Four-dimensional ultrasonography of the fetal heart using a novel Tomographic Ultrasound Imaging display

Objective: The objective of this study was to investigate the feasibility of examining the fetal heart with Tomographic Ultrasound Imaging (TUI) using four-dimensional (4D) volume datasets acquired with spatiotemporal image correlation (STIC). Material and methods: One hundred and ninety-five fetuses underwent 4D ultrasonography ( US) of the fetal heart with STIC. Volume datasets were acquired with B-mode ( n = 195) and color Doppler imaging (CDI) (n = 168), and were reviewed offline using TUI, a new display modality that automatically slices 3D/ 4D volume datasets, providing simultaneous visualization of up to eight parallel planes in a single screen. Visualization rates for standard transverse planes used to examine the fetal heart were calculated and compared for volumes acquired with B-mode or CDI. Diagnoses by TUI were compared to postnatal diagnoses. Results: ( 1) The four- and five-chamber views and the three-vessel and trachea view were visualized in 97.4% (190/195), 88.2% (172/195), and 79.5% (142/195), respectively, of the volume datasets acquired with B-mode; ( 2) these views were visualized in 98.2% (165/ 168), 97.0% (163/168), and 83.6% (145/168), respectively, of the volume datasets acquired with CDI; ( 3) CDI contributed additional diagnostic information to 12.5% ( 21/168), 14.2% (24/168) and 10.1% (17/168) of the four- and five-chamber and the three- vessel and trachea views; ( 4) cardiac anomalies other than isolated ventricular septal defects were identified by TUI in 16 of 195 fetuses (8.2%) and, among these, CDI provided additional diagnostic information in 5 (31.3%); ( 5) the sensitivity, specificity, positive- and negative-predictive values of TUI to diagnose congenital heart disease in cases where both B-mode and CDI volume datasets were acquired prenatally were 92.9%, 98.8%, 92.9% and 98.8%, respectively. Conclusion: Standard transverse planes commonly used to examine the fetal heart can be automatically displayed with TUI in the majority of fetuses undergoing 4D US with STIC. Due to the retrospective nature of this study, the results should be interpreted with caution and independently confirmed before this methodology is introduced into clinical practice.