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Prenatal screening for congenital heart disease using real-time three-dimensional echocardiography and a novel 'sweep
M Sklansky1, D Miller, G Devore
1University of Southern California, Keck School of Medicine, Los Angeles, CA, USA. msklansky@chla.usc.edu
Insights
Real-time three-dimensional echocardiography (RT3DE) shows promise for screening congenital heart disease (CHD) in fetuses, offering high sensitivity but requiring artifact reduction and improved resolution for clinical use.
Area of Science:
- Medical imaging
- Cardiology
- Prenatal diagnostics
Background:
- Conventional prenatal screening for congenital heart disease (CHD) is operator-dependent and time-consuming.
- Real-time three-dimensional echocardiography (RT3DE) offers rapid acquisition of the entire fetal heart.
- RT3DE may streamline fetal cardiac screening.
Purpose of the Study:
- To evaluate the potential of RT3DE as a screening tool for fetal CHD.
- To assess the sensitivity and specificity of RT3DE in detecting fetal CHD.
- To identify limitations of RT3DE for prenatal cardiac assessment.
Main Methods:
- Four experienced reviewers independently evaluated cardiac volumes from 18 fetuses (11 normal, 7 with CHD).
- Two-dimensional echocardiography was used as the gold standard.
- A 'sweep volume' technique was employed for RT3DE acquisition (2-6 seconds per volume).
Main Results:
- RT3DE demonstrated high sensitivity (93%) for detecting CHD.
- Specificity for CHD detection was low (45%), with frequent 'cannot determine' responses.
- False positive artifacts were noted, impacting specificity.
Conclusions:
- RT3DE shows potential as a screening tool for fetal heart disease.
- Minimizing artifacts and improving resolution are crucial for clinical application.
- Significant training is required before widespread adoption of RT3DE for fetal cardiac screening.
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.
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