Advances in Fetal Echocardiography.ppt · Advances in Fetal Echocardiography LuísLuís F. F. GonçalvesGonçalves, M.D., M.D. Oakland University William Beaumont School of Medicine,

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Advances in Fetal Advances in Fetal EchocardiographyEchocardiographyLuísLuís F. F. GonçalvesGonçalves, M.D., M.D.Oakland University William Beaumont School of Medicine, Rochester MIOakland University William Beaumont School of Medicine, Rochester MI

Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, MIDivision of Fetal Imaging, William Beaumont Hospital, Royal Oak, MI

Fetal Echocardiography for Prenatal DiagnosisFetal Echocardiography for Prenatal Diagnosis

Authored by Drs. XinAuthored by Drs. Xin--Fang WANG and JiFang WANG and Ji--Peng XiauPeng Xiau

Wuhan Medical College, now Tongji Medical College, Wuhan Medical College, now Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Huazhong University of Science & Technology, Wuhan, Central ChinaCentral China

140 women / 147 fetuses examined w/ M140 women / 147 fetuses examined w/ M--Mode Mode

Study describes a technique for diagnosis of early Study describes a technique for diagnosis of early pregnancy, observation of fetal heart and estimation of pregnancy, observation of fetal heart and estimation of fetal cardiac sizefetal cardiac size

Kleinman CS et al. Pediatrics 1980;65: 1059Kleinman CS et al. Pediatrics 1980;65: 1059--10681068

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Sahn DJ et al. Circulation 1980;62:588Sahn DJ et al. Circulation 1980;62:588--597597 Sahn DJ et al. Circulation 1980;62:588Sahn DJ et al. Circulation 1980;62:588--597597

Sahn DJ et al. Circulation 1980;62:588Sahn DJ et al. Circulation 1980;62:588--597597

Yonouszai Ak et al. J Am Soci Echo 2008;21:470Yonouszai Ak et al. J Am Soci Echo 2008;21:470--88

velocityvelocity

Yonouszai Ak et al. J Am Soci Echo 2008;21:470Yonouszai Ak et al. J Am Soci Echo 2008;21:470--88

strainstrain

strain ratestrain rate

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3D and 4D Evaluation of the 3D and 4D Evaluation of the Fetal HeartFetal Heart

Adult Aortic Valve Adult Aortic Valve –– 3D3D

Image from the Tomtech Website Image from the Tomtech Website -- GermanyGermany

PP

QRSQRS

TT PP

QRSQRS

TT

GatingGating

11 22 33 4 …4 … …n…n 11 22 33 44 Image Image numbernumber

Trigger Trigger pulsepulse

TimeTime

3D Heart Acquisition 3D Heart Acquisition No GatingNo Gating

Temporal Fourier Analysis of Temporal Fourier Analysis of the Periodic Cardiac Motionthe Periodic Cardiac Motion

ROIROIMagnitudeMagnitude

displaydisplay

Nelson et al. Med Phys 1995;22:973; JUM 1996;15:1Nelson et al. Med Phys 1995;22:973; JUM 1996;15:1

AmplitudeAmplitudeSummedSummedValues ofValues of

Fourier TransformFourier Transform

Heart motionHeart motionplusplus

FourierFourier--basedbasedCardiac cycleCardiac cycle

synchronizationsynchronization

Fundamental FHRFundamental FHR

Mechanical 4DUS Probes

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STICSTICSSpatiopatioTTemporal emporal IImage mage CCorrelationorrelation

Retrospective gating algorithm Retrospective gating algorithm

Synchronizes volumetric imaging data to the Synchronizes volumetric imaging data to the phase of the fetal cardiac cycle at the time of phase of the fetal cardiac cycle at the time of acquisitionacquisition

Temporal information (motion) is incorporated Temporal information (motion) is incorporated into the final volume datasetinto the final volume dataset

Volume 1Volume 1 Volume 2Volume 2 Volume 3Volume 3 Volume 4Volume 4 Volume 5Volume 5 Volume 6Volume 6

Volume AcquisitionVolume Acquisition

4D Fetal Echocardiography4D Fetal EchocardiographyWhat Does The Technology Allow?What Does The Technology Allow?

Examination of the fetal heart in a systematic Examination of the fetal heart in a systematic manner, offline, after volume dataset acquisition, manner, offline, after volume dataset acquisition, in the absence of fetal movementin the absence of fetal movementin the absence of fetal movementin the absence of fetal movement

Correlation between image planes that are Correlation between image planes that are perpendicular to the main acquisition planeperpendicular to the main acquisition plane

Volume data can viewed by experts at a remote Volume data can viewed by experts at a remote sitesite

Tips for Volume AcquisitionTips for Volume AcquisitionTips for Volume AcquisitionTips for Volume Acquisition

Region of Interest (ROI)Region of Interest (ROI)

DecreasesDecreasesIncreasesIncreases

XX

YYDecreasesDecreasesframe rateframe rateIncreasesIncreasesframe rateframe rate

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Acquisition AngleAcquisition Angle

XX

Acquisition angle determines Z (or depth)Acquisition angle determines Z (or depth)

YYZZ =15 to 40=15 to 40°°

Acquisition Angle SelectionAcquisition Angle Selection

Smaller angles for youngerSmaller angles for youngerSmaller angles for younger Smaller angles for younger fetusesfetuses

Larger angles for older fetusesLarger angles for older fetuses

Acquisition TimeAcquisition Time

Determines the duration of the 3D sweepDetermines the duration of the 3D sweep

Slower acquisition = better spatial resolutionSlower acquisition = better spatial resolution

Caveat: fetal movement Caveat: fetal movement

General rule:General rule:

Slow sweep for fetuses that are still Slow sweep for fetuses that are still

Fast sweep for those that are moving or breathingFast sweep for those that are moving or breathing

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X6-1 Matrix Transducer

• 9,212 elements• self-contained beam former• frequency range 1-6 MHz• active aperture 36 x 17 mm

Working With Volume DataWorking With Volume DataWorking With Volume DataWorking With Volume Data

MultiplanarMultiplanar Display and NavigationDisplay and Navigation

transverse sagittal

A B

coronal

C

Gonçalves et al. Am J Obstet Gynecol 2003;189:1792Gonçalves et al. Am J Obstet Gynecol 2003;189:1792--18021802

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Scroll in the original plane of acquisitionScroll in the original plane of acquisition 33--Step Technique to Systematically Step Technique to Systematically Visualize the Outflow TractsVisualize the Outflow Tracts


Transposition of the great arteriesTransposition of the great arteries

Gonçalves et al. J Ultrasound Med 2004;23:1225Gonçalves et al. J Ultrasound Med 2004;23:1225--3131

LowLow--RiskRiskn = 112n = 112

Tetralogy of Fallot (n=5)Tetralogy of Fallot (n=5)Interrupted Ao arch (n=1)Interrupted Ao arch (n=1)

Complete TGA (n=3)Complete TGA (n=3)Corrected TGA (n=1)Corrected TGA (n=1)

Offline AnalysisOffline AnalysisBlinded examinersBlinded examiners

Outflow tract anomaliesOutflow tract anomaliesn = 10n = 10

1 case of hypoplastic 1 case of hypoplastic left heart correctly left heart correctly

diagnoseddiagnosed

ThreeThree--step techniquestep technique

Rizzo et al. Fetal Diagn Ther 2008;24:126Rizzo et al. Fetal Diagn Ther 2008;24:126--131131

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Spin Technique For Spin Technique For Evaluation Of The LVOTEvaluation Of The LVOT

DeVore et al. Ultrasound Obstet Gynecol 2004;24:72DeVore et al. Ultrasound Obstet Gynecol 2004;24:72--8282

Spin Technique for Spin Technique for Evaluation of the RVOTEvaluation of the RVOT


Spin Technique for Spin Technique for Evaluation of the Aortic Evaluation of the Aortic ArchArch

DeVore et al. Ultrasound Obstet Gynecol 2004;24:72DeVore et al. Ultrasound Obstet Gynecol 2004;24:72--8282 Espinoza et al. JUM 2007;26:1181Espinoza et al. JUM 2007;26:1181--11881188

Espinoza et al. JUM 2007;26:1181Espinoza et al. JUM 2007;26:1181--11881188

Tetralogy of FallotTetralogy of Fallot


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Transposition of the Great ArteriesTransposition of the Great Arteries


Truncus ArteriosusTruncus Arteriosus


Pulmonary AtresiaPulmonary Atresia


178 volume datasets 178 volume datasets Transverse acquisitionTransverse acquisition

Normal Normal heartheart

Conotruncal Conotruncal anomaliesanomalies

Other Other anomaliesanomalies

Visualization rates for the ductal archVisualization rates for the ductal arch


n=116n=116 n=18n=18 n=34n=34

5.6%5.6%(1/18)(1/18)

93.1% 93.1% (108/116)(108/116)

79.4%79.4%(27/34)(27/34)

chichi--square, p<0.01square, p<0.01 chichi--square, p<0.01square, p<0.01

““The lack of visualization of the The lack of visualization of the sagittal view of the ductal arch sagittal view of the ductal arch should raise the index ofshould raise the index of


should raise the index of should raise the index of suspicion for conotruncal suspicion for conotruncal anomalies.anomalies.””

Rendered ViewsRendered Views


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Rendered ViewsRendered Views Rendered Views Rendered Views –– AV ValvesAV Valves


Normal AV ValvesNormal AV Valves

AV CanalAV CanalAV CanalAV Canal

Tricuspid StenosisTricuspid Stenosis


Overriding Aorta Overriding Aorta -- RenderedRendered

Perinatology Research Branch, NICHD/NIH/DHHSPerinatology Research Branch, NICHD/NIH/DHHS

Stenotic Pulmonary Valve Stenotic Pulmonary Valve AnnulusAnnulus


Absent Pulmonary Valve Absent Pulmonary Valve SyndromeSyndrome


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Static, R. Chaoui, 2001Static, R. Chaoui, 2001 Dynamic, Deng, 2002Dynamic, Deng, 2002

Color STIC Color STIC -- RenderingRendering

Gonçalves et al. JUM 2004;23:473Gonçalves et al. JUM 2004;23:473--481481

Inversion ModeInversion ModeVisualization of Hollow Structures Without DopplerVisualization of Hollow Structures Without Doppler

Nelson et al. UMB 1998;24:1254

How is Invert Mode Rendering Generated?How is Invert Mode Rendering Generated?

Transverse Sagittal

Coronal

Inversion Mode ExampleInversion Mode Example

Perinatology Research Branch, NICHD/NIH/DHHS

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4D Rendering with Inversion 4D Rendering with Inversion

NORMALNORMAL TRANSPOSITIONTRANSPOSITION

Gonçalves et al. J Ultrasound Med 2005;24:415Gonçalves et al. J Ultrasound Med 2005;24:415--424424

AortaAorta AzygosAzygosveinvein

Interrupted IVCInterrupted IVCw/ azygous continuationw/ azygous continuation

Espinoza et al. Ultrasound Obstet Gynecol 2005;25:428Espinoza et al. Ultrasound Obstet Gynecol 2005;25:428--34 34

RightRight LeftLeftRightRight LeftLeft

BB--Flow ImagingFlow Imaging

Technology that digitally enhances signals from weak Technology that digitally enhances signals from weak blood reflectors from vessels and, at the same time, blood reflectors from vessels and, at the same time, , ,, ,suppresses strong signals from surrounding tissuessuppresses strong signals from surrounding tissues

Does not rely on Doppler methods to display blood flow, Does not rely on Doppler methods to display blood flow, is angle independent and interferes less with the frame is angle independent and interferes less with the frame raterate

BB--Flow Rendering of the Flow Rendering of the Aortic and Ductal ArchesAortic and Ductal Arches


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Comparison Between Different Algorithms for Comparison Between Different Algorithms for 3D Rendering of the Aortic and 3D Rendering of the Aortic and DuctalDuctal ArchesArches

24 weeks24 weeks

BB--FlowFlow Power DopplerPower Doppler Color DopplerColor Doppler


200 consecutive patients (13 200 consecutive patients (13 –– 40 weeks)40 weeks)

DeVore & Polanko. JUM 2005;24:1685DeVore & Polanko. JUM 2005;24:1685

Transverse acquisitionsTransverse acquisitions

44--chamber view as the initial point of image acquisitionchamber view as the initial point of image acquisition

4CH, 5CH, 3VV, 3VTV4CH, 5CH, 3VV, 3VTV

Adjustments in image distance allowed until desired Adjustments in image distance allowed until desired views were identified views were identified

Tomographic Ultrasound ImagingTomographic Ultrasound Imaging

Gonçalves et al. J Perinat Med 2006;34:39Gonçalves et al. J Perinat Med 2006;34:39--5555

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TomographicTomographic Ultrasound ImagingUltrasound Imaging


Hypoplastic Right VentricleHypoplastic Right VentriclePulmonary AtresiaPulmonary Atresia


Coarctation of the AortaCoarctation of the Aorta


Hypoplastic Left Heart SyndromeHypoplastic Left Heart Syndrome


AutomationAutomationAutomationAutomation

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Diagnosis of complete TGA in 10 confirmed casesDiagnosis of complete TGA in 10 confirmed cases

N l Ab l

Rizzo et al. J Ultrasound Med 2008;27:771-6

ViewNormal Abnormal

N % N %

4CH 10 100% 0 -

LVOT (cardiac plane 1) 1 10% 9 90%

RVOT (cardiac plane 2) 3 30% 7 70%

In all cases an abnormal ventriculoarterial connection was In all cases an abnormal ventriculoarterial connection was shown after activation of either cardiac plane 1 or 2shown after activation of either cardiac plane 1 or 2

Clinical QuestionsClinical QuestionsClinical QuestionsClinical Questions

How Often Are Volumes of How Often Are Volumes of Diagnostic Quality Acquired?Diagnostic Quality Acquired?

Feasibility of STIC in Feasibility of STIC in Clinical PracticeClinical Practice

STIC incorporated in clinical practice over a 2 month STIC incorporated in clinical practice over a 2 month period period pp

High risk fetuses / no suspected CHDHigh risk fetuses / no suspected CHD

2 experienced sonographers2 experienced sonographers

No more than 4 attempts per examNo more than 4 attempts per exam

Uittenbogaard et al. Ultrasound Obstet Gynecol 2008;31:625Uittenbogaard et al. Ultrasound Obstet Gynecol 2008;31:625--632632

Study populationStudy populationn = 165n = 165

Successful Successful acquisitionacquisition

STIC not attemptedSTIC not attemptedn = 17 (10%)n = 17 (10%)

STIC datasetsSTIC datasetsn =148n =148

Storage Storage errorserrors

7 (6%)7 (6%) n = 112 (76%)n = 112 (76%)

AnalysisAnalysisn=105 (64%)n=105 (64%)

n = 7 (6%)n = 7 (6%)


High qualityHigh qualityn=26 (25%)n=26 (25%)

Sufficient qualitySufficient qualityn=42 (40%)n=42 (40%)

Insufficient qualityInsufficient qualityn=37 (35%)n=37 (35%)

Factors associated with Factors associated with high quality volume high quality volume datasetsdatasets

BMI:BMI:

23 8 kg/m223 8 kg/m2 x 26 5 kg/m2 p =x 26 5 kg/m2 p =23.8 kg/m223.8 kg/m2 x 26.5 kg/m2, p x 26.5 kg/m2, p 0.040.04

Posterior placenta:Posterior placenta:

56.0% x 30.3%, p = 0.0556.0% x 30.3%, p = 0.05


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Objective:Objective:

T d t i h f tl STIC l d t tT d t i h f tl STIC l d t t

Cohen et al. JUM 2009;28:1645Cohen et al. JUM 2009;28:1645--16501650

To determine how frequently a STIC volume dataset To determine how frequently a STIC volume dataset could be obtained in nonobese patients at 18could be obtained in nonobese patients at 18--22 22 weeks of gestationweeks of gestation

Frequency of satisfactory images for screeningFrequency of satisfactory images for screening

45 minutes maximum time allowed for volume 45 minutes maximum time allowed for volume acquisitionacquisition

Cohen et al. JUM 2009;28:1645Cohen et al. JUM 2009;28:1645--16501650

Cohen et al. JUM 2009;28:1645Cohen et al. JUM 2009;28:1645--16501650 Cohen et al. JUM 2009;28:1645Cohen et al. JUM 2009;28:1645--16501650

TelemedicineTelemedicineTelemedicineTelemedicine100 fetuses between 18 and 37 weeks100 fetuses between 18 and 37 weeks

Volume acquisition by a general obstetrician with no Volume acquisition by a general obstetrician with no expertise in fetal echocardiographyexpertise in fetal echocardiography

Acquisition time = 7.5 sAcquisition time = 7.5 s

Acquisition angle = 30Acquisition angle = 30°°

Volumes stored for later review by an expert:Volumes stored for later review by an expert:

Scrolling in the original plane of acquisitionScrolling in the original plane of acquisition

Multiplanar displayMultiplanar display

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Visualization rates slightly Visualization rates slightly better, but not significantly better, but not significantly different between scrolling different between scrolling

in the original plane vs. in the original plane vs. multiplanar displaymultiplanar display

Viñals et al. Ultrasound Obstet Gynecol 2003;22:388Viñals et al. Ultrasound Obstet Gynecol 2003;22:388--394394

Visualization rates lower Visualization rates lower for apex/stomach for apex/stomach

continuity and threecontinuity and three--vessel vessel and trachea viewand trachea view

2 examiners instructed on how on perform a STIC 2 examiners instructed on how on perform a STIC volume acquisition by emailvolume acquisition by emailvolume acquisition by emailvolume acquisition by email

Acquisition time = 7.5 sAcquisition time = 7.5 s

Acquisition angle = 30 sAcquisition angle = 30 s

Specific instructions on how to avoid common Specific instructions on how to avoid common artifactsartifacts

Volumes uploaded to a web serverVolumes uploaded to a web server

Review by a sonologist with experience in fetal Review by a sonologist with experience in fetal echocardiographyechocardiography

50 fetuses (77 volumes)50 fetuses (77 volumes)20 20 –– 36 weeks of gestation36 weeks of gestation

20 to 40 min for 2520 to 40 min for 25--30 Mb volume upload30 Mb volume uploadInternet speed 128 to 300 kb/sInternet speed 128 to 300 kb/s

ExtraExtra cardiaccardiac

NormalNormaln = 47n = 47

NormalNormaln = 47n = 47

ExtraExtra--cardiac cardiac anomaliesanomalies

n = 2n = 2 AbnormalAbnormaln = 3n = 3

AbnormalAbnormaln = 3n = 3

Suspected Suspected echogenic focusechogenic focus

n = 1n = 1

VSDVSDAV canalAV canal

TGATGASTIC reviewSTIC review

OutcomeOutcome


Visualization rates slightly Visualization rates slightly better for Operator 2better for Operator 2


Visualization rates lower Visualization rates lower for apex/stomach for apex/stomach

continuity and threecontinuity and three--vessel vessel and trachea viewand trachea view

First TrimesterFirst TrimesterFirst TrimesterFirst Trimester

12 week pregnancy12 week pregnancySTIC w/ tomographic imagingSTIC w/ tomographic imaging

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Assessed whether early pregnancy heart volumes could Assessed whether early pregnancy heart volumes could be obtained by nonbe obtained by non--experts with remote interpretation by experts with remote interpretation by


yy p p yp p yexperts via telemedicine linkexperts via telemedicine link

49 singleton pregnancies between 11 and 13+6 weeks49 singleton pregnancies between 11 and 13+6 weeks

Acquisition parameters: 7.5 s / 15 degree angle / gray Acquisition parameters: 7.5 s / 15 degree angle / gray and color Dopplerand color Doppler

Successful acquisition = 39/45 cases (71%)Successful acquisition = 39/45 cases (71%)


Viñals et al. Ultrasound Obstet Gynecol 2008;31:633Viñals et al. Ultrasound Obstet Gynecol 2008;31:633--638638 Viñals et al. Ultrasound Obstet Gynecol 2008;31:633Viñals et al. Ultrasound Obstet Gynecol 2008;31:633--638638

107 consecutive singleton pregnancies107 consecutive singleton pregnancies107 consecutive singleton pregnancies 107 consecutive singleton pregnancies at 11 to 13+6 weeksat 11 to 13+6 weeks

Color STIC acquisitions Color STIC acquisitions –– 10 seconds / 20 degrees10 seconds / 20 degrees

Transabdominal onlyTransabdominal only92%92%

Additional transvaginalAdditional transvaginal8%8%

Turan et al. Ultrasound Obstet Gynecol 2009;33;652Turan et al. Ultrasound Obstet Gynecol 2009;33;652--5656

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First 3 volume datasets of high quality in 80%First 3 volume datasets of high quality in 80%

20% required up to 9 volume acquisitions until a 20% required up to 9 volume acquisitions until a satisfactory quality was achievedsatisfactory quality was achieved

12 anatomic landmarks including:12 anatomic landmarks including:12 anatomic landmarks, including:12 anatomic landmarks, including:

4 chamber view seen 100% of patients4 chamber view seen 100% of patients

two great arteries of equal size and crossing in 93% two great arteries of equal size and crossing in 93% of patientsof patients

Turan et al. Ultrasound Obstet Gynecol 2009;33;652Turan et al. Ultrasound Obstet Gynecol 2009;33;652--5656

AccuracyAccuracyAccuracyAccuracy

Singleton pregnancies at 21Singleton pregnancies at 21--36 weeks (n=1,163)36 weeks (n=1,163)g p gg p g ( )( )

Volumes acquired with gray scale + color Doppler imagingVolumes acquired with gray scale + color Doppler imaging

For suspected CHD, volumes were acquired until a good For suspected CHD, volumes were acquired until a good quality volume dataset was achieved with no time limitquality volume dataset was achieved with no time limit

Autopsy or postnatal followAutopsy or postnatal follow--up in all casesup in all cases

Average volume acquisition time:Average volume acquisition time:

Normal cases: 6.42 minutes, 70% success rateNormal cases: 6.42 minutes, 70% success rate

VSD cases: 53.26 minutes to obtain a good quality volumeVSD cases: 53.26 minutes to obtain a good quality volume

DanDan--dan et al. Arch Gynecol Obstet 2010 (online publication 5/6/2010)dan et al. Arch Gynecol Obstet 2010 (online publication 5/6/2010)

1,163 singletons1,163 singletons2121--36 weeks36 weeks

CHD w/o VSDCHD w/o VSDn=43n=43

CHD w/ VSDCHD w/ VSDn=58n=58

DanDan--dan et al. Arch Gynecol Obstet 2010 (online publication 5/6/2010)dan et al. Arch Gynecol Obstet 2010 (online publication 5/6/2010)

Simple VSDSimple VSDn=21 (36%)n=21 (36%)

Complex CHDComplex CHDn=37 (64%)n=37 (64%)

VSD size = 2 VSD size = 2 -- 10 mm10 mm1 false1 false--positive diagnosis by 2Dpositive diagnosis by 2D

2 VSDs missed by both 2D and STIC2 VSDs missed by both 2D and STIC

Compared STIC vs. 2D accuracy in a highCompared STIC vs. 2D accuracy in a high--risk risk populationpopulationpopulationpopulation

STIC performed after fetal echo by fetal medicine STIC performed after fetal echo by fetal medicine specialists wellspecialists well--trained in routine screening but trained in routine screening but inexperienced in fetal echocardiographyinexperienced in fetal echocardiography

Standard acquisition: 4Standard acquisition: 4--chamber view, preferably apicalchamber view, preferably apical

Volume review by specialists 1 year after acquisitionVolume review by specialists 1 year after acquisition

Bennasar et al. Ultrasound Obstet Gynecol 2010;36:458Bennasar et al. Ultrasound Obstet Gynecol 2010;36:458--464464

342 w/ suspected CHD342 w/ suspected CHD1414--40 weeks40 weeks

NormalNormaln=167 (48.8%)n=167 (48.8%)

CHDCHDn=175 (51.2%)n=175 (51.2%)

Successful acquisition 98%Successful acquisition 98%Overall accuracy 91.% for STIC and 94.2% for 2DOverall accuracy 91.% for STIC and 94.2% for 2D


STICSTICFalse negatives (n=9)False negatives (n=9)

VSD (n=8)VSD (n=8)

Aortic arch interruption Aortic arch interruption type B (n=1)type B (n=1)

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NormalNormaln=167 (48.8%)n=167 (48.8%)

CHDCHDn=175 (51.2%)n=175 (51.2%)



2D2DFalse negatives (n=3)False negatives (n=3)

VSD (n=2)VSD (n=2)

Persistent left SVCPersistent left SVC(n=1)(n=1)


NormalNormaln=167 (48.8%)n=167 (48.8%)

CHDCHDn=175 (51.2%)n=175 (51.2%)



STICSTICFalse positives (n=19)False positives (n=19)

VSD (n=10)VSD (n=10)

Coarctation of Ao (n=4)Coarctation of Ao (n=4)

Persistent LSVC (n=2)Persistent LSVC (n=2)

Pulmonary stenosis (n=1)Pulmonary stenosis (n=1)

Tricuspid dysplasia (n=1)Tricuspid dysplasia (n=1)

Rhabdomyoma (n=1)Rhabdomyoma (n=1)


NormalNormaln=167 (48.8%)n=167 (48.8%)

CHDCHDn=175 (51.2%)n=175 (51.2%)



2D2DFalse positives (n=17)False positives (n=17)

VSD (n=11)VSD (n=11)

Coarctation of Ao (n=4)Coarctation of Ao (n=4)

Tricuspid dysplasia (n=1)Tricuspid dysplasia (n=1)

Ostium primum ASD (n=1)Ostium primum ASD (n=1)


ConclusionConclusion

•• ““...we present a large series of CHDs evaluated with ...we present a large series of CHDs evaluated with

STIC technology and conclude that, STIC technology and conclude that, in a highin a high--risk risk

populationpopulation 4D4D STIC echocardiography could beSTIC echocardiography could bepopulationpopulation, 4D, 4D--STIC echocardiography could be STIC echocardiography could be

incorporated into a clinical setting, with a high incorporated into a clinical setting, with a high

accuracy for offline reassurance of normality and accuracy for offline reassurance of normality and

diagnosis of any anomaly in the whole spectrum of diagnosis of any anomaly in the whole spectrum of

CHDCHD””

Bennasar et al. Ultrasound Obstet Gynecol 2010;36:458Bennasar et al. Ultrasound Obstet Gynecol 2010;36:458--464464 Espinoza et al. JUM 2010;29:1573Espinoza et al. JUM 2010;29:1573--15801580

Objectives:Objectives:

To determine the accuracy of 4DUS for the diagnosis To determine the accuracy of 4DUS for the diagnosis of congenital heart defectsof congenital heart defects

To determine agreement of diagnostic impressions To determine agreement of diagnostic impressions among participting centersamong participting centers

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7 International Centers with Expertise 7 International Centers with Expertise in 4DUS Echocardiographyin 4DUS Echocardiography

Each center uploaded 20 volume datasets of fetuses with and without CHDEach center uploaded 20 volume datasets of fetuses with and without CHD

1818--26 weeks, B26 weeks, B--mode or Color, 1 volume/case, 90 randomly selected for analysismode or Color, 1 volume/case, 90 randomly selected for analysis

Sensitivity 93% (77Sensitivity 93% (77--100%)100%)

Specificity 96% (84Specificity 96% (84--100%)100%)

PPV 96% (83PPV 96% (83--100%)100%)


PPV 96% (83PPV 96% (83 100%)100%)

NPV 93% (79NPV 93% (79--100%)100%)

Intercenter agreement kappa = 0.97Intercenter agreement kappa = 0.97

Median time to upload/download Median time to upload/download each dataset = 2 min (1each dataset = 2 min (1--3 min)3 min)

Median time to analyze each volume Median time to analyze each volume = 6 min (2= 6 min (2--15 min)15 min)

Datasets w/ limited quality = 10%Datasets w/ limited quality = 10%


Documents

Advances in Fetal Echocardiography.ppt · Advances in Fetal Echocardiography LuísLuís F. F. GonçalvesGonçalves, M.D., M.D. Oakland University William Beaumont School of Medicine,