Three- and 4-dimensional ultrasound in obstetrics and gynecology: proceedings of the american institute of ultrasound in medicine consensus conference.

The American Institute of Ultrasound in Medicine convened a panel of physicians and scientists with interest and expertise in 3-dimensional (3D) ultrasound in obstetrics and gynecology to discuss the current diagnostic benefits and technical limitations in obstetrics and gynecology and consider the utility and role of this type of imaging in clinical practice now and in the future. This conference was held in Orlando, Florida, June 16 and 17, 2005. Discussions considered state-of-the-art applications of 3D ultrasound, specific clinical situations in which it has been found to be helpful, the role of 3D volume acquisition for improving diagnostic efficiency and patient throughput, and recommendations for future investigations related to the utility of volume sonography in obstetrics and gynecology.     

Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years

Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.     

Three-dimensional ultrasound in the evaluation of fetal anomalies.

OBJECTIVES: To determine the additional information and clinical impact provided by three-dimensional ultrasound (3D US) imaging of fetal anomalies compared to conventional 2-dimensional ultrasound (2D US). MATERIALS AND METHODS: Sixty-three patients with 103 anomalies were scanned prospectively with both 2D and 3D US. Each anomaly was reviewed by one or more fetal imaging specialists to determine whether the 3D US data were advantageous, equivalent, or disadvantageous when compared with 2D US images. Clinical impact and pathologic or clinical outcome were determined in all cases. RESULTS: The 3D US images provided additional information in 53 anomalies (51%), were equivalent to 2D US images in 46 anomalies (45%), and were disadvantageous in four anomalies (4%). The 3D US was most helpful in evaluating fetuses with facial anomalies, hand and foot abnormalities and axial spine and neural tube defects. Planar images derived from 3D US volume data sets generally were more helpful for diagnostic purposes, whereas rendered 3D US images were more useful as a point of reference and were better appreciated by patients in understanding fetal abnormalities. Additional information provided by 3D US images impacted clinical management in 5% of patients. The 3D US images were disadvantageous in two fetuses with multiple anomalies and two with cardiac anomalies. CONCLUSION: The 3D US offered diagnostic advantages in about one-half of the selected cases studied and had effect on patient management in 5% of cases. This modality can be a powerful adjunctive tool to 2D US in providing a more comprehensible, 3D US impression of congenital anomalies. Thus, 3D US is currently most helpful as a targeted study complementing 2D US.     

Real‐time Interpolation for True 3‐Dimensional Ultrasound Image Volumes

We compared trilinear interpolation to voxel nearest neighbor and distance‐weighted algorithms for fast and accurate processing of true 3‐dimensional ultrasound (3DUS) image volumes. In this study, the computational efficiency and interpolation accuracy of the 3 methods were compared on the basis of a simulated 3DUS image volume, 34 clinical 3DUS image volumes from 5 patients, and 2 experimental phantom image volumes. We show that trilinear interpolation improves interpolation accuracy over both the voxel nearest neighbor and distance‐weighted algorithms yet achieves real‐time computational performance that is comparable to the voxel nearest neighbor algrorithm (1–2 orders of magnitude faster than the distance‐weighted algorithm) as well as the fastest pixel‐based algorithms for processing tracked 2‐dimensional ultrasound images (0.035 seconds per 2‐dimesional cross‐sectional image [76,800 pixels interpolated, or 0.46 ms/1000 pixels] and 1.05 seconds per full volume with a 1‐mm³ voxel size [4.6 million voxels interpolated, or 0.23 ms/1000 voxels]). On the basis of these results, trilinear interpolation is recommended as a fast and accurate interpolation method for rectilinear sampling of 3DUS image acquisitions, which is required to facilitate subsequent processing and display during operating room procedures such as image‐guided neurosurgery.     

Three-dimensional ultrasound: Display modalities in obstetrics

Three-dimensional ultrasound (3DUS) has recently been introduced into clinical practice. Various techniques are available for display of the volume data. We review the importance of selecting the proper display option and rendering mode depending on the specific diagnostic question. Current display options include (1) arbitrary planar images similar to conventional two-dimensional US images, (2) surface rendering with emphasis on soft tissues or skeletal detail, (3) stereo viewing using liquid crystal glasses or red/blue glasses, and (4) cine review of gated studies. Rotation of volume data also is important in understanding/comprehending patient anatomy. The range of rotation angles varies depending on the clinical setting. Also data storage requirements increase as the number of views increases. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:157–167, 1997     

三维超声STIC技术辅助诊断胎儿心脏畸形的研究

目的对照引产后病理检查结果比较二维超声与三维超声时间-空间相关成像技术(spatio-temporalimage correlation,STIC)判断胎儿心脏结构异常细节的准确性,探讨STIC技术对胎儿心脏畸形的产前诊断价值。方法 2006年1月～2008年10月在中山大学附属第一医院行胎儿心脏二维超声检查、可疑胎儿心脏畸形、并存储完整心脏三维超声STIC容积数据、有胎儿心脏病理检查结果的病例24例;应用4DView软件多平面重建和断层显像模式分析心脏STIC容积数据;对照引产后病理检查结果,比较二维超声和STIC技术对各类心脏结构异常的细节诊断符合率。结果心脏病理解剖显示24例中有92个心脏结构异常。二维超声和STIC技术对心脏结构异常的细节诊断总符合率分别为64.1%和97.8%;二维超声和STIC技术对房室连接异常、房室间隔异常的诊断符合率无明显差异(P0.05),而对静脉与心房连接异常、动脉与心室连接异常、动脉干及分支异常的诊断,STIC技术则优于二维超声(P0.05)。结论 STIC技术对胎儿心脏畸形中静脉与心脏连接异常、动脉与心室连接异常、动脉干及分支异常的诊断较二维超声可提供更加丰富的诊断信息,为精确诊断胎儿复杂心脏畸形提供了一个新的方法。     

胎儿泌尿系统畸形的产前超声诊断与产后随访及引产后尸体解剖的对比分析

目的 提高泌尿系统畸形产前超声检查的准确率. 方法 将产前超声检查发现单纯泌尿系统畸形或合并其他系统畸形的14例胎儿进行产后超声随访及引产后进行尸体解剖,将随访结果及尸体解剖结果与产前超声检查结果进行对比分析. 结果 产前超声诊断14例泌尿系统畸形.共有泌尿系统畸形24处,产前超声诊断19处,灵敏度98％,特异度85.4％;准确率79.2％,漏诊率20.8％. 结论 产前超声检查发现胎儿泌尿系统畸形的准确率较高,对该疾病的早期发现有重要意义.     

Three-dimensional multi-slice view: new prospects for evaluation of congenital anomalies in the fetus.

OBJECTIVES: The purpose of this study was to describe the use and potential of Multi-Slice View 3-dimensional (3D) ultrasonographic software (Medison Co, Ltd, Seoul, Korea) in showing fetal congenital anomalies. METHODS: Fetuses with congenital anomalies diagnosed by means of 2-dimensional ultrasonography were prospectively included in the study. Good-quality 3D volumes of the region of interest were obtained in each case. Subsequently, these volumes were reviewed with use of 3D eXtended Imaging with Multi-Slice View and SonoMR (Medison Co, Ltd). Image processing was performed through the use of off-line software (Medison XI Viewer, version 1.0.0.218). RESULTS: A total of 6 fetuses (median gestational age, 27 weeks; range, 16-35 weeks) with the following anomalies were examined: dacryocystocele, esophageal atresia, right-sided aortic arch, hydrometrocolpos, horseshoe kidney, and hemivertebra. Images of diagnostic quality were obtained from all patients. According to the respective underlying anomalies and the positions of the fetuses, images were obtained from the initial axial plane in 2 cases (esophageal atresia and right-sided aortic arch) and from reconstructed planes in the remaining 4 cases (dacryocystocele, hydrometrocolpos, horseshoe kidney, and hemivertebra). CONCLUSIONS: Three-dimensional Multi-Slice View can deliver informative images of the region of interest regardless of fetal position. It may be particularly helpful for evaluation of difficult anomalies in the fetus.     

Collaborative Study on 4‐Dimensional Echocardiography for the Diagnosis of Fetal Heart Defects

Objective. Congenital anomalies are the leading cause of infant mortality in the United States, and congenital heart defects (CHDs) are the most common type of birth defects. Recently, 4‐dimensional ultrasonography (4DUS) with spatiotemporal image correlation (STIC) has been introduced for fetal echocardiography. Accumulating evidence indicates that 4DUS with STIC may facilitate the examination of the fetal heart. Our objectives were to determine the accuracy of 4DUS for the diagnosis of CHDs and the agreement among centers. Methods. This study included 7 centers with expertise in 4D fetal echocardiography. Fetuses with and without confirmed heart defects were scanned between 18 and 26 weeks, and their volume data sets were uploaded onto a centralized file transfer protocol server. Intercenter agreement was determined using a κ statistic for multiple raters. Results. Ninety volume data sets were randomly selected for blinded analysis. Overall, the median (range) sensitivity, specificity, positive and negative predictive values, and false‐positive and ‐negative rates for the identification of fetuses with CHDs were 93% (77%–100%), 96% (84%–100%), 96% (83%–100%), 93% (79%–100%), 4.8% (2.7%–25%), and 6.8% (5%–22%), respectively. The most frequent CHDs were conotruncal anomalies (36%). There was excellent intercenter agreement (κ = 0.97). Conclusions. (1) Four‐dimensional volume data sets can be remotely acquired and accurately interpreted by different centers. (2) Among centers with technical expertise, 4DUS is an accurate and reliable method for fetal echocardiography.     

Congenital dacryocystocele: prenatal 2- and 3-dimensional sonographic findings.

OBJECTIVE: The purpose of this series is to present our experience with cases of dacryocystocele diagnosed prenatally. The role of prenatal 3-dimensional sonography, as an adjunct to 2-dimensional sonography, in the prenatal assessment of these cases is emphasized. METHODS: A retrospective review of cases was conducted. Information was obtained by reviewing the sonographic reports and medical records. Outcomes were obtained from the referring obstetricians or directly from the parents. RESULTS: Ten fetuses had the diagnosis of a congenital dacryocystocele at a median gestational age of 30.1 weeks (range, 27-33 weeks). In 6 cases, the cystic lesion was unilateral, and in 4 it was bilateral, with a mean largest diameter at the time of diagnosis of 7.5 mm (range, 4-11 mm). There were no other associated findings. Three-dimensional sonography, carried out in 3 cases, clearly depicted the anomaly, the degree of intranasal extension, and swelling below the medial canthal area. Spontaneous resolution was documented prenatally in 5 fetuses, and 1 additional case resolved between the last prenatal scan and the delivery. There were no reported long-term complications associated with this finding, although 1 infant required probing at 2 months of age to resolve the dacryocystocele. CONCLUSIONS: Prenatal diagnosis of dacryocystocele is straightforward. A considerable number of lesions are bilateral, and many resolve in utero spontaneously or neonatally after minimal intervention. For those not resolving by the time of the delivery, ophthalmologic or rhinologic consultation is warranted because of potential complications. Three-dimensional sonography may provide a noninvasive method for evaluating these cystic masses and may contribute to the avoidance of additional diagnostic techniques in the neonatal period.     

三维超声成像在产前诊断中的初步临床应用研究

目的：评估三维超声在产前诊断及评价胎儿畸形中的应用价值。方法：对46例中晚期娠的高危发行二维及三维超声检查,并对照其检查结果：结果：在35例正常胎儿中,三维超声可提供更多的诊断信息,排除了畸形的存在,在11例异常胎儿中,有6例（54％）3DUS可对诊断提供帮助。结论：3DUS可对胎儿畸形的诊断提供帮助,可作为二维超声的补充在产前诊断中发挥重要的作用。     

Prenatal detection of congenital heart disease in southern Nevada: the need for universal fetal cardiac evaluation.

OBJECTIVE: Congenital cardiac malformations are common developmental anomalies. In the United States, congenital heart disease is the number one cause of infant mortality from congenital malformations. Prenatal diagnosis of congenital heart defects aids treatment coordination. Our aim was to evaluate prenatal detection of serious congenital heart malformations in Clark County, Nevada. METHODS: We electronically searched our research department-maintained computer database for patients with serious congenital heart disease born in Clark County between May 2003 and April 2006. We excluded patients that did not have at least 1 local prenatal ultrasound examination. All pre-natal ultrasound studies were performed in obstetric offices, radiology imaging centers, or maternal-fetal medicine specialty practices. Fetal echocardiography was performed in maternal-fetal medicine specialists' offices under the supervision of a fetal cardiologist. Pediatric cardiologists performed all postnatal echocardiographic examinations. RESULTS: During the study period, we diagnosed serious congenital heart malformations in 161 patients among a total estimated 77,000 births (2/1000). Of the 161 patients, 58 (36%) had a prenatal diagnosis, and 103 (64%) had an exclusively postnatal diagnosis. CONCLUSIONS: Standard prenatal ultrasound fails to show congenital heart disease in most fetuses.     

经阴道三维超声诊断子宫发育异常的准确性及可重复性

目的 评价经阴道三维超声(TV3DUS)诊断子宫发育异常的价值及测量宫腔的可重复性。方法 随机选择接受TV3DUS检查的30例子宫正常及49例子宫发育异常的患者进行分析,测量其中39例发育异常子宫的宫腔底部宽度、宫底内膜面向宫腔凸起高度或纵隔长度、宫腔长度。由2名医师在双盲情况下分别独立完成图像的分析、测量和诊断,对诊断结果和测量数据进行一致性检验。结果 2名医师诊断子宫发育异常具有高度一致性(Kappa=0.932,P<0.01)。对39例发育异常子宫宫腔径线的测量结果显示,观察者内及观察者间均有高度一致性,组内相关系数均高于0.8。结论 TV3DUS可准确诊断子宫发育异常,其测量宫腔径线的可重复性良好。     

二维超声和三维超声在产前胎儿畸形筛查中的应用价值

目的：探讨二维超声和三维超声检查在产前胎儿畸形筛查中的应用价值,评价其在产前诊断中的应用效果。方法选择56例接受二维和三维超声产前检查并经引产或随访证实有胎儿畸形的孕妇作为研究对象,观察记录56例孕妇共58个畸形胎儿的畸形情况,比较观察二维超声和三维超声检查结果。结果56例孕妇共检出58个胎儿,最终随访结果发现75处胎儿畸形,其中腹部畸形最多,共27处,占36．0％。三维超声在评价颅面部、脊柱四肢以及体表处的畸形效果优于二维超声,但差异无统计学意义（P ＞0．05）;三维超声总的畸形检出率为92．0％,显著高于二维超声的80．0％,差异有统计学意义（P ＜0．05）。结论三维超声能够弥补二维超声在产前胎儿畸形筛查中的不足,提高胎儿畸形的检出率,并且可提供更丰富的诊断信息,具有较高的临床应用价值。     

产前超声诊断胎儿全前脑及其面部畸形

目的 观察胎儿全前脑畸形(HPE)及其面部畸形的声像图特点,探讨产前超声诊断HPE的价值。方法 回顾性分析我院产前超声诊断或拟诊的15胎HPE的超声表现,与引产后尸体解剖结果进行对照分析。结果 15胎HPE中,无叶型10胎,半叶型5胎,均伴不同程度、不同部位面部畸形,其中独眼畸形7胎、正中唇腭裂4胎、猴头畸形2胎、头发育不全畸胎1胎、轻度眼距过近1胎。27处面部畸形中,以眼、鼻、唇、腭等中轴结构多处受累、多种畸形组合为主,超声诊断符合率为70.37%(19/27)。10胎合并面部以外其他结构异常(共30处),7胎为多发畸形,超声诊断符合率76.67%(23/30)。结论 超声可准确显示HPE的典型颅内改变和特殊的面部畸形,有助于诊断及鉴别诊断。     

What Does 2‐Dimensional Imaging Add to 3‐ and 4‐Dimensional Obstetric Ultrasonography?

OBJECTIVE: The purpose of this study was to determine whether 2-dimensional (2D) ultrasonography adds diagnostic information to that provided by the examination of 3-dimensional/4-dimensional (3D/4D) volume data sets alone. METHODS: Ninety-nine fetuses were examined by 3D/4D volume ultrasonography. Volume data sets were evaluated by a blinded independent examiner who, after establishing an initial diagnostic impression by 3D/4D ultrasonography, performed a 2D ultrasonographic examination. The frequency of agreement and diagnostic accuracy of each modality to detect congenital anomalies were calculated and compared. RESULTS: Fifty-four fetuses with no abnormalities and 45 fetuses with 82 anomalies diagnosed by 2D ultrasonography were examined. Agreement between 3D/4D and 2D ultrasonography occurred for 90.4% of the findings (123/136; intraclass correlation coefficient, 0.834; 95% confidence interval, 0.774-0.879). Six anomalies were missed by 3D/4D ultrasonography when compared to 2D ultrasonography (ventricular septal defect [n = 2], interrupted inferior vena cava with azygous continuation [n = 1], tetralogy of Fallot [n = 1], horseshoe kidney [n = 1], and cystic adenomatoid malformation [n = 1]). There were 2 discordant diagnoses: transposition of the great arteries diagnosed as a double-outlet right ventricle and pulmonary atresia misinterpreted as tricuspid atresia on 3D/4D ultrasonography. One case of occult spinal dysraphism was suspected on 3D ultrasonography but not confirmed by 2D ultrasonography. When compared to diagnoses performed after delivery (n = 106), the sensitivity and specificity of 3D/4D ultrasonography (92.2% [47/51] and 76.4% [42/55], respectively) and 2D ultrasonography (96.1% [49/51] and 72.7% [40/55]) were not significantly different (P = .233). CONCLUSIONS: Information provided by 2D ultrasonography is consistent, in most cases, with information provided by the examination of 3D/4D volume data sets alone.     

Normal and abnormal images of intrauterine devices: Role of three-dimensional sonography

The purpose of this pictorial essay is to describe the diagnostic value of two‐dimensional ultrasound (2DUS) and the additional information that three‐dimensional ultrasound (3DUS) provides in the assessment of location, type and complications of IUDs. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:433–438, 2012     

Prenatal diagnosis of Jeune-like syndromes with two-dimensional and three-dimensional sonography

The purpose of this article is to describe the use of three-dimensional sonography as an adjuvant to two-dimensional sonography facilitating an earlier and more definitive diagnosis of Jeune and Jeune-like syndromes in the second trimester. We report two cases in which three-dimensional sonography facilitated the diagnosis of these malformations. A diagnosis of Jeune syndrome was made in our first case. Our second case was found to be short-rib polydactyly syndrome Type IV. Three-dimensional skeletal survey visualized short ribs, short limbs, the presence of normal scapulae, and the absence of polydactyly in both cases. Three-dimensional sonography can assist two-dimensional sonography in providing a more accurate display of skeletal anomalies, limb abnormalities, and facial features.