Three-dimensional power Doppler ultrasound improves the diagnostic accuracy for ovarian cancer prediction.

OBJECTIVE: The goal of this study was to determine if three-dimensional power Doppler ultrasound improves the specificity for ovarian cancer detection as compared with two-dimensional ultrasound. METHODS: Seventy-one women with a known complex pelvic mass were referred for a preoperative ultrasound evaluation with both two-dimensional and three-dimensional gray-scale ultrasonography. The 3D studies were performed with the Kretz Voluson 530D using a mechanized transvaginal probe. Surface rendering and power Doppler imaging were performed by the same gynecologic sonologist, and reassigned to one of four echo patterns: cystic, multicystic, complex, or solid. Sonographic criteria used for diagnosing ovarian cancer were based on a system that included morphological characteristics, histological prediction, and power Doppler imaging. RESULTS: Seventy-one women underwent surgical exploration: 14 (19.7%) had ovarian cancer (2 FIGO stage I, 2 stage II, 7 stage III, and 3 metastatic colon) and 2 had uterine cancer. Two-dimensional gray-scale ultrasound identified 40 masses as suspicious for cancer, including all 14 malignancies, yielding a sensitivity, specificity, and positive predictive value of 100, 54, and 35%, respectively. However, evaluation with 3D power Doppler identified only 28 cases as suspicious (including all 14 cancers), resulting in a sensitivity, specificity, and positive predictive value of 100, 75, and 50%, respectively. CONCLUSIONS: Three-dimensional power Doppler imaging better defines the morphological and vascular characteristics of ovarian lesions. All malignancies were correctly identified by both 2D and 3D imaging; however, the specificity significantly improved with the addition of 3D power Doppler. This improved diagnostic accuracy may promote improved patient care by separating complex benign masses from ovarian cancer, therefore facilitating appropriate physician referral.     

Prenatal diagnosis of alobar holoprosencephaly by two-dimensional and three-dimensional ultrasound

The aim of this study is to evaluate the sonographic characteristics of alobar holoprosencephaly (AH) in utero. Seventeen cases were diagnosed at 16-30 weeks' gestation by two-dimensional and three-dimensional ultrasound from October 1994 to December 1998. In this series, the prenatal prevalence was 1 out of 415 and the detection rate of AH by prenatal ultrasound was 100%. Eleven cases (64.7%) had concurrent facial anomalies. Cleft lip and hypotelorism were the most common associated facial anomalies (72.7%). Two cases (11.8%) were twin pregnancy with one fetus affected. We present one of the largest series in the literature and compare it with previous reports. From this series, we concluded that: (1) intracranial findings, including monoventricle, fused thalami, and the absence of midline structures, were reliable sonographic characteristics for prenatal diagnosis; (2) cleft lip and hypotelorism seemed to be more common associated facial malformations than cyclopia or cebocephaly with AH; and (3) although three-dimensional ultrasound did not change the diagnosis of AH made by two-dimensional ultrasound in this series, three-dimensional ultrasound does assist in defining the severity and extent of AH.     

3D/4D sonographic evaluation of amniotic band syndrome in early pregnancy: a supplement to 2D ultrasound

We present two cases of amniotic band syndrome diagnosed using two-dimensional (2D) ultrasound with three-dimensional (3D)/four-dimensional (4D) ultrasound in early pregnancy. In Case 1, at 13 weeks' gestation, multiple amniotic bands, acrania, the absence of fingers and amputation of the toes bilaterally were clearly shown using transvaginal 3D/4D ultrasound. In Case 2, at 15 weeks' gestation, several amniotic bands, acrania and a cleft lip were depicted with transabdominal 3D/4D ultrasound. The spatial relationship between the amniotic bands and the fetus was clearly visualized and easily discernible by 3D/4D ultrasound. The parents and families could readily understand the fetal conditions and undergo counseling; they then choose the option of termination of pregnancy. 3D/4D ultrasound has the potential to be a supplement to conventional 2D ultrasound in evaluating amniotic band syndrome.     

Three-dimensional ultrasound for nuchal translucency thickness measurements: comparison of transabdominal and transvaginal ultrasound

OBJECTIVE: We compared nuchal translucency (NT) thickness measurements using two-dimensional (2D) transabdominal, three-dimensional (3D) transabdominal, and 3D transvaginal ultrasound to determine levels of agreement. METHODS: One hundred one pregnant women with a median gestational age of 12.6 weeks (range 11-14 weeks) were included in this study. First-trimester NT thickness measurements with 2D transabdominal ultrasound were performed on all women and were used as the gold standard. They also underwent 3D transabdominal and 3D transvaginal NT examinations. Both methods were compared with 2D transabdominal ultrasound measurements with respect to fetal nuchal translucency thickness, and levels of agreement were calculated by correlation coefficient. RESULTS: There were no significantly different results between 2D transabdominal and 3D ultrasound. Furthermore, 3D transabdominal and 3D transvaginal measurements did not differ significantly. When 3-mm NT thickness was used as a cut-off level, however, there was a statistically significant overestimation of NT measurements by 3D transabdominal and 3D transvaginal ultrasound (median 1.4 mm versus 1.6 mm and 1.6 mm; P =.016 and P =.015 respectively) in the patient group with 2D transabdominal NT thickness less than 3 mm. In the patient group with 2D transabdominal NT thickness of 3 mm or more, there was a statistically significant underestimation of NT measurements by 3D transabdominal ultrasound (median 5.0 mm versus 4.6 mm; P =.002). CONCLUSION: Two-dimensional transabdominal and 3D transabdominal and 3D transvaginal NT measurements differed minimally but significantly when compared with each other.     

Three-dimensional sonographic features of placental abnormalities

OBJECTIVE: To describe three-dimensional (3D) sonographic features of placental abnormalities in utero. METHODS: A total of 6 cases with placental abnormalities (1 chorioangioma, 1 subchorionic hematoma, 2 placental cysts, and 2 subplacental fibromas) from 22 to 34 weeks of gestation were studied with transabdominal 3D sonography. RESULTS: Placental abnormalities could be easily imaged with both two-dimensional (2D) and 3D sonography; however, visualization of the continuity and curvature of structures was more easily accomplished with 3D sonography. In the case with chorioangioma, the thick and rough surface of the tumor was clearly depicted. With the use of color Doppler ultrasound, only a case of chorioangioma was shown to have abundant blood flow within the tumor. In cases with placental cyst and subchorionic hematoma, the wall of the cyst becomes a transparent-like structure, so internal textures can be clearly identified. In the case with subplacental fibroma, the location in relation to the placenta was clearly recognized. CONCLUSION: These results suggest that 3D sonography has the potential to be a supplement to 2D sonography and color Doppler ultrasound in identifying placental masses and provides a novel means of visualizing placental abnormalities in utero.     

Prenatal diagnosis of fetal multicystic dysplastic kidney in the era of three-dimensional ultrasound: 10-year experience

ObjectiveTo demonstrate the usefulness of three-dimensional (3D) ultrasound in prenatal diagnosis of fetal multicystic dysplastic kidney (MCDK) disease.MethodsIn our previous study, we demonstrated that using 3D ultrasound in conjunction with traditional two-dimensional (2D) ultrasound can facilitate the diagnosis of MCDK. In this study, we followed all the MCDK cases diagnosed in our center in the recent decade (from 2002 to 2011) and compared the results with the data collected in the prior decade (from 1995 to 2002).ResultsBetween 2002 and 2011, a total of 39 cases with fetal MCDK diagnosed by 2D and 3D ultrasound were retrospectively analyzed. The average gestational age when the diagnosis of MCDK was made was 23.6 weeks of gestation (95% confidence interval: 22.09–25.09). The Pearson chi-square test revealed a borderline nonsignificant difference statistically in the categorized gestational age at diagnosis (p = 0.052) as compared to the gestational age in the prior study. The average amniotic fluid index in fetuses with unilateral and bilateral MCDK was 16.76 ± 3.34 and 4.78 ± 5.82, respectively (p < 0.001). MCDK was not found to be associated with gestational age or chromosomal anomalies in our study.ConclusionThe surface-rendering mode of 3D ultrasound is very useful in prenatal diagnosis and counseling for MCDK.     

Three- versus two-dimensional ultrasound for nuchal translucency thickness measurements: comparison of feasibility and levels of agreement

We have determined feasibility and levels of agreement for visualizing the nuchal translucency within a time limit with three-dimensional (3D) and two-dimensional (2D) transvaginal ultrasound. A total of 213 women of median gestational age 13 weeks (range 11-14 weeks) undergoing first-trimester nuchal translucency (NT) thickness measurements with 2D transabdominal ultrasound were included in the study. Additionally all women underwent 2D and 3D transvaginal NT examination within a time limit of 90 s. These two methods were compared with each other and with our standard method (2D transabdominal ultrasound) with respect to visualization of fetal nuchal fold and to the levels of agreement. The nuchal fold was visualized by 3D and 2D transvaginal ultrasound in 85.9% (95% CI: 80.5%, 90.3%) and 25.8% (95% CI: 20.1%, 32.2%), respectively (p<0.001). There was a statistically significant underestimation of the NT by 2D transabdominal as compared with 3D transvaginal ultrasound of 0.1 mm (p<0.001), and by 3D transvaginal as compared with 2D transvaginal ultrasound of even 0.1 mm (p<0.001). 3D transvaginal ultrasound of the nuchal fold has increased feasibility to 2D transvaginal ultrasound within a short examination time and with minimal, but significant, measurement differences.     

Cervical length measurements in pregnancy are longer when measured with three-dimensional transvaginal ultrasound.

OBJECTIVE: To compare cervical length measurements obtained by transvaginal two-dimensional (2D) and transvaginal three-dimensional (3D) ultrasound. STUDY DESIGN: Thirty-four consecutive women having transvaginal assessment of cervical length as part of an obstetric ultrasound examination consented to have a 3D ultrasound scan. The cervical lengths obtained by the two methods were compared by Student's t test and regression equations. RESULTS: The mean cervical 2D length was 35.7 +/- 1.4 (SE) mm and 3D length was 43.7 +/- 1.9 mm (difference 8.0 mm +/- 0.98, p < 0.001). In the 12 women with cervical length on 2D < 35 mm, there was a 7.5 +/- 1.7 (SE) mm difference (p = 0.007). In all but one woman the 3D length obtained was the same or longer than the 2D length. The longer the cervical length on 3D imaging, the greater the difference from the 2D length (p < 0.001). CONCLUSION: The longer 3D cervical measurements may reflect the inability to measure the cervix adequately with 2D imaging, owing to anatomical factors. This finding may be useful in improving the predictive value of transvaginal ultrasound in assessing the risk for preterm delivery.     

Limb deformities and three-dimensional ultrasound

AIM: To assess the ability of three-dimensional (3D) ultrasonography for improvement of antenatal detection of limb deformities. METHODS: 347 patients were selected from a routine outpatient clinic or sent for supervision from other units because of suspected anomalies of fetal extremities. 3D ultrasound devices used in the study were Combison 530D and Voluson 530D MT (Kretztechnik, Zipf, Austria) with a 3-5 MHz annular array transducer for three-dimensional volume scanning. RESULTS: In 41 of 347 patients the initial diagnosis was suspected by two-dimensional sonography (gestational age 18-32 weeks). In 28 of 41 suspected cases the diagnosis of abnormalities was determined after examination by 3D sonography: 17/28 clubfoot, 3/28 hand-polydactily, 2/28 upper limb contractures, 1/28 lower limb contractures, 4/28 micromelia within the syndrome of skeletal dysplasia. In 13 of 41 suspected cases, normal anatomy was confirmed using 3D sonography. CONCLUSION: Three-dimensional sonography is the "method of choice" for the detection of an isolated defect of a single limb, developmental or positional deformations and minor defects of hands and feet. Surface-mode reconstruction of the complete limb and transparent-view reconstruction of the entire skeletal structure are effective technical advantages enabling a completely new visual perception of the unborn baby.     

Transvaginal volumetry of first trimester gestational sac: a comparison of conventional with three-dimensional ultrasound

The aim of this study was to determine whether three-dimensional (3D) ultrasound is superior to two-dimensional (2D) ultrasound in evaluating first trimester gestational sac volume (GSV). 130 mainly low risk pregnancies between 5 and 12 weeks gestation were prospectively investigated. The 2D volumetry of GSV was performed using the ellipsoid formula; the 3D volumetry was carried out in all three planes using the contour mode and the volume from the measured circumferences and the distances between them were computed by a software. The data were analysed by variance and regression. The mean GSV increased from 1.5 +/- 2 ml with 5 weeks to 127 +/- 27 ml with 12 weeks (3D, longitudinal plane). The standard deviation of measured GSV increased with gestational age (GA) and GSV, and was more evident using 2D than 3D volumetry. GSV of pregnancies with similar GA differed considerably and viable pregnancies followed by miscarriage did not show different GSV. We conclude, that 3D volumetry of first trimester GSV is superior to 2D volumetry in its estimation, but seems to be without a prognostic significance for gestational outcome.     

Demonstration of cranial sutures and fontanelles at 15 to 16 weeks of gestation: a comparison between two-dimensional and three-dimensional ultrasonography

OBJECTIVE: The purpose of this study was to evaluate the feasibility of obtaining good quality three-dimensional ultrasound pictures of the cranial sutures and fontanelles and to compare between two-dimensional and three-dimensional ultrasound in identifying the normal appearance of cranial sutures and fontanelles by the transvaginal approach at 15 to 16 weeks of gestation. METHODS: Fifty fetuses were prospectively evaluated by two-dimensional and three-dimensional transvaginal sonography between 15 and 16 weeks of gestation. The sagittal, coronal, lambdoidal, and metopic sutures, as well as anterior and posterior fontanelles, were inspected. RESULTS: Three-dimensional ultrasound enabled visualization of all sutures in 37 (74%) fetuses compared to 28 (56%) fetuses examined by two-dimensional ultrasonography (p = NS). The visualization of the sagittal suture was significantly superior by three-dimensional ultrasonography compared to two-dimensional ultrasonography (50 (100%) vs 35 (70%), p < 0.001). No significant difference between the two modalities was found in visualization of the fontanelles. CONCLUSION: Sutures and fontanelles are usually satisfactorily demonstrated by two-dimensional and three-dimensional ultrasound at 15 to 16 weeks of gestation. The sagittal suture is difficult to visualize using two-dimensional ultrasound, and three-dimensional ultrasound appears to be the best method for its demonstration.     

Diagnosis of Apert syndrome in the second-trimester using 2D and 3D ultrasound

OBJECTIVES: To illustrate how Apert syndrome, a rare autosomal dominant genetic syndrome, can be detected in the second-trimester of pregnancy using 2D ultrasound, and how 3D ultrasound examination may provide parents with a better understanding of the structural defects affecting their baby. METHODS: Fetal Medicine Unit database searches to identify Apert syndrome cases. RESULTS: Five cases of Apert syndrome were suspected in the second-trimester when sonography showed abnormal extremities including syndactyly, and an abnormal skull shape. In 1 case there was increased nuchal translucency with a normal fetal karyotype in the first-trimester. In all cases, a mutation of the FGFR2 gene confirmed the diagnosis of Apert syndrome. 3D ultrasound was used to show parents the extent of the abnormalities of the skull, face and extremities. Parents were counseled by craniofacial surgeons and geneticists. CONCLUSION: Apert syndrome can be accurately suspected in the second-trimester by careful ultrasound examination of the fetus including the extremities and skull shape. 3D ultrasound can be a useful adjunct to 2D examination for parental counseling.     

Prenatal diagnosis of isolated otocefalia. Usefulness of three-dimensional ultrasound

Otocephaly is a rare and lethal congenital malformation characterized by the presence of agnathia, microstomia, aglossia and synotia. Despite its frequent association with severe malformations, diagnosis in the few published cases is usually made at III trimester. In this case, three-dimensional ultrasound scan was performed in a Chinese primigravida with no remarkable personal nor familiar history since mandible was difficulty visualized with two-dimensional sonography at 21 weeks of gestation. Multiplanar and rendering mode showed the typical cervicofacial features of otocephaly without associated malformations. After parental counselling, they opted for termination of pregnancy and necropsy confirmed our prenatal findings. Our case shows the usefulness of three-dimensional ultrasound in assessing fetal cervicofacial pathology. Volumetric capture allows a delayed study of fetal anatomy and multiplanar mode offers the reconstruction of views whose achivement is difficult with conventional 2D ultrasound. Surface rendering provides excellent spatial vision and enables parents to understand the severity of the malformation thus helping with their decisions.     

Comparison of two- and three-dimensional ultrasonography in the evaluation of fetal heart: image quality and time spent in the exam

OBJECTIVES: To compare fetal heart evaluation done through two-dimensional (2DUS) and three-dimensional ultrasonography (3DUS) as to optimal plane imaging, image quality, and time needed to perform the examination. METHODS: Prospective study involving 12 normal pregnant women, with gestational ages ranging from 22 to 26 weeks, scanned with a VOLUSON 730 with a convex 4.0-7.0 MHz transducer, in both two- and three-dimensional modes. In each case, three basic view planes were obtained: four-chambers view, right, and left ventricular outflow tracts. Each view was subjectively evaluated by three different examiners as to image quality, and graded from 0 (minimum) to 4 (maximum) cross-marks (+). The sum of all grades obtained for each case was used to classify the quality of the exam as unsatisfactory (0 to 1+), poor (2 to 4+), regular (5 to 7+), and good (8 to 12+). The time taken to obtain the views was recorded for each case, starting with the acquisition of the first view on the 2D exam and with the identification and opening of the volume blocks on the three-dimensional software. RESULTS: The number of three-dimensional blocks with good, regular, poor, and unsatisfactory grades were, respectively, 6, 15, 9, and 10. The average in cross-marks of the cases graded good in each group without the worst result for each plane was 8. 2DUS was superior to 3DUS regarding the quality of the images obtained by the three pattern view planes and the average time to obtain high quality view planes was longer for 3DUS when compared to 2DUS. 2DUS offered better quality images and in less time than 3DUS. CONCLUSIONS: Three-dimensional ultrasound is an advancement in fetal heart evaluation; however two-dimensional ultrasound remains the best screening method in diagnosing cardiac malformations, due to the good quality of its images and the lesser time needed to perform the exam.     

Prenatal diagnosis of craniofacial malformations with ultrasonography

Although the utility of ultrasound in the prenatal diagnosis of many congenital anomalies is well established, its accuracy in detecting craniofacial malformations has not been examined in a large series. Sonographic examinations of 223 patients at risk for fetuses with craniofacial malformations were performed between 18 and 40 weeks. The risk factors included a familial history of craniofacial malformations, extrafacial anomalies diagnosed on ultrasound, fetal chromosomal aberrations, and maternal drug intake. Sonographic diagnosis was possible in 151 (67.7%) patients on the first scan and in 47 (21.1%) patients on the second scan and was not possible in 25 patients (11.2%). Of the 198 cases diagnosed antenatally, craniofacial malformation was detected in 14 and confirmed postnatally. No false positive diagnoses were made. A negative diagnosis of craniofacial malformation was made in 184 cases with two false negative results (1.0%). Anomalies diagnosed sonographically included anophthalmia, anterior cleft lip and/or palate, hypotelorism, hypertelorism, and micrognathia. The results of this study demonstrate that ultrasound is an accurate and reliable tool for the prenatal diagnosis of craniofacial malformations.     

Maternal reactions to two-dimensional compared to three-dimensional foetal ultrasonography

Our objective was to quantitatively compare maternal reactions to viewing a three-dimensional (3D) ultrasound image of the foetal face to a traditional two-dimensional (2D) sonographic image. One hundred and twelve pregnant women were asked to evaluate their excitement, relief, amazement and satisfaction reactions to 2D and 3D ultrasound images of their foetus' face. A weighted kappa Cochran-Armitage trend test, Fisher exact test and generalised estimating equations were used to analyse the data obtained. 3D imaging was found to result in significantly more favourable reactions than 2D imaging of the foetal face. 3D imaging was significantly better than 2D in regard to the clearness of the image, feeling closer to the baby, experiencing amazement and recognising specific facial features. We hypothesised that 3D images might evoke more feelings of fear than 2D, but our analysis found there were no significant differences in this regard. 3D ultrasonography of the foetal face is well received by patients. It has been shown in this study to elicit stronger and more positive maternal reactions regarding excitement, amazement and satisfaction than experienced with 2D ultrasound.     

The role of three-dimensional ultrasound in the diagnosis of fetal congenital anomalies: a review

The objective of this review was to establish whether three-dimensional (3D) and four dimensional (4D) ultrasonography adds diagnostic information to what is currently provided by two-dimensional (2D) ultrasound in the diagnosis of the most frequent fetal structural defects: congenital heart disease and central nervous system congenital anomalies. There are evidences suggesting that 3D ultrasound allows to reduce the operator dependency in the visualization of standard diagnostic planes, thus reducing the examination time require for the obstetric ultrasound examination, with minimal impact on the visualization quality of the anatomic landmarks. Furthermore, operators with minimal experience may record cardiac or brain volumes that can be successfully analyzed off-line locally or sent by internet to experts for remote review. As a consequence 3D ultrasonography promises to become the method of choice for diagnosis congenital structural defects.     

The feasibility of using 5D CNS software in obtaining standard fetal head measurements from volumes acquired by three-dimensional ultrasonography: comparison with two-dimensional ultrasound

Objective: To evaluate the performance of a new software (5D CNS) developed to automatically recognize the axial planes of the fetal brain from three-dimensional volumes and to obtain the basic standard biometric measurements. The accuracy, reproducibility, and time required for analysis of 5D CNS were compared with that of two-dimensional (2D) ultrasound.

Methods: This was a prospective study of 120 uncomplicated singleton pregnancies undergoing routine second trimester examination. For every pregnancy standard biometric measurements including biparietal diameter, head circumference, distal lateral ventricle width, transverse cerebellar diameter and cisterna magna width were obtained using 2D ultrasound and three-dimensional (3D) ultrasound with 5D CNS software. Reliability and agreement of the two techniques were evaluated using intraclass correlation coefficients (ICCs) and proportionate Bland–Altman plots were constructed. The time necessary to complete the measurements with either technique was compared and intraobserver and interobserver agreements of measurements calculated.

Results: In 118/120 (98.3%), 5D CNS successfully reconstructed the axial diagnostic planes and calculated all the basic biometric head and brain measurements. The agreement between the two techniques was high for all the measurements considered (all ICCS?>?0.920). The time necessary to measure the biometric variables considered was significantly shorter with 5D CNS (54 versus 115?s, p?<?0.0001) than with 2D ultrasonography. No significant differences were found in 5D CNS repeated measurements obtained either by the same observer or by two independent observers.

Conclusion: 5D CNS software allows us to obtain reliable biometric measurements of the fetal brain and to reduce the examination time. Its application may improve work-flow efficiency in ultrasonographic practices     

Three-dimensional sonographic volume measurement of the fetal spleen

AIM: The objective of this longitudinal study was to evaluate the growth of the fetal spleen in normal pregnancies, using three-dimensional ultrasound. METHODS: Three-dimensional sonographic examinations were performed on 14 appropriate-for-gestational-age fetuses. Fetal splenic volume was measured every 2-3 weeks after 20 weeks of gestational age until delivery. RESULTS: Curvilinear relationships were found between the gestational age and splenic volume (R(2) = 80.2%, P < 0.0001), and normal ranges of splenic volume measurements for estimating the growth of the fetal spleen during normal pregnancy were generated. We found that the splenic volume calculation based on the equation for the volume of the ellipsoid by conventional two-dimensional ultrasound in previous investigations is about twice as large as that using three-dimensional ultrasound in our study, whereas the present data described in this study is quite comparable with previous data from an autopsy series. CONCLUSION: Our findings suggest that the standard curve for the fetal splenic volume using three-dimensional ultrasound provides a superior means for evaluating the normal splenic growth in the fetus and for identifying splenic abnormalities in utero. However, the data and its interpretation in our study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size would be needed to confirm these findings.