Electronic spatiotemporal image correlation improves four‐dimensional fetal echocardiography

Guasina, Francesca; Bellussi, Federica; Morganelli, G.; Salsi, G.; Pilu, Gianluigi; Simonazzi, Giuliana

doi:10.1002/uog.17474

Cited by 19 publications

(23 citation statements)

References 16 publications

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“…It also represents a promising research tool, allowing for fetal heart volumetry [7], biometry [8] and assessment of systolic ventricular function [9,10], while it enhances fetal echocardiography teaching [11] and morphological interpretation especially when assisted by designated software applications [12,13]. Recent modification of electronic probes to enable electronic STIC (eSTIC) may address the current limitations due to faster acquisition [1,14] The main aim of this study is to compare the feasibility of acquisition and diagnostic concordance in fetal heart volumes obtained consecutively using STIC and eSTIC during routine obstetric sonography. Secondary aims include the impact of imaging mode (2 D, color Doppler) and of gestational age (early, mid-, late gestation) on the performance of each STIC approach.…”

Section: Introductionmentioning

confidence: 99%

Electronic versus conventional spatiotemporal image correlation (STIC) fetal echocardiography: a direct comparison

Pepes

Parthenakis

Makrigiannakis

et al. 2020

The Journal of Maternal-Fetal & Neonatal Medicine

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Objectives: Recent advances in Spatial Temporal Image Correlation (STIC) 4 D fetal echocardiography include the application of eSTIC based on electronic probe image acquisition. We aimed to directly compare the performance of conventional STIC versus eSTIC technique (B-Mode and color Doppler imaging) during off-line reconstruction of STIC/eSTIC fetal heart volume pairs. Methods: Pairs of B-Mode and Color Doppler STIC volumes were acquired sequentially by firstly conventional (STIC) followed by electronic (eSTIC) probes during 33 consecutive obstetric scans at median 23 (range 13-31) gestational weeks. The resulting 66 fetal heart volume pairs were assessed blindly off-line by a fetal cardiologist who documented feasibility of reconstruction, presence of motion artifacts, subjective image quality on a 4-level scale: 1-best to 4-non-diagnostic and morphological diagnosis, to enable a paired comparison of STIC and eSTIC in the same fetus under similar scanning conditions. Results: eSTIC volumes had higher temporal resolution (37 vs. 24 frames per second, p < .001), less motion during acquisition (12 vs. 20 cases, O.R. 7.0, p ¼ .002) and better average image quality (1.9 vs. 2.2, p ¼ .006) compared to STIC volumes. More diagnostic reconstructions were achieved by eSTIC (n ¼ 55, 86%) than STIC (n ¼ 52, 78.8%), p ¼ .001), in a comparable analysis time (mean 4.96 vs. 4.94 min). During a comparison of image quality of the original acquisition (A) and reconstructed planes (B and C planes) e STIC was superior in 22 (33%), 39 (59%) and 21 (38%) volumes, respectively, with the remaining cases being of similar quality (<10% in each plane in favor of STIC). Imaging mode and gestational age had a similar impact on both eSTIC and STIC performance: diagnostically acceptable studies in 49 (75.8%) vs. 48 (72.2%) by B-Mode, 60 (90.9%) vs. 56 (84.8%) by Color Doppler Mode, 8 (62.5%) vs. 10 (50%) in early scans, 38 (95%) vs. 38 (95%) in mid-gestation scans, and 7 (70%) vs. 6 (60%) in third trimester scans. Eight obstetric scans identified a fetus with a cardiac variant or structural abnormality. Diagnostic concordance of the two STIC approaches was comparable (40/48 concordant interpretations, kappa 0.657) all confirmed by fetal and/or postnatal echocardiography. Conclusions: eSTIC was associated with more effective 4 D fetal heart reconstruction due to reduced motion artifacts and superior image quality in all planes, when compared to STIC. Early gestation reconstructions were not generally successful using either technology. Further study is needed to define the cost-effectiveness and diagnostic impact of eSTIC over conventional STIC and their role over, or in addition to, screening 2 D fetal echocardiography by appropriately trained sonographers.

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Section: Introductionmentioning

confidence: 99%

Electronic versus conventional spatiotemporal image correlation (STIC) fetal echocardiography: a direct comparison

Pepes

Parthenakis

Makrigiannakis

et al. 2020

The Journal of Maternal-Fetal & Neonatal Medicine

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“…The standardized acquisition plane was the four-chamber view, preferably the apical four-chamber view. The acquisition time was 2–3 s [9], and acquisition angles ranged from 15 to 40°, mainly depending on the fetal heart size. Maternal and fetal movements were avoided when possible.…”

Section: Methodsmentioning

confidence: 99%

“…The volume datasets were analyzed by a single experienced observer (Y.K.M. ), according to instructions described previously [9]. Dynamic images of the fetal heart were simultaneously displayed in the three orthogonal planes on panels A, B, and C. Adjustments were performed by moving the reference point and rotating the fetal heart around the three orthogonal axes ( x , y , and z ) to get the perfect plane of the four-chamber view, which lies just below the aortic outflow tract [14].…”

Section: Methodsmentioning

confidence: 99%

“…Four-dimensional spatiotemporal image correlation (4D-STIC) allowed volume datasets to be maneuvered in all axes to get the proper plane [8], so that the measurements can be more accurate. With the recently introduced electronic 4D probe, the acquisition process has become much faster [9]. Another important concern is that one cannot precisely quantify the measurements that fall outside the extreme centile range, since the standard deviation (SD) does not change smoothly with advancing GA [10].…”

Section: Introductionmentioning

confidence: 99%

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<b><i>Z</i></b>-Score Reference Ranges for the Offset of the Tricuspid Septal Leaflet in Normal Fetuses

et al. 2018

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Objectives: To determine Z-score equations and reference ranges for mitral valve-tricuspid valve distance (MTD) and the MTD index in the fetal heart. Methods: A prospective cross-sectional study was performed in 899 normal singleton fetuses from 14 to 40 weeks’ gestation. The MTD and interventricular septum length (IVSL) were measured offline after electronic cardiac spatiotemporal image correlation volume acquisition. The MTD index was determined as the ratio of MTD to IVSL. Z-score reference ranges of these measurements were determined against gestational age (GA) and estimated fetal weight (EFW), using regression analysis of the mean and standard deviation (SD). Results: Strong positive correlations were found between the MTD and the independent variables. A simple linear regression model was the best description of the mean and SD of MTD based on GA, while a cubic regression best fitted the mean MTD against EFW. In contrast, the MTD index decreased progressively with the independent variables. Fractional polynomials best fitted the MTD index in terms of GA and EFW. Conclusion: Normal reference values and Z-scores of fetal MTD and MTD index were provided against GA and EFW, which may be useful tools for quantitative assessment of some cardiac and extracardiac diseases.

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“…Two-dimensional ultrasonography is commonly applied in the screening of fetal cardiac malformation and chromosomal abnormalities, but it has defect due to the limitation that its planar image can only display one side of the fetus and can only detect limited indexes (10,11). Compared with conventional Diagnostic value of four-dimensional ultrasonography with STIC combined with two-dimensional ultrasonography for fetal cardiac malformation and chromosomal abnormalities in early pregnancy two-dimensional ultrasonography diagnosis, four-dimensional ultrasonography with spatio-temporal image correlation (STIC) technology can offer a more comprehensive and intuitive observation of the fetal heart dynamically or statically (12). Although the current four-dimensional ultrasonography with STIC technique has been reported in some studies on the diagnosis of fetal cardiac malformation, few studies have explored its application in chromosome screening.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of four-dimensional ultrasonography with STIC combined with two-dimensional ultrasonography for fetal cardiac malformation and chromosomal abnormalities in early pregnancy

P’eng

et al. 2019

Exp Ther Med

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Diagnostic value of four-dimensional ultrasonography with spatio-temporal image correlation (STIC) technique combined with two-dimensional ultrasonography for fetal cardiac malformation and chromosomal abnormalities in early pregnancy was investigated. Medical data of 178 pregnant women enrolled in Tianjin Central Hospital of Gynecology and Obstetrics for screening of fetal cardiac malformations and chromosomal abnormalities from January 2014 to March 2016 were collected. According to the results of the pregnant women's biopsy and the results of labor induction and delivery, 95 fetuses were diagnosed with chromosomal abnormalities and cardiac malformations, 40 fetuses with cardiac malformations and no chromosomal abnormalities, and 43 fetuses with neither cardiac malformations nor chromosomal abnormalities. Fetal cardiac malformations and chromosomal abnormalities were diagnosed by three methods: single two-dimensional ultrasonography, single four-dimensional ultrasonography with STIC, and a combination of two-dimensional ultrasonography and four-dimensional ultrasonography with STIC. The two-dimensional ultrasonography diagnosed 97 cases of fetal cardiac malformation and 61 cases of chromosomal abnormalities, four-dimensional ultrasonography with STIC diagnosed 122 cases of fetal cardiac malformation and 81 cases of chromosomal abnormalities. The combination of two-dimensional ultrasonography and four-dimensional ultrasonography diagnosed 130 cases of fetal cardiac malformation and 90 cases of chromosomal abnormalities. The sensitivities of fourdimensional ultrasonography with STIC and the combination of two-dimensional ultrasonography and four-dimensional ultrasonography were significantly higher than that of single examination by two-dimensional ultrasonography (P<0.05), while the diagnostic sensitivities by four-dimensional ultrasonography with STIC and the combined diagnosis were not statistically significant (P>0.05). The diagnostic accordance rates of the single four-dimensional ultrasonography and the combined diagnosis for fetal cardiac malformations and chromosomal abnormalities were not much different (P>0.05), but both were greatly higher than that of single two-dimensional ultrasonography diagnosis (P<0.05). Thus, a combination of four-dimensional ultrasonography with STIC and twodimensional ultrasonography is recommended for screening fetal defects.

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Electronic spatiotemporal image correlation improves four‐dimensional fetal echocardiography

Cited by 19 publications

References 16 publications

Electronic versus conventional spatiotemporal image correlation (STIC) fetal echocardiography: a direct comparison

Electronic versus conventional spatiotemporal image correlation (STIC) fetal echocardiography: a direct comparison

<b><i>Z</i></b>-Score Reference Ranges for the Offset of the Tricuspid Septal Leaflet in Normal Fetuses

Diagnostic value of four-dimensional ultrasonography with STIC combined with two-dimensional ultrasonography for fetal cardiac malformation and chromosomal abnormalities in early pregnancy

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