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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.
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Objective To explore the potential of spatio-temporal image correlation (STIC) and tissue Doppler imaging (TDI) in observation on fetal cardiac structure and function in pregnant women with gestational diabetes mellitus (GDM). Methods Totally 140 GDM pregnancies (40 in the insulin treatment group, 62 in the diet control group, 38 in the glycemic uncontrolled group) and 211 normal pregnancies (control group) were enrolled. STIC with M-mode display (STIC-M) was used to measure the thicknesses of fetal ventricular wall and interventricular septum at the end of diastole and systole. TDI ultrasound was used to measure fetal atrioventricular annular velocity in early diastole (Ea), during atrial contraction (Aa), and in systole (Sa), and to calculate the Ea/Aa ratios. The parameters were compared among the 4 groups. Results The overall differences of thickness of the left and right ventricular wall and interventricular septum at the end of diastole and systole were statistically significant among the 4 groups (all P0.05). The overall differences of mitral annular Ea/Aa among the 4 groups were statistically significant (P=0.002), and those in all GDM pregnancy groups were lower than in control group (all P0.05). The differences in tricuspid annular Ea/Aa, mitral and tricuspid annular Sa were not statistically significant among 4 groups (all P>0.05). Conclusion The fetal ventricular wall and interventricular septum thicknesses are increased, cardiac diastolic function is decreased in GDM pregnancy independent of glycemic control condition. Combination of STIC-M and TDI has certain value to observe fetal cardiac structure and function in GDM pregnancy.
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Objective To evaluate the effectiveness of spatio-temporal image correlation with M-mode display ( STIC-M ) in monitoring fetal left ventricular systolic function in fetuses with congenital heart disease(CHD) . Methods Five hundred and thirty-six normal fetuses and 34 fetuses with CHD( 29 without hydrops and 5 with hydrops) were involved in the study . Left ventricular fractional shortening ( LVFS) was measured using STIC-M . The data of normal fetuses was used to construct reference ranges of LVFS for assessment of fetuses with CHD . Results The LVFS of the normal fetuses [ range :26 .8％ - 42 .9％ , mean :( 34 .9 ± 4 .1) ％ ] was negatively correlated with gestational age ( r = - 0 .16 , P < 0 .001) . Compared with the normal controls ,LVFS was significantly decreased in CHD fetuses with hydrops ( P < 0 .001) . However ,there was no significant difference in LVFS between normal controls and CHD fetuses without hydrops ( P > 0 .05) . Conclusions STIC-M is a new method that can be used to measure LVFS to evaluate fetal ventricular systolic function . The fetal ventricular contractile function of CHD fetuses without hydrops may not be damaged or is in compensation stage . The fetuses with cardiac hydrops generally become lower .
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Objective To evaluate the diagnostic accuracy and integrity of two-dimension ultrasound (2DUS)assisted with spatio-temporal image correlation (STIC)for cardiac and vascular abnormalities in fetal heterotaxy syndrome (HS).Methods The retrospective study was conducted from Nov 2007 to Feb 2013.Forty-five fetuses with suspected heterotaxy syndrome on routine prenatal ultrasonic screening underwent STIC volume sweep.The diagnosis was confirmed by pathological or echocardiographic examination.STIC volume data sets of fetal hearts were off-line analyzed blindly by one doctor who had practiced fetal echocardiography for more than five years.The concordance and integrity levels of diagnosis with 2DUS or assisted with STIC were compared according with pathological results.Results There were 397 cardiac and vascular defects in 37 cases of right isomerism.The overall concordance of various defects in right isomerism diagnosed assisted with STIC (96.5%)was significantly higher than that of 2DUS (60.2%) (P 0.05).There was no significant difference in concordance rates of various defects of left isomerism diagnosed between two methods,except that the concordance rate of left atria isomerism diagnosed assisted with STIC was higher(P <0.05).There was no difference in percentages of diagnostic integrity levels (0-3)in left isomerism between two methods.Conclusions STIC technology may provide considerable diagnostic information for ultrasonic diagnosis of fetal heterotaxy syndrome,especially in abnormalities of atria and ventricle isomerism,ventriculo-arterial junction,arterial arches,systematic and pulmonary veins in right isomerism.
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Objective To preliminary investigate fetal left heart function of fetuses in α-thalassemia using spatio-temporal image correlation (STIC).Methods 95 volumes from fetal hearts in singleton pregnancies at 20-28 weeks of gestation were collected.STIC datasets were frozen in end-systole and enddiastole.Ventricular volumes were measured using VOCAL,Inversion and SonoAVC.The stroke volume was calculated from these measurements.Results All data sets could be measured with all three techniques in this study.The intraclass correlation coefficients (ICCs) between techniques were all ＞ 0.90.The time necessary to measure the stroke volume was significantly shorter using SonoAVC than using VOCAL and Inversion.Bland-Altman plots showed no clinically significant mean percent differences between stroke volume measurements obtained from each ventricle using three techniques.The left ventricular end-systole volume(ESV),stroke volume(SV)and ejection fraction(EF)was significantly different than fetuses with normal heart (P ＜ 0.05).Conclusions This study shows the feasibility of measuring left ventricular volumes during either systole or diastole and thereby calculating stroke volumes with all three techniques.And there was a high degree of reliability for all three techniques,as shown by excellent ICCs.There was good accuracy of STIC techniques in measuring fetal left ventricular volumes with cardiomegaly.
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Objective To establish z-score model for fetal aorta (Ao) and pulmonary artery (PA) dimensions base on fetal femur length (FL),then to evaluate them in prenatal diagnosis of tetralogy of Fallot (TOF).Methods Three hundred twenty-nine normal fetuses and 43 fetuses with TOF were involved,Ao and PA dimensions were measured for all cases offline after cardio-spatiotemporal image correlation (STIC) volume acquisition,and PA to Ao ratio (PA/Ao) was calculated.Normal Ao and PA dimensions z-score models were constructed by using first standard regression analysis using FL as independent variable.Subsequently,the three parameters between normal and TOF fetuses were compared.Results The models use to calculate z-score for Ao and PA dimensions were constructed,FL had close correlation with fetal Ao and PA dimensions.Compared with normal fetuses,the mean z-scores of Ao,PA and PA/Ao ratio were statistical different in TOF fetuses.All Ao z-scores were ＞ + 2 z-scores and all the PA/Ao ratio were ＜ the 95％ CI in TOF group,however,only 48.84％ (21/43) PA z-scores of TOF cases were ＜-2 z-scores.Conclusions The Ao and PA dimensions z-score can provide quantitative evidence in prenatal diagnosis of TOF.Aortic dilatation and abnormal PA/Ao ratio are the main performances in fetal TOF and would be markers for prenatal diagnosis of TOF.
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Objective To explore the application value of two-dimensional echocardiography with spatio-temporal im-age correlation (STIC) in fetal congenital heart disease (CHD) prenatal ultrasonography. Methods 11 036 hearts of fetus were inspected by severalviews order scanning method and for STIC volume database acquisition and off-line a-nalysis congenital heart disease fetus for autopsy after induced labor or contrast the follow-up results after birth. Re-sults 97 cases with spatio-temp-oral image correlation in 176 cases congenital heart and great vessels exception (dysrhythmias not including) with simple two-dimensional echocardiography,92 cases were accordant (one case with incorporative intracardiac malformation missed diagnosis);in screened congenital heart disease fetus,STIC (n=79) and routine ultrasonography (n=87) took (7.76±2.42) min and (9.68±2.13) min per case,respectively;in dif-ferent gestational weeks,the quality of the images derived from volume datasets were comparable to that directly ob-tained from 2D echocardiography. Conclusion STIC technology can be used as effective supplementary means of 2D echocardiography, and the combination can further improve the prenatal diagnosis of fetal congenital heart disease.
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Objective To investigate the evaluation value of spatiotemporal image correlation (STIC) on fetal cardiac systolic function .Methods The fetal cardiac cycle images were collected by the four-dimensional(4D) STIC ultrasound technique in 160 normal singleton pregnancies .The virtual organ computer-aided analysis(VOCAL) technique was used to measure the ventricular end-systolic volume (VESV) and ventricular end -diastolic volumes(VEDV) .The stroke volume(SV) ,ejection fraction(EF) and cardiac output(CO) were calculated .Results VESV ,VEDV together with SV and CO in normal pregnancy were increased with gestation week increase .EF remained constant with advancing gestational week .VESV ,VEDV ,SV ,CO and EF of right ventricle were all larger than those of the left ventricle .Conclusion The fetal cardiac systolic function in normal pregnancy is increased with gestational age increase ,the right heart systolic function is superior to the left heart .
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Objective To explore the clinical application of spatio -temporal image correlation combined with multiplanar mode (STIC-MP) in the routine scanning of normal fetal heart ,and to provide evidence for the application of STIC in the routine scanning of fetal heart in second trimester .Methods One hundred pregnant women at 20-27 weeks′gestation were enrolled.The routine five views of normal fetal heart were examined and recorded by two-dimensional ultrasound,and the volume datasets were acquired with STIC.The time of picture storing and the fetal cardiac structures were recorded respectively .The quality of pictures obtained by both methods were compared by the scoring system .The imaging method of STIC-MP was explored and analyzed.Results Satisfactory gray-scale volume acquisitions were accomplished in all 100 cases.The quality of the four views(four chamber view,left outflow tract,right outflow tract,three vessel-trachea views) derived from volume datasets were comparable to that directly obtained from two-dimensional scanning.No significant difference of visualization rate ( χ2 =3.030,0.337,2.010,0.000,all P>0.05)was found between the STIC-MP(100/100,98/100,98/100,95/99 as 100.0%,98.0%,98.0%,96.0%)and two-dimensional(97/100,99/100,100/100,95/98 as 97.0%,99.0%,100.0%,96.9%).However,the difference of visualization rate was found in the stomach transverse view ( χ2 =9.776,P=0.001).The mean time for the examination and picture saving of fetal cardiac structures by STIC ,mean acquisition time was (1.17 ±0.52) min,which was much shorter than that by two-dimensional scanning (4.20 ±1.35) min (t=0.38,P<0.05).The mean time for obtaining the routine five views of fetal heart and analyzing by STIC and MP were (6.75 ±1.51) min,(1.35 ±0.30)min respectively,which was longer than (4.20 ±1.35)min and (0.83 ±0.22)min by two-dimensional ultrasound(t=11.75,11.75,both P=0.00).Conclusions STIC-MP simplifies the picture-gathering process,decreases the ultrasound exposure upon fetal heart obviously .No significant difference was found between the quality of the five views obtained from STIC-MP and two-dimensional ultrasound.The views of STIC-MP can satisfied the routine scanning of fetal heart ,although the interpretation time of STIC-MP was longer compared with two-dimensional ultrasound.There will be vital significance on the use of STIC in clinical application .
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Objective To discuss the optimal imaging conditions of spatio-temporal image correlatin (STIC). Methods Conventional 2D fetal echocardiography and 3D STIC volume collection were performed in 130 fetuses. The images obtained using two methods were scored and compared. Results Complete 3D volume collection with the initial view of four chamber view were abtained in 121 fetuses, the successful rate was 93.13%. There was no significant differences in total score between the two methods. Significant difference was found between the score of different condition groups.The highest scores mostly appeared in lateral four chamber heart in both method groups. The highest scores mostly appeared in 25-29 gestational weeks with 2D ultrasound, while 20-24 gestational weeks with 3D ultrasound, scores in long axis views of vessels were statistically different. Conclusion STIC has advantages over conventional ultrasonography, but needs conditions control and analysis skills.
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Objective To evaluate the value of spatio-temporal, image correlation (STIC) in prenatal diagnosis of complex heart malformations.Methods STIC was used to examine 25 fetuses with 20-30 weeks of gestation who were doubted with complex heart malformations prospectively by two-dimensional (2D) echocardiography.Dynamic three-dimensional imaging was achieved by postprocessing technique with STIC across the entire fetal heart and thorax.An offline analysis of the acquired volume was carried out to examine the fetal cardiac anatomy with multiplanar mode, surface rendering and minimum mode.The results of prenatal diagnosiswere compared with postnatal color Doppler and surgical findings.Results Successful STIC volume datasets were obtained in all 25 fetuses.The findings of all 25 fetus with complex heart malformations included double outlet of right ventricle in 1 case, truncus arteriosus in 1 case, complete transposition of the great arteries in 3 cases,corrected transposition of the great arteries in 1 case, complete endocardial cushion defect in 4 cases, hypoplastic right ventricle syndrome in 1 case, hypoplastic left heart syndrome in 2 cases, tricuspid atresia in 1 case,pulmonary atresia in 1 case, tetralogy of Fallot in 3 cases, single atrium in 1 case, single atrium and single ventrium in 4 cases,in 1 case, atrial septal defect and ventricular septal defect with coronary sinus dilatation in 1 case.The major diagnoses derived from STIC in 23 of 25 cases were consistent with the results of postnatal color Doppler and surgical findings.Conclusions STIC can provide more accurate information of structures of complex fetal heart malformations and has great value in pregnant prognosis.
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Objective To assess the value of tomographic ultrasound imaging (TUI) for prenatal analysis of the relative orientation of fetal heart and great arteries. Methods Volume datasets acquired from 12 patients of transposition of the great arteries (TGA) and 13 normal fetal heart were evaluated offline with TUI. The aortic valves (AV) and pulmonary valves (PV) were respectively showed on the two parallel slices. According to the pivot point in the middle of the PV in one slice, the relative orientation of the AV on another slices were analyzed. Results In the 12 patients of TGA confirmed postnatally, 7 were concomitant with single ventricle anomaly, AV was on the anterior-right orientation of the PV in 5, and was relatively on the anterior and anterior-left orientation in other 2 of them.In the remained 5 with seeming normal 4 chamber view, AV was found on the anterior-right of the PV in 3, and was relatively on the anterior and upright orientation.in other 2 patients. In 13 normal fetuses, TUI showed that all AV located on the posterior-right orientation to the PV. Conclusion TUI can provide detailed spatial information of the great arteries both in normal and abnormal fetal heart. It may be a convenient and veracious tool for prenatal exploring the morphology of the great arteries.
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Objective To explore the basic method and clinical application of spatio-temporal image correlation (STIC) in the routine scanning of normal fetal heart. Methods Totally 120 volume datasets of normal fetal heart were acquired with 2D and STIC, respectively. The difference in time between the two methods were compared and the basic imaging method was explored and analyzed.Results Satisfactory gray-scale volume acquisitions were accomplished in all 120 cases. The quality of the images derived from volume datasets were comparable to that directly obtained from 2D echocardiography. No significant difference of visualization rate was found between the two methods (P>0.05). Some views that could not be showed with 2D were acquired with STIC. In fetal heart screening, STIC (n=104) and routine ultrasonography (n=85) took (4.47±2.32) min and (5.26±2.01) min per case, respectively.Conclusion STIC provides more views and information than 2D, simplifies the picture-gathering process, decreases the dependence of examiner, increases the efficiency, and decreases the exposure upon fetal heart obviously.
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Objective To investigate the value of combination of B-flow imaging and spatio-temporal image correlation in prenatal diagnosis of congenital heart diseases. Methods Volume images of 50 normal fetuses and 14 fetuses with congenital heart diseases were recruited in the study. Surface mode was used to reconstruct the volume images. Results Sixty-three and twenty-six qualified volume images were obtained in 50 normal fetuses and 14 fetuses with congenital heart diseases respectively. All volume images were reconstructed successfully and showed the spacial relationship of cardiac blood vessel directly. Conclusions The combination of B-flow imaging and spatio-temporal image correlation was feasible and useful in prenatal diagnosis of congenital heart diseases.