title: Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio-Temporal Image Correlation in the Second and Third Trimesters of Pregnancy.
abstract: OBJECTIVE
  To assess the quality of fetal heart views by three-dimensional/four-dimensional (3D/4D) ultrasonography using spatio-temporal image correlation (STIC) in the second and third trimester of pregnancy.
  
  
  METHODS
  This prospective and cross-sectional study was conducted at a single referral service for the screening of congenital heart diseases (CHDs), with pregnant women at 20-30 weeks' gestation with a normal fetal heart. 3D/4D STIC were obtained from the fetal heart screening in the following views: four-chamber (4C), left and right ventricular outflow tracts (LVOT and RVOT), 3 vessels and trachea (3VT), aortic arch (AA), and ductal arch (DA). We categorized the images as satisfactory or unsatisfactory and performed McNemar's test to evaluate the differences between the two-dimensional (2D) echocardiography and 3D/4D STIC techniques. The inter-observer concordance was obtained by kappa coefficient.
  
  
  RESULTS
  The rate of satisfactory fetal heart views using 3D/4D STIC was 54% by using 4 planes (4C, RVOT, LVOT, and 3VT) and 14% by using 6 planes (4C, RVOT, LVOT, 3VT, AA, and DA). In contrast, 100% of the 2D echocardiography images were satisfactory (McNemar's test, P < 0.001). We observed moderate inter-observer concordance to both 4- and 6 planes (κ = 0.56 and 0.43, respectively).
  
  
  CONCLUSIONS
  The quality of the main fetal heart views by 3D/4D STIC still present some limitations compared with the 2D echocardiography.
authors.affiliation: Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Luciane Alves
authors.initials: LA
authors.lastname: Rocha
authors.affiliation: Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Liliam Cristine
authors.initials: LC
authors.lastname: Rolo
authors.affiliation: Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Fernanda Silveira Bello
authors.initials: FS
authors.lastname: Barros
authors.affiliation: Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Luciano Marcondes Machado
authors.initials: LM
authors.lastname: Nardozza
authors.affiliation: Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Antonio Fernandes
authors.initials: AF
authors.lastname: Moron
authors.affiliation: Fetal Cardiology Unit, Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Edward
authors.initials: E
authors.lastname: Araujo Júnior
mesh_terms: D001938:Brazil; D019560:Echocardiography, Three-Dimensional / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods* / Q000592:standards; D056888:Patient Positioning / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D062211:Spatio-Temporal Analysis; D013223:Statistics as Topic; D016216:Ultrasonography, Prenatal / Q000379:methods* / Q000592:standards
keywords: STIC; fetal echocardiography; fetal heart standard views; quality; three-dimensional ultrasound