Echocardiography in the Fetus – A Systematic Comparative Analysis of Standard Cardiac Views with 2D, 3D Reconstructive and 3D Real-Time Echocardiography

Zusammenfassung

Ziel: Ziel der Studie ist es, die Genauigkeit der fetalen 3-D-Freihand-Rekonstruktion (3-DR) und der 3-D-Echtzeit-Echokardiografie (RT-3-D mittels Matrix-Technologie) an einer konsekutiven Serie von Schwangeren zu überprüfen sowie beide Verfahren mit dem fetalen 2-D-Ultraschall und postnatalen Befunden als Standard zu vergleichen. Material und Methoden: 50 schwangere Frauen (Gestationsalter 19 + 3 bis 37 + 0) einschließlich 10 herzkranker Feten wurden prospektiv mittels 2-D, 3-DR und RT-3-D untersucht. Die 3-D-Daten wurden von einem unabhängigen Zweituntersucher ausgewertet. Jede der 3 Methoden wurde hinsichtlich der Rate an darstellbaren Standardschnitten, ihrer Qualität sowie ihrer diagnostischen Genauigkeit überprüft. Ergebnisse: Standardebenen guter Qualität konnten in RT-3-D ebenso häufig dargestellt werden wie in 2-D, demgegenüber war die Detektionsrate in 3-DR signifikant niedriger (4cv: 2-D 98 %, RT-3-D 100 %, 3-DR 96 % RVOT: 2-D 96 %, RT-3-D 98 %, 3-DR 84 %). Mittels RT-3-D wurden Ebenen wie die kurze Achse oder der komplette Aorten- und Duktusbogen häufiger eindeutig identifiziert als mittels 2-D (2-D 70 %, RT-3-D 82 %). Beim Vergleich zu postnatalen Befunden wiesen RT-3-D und 2-D gegenüber 3-DR eine signifikant höhere Sensitivität und diagnostische Genauigkeit auf. Schlussfolgerung: Im Vergleich zu RT-3-D und 2-D zeigt die fetale 3-DR eine signifikant niedrigere Detektionsrate und diagnostische Genauigkeit. Demgegenüber erweist sich die Echtzeit-3-D-Echokardiografie als zuverlässige Methode zur Untersuchung des fetalen Herzens und eröffnet durch die Möglichkeit der wiederholten Datenbearbeitung und Analyse neue Ansätze für die morphologische und funktionelle Diagnostik des fetalen Herzens.

Abstract

Purpose: The aim of our study was to assess the feasibility and reliability of fetal three-dimensional reconstructive echocardiography using freehand technique (3DR) and 3D real-time echocardiography using matrix technology (RT-3D) in consecutive series of pregnancies and to compare the findings with the gold standard 2D ultrasound, as well as postnatal findings. Materials and Methods: Fifty consecutive pregnant women (gestational age 19 + 3 to 37 + 0) including 10 fetuses with cardiac malformations were scanned prospectively with 2D, 3DR and RT-3D. 3D data sets were evaluated by a blinded independent examiner. The visualization rates for standard cardiac views and structures were determined and the quality and diagnostic accuracy of each modality were calculated. Results: In RT-3D, the visualization rate of fetal cardiac views was equivalent to 2D, but was significantly lower for 3DR (4cv: 2D 98 %, RT-3D 100 %, 3DR 96 % RVOT: 2D 96 %, RT-3D 98 %, 3DR 84 %). Short-axis views or views of the complete aortic or ductal arch were more readily identified in RT-3D than in 2D (2D 70 %, RT-3D 82 %). 3DR was more susceptible than RT-3D to artifacts during acquisition and post-processing. The sensitivity and overall accuracy were significantly higher for 2D and RT-3D than for 3DR, when prenatal data was compared with postnatal findings. Conclusion: 3D freehand reconstruction has significantly lower visualization rates and overall accuracy compared to 2D and RT-3D. RT-3D echo is a feasible and reliable method for imaging the fetal heart. Offering the opportunity of data post-processing and evaluation, RT-3D is a promising method for improving the accuracy of sonographic analysis of fetal cardiac morphology and function.

Key words

heart - fetus - 3D ultrasound - accuracy - real-time 3D echocardiography

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