Prenatal screening for congenital heart disease using real‐time three‐dimensional echocardiography and a novel ‘sweep volume’ acquisition technique

• Published in: Ultrasound in obstetrics & gynecology 2005-05, Vol.25 (5), p.435-443
• Main Authors: Sklansky, M., Miller, D., Devore, G., Kung, G., Pretorius, D., Wong, P., Chang, R.‐K.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Case-Control Studies; Echocardiography; Echocardiography, Three-Dimensional - methods; Female; fetal cardiology; fetal echocardiography; Fetal Heart - diagnostic imaging; Gynecology. Andrology. Obstetrics; Heart Defects, Congenital - diagnostic imaging; Humans; Likelihood Functions; Medical sciences; Observer Variation; Pregnancy; Pregnancy Trimester, Second; Sensitivity and Specificity; three‐dimensional echocardiography; three‐dimensional ultrasound
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.1858

Objectives Conventional prenatal screening for congenital heart disease (CHD) involves a time‐consuming and highly operator‐dependent acquisition of the four‐chamber view and outflow tracts. By acquiring the entire fetal heart instantaneously as a single volume, real‐time three‐dimensional echocardiography (RT3DE) may facilitate fetal cardiac screening. Methods Four reviewers, each experienced with fetal cardiac imaging, blindly and independently evaluated a single cardiac volume from each of 18 fetuses (11 normal, seven with CHD). Two‐dimensional echocardiography served as the gold standard. Three‐dimensional evaluation of each fetus included a series of volume acquisitions lasting 2–6 s each. A ‘sweep volume’ technique was developed to fit larger hearts into a single non‐gated volume. Results RT3DE had a high sensitivity for detecting CHD (93%), with only a single case being missed by two observers. Specificity for CHD was low (45%), with a high rate of ‘cannot determine’ responses and false positive artifacts. Conclusions These preliminary results suggest that RT3DE has the potential to function as a screening tool for fetal heart disease. However, artifacts must be recognized and minimized, resolution must improve, and substantial training will be necessary prior to widespread clinical use. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.