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Performance of Fetal Cardiac Volume Derived from VOCAL (Virtual Organ Computer-Aided AnaLysis) in Predicting
Keooudone Thammavong1, Suchaya Luewan1, Theera Tongsong1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Insights
Fetal cardiac volume (CV) effectively detects Hb Bart's disease in at-risk fetuses. This method shows high performance, outperforming middle cerebral artery peak systolic velocity (MCA-PSV) and comparable to cardiothoracic diameter ratio (CTR).
Area of Science:
- Perinatology
- Fetal Medicine
- Diagnostic Imaging
Background:
- Hemoglobin Bart's disease is a severe anemia affecting fetuses.
- Early detection is crucial for management and intervention.
- Existing diagnostic methods have limitations in accuracy and timing.
Purpose of the Study:
- To evaluate fetal cardiac volume (CV) for detecting Hb Bart's disease.
- To compare CV performance with cardiothoracic diameter ratio (CTR) and MCA-PSV.
- To assess diagnostic accuracy at 18-22 weeks gestation.
Main Methods:
- Prospective echocardiography using 4D-cardiac STIC in fetuses at risk.
- Offline analysis of fetal heart volume datasets using VOCAL technique.
- Blind measurement of CV, CTR, and MCA-PSV for comparison.
Main Results:
- 502 fetuses analyzed; 117 with Hb Bart's disease.
- CV achieved 94.9% sensitivity and 94.0% specificity.
- Area under the curve for CV was 0.988, superior to MCA-PSV (0.862) and comparable to CTR (0.974).
Conclusions:
- Fetal CV is a highly effective predictor of Hb Bart's disease in mid-pregnancy.
- CV performance is superior to MCA-PSV and comparable to CTR.
- This technique offers a valuable tool for early diagnosis in at-risk pregnancies.
Objective:
To determine the performance of fetal cardiac volume (CV) in the detection of fetal Hb Bart's disease among fetuses at risk at 18-22 weeks of gestation and to compare the performance with those of cardiothoracic diameter ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV).
Methods:
Fetuses at risk of Hb Bart's disease between 18 and 22 weeks of gestation prospectively underwent echocardiography with acquisition of the volume datasets (VDS) of fetal heart, using 4D-cardiac STIC. Subsequently, off-line analysis was blindly performed to measure cardiac volume using the VOCAL technique.
Results:
A total of 502 fetuses at risk meeting the inclusion criteria were included in the analysis, consisting of 117 (23.3%) fetuses with Hb Bart's disease and 385 (76.7%) unaffected fetuses. The mean (±SD) gestational age at the time of ultrasound examination was 19.70 ± 1.3 weeks. In predicting fetal Hb Bart's disease, CV, using a cut-off Z-score of 1.7, had a sensitivity of 94.9% and specificity of 94.0%. The performance of CV was slightly better than that of CTR but very superior to that of MCA-PSV (areas under curve: 0.988, 0.974 and 0.862, respectively).
Conclusions:
Fetal CV has a very high performance in predicting fetal Hb Bart's disease at mid-pregnancy, comparable with CTR and much better than MCA-PSV.
