Subscribe to RSS
DOI: 10.1055/s-2002-35110
Georg Thieme Verlag Stuttgart · New York
Dreidimensionaler Ultraschall in der Pränataldiagnostik: Routine oder gezielte diagnostische Zusatzoption?
Three-dimensional Sonography in Prenatal Diagnosis: Current Routine Problems and Possible Benefits in Specific Malformations?Publication History
Publication Date:
28 October 2002 (online)
Zusammenfassung
Durch die Fortschritte auf dem Gebiet der computertechnologischen Bildverarbeitung ist es in den letzten Jahren möglich geworden, aus Serien von zweidimensionalen (2D) Ultraschallschnittbildern dreidimensionale Rekonstruktionen zu berechnen.
Die Anwendungsmöglichkeiten der dreidimensionalen (3D) Sonographie in der Geburtshilfe erstrecken sich von Darstellungen des fetalen Gesichts- und Halsbereiches über die einzelnen Organsysteme (Zentralnervensystem, Abdomen und Thorax, Urogenitaltrakt), der Darstellung von Skelett und Extremitäten bis hin zur 3D-Fetalechokardiographie.
Die Vorteile der dreidimensionalen Methode liegen in der räumlichen Plastizität der Darstellung und den beinahe unbegrenzten Bearbeitungsmöglichkeiten eines einmal gespeicherten Datensatzes. Die Nachteile liegen in dem zum Teil immer noch hohen technischen und zeitlichen Bildbearbeitungsaufwand und der durch die fetale Motorik bedingten Störanfälligkeit der Methode.
Mit fortschreitender Entwicklung der Computertechnologie und damit verbundener Vereinfachung der Handhabung sowie Verbesserung der zweidimensionalen Bildqualität wird die dreidimensionale Sonographie eine immer wichtigere Rolle in der vorgeburtlichen Diagnostik spielen, obgleich ihr Nutzen derzeit durchaus noch kontrovers diskutiert wird.
Abstract
The rapid development of ultrasound computer technology has made three-dimensional (3D) ultrasound a promising diagnostic tool in obstetric imaging over the last decade. In this article the authors describe the current feasibility of methods for 3D data acquisition and image analysis and assess their clinical application in different organ systems of the fetus. Most advantages of 3D sonographic imaging over conventional ultrasound are related to the limitations of two-dimensional assessment of the multidimensional fetal anatomy. Thus, prenatal 3D ultrasound data sets provide a novel different approach to prenatal evaluation of the fetus as they allow image reconstructions from different viewing perspectives for repeatable evaluation of anatomic structures and disease entities. However, considering the current technical limitations as well as the operator time needed for 3D image processing and analysis its routine clinical relevance in the antenatal situation so far remains unlimited.
Schlüsselwörter
3D-Sonographie - pränatale Diagnostik - fetale Anomalien - fetale Echokardiographie
Key words
3D ultrasound - fetal anomalies - fetal echocardiography - prenatal diagnosis
Literatur
- 1 Downey D B, Fenster A, Williams J C. Clinical utility of three-dimensional US. Radiographics. 2000; 20 559-571
- 2 Campbell S. 4 D, or not 4 D: that is the question. Ultrasound Obstet Gynecol. 2002; 19 1-4
- 3 Platt L D. Three-dimensional ultrasound. Ultrasound Obstet Gynecol. 2000; 16 295-298
- 4 Merz E, Miric-Tesanic D, Welter C. Value of the electronic scalpel (cut mode) in the evaluation of the fetal face. Ultrasound Obstet Gynecol. 2000; 16 564-568
- 5 Pooh R K, Pooh K H. The assessment of fetal brain morphology and circulation by transvaginal 3 D sonography and power Doppler. J Perinat Med. 2002; 30 48-56
- 6 Chaoui R, Kalache K D, Hartung J. Application of three-dimensional power Doppler ultrasound in prenatal diagnosis. Ultrasound Obstet Gynecol. 2001; 17 22-29
- 7 Matijevic R, Kurjak A. The assessment of placental blood vessels by three-dimensional power Doppler ultrasound. J Perinat Med. 2002; 30 26-32
- 8 Kurjak A, Kupesic S, Banovic I, Hafner T, Kos M. The study of morphology and circulation of early embryo by three-dimensional ultrasound and power Doppler. J Perinat Med. 1999; 27 145-157
- 9 Kurjak A, Hafner T, Kos M, Kupesic S, Stanojevic M. Three-dimensional sonography in prenatal diagnosis: a luxury or a necessity?. J Perinat Med. 2000; 28 194-209
- 10 Monteagudo A, Timor-Tritsch I, Mayberry P. Three-dimensional transvaginal neurosonography of the fetal brain: “navigating” in the volume scan. Ultrasound Obstet Gynecol. 2000; 16 307-313
- 11 Michailidis G D, Simpson J M, Karidas C, Economides D L. Detailed three-dimensional fetal echocardiography facilitated by an Internet link. Ultrasound Obstet Gynecol. 2001; 18 325-328
- 12 Macedonia C R, Littlefield R J, Satava R M, Cramer T, Mogel G, Coleman J, Eglington G. Three-dimensional ultrasound telepresence. J Telemed Telecare. 1998; 12 84-85
- 13 Dyson R L, Pretorius D H, Budorick N E, Johnson D D, Sklansky M S, Cantrell C J, Lai S, Nelson T R. Three-dimensional ultrasound in the evaluation of fetal anomalies. Ultrasound Obstet Gynecol. 2000; 16 321-328
- 14 Floto C, Huk T. Neue Medien in der Medizin. Stellenwert, Chancen und Grenzen. Dtsch Ärztebl. 2002; 99 A1875-1878
- 15 Burg G, Haeffner A. Dr. JPEG and Mr. BYTE. Dtsch Ärztebl. 2002; 99 A1888-1890
- 16 Scharf A, Geka F, Steinborn A, Frey H, Schlemmer A, Sohn C. 3 D real-time imaging of the fetal heart. Fetal Diagn Ther. 2000; 15 267-274
- 17 Kurjak A, Vecek N, Hafner T, Bozek T, Funduk-Kurjak B, Ujevic B. Prenatal diagnosis: what does four-dimensional ultrasound add?. J Perinat Med. 2002; 30 57-62
- 18 Deng J, Gardener J E, Rodeck C H, Lees W R. Fetal echocardiography in three and four dimensions. Ultrasound Med Biol. 1996; 22 979-986
- 19 Blass H G, Eik-Nes S H, Berg S, Torp H. In-vivo three-dimensional ultrasound reconstructions of embryos and early fetuses. Lancet. 1998; 352 1182-1186
- 20 Meinel K, Guntermann E. Transparent 3-D ultrasound in fetal abnormalities. Ultraschall Med. 1998; 19 120-125
- 21 Kurjak A, Kupesic S, Ivančić-Košuta M. Three-dimensional transvaginal ultrasound improves measurement of nuchal translucency. J Perinat Med. 1999; 27 97-102
- 22 Hull A D, Pretorius D H. Fetal face: what we can see using two-dimensional and three-dimensional ultrasound imaging. Semin Roentgenol. 1998; 33 369-374
- 23 Pretorius D H, House M, Nelson T R, Hollenbach K A. Evaluation of normal and abnormal lips in fetuses: comparison between three- and two-dimensional sonography. Am J Roentgenol. 1995; 165 1233-1237
- 24 Merz E, Weber G, Bahlmann F, Miric-Tesanic D. Application of transvaginal and abdominal three-dimensional ultrasound for the detection or exclusion of malformations of the fetal face. Ultrasound Obstet Gynecol. 1997; 9 237-243
- 25 Johnson D D, Pretorius D H, Budorick N E, Jones M C, Lou K V, James G M, Nelson T R. Fetal lip and primary palate: three-dimensional versus two-dimensional US. Radiology. 2000; 217 236-239
- 26 Hata T, Yonehara T, Aoki S, Manabe A, Hata K, Miyazaki K. Three-dimensional sonographic visualization of the fetal face. AJR Am J Roentgenol. 1998; 170 481-483
- 27 Viereck N, Meyer-Wittkopf M, Schmidt S. Dreidimensionale sonographische Darstellbarkeit des fetalen Gesichtes im Rahmen der weiterführenden Ultraschalldiagnostik. Geburtshilfe Frauenheilkd. 2002; 62 768-771
- 28 Hata T, Yanagihara T, Matsumoto M, Hanaoka U, Ueta M, Tanaka Y, Kanenishi K, Kuno A, Yamashiro C, Ohnishi Y, Tanaka H, Hayashi K. Three-dimensional sonographic features of fetal central nervous system anomaly. Acta Obstet Gynecol Scand. 2000; 79 635-639
- 29 Merz E, Bahlmann F, Weber G. Volume scanning in the evaluation of fetal malformations: a new dimension in prenatal diagnosis. Ultrasound Obstet Gynecol. 1995; 5 222-227
- 30 Merz E, Bahlmann F, Weber G, Macchiella D. Three-dimensional ultrasonography in prenatal diagnosis. J Perinat Med. 1995; 23 213-222
- 31 Baba K, Okai T, Kozuma S, Taketani Y. Fetal abnormalities: evaluation with real-time-processible three-dimensional US - preliminary report. Radiology. 1999; 211 441-446
- 32 Garjian K V, Pretorius D H, Budorick N E, Cantrell C J, Johnson D D, Nelson T R. Fetal skeletal dysplasia: three-dimensional US - initial experience. Radiology. 2000; 214 717-723
- 33 Hull A D, Pretorius D H, Lev-Toaff A, Budorick N E, Salerno C C, Johnson M M, James G, Nelson T R. Artifacts and the visualization of fetal distal extremities using three-dimensional ultrasound. Ultrasound Obstet Gynecol. 2000; 16 341-344
- 34 Chang F M, Liang R I, Ko H C, Yao B L, Chang C H, Yu C H. Three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight. Obstet Gynecol. 1997; 90 331-339
- 35 Liang R I, Chang F M, Yao B L, Chang C H, Yu C H, Ko H C. Predicting birth weight by fetal upper-arm volume with use of three-dimensional ultrasonography. Am J Obstet Gynecol. 1997; 177 632-638
- 36 Schild R L, Fimmers R, Hansmann M. Can 3 D volumetric analysis of the fetal upper arm and thigh improve conventional 2 D weight estimates?. Ultraschall Med. 1999; 20 31-37
- 37 Schild R L, Fimmers R, Hansmann M. Fetal weight estimation by three-dimensional ultrasound. Ultrasound Obstet Gynecol. 2000; 16 445-452
- 38 Song T B, Moore T R, Lee J I, Kim Y H, Kim E K. Fetal weight prediction by thigh volume measurement with three-dimensional ultrasonography. Obstet Gynecol. 2000; 96 157-161
- 39 Meyer-Wittkopf M, Rappe N, Sierra F, Barth H, Schmidt S. Three-dimensional (3-D) ultrasonography for obtaining the four and five-chamber view: comparison with cross-sectional (2-D) fetal sonographic screening. Ultrasound Obstet Gynecol. 2000; 15 397-402
- 40 Meyer-Wittkopf M, Cooper S, Vaughan J, Schmidt S, Sholler G F. Three-dimensional (3-D) echocardiographic analysis of congenital heart disease in the fetus: comparison with cross-sectional (2-D) fetal echocardiography. Ultrasound Obstet Gynecol. 2001; 17 485-492
- 41 Guerra F A, Isla I, Aguilar R C, Fritz E G. Use of free-hand three-dimensional ultrasound software in the study of the fetal heart. Ultrasound Obstet Gynecol. 2000; 16 329
- 42 Sklansky M S, Nelson T R, Pretorius D H. Three-dimensional fetal echocardiography: gated versus nongated techniques. J Ultrasound Med. 1998; 17 451-457
- 43 Meyer-Wittkopf M, Schmidt S. Dreidimensionale fetale Echokardiographie - Aktueller Stand und künftige Perspektiven. Z Geburtshilfe Neonatol. 2001; 205 86-93
- 44 Levental M, Pretorius D H, Sklansky M S, Budorick N E, Nelson T R, Lou K. Three-dimensional ultrasonography of normal fetal heart: comparison with two-dimensional imaging. J Ultrasound Med. 1998; 17 341-348
- 45 Sklansky M S, Nelson T, Strachan M, Pretorius D. Real-time three-dimensional fetal echocardiography: initial feasibility study. J Ultrasound Med. 1999; 18 745-752
PD Dr. med. Matthias Meyer-Wittkopf
Universitäts-Frauenklinik Tübingen
Calwer Straße 7
72076 Tübingen
Email: m-mw@gmx.de