Liliam Cristine Rolo

Heart stroke volume, cardiac output, and ejection fraction in 265 normal fetus in the second half of gestation assessed by 4D ultrasound using spatio-temporal image correlation

Objectives. The aim of this study was to establish nomograms for fetal stroke volume (SV), cardiac output (CO), and ejection fraction (EF) using four-dimensional ultrasound with spatio-temporal image correlation (STIC) modality. Methods. The fetal heart was scanned using STIC modality, starting with classic four-chamber view plane, during fetal quiescence with abdomen uppermost, at an angle of 20–30°, without color Doppler flow mapping. In post-processing virtual organ, computer-aided analysis technique was used to obtain a sequence of six sections of each ventricular volume in end-systolic volume (ESV) and end-diastolic volume (EDV). The SV (SV = EDV–ESV), CO (CO = SV × fetal heart rate), and EF (EF = SV/EDV) for each ventricle were then calculated. Intra- and interobserver agreement were then calculated. Results. Two hundred sixty-five fetuses, ranging in gestational age (GA) from 20 to 34+6 weeks, were included in the study. The left and right SV and CO increased exponentially with gestation and EF remained fairly stable through gestational. Mean left and right SV increased from 0.211 ml and 0.220 ml at 20 weeks to 1.925 ml and 2.043 ml, respectively, at 34 weeks. Mean left and right CO increased from 30.25 ml/min and 31.52 ml/min at 20 weeks to 268.49 ml/min and 287.80 ml/min, respectively, at 34 weeks. Both left and right mean EF remained constant at around 0.63 with advancing GA. Nomograms were created for LSV, RSV, LCO, RCO, LEF, and REF vs. gestational age. Intra- and interobserver agreement reached 95%. Conclusions. Four-dimensional ultrasound using STIC represents a simple and reproducible method for estimating fetal cardiac function. STIC seems to overcome many of the pitfalls of conventional ultrasound methods and has the potential to become the method of choice.

Reliability and Validity of In Vitro Volume Calculations by 3-Dimensional Ultrasonography Using the Multiplanar, Virtual Organ Computer-Aided Analysis (VOCAL), and Extended Imaging VOCAL Methods

Objective. The purpose of this study was to assess the reliability and validity of in vitro volume calculations by 3‐dimensional ultrasonography. Methods. This observational study was performed by 2 examiners to obtain volumes of 3 objects of different shapes and sizes filled with ultrasound gel and immersed in water. The examiners used the multiplanar (5‐mm interval), virtual organ computer‐aided analysis (VOCAL, 30°) and extended imaging (XI) VOCAL (5, 10, 15, and 20 planes) methods to estimate the volumes of each object. A paired Student t test (P) and intraclass correlation coefficients (ICCs) were used to assess reproducibility of the methods. Validity was assessed comparing the percent differences between the estimated and the real volumes using the P value, mean differences, and ICC for each method. Results. All methods were highly reliable and valid. There were no significant differences in interobserver variability; there was a strong interobserver correlation. There were no significant differences in the percent differences between the estimated and real volumes of the objects using the 3 methods. The XI VOCAL method was superior to the multiplanar and VOCAL methods in the measurement of irregularly shaped objects. The XI VOCAL method with 10 planes estimated volumes closest to the real volumes. Conclusions. All 3 methods were reliable and valid; however, XI VOCAL was superior to the other methods in the measurement of irregularly shaped objects.

Reference ranges of atrioventricular valve areas by means of four-dimensional ultrasonography using spatiotemporal image correlation in the rendering mode.

This study aims to determine reference curves for fetal atrioventricular valve areas by means of three‐dimensional ultrasound using the spatiotemporal image correlation (STIC) software.

Yolk sac volume assessed by three‐dimensional ultrasonography using the VOCAL method

Objectives. Establish normative data for yolk sac volume (YSV) at 7–10 weeks of gestation assessed by transvaginal three‐dimensional ultrasonography (3D‐US) using the VOCAL method and analyze its correlation with gestational age (GA) and crown‐rump length (CRL). Methods. A cross‐sectional study involving 62 normal pregnancies was performed to assess YSV from 7 to 10 weeks of gestational age. An endocavitary volumetric transducer (3D5‐8EK) was used for all measurements. The VOCAL (Virtual Organ Computer‐aided AnaLysis) method with a 30° rotation angle was used for volumetric calculations. Regression models were constructed to analyze the correlation between YSV and GA or CRL The mean, standard deviation, median, minimum and maximum values were calculated for each gestational age. Results. There was a poor correlation between YSV and GA or CRL. The quadratic regression was the model that best expressed the correlation between these variables: R2 = 0.188 for GA and R2 = 0.203 for CRL. The mean YSV went from 0.063 cm3 (95% CI: 0.047; 0.080) at 7 weeks to 0.164 cm3 (95% CI 0.095; 0.232) at 10 weeks. Conclusion. Reference limits were generated for first trimester YSV using 3D‐US. There was a poor correlation between YSV and GA or CRL.Objectives. Establish normative data for yolk sac volume (YSV) at 7–10 weeks of gestation assessed by transvaginal three-dimensional ultrasonography (3D-US) using the VOCAL method and analyze its correlation with gestational age (GA) and crown-rump length (CRL). Methods. A cross-sectional study involving 62 normal pregnancies was performed to assess YSV from 7 to 10 weeks of gestational age. An endocavitary volumetric transducer (3D5-8EK) was used for all measurements. The VOCAL (Virtual Organ Computer-aided AnaLysis) method with a 30° rotation angle was used for volumetric calculations. Regression models were constructed to analyze the correlation between YSV and GA or CRL The mean, standard deviation, median, minimum and maximum values were calculated for each gestational age. Results. There was a poor correlation between YSV and GA or CRL. The quadratic regression was the model that best expressed the correlation between these variables: R2=0.188 for GA and R2=0.203 for CRL. The mean YSV went from 0.06...

Reference Range for Fetal Interventricular Septum Area by Means of Four-Dimensional Ultrasonography Using Spatiotemporal Image Correlation

Objective: To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. Methods: A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. Results: The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 ± 0.10 cm2 in the 18th week to 2.42 ± 1.13 cm2 in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 × gestational age (R2 = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm2, precision of 0.07 cm2 and absolute limits of agreement of -0.14 and +0.15 cm2. Conclusions: Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible.

The value of 3D and 4D assessments of the fetal heart.

The objective of this review was to demonstrate the main tools of three- and four-dimensional ultrasonography, using the spatiotemporal image correlation software and its respective applications for assessing the fetal heart and its vascular connections, along with its potential contribution towards screening for congenital heart diseases. Today, conventional, two-dimensional, echocardiography continues to be the gold standard for diagnosing congenital heart diseases. However, recent studies have demonstrated that spatiotemporal image correlation offers some advantages that boost two-dimensional accuracy in detecting congenital heart diseases, given that the fetal heart assessment can be completed in the absence of the patient (offline) and be discussed by different examiners. Additionally, data volumes can be sent for analysis in reference centers via internet links. Spatiotemporal image correlation also enables direct measurement of heart structures in rendering mode, such as the interventricular septum and the annulus of the atrioventricular valves. Furthermore, it enables assessment of cardiac function when used in association with the virtual organ computer-aided analysis software, thus making it possible to calculate the total systolic function, ejection fraction, and cardiac output.

Comparison of gestational sac volume by 3D-sonography using planimetric, virtual organ computer-aided analysis and extended imaging virtual organ computer-aided analysis methods between 7 and 11 weeks of pregnancy.

Objective. To compare different three‐dimensional (3D) methods in the assessment of gestational sac volume (GSV). Design. Cross‐sectional study involving 74 normal pregnancies between 7 and 11 weeks. Setting. Department of Obstetrics, São Paulo Federal University (UNIFESP). Methods. GSV was measured through 3D ultrasound using the planimetric, virtual organ computer‐aided analysis (VOCAL) and extended imaging virtual organ computer‐aided analysis (XI VOCAL) methods. The planimetric method used a sequence of adjacent planes that are 3 mm thick. For the VOCAL methods, six adjacent planes and a 30° rotation were used. A total of 15 adjacent planes were used for the XI VOCAL method. Regression models with a determination coefficient (R2) were created to assess the correlation between GSV and gestational age (GA). Intraclass correlation coefficient (ICC) and Bland‐Altman graphs were used to assess the correlation between the three methods and ANOVA was used to compare means. Results. All three methods showed a correlation between GSV and GA (R2 = 0.65 for XI VOCAL, R2 = 0.65 for planimetric and R2 = 0.66 for VOCAL). There was a strong correlation between the three methods (XI VOCAL vs. planimetric ICC = 0.995; XI VOCAL vs. VOCAL ICC = 0.998 and planimetric vs. VOCAL ICC = 0.995) without any significant differences according to the Bland‐Altman graphs or ANOVA (p < 0.002). Conclusions. The three 3D ultrasound methods used for GSV assessment between 7 and 11 weeks are concordant. These methods can be used interchangeably during the first trimester of pregnancy to measure GSV.

Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC): comparison between male and female fetuses

OBJECTIVE To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30º. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.OBJECTIVE: To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30o. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS: The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS: The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.

Fetal cerebral ventricle volumetry: comparison between 3D ultrasound and magnetic resonance imaging in fetuses with ventriculomegaly

Objectives. The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with those obtained by magnetic resonance imaging (MRI). Methods. This cross-sectional study evaluated 30 fetuses with atrial width (AW) between 10 and 30 mm, from 20 to 36 gestational weeks. Fifty-nine ventricles were measured by two observers. Sonographic volumetric measurements using VOCAL 30° were performed with an ACCUVIX XQ machine (Medison, Korea) and MRI assessments with a Sonata system using ARGUS software (Siemens, Germany). Agreement between both techniques was assessed by intraclass correlation coefficient (ICC) calculation, and proportionate Bland–Altman plots were constructed. Results. A high degree of reliability was observed between VOCAL and MRI measurements (ICC 0.928, 95%CI [0.876;0.958]). Bland–Altman plots confirmed the high correlation (mean of differences: 1.62 cm3 and standard deviation: ± 8.41 cm3). Conclusion. Three-dimensional volumetry of fetal LVs by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly and may be used as an additional tool in patient counseling and prognosis prediction.

Fetal lung volume in fetuses with urinary tract malformations: Comparison by 2D-, 3D-sonography and magnetic resonance imaging

Objective. To evaluate the concordance between two-dimensional ultrasonography (2DUS), three-dimensional ultrasonography (3DUS) and magnetic resonance imaging (MRI) in the assessment of lung volume in fetuses with urinary tract malformations (UTM). Methods. This was a cross-sectional study involving 12 pregnancies between 19 and 34 weeks, with various fetal UTM. Pulmonary volume was obtained by 2DUS using the following equation: total lung volume = [right lung antero-posterior diameter (X) × transverse diameter (Y) × cranial-caudal diameter × 0.152 + left lung (X1) × (Y1) × (Z1) × 0.167]. Pulmonary volume by 3DUS was obtained using the virtual organ computer-aided analysis (VOCAL) method with a 30° (VOL30), 18° (VOL18) and 12° (VOL12) rotation. A fast sequence of transverse lung section was also obtained by MRI. The intraclass correlation coefficient was used to evaluate the correlation between the three methods. The paired student t-test was used to compare the means. Results. There was a strong correlation between the three methods, and the highest correlations were between MRI and VOL18 for the right (ICC = 0.913) and left (ICC = 0.947) lungs. A strong correlation was also found between the lung volumes obtained through MRI and VOL12 as well as VOL18 (p = 0.544 and 0.286, respectively). However, for the left lung there was only a correlation between MRI and VOL12 (p = 0.49). Conclusions. There is a good concordance between 3DUS (VOL12) and MRI in the evaluation of lung volume in fetuses with UTM.