible and reliable method for imaging the fetal heart. Offering the opportunity of data post-processing and evaluation, RT-3D is a promising method for improving the accuracy of sonographic analysis of fetal cardiac morphology and function.
Herberg
U
U
Department of Pediatric Cardiology, Universitätsklinikum Bonn, Bonn, Germany. ulrike.herberg@ukb.uni-bonn.de
Steinweg
B
B
Berg
C
C
Breuer
J
J
D000293:Adolescent; D000328:Adult; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007231:Infant, Newborn; D015588:Observer Variation; D011247:Pregnancy; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult