title: Fetal Intelligent Navigation Echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart.
abstract: OBJECTIVE
  To describe a novel method (Fetal Intelligent Navigation Echocardiography (FINE)) for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC) and application of 'intelligent navigation' technology.
  
  
  METHODS
  We developed a method to: 1) demonstrate nine cardiac diagnostic planes; and 2) spontaneously navigate the anatomy surrounding each of the nine cardiac diagnostic planes (Virtual Intelligent Sonographer Assistance (VIS-Assistance®)). The method consists of marking seven anatomical structures of the fetal heart. The following echocardiography views are then automatically generated: 1) four chamber; 2) five chamber; 3) left ventricular outflow tract; 4) short-axis view of great vessels/right ventricular outflow tract; 5) three vessels and trachea; 6) abdomen/stomach; 7) ductal arch; 8) aortic arch; and 9) superior and inferior vena cava. The FINE method was tested in a separate set of 50 STIC volumes of normal hearts (18.6-37.2 weeks of gestation), and visualization rates for fetal echocardiography views using diagnostic planes and/or VIS-Assistance® were calculated. To examine the feasibility of identifying abnormal cardiac anatomy, we tested the method in four cases with proven congenital heart defects (coarctation of aorta, tetralogy of Fallot, transposition of great vessels and pulmonary atresia with intact ventricular septum).
  
  
  RESULTS
  In normal cases, the FINE method was able to generate nine fetal echocardiography views using: 1) diagnostic planes in 78-100% of cases; 2) VIS-Assistance® in 98-100% of cases; and 3) a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases. In all four abnormal cases, the FINE method demonstrated evidence of abnormal fetal cardiac anatomy.
  
  
  CONCLUSIONS
  The FINE method can be used to visualize nine standard fetal echocardiography views in normal hearts by applying 'intelligent navigation' technology to STIC volume datasets. This method can simplify examination of the fetal heart and reduce operator dependency. The observation of abnormal echocardiography views in the diagnostic planes and/or VIS-Assistance® should raise the index of suspicion for congenital heart disease.
authors.affiliation: Perinatology Research Branch, National Institute for Child Health and Human Development-NIH/DHHS, Bethesda, MD 20892, USA. lyeo@med.wayne.edu
authors.forename: Lami
authors.initials: L
authors.lastname: Yeo
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
mesh_terms: D001017:Aortic Coarctation / Q000000981:diagnostic imaging; D001185:Artificial Intelligence; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D011247:Pregnancy; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: 4D; STIC; VIS-Assistance®; Virtual Intelligent Sonographer Assistance; cardiac; congenital heart disease; fetal heart; prenatal diagnosis; spatiotemporal image correlation; ultrasound