F.S. Barros

Reference ranges for the volumes of fetal cardiac ventricular walls by three‐dimensional ultrasound using spatiotemporal image correlation and virtual organ computer‐aided analysis and its validation in fetuses with congenital heart diseases

To establish reference values for the volumes of fetal cardiac ventricular walls using three‐dimensional ultrasonography (3DUS) and perform data validation using fetuses with confirmed congenital heart disease (CHD).

Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio-Temporal Image Correlation in the Second and Third Trimesters of Pregnancy

To assess the quality of fetal heart views by three‐dimensional/four‐dimensional (3D/4D) ultrasonography using spatio‐temporal image correlation (STIC) in the second and third trimester of pregnancy.

Viewing rate and reference ranges for papillary muscle areas of the fetal heart using four-dimensional ultrasound in the rendering mode

The aims of this study were to assess the viewing rate and determine reference ranges for the papillary muscle areas in the fetal atrio‐ventricular valves using four‐dimensional (4D) ultrasound and spatio‐temporal image correlation (STIC) in the rendering mode.

Viewing rate and reproducibility of papillary muscle areas in foetal atrioventricular valves using spatio-temporal image correlation in the rendering mode in congenital heart disease.

Abstract Objective: To assess the viewing rate and reproducibility of areas of the papillary muscles (PMs) of foetal atrioventricular valves using spatio-temporal image correlation (STIC) in the rendering mode in congenital heart disease (CHD). Methods: We retrospectively reviewed 40 4D-STIC volume datasets from different foetal CHD cases at a gestational age of 18w6d–35w6d. The following papillary muscles (PMs) were assessed: antero-lateral (MPAL) and postero-medial (MPPM) to the mitral valve and antero-superior (MPAS), inferior (MPI) and septal (MPS) to the tricuspid valve. To assess the valve viewing rate, percentages (%) were used. The concordance correlation coefficient (CCC) was used to assess inter-observer reliability. Results: Two independent observers concluded that a complete examination of the PMs was impossible in 11 cases, yielding a viewing rate of 72.5%. The complete examination of the PMs of the tricuspid and mitral valves was possible by both examiners in 33/40 (82.5%) and 32/40 (80.0%) cases, respectively. We observed moderate to good inter-observer reliability with CCCs of 0.95, 0.92, 0.97, 0.96 and 0.97 for MPS, MPI, MPAS, MPAL and MPPM, respectively. Conclusion: The viewing rate of PM areas in different CHDs using STIC in the rendering mode was moderate. The inter-observer reproducibility was moderate to good for all PM areas.

Reference values for the volumes of foetal heart atrial wall by three-dimensional ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation.

Abstract Objective: To establish reference values for the volumes of foetal heart atrial wall by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods. Methods: We performed a retrospective cross-sectional study with 170 normal singleton pregnancies between 20 weeks + 0 days (20w0d) and 33 weeks + 6 days (33w6d) of gestation. Foetal heart atrial wall volume was obtained by VOCAL method with 30-degree rotation (six planes) subtracting the internal volume from the atrium volume. Polynomial regression with adjustments by determination coefficient (R2) was performed. To calculate the interobserver reproducibility, concordance correlation coefficient (CCC) was applied. Results: The mean ± standard deviation (SD) for the left atrium wall volume (cm3) ranged from 0.54 ± 0.21 at 20w0d–20w6d to 2.17 ± 0.30 at 33w0d–33w6d. The mean ± SD for the right atrium wall volume (cm3) ranged from 0.45 ± 0.16 at 20w0d–20w6d to 2.17 ± 0.62 at 33w0d–33w6d. We observed a satisfactory interobserver reproducibility with CCC = 0.69 and 0.58 for the left and right volumes of foetal heart atrial wall, respectively. The best-fit models were first-degree: volume for the left atrium wall = −2.194 + 0.139*GA (R2 = 0.41) and volume for the right atrium wall = −2.757 + 0.155*GA (R2 = 0.37). Conclusion: Reference values for the volumes of foetal heart atrial wall by 3D ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation were established.

Comparison of Fetal Nuchal Fold Thickness Measurements by Two- and Three-Dimensional Ultrasonography (3DXI Multislice View).

Purpose. To compare the measurements of fetal nuchal fold (NF) thickness by two-dimensional (2D) and three-dimensional (3D) ultrasonography using the three-dimensional extended imaging (3DXI). Methods. A cross-sectional study was performed with 60 healthy pregnant women with a gestational age between 16 and 20 weeks and 6 days. The 2D-NF measurements were made as the distance from the outer skull bone to the outer skin surface in the transverse axial image in the suboccipital-bregmatic plane of the head. For the 3D we employed the 3DXI multislice view software, in which 3 × 2 tomographic planes was displayed on the screen and the distance between the tomographic slices was 0.5 mm. Maximum, minimum, mean, and standard deviation were calculated for 2D and 3D ultrasonography, as well the maximum and minimum, mean, and standard deviation for the difference between both methods. The Wilcoxon signed-rank test was used to compare the two different techniques. Results. 2D-NF showed a mean of thickness of 3.52 ± 0.95 mm (1.69–7.14). The mean of 3D-NF was 3.90 ± 1.02 mm (2.13–7.72). The mean difference between the methods was 0.38 mm, with a maximum difference of 3.12 mm. Conclusion. The NF thickness measurements obtained by 3D ultrasonography were significantly larger than those detected with 2D ultrasonography.

Evaluation of fetal heart geometry during pregnancy by three-dimensional ultrasound using the STIC rendering mode

To determine fetal heart geometry during pregnancy using three‐dimensional (3D) ultrasound and the spatiotemporal image correlation (STIC) rendering mode.

Fetal Heart Function by Tricuspid Annular Plane Systolic Excursion and Ventricular Shortening Fraction Using STIC M-Mode: Reference Ranges and Validation

Objective To determine the reference values for fetal tricuspid annular plane systolic excursion (f‐TAPSE) and fetal ventricular shortening fraction (f‐VSF) using spatiotemporal image correlation (STIC) with M‐mode, and validate these curves in fetuses of pregnant women with preexisting diabetes mellitus (DM) and with intrauterine growth restriction (IUGR). Study Design Crosssectional study assessed 300 fetal cardiac volumes of normal pregnancies between 20 and 33 + 6 weeks of gestation. For the construction of the reference curves, we used a polynomial regression model adjusted with the coefficient of determination (R2). For the calculation of reproducibility, the concordance correlation coefficient (CCC) was used. Results f‐TAPSE value correlated with gestational age (GA, R2 = 0.46), whereas fetal right ventricular shortening fraction (f‐RVSF, R2 = 0.02) and fetal left ventricular shortening fraction (f‐LVSF, R2 = 0.005) did not vary with GA. Fetuses of pregnant women with preexisting DM (30) had lower values of f‐RVSF (p = 0.028), f‐LVSF (p = 0.001), and f‐TAPSE (p = 0.009) than normal fetuses. The f‐TAPSE values were lower (p = 0.005) in IUGR group (17). The f‐TASPSE values showed adequate reliability as well as good intra and interobserver concordance (CCC = 0.95 and 0.79, respectively). Conclusion The reference ranges for f‐TAPSE, f‐RVSF, and f‐LVSF using the STIC M‐mode were established and had good reproducibility for f‐TAPSE measurements.

EP03.06: Reference range for fetal tricuspid annular plane systolic excursion (TAPSE) measurement using spatiotemporal image correlation (STIC) M-mode in a Brazilian population.

G. Tedesco4,5, L.C. Bussamra4,5, L.C. Rolo1, F.S. Barros1, W.P. Martins4,3, L. Nardozza2, A.F. Moron4, E. Araujo4 1Department of Obstetrics, Federal University of São Paulo-UNIFESP, São Paulo, Brazil; 2São Paulo Federal University, São Paulo, Brazil; 3Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; 4Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil; 5Department of Obstetrics, Medical College Science of Santa Casa of São Paulo (FCMSCSP), São Paulo, Brazil

P01.17: The lethal multiple pterygium syndrome: prenatal ultrasonographic and postmortem findings-a case report: Poster abstracts

Results: We identified 84 cases. 24 had associated gastro-intestinal tract and respiratory anomalies; 22 had abnormal karyotypes (10 Trisomy 18s, 5 Trisomy 21s and 1 each of other aneuploidies or other karyotypical abnormalities); 6 had neuromuscular syndromes; 3 had major central nervous system anomalies; 7 had renal anomalies causing anhydramnios; 5 had other genetic syndromes; 2 had placental insufficiency leading to anhydramnios; 8 were found to have normal stomach appearances and had normal outcomes and 7 had a normal outcome despite persistently absent stomach on ultrasound examination. Of these 84: 26 underwent termination of pregnancy; 9 suffered in utero fetal demise; 8 died in the neonatal period; 3 died in infancy; 44 had a live birth and survived infancy and 5 outcomes were not obtained. Conclusions: A persistently absent stomach on ultrasound scanning is associated with a guarded prognosis – with an incidence of abnormal karyotype of 29% and a high incidence of associated structural abnormalities. In only 9.2% of persistently absent stomachs was the outcome normal. We have not been able to explain why these normal fetuses did not demonstrate stomach ‘bubbles’ on ultrasound.