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Updated: Jun 7, 2026
Murine Fetal Echocardiography
Published on: February 15, 2013
Collaborative study on 4-dimensional echocardiography for the diagnosis of fetal heart defects: the COFEHD study
Jimmy Espinoza1, Wesley Lee, Christine Comstock
1Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, 3601 W Thirteen Mile Road, Royal Oak, MI 48073 USA. jimmy.espinoza@beaumont.edu
Insights
Four-dimensional ultrasonography (4DUS) accurately diagnoses congenital heart defects (CHDs) in fetuses. This advanced imaging technique shows excellent agreement among expert centers for reliable fetal echocardiography.
Area of Science:
- Medical imaging
- Fetal medicine
- Cardiology
Background:
- Congenital anomalies are a leading cause of infant mortality.
- Congenital heart defects (CHDs) are the most common birth defects.
- 4-dimensional ultrasonography with spatiotemporal image correlation (4DUS-STIC) is a novel technique for fetal echocardiography.
Purpose of the Study:
- To evaluate the diagnostic accuracy of 4DUS for CHDs.
- To assess intercenter agreement in interpreting 4DUS data for fetal echocardiography.
Main Methods:
- Multi-center study involving 7 expert centers in 4D fetal echocardiography.
- Acquisition of fetal ultrasound volume datasets between 18-26 weeks gestation.
- Remote analysis of anonymized datasets using κ statistic for interrater reliability.
Main Results:
- High diagnostic performance for CHDs: sensitivity 93%, specificity 96%.
- Excellent positive predictive value (96%) and negative predictive value (93%).
- Exceptional intercenter agreement (κ = 0.97), indicating reliable interpretation across sites.
Conclusions:
- 4DUS enables accurate remote acquisition and interpretation of fetal echocardiography data.
- 4DUS is a reliable and accurate method for diagnosing fetal heart defects among experienced centers.
Objective:
Congenital anomalies are the leading cause of infant mortality in the United States, and congenital heart defects (CHDs) are the most common type of birth defects. Recently, 4-dimensional ultrasonography (4DUS) with spatiotemporal image correlation (STIC) has been introduced for fetal echocardiography. Accumulating evidence indicates that 4DUS with STIC may facilitate the examination of the fetal heart. Our objectives were to determine the accuracy of 4DUS for the diagnosis of CHDs and the agreement among centers.
Methods:
This study included 7 centers with expertise in 4D fetal echocardiography. Fetuses with and without confirmed heart defects were scanned between 18 and 26 weeks, and their volume data sets were uploaded onto a centralized file transfer protocol server. Intercenter agreement was determined using a κ statistic for multiple raters.
Results:
Ninety volume data sets were randomly selected for blinded analysis. Overall, the median (range) sensitivity, specificity, positive and negative predictive values, and false-positive and -negative rates for the identification of fetuses with CHDs were 93% (77%-100%), 96% (84%-100%), 96% (83%-100%), 93% (79%-100%), 4.8% (2.7%-25%), and 6.8% (5%-22%), respectively. The most frequent CHDs were conotruncal anomalies (36%). There was excellent intercenter agreement (κ = 0.97).
Conclusions:
(1) Four-dimensional volume data sets can be remotely acquired and accurately interpreted by different centers. (2) Among centers with technical expertise, 4DUS is an accurate and reliable method for fetal echocardiography.
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