ABSTRACT
Objective:To explore the feasibility and accuracy of three-dimensional (3D) modeling methods based on ultrasound imaging data for normal and abnormal fetal cardiac structures, and to construct a methodology system for 3D printing of fetal heart based on ultrasound.Methods:A total of 93 fetuses examined in Tangdu Hospital of Air Force Military Medical University from January to December 2019 were selected. Fetal echocardiography was obtained using spatio-temporal image correlation (STIC). Ninety-three hearts were 3D modeled by blood flow modeling, blood pool modeling and cavity modeling, and printed by stereolithography technique. The data measured on the 3D digital models and 3D printed solid models were compared with the corresponding fetal echocardiographic images respectively in order to evaluate the accuracy of the modeling methods.Results:The fetal cardiac blood flow models based on Doppler flow image data showed the malformation and trend of small blood vessels. The fetal cardiac structure models printed based on blood pool modeling displayed the malformation of heart and large blood vessels. Models printed based on cavity modeling method accurately displayed valve and structural defects.For 83 normal fetal hearts, the long diameters of left and right ventricles measured on echocardiography [(15.3±1.9)mm, (13.2±1.9)mm] were compared with those measured on digital models [(15.1±1.9)mm, (12.9±1.9)mm] and 3D printed models[(15.1±1.9)mm, (13.0±1.9)mm], respectively, and there were no significant differences between any two groups of them ( P>0.05). Bland-Altman showed good consistency for all measurements within and between operators. Conclusions:The three modeling methods, including blood flow modeling, blood pool modeling and cavity modeling, have their own advantages in displaying different types of fetal heart malformations. Appropriate modeling methods should be selected for 3D modeling and printing to make up for the limitations of single modeling method. The consistency between measurements on 3D models and those on echocardiography is high, and the repeatability between operators is good.
ABSTRACT
Objective To summarize the characteristics of two‐dimensional ( 2D ) ultrasound , spatiotemporal imaging correlation ( ST IC ) and vascular casting of fetal inferior vena cava ( IVC ) malformations ,analyze the clinical characteristics and the prognosis of fetal IVC malformations ,and explore the early diagnostic value of fetal echocardiography for fetal IVC malformations . Methods Sixty‐one cases of fetal IVC malformation diagnosed by fetal echocardiography in Beijing Anzhen Hospital M aternal Fetal M edical Consultation Center were retrospectively analyzed . T he clinical data ,echocardiographic features , genetic testing information and prognosis were summarized . Results ① In the 61 cases of IVC malformation ,there were 51 cases of absence of IVC ,46 cases of absence of liver segment ,5 cases of absence of left IVC hepatic segment ,9 cases of left IVC ( including 5 cases of left IVC and absence of IVC hepatic segment) ,5 cases of double IVC ,and 1 case of right hepatic vein reflux . ② Ten fetuses of the 61 fetuses were simple IVC deformity without any other malformations . O ther venous malformations included 7 cases of absence of right superior vena cava and persistent left superior venacava , 2 cases of absence of venous catheters ,and 3 cases of persistent right umbilical vein ,2 cases were merged alone ; 49 cases were merged with intracardiac structural malformations and arrhythmia . ③ T hirty‐eight pregnant women underwent Down′s screening or non‐invasive DNA ,all of which were at low risk .Four cases underwent amniocentesis , and no obviously abnormality was found . Sixteen cases underwent autopsy and genome sequencing after induced labor , one was single gene abnormalities ( ZFPM 2 classical mutation ) . ④ STIC images were collected in 20 cases ,and 19 cases were clearly visualized . ⑤Vascular cast was made to show the shape of blood vessel more clearly and stereoscopically in 4 cases of absent hepatic segment of IVC . ⑥Eleven fetuses were born and confirmed from the results of postnatal ultrasound ,w ho were healthy in follow‐up ; 16 fetuses were induced labor ; 33 fetuses were losed during follow‐up ; 1 fetus died after birth ( arrhythmia ) . Conclusions Fetal echocardiography combined with STIC technology can clearly diagnose the anomalies of IVC . Vascular casting can provide stereoscopic and visual manifestations of the anomalies of IVC . The prognosis of simple anomalies of IVC is good .