Evolution of Fetal Cardiac Imaging over the Last 20 Years.

The purpose of this article is to describe the evaluation of a variety of congenital heart diseases (CHDs) using three-dimensional (3D) ultrasound with different software, such as Cristal Vue, Realistic Vue, LumiFlow, and Spatiotemporal Image Correlation (STIC), with HDlive and HDlive Flow Silhouette modes. These technologies provide realistic images of the fetal heart and cardiac vessels using a fixed virtual light source that allows the operator to freely select a better light source position to enhance the cardiovascular anatomical details. In addition, Fetal Intelligent Navigation Echocardiography (FINE) technology, also known as "5D Heart" or "5D", is a technology that enables the automatic reconstruction of the nine standard fetal echocardiographic views and can alert non-specialists to suspected CHD. Through the use of artificial intelligence, an ultrasound machine is able to perform automatic anatomical and functional measurements. In addition, hese technologies enable the reconstruction of fetal cardiac structures in realistic images, improving the depth perception and resolution of anatomic cardiac details and blood vessels compared to those of standard two-dimensional (2D) ultrasound.

Semi-Automatic Measurement of Fetal Cardiac Axis in Fetuses with Congenital Heart Disease (CHD) with Fetal Intelligent Navigation Echocardiography (FINE).

Congenital heart disease (CHD) is one of the most common organ-specific birth defects and a major cause of infant morbidity and mortality. Despite ultrasound screening guidelines, the detection rate of CHD is limited. Fetal intelligent navigation echocardiography (FINE) has been introduced to extract reference planes and cardiac axis from cardiac spatiotemporal image correlation (STIC) volume datasets. This study analyses the cardiac axis in fetuses affected by CHD/thoracic masses (n = 545) compared to healthy fetuses (n = 1543) generated by FINE. After marking seven anatomical structures, the FINE software generated semi-automatically nine echocardiography standard planes and calculated the cardiac axis. Our study reveals that depending on the type of CHD, the cardiac axis varies. In approximately 86% (471 of 542 volumes) of our pathological cases, an abnormal cardiac axis (normal median = 40-45°) was detectable. Significant differences between the fetal axis of the normal heart versus CHD were detected in HLHS, pulmonary atresia, TOF (p-value < 0.0001), RAA, situs ambiguus (p-value = 0.0001-0.001) and absent pulmonary valve syndrome, DORV, thoracic masses (p-value = 0.001-0.01). This analysis confirms that in fetuses with CHD, the cardiac axis can significantly deviate from the normal range. FINE appears to be a valuable tool to identify cardiac defects.

Accuracy and safety of robotic navigation-assisted distraction osteogenesis for hemifacial microsomia.

Introduction: This study aimed to verify the accuracy and safety of distraction osteogenesis for hemifacial microsomia assisted by a robotic navigation system based on artificial intelligence. Methods: The small sample early-phase single-arm clinical study, available at http://www.chictr.org.cn/index.aspx, included children aged three years and older diagnosed with unilateral hemifacial microsomia (Pruzansky-Kaban type II). A preoperative design was performed, and an intelligent robotic navigation system assisted in the intraoperative osteotomy. The primary outcome was the accuracy of distraction osteogenesis, including the positional and angular errors of the osteotomy plane and the distractor, by comparing the preoperative design plan with the actual images one week postoperatively. Perioperative indicators, pain scales, satisfaction scales, and complications at one week were also analyzed. Results: Four cases (mean 6.5 years, 3 type IIa and 1 type IIb deformity) were included. According to the craniofacial images one week after surgery, the osteotomy plane positional error was 1.77 ± 0.12 mm, and the angular error was 8.94 ± 4.13°. The positional error of the distractor was 3.67 ± 0.23 mm, and the angular error was 8.13 ± 2.73°. Postoperative patient satisfaction was high, and no adverse events occurred. Discussion: The robotic navigation-assisted distraction osteogenesis in hemifacial microsomia is safe, and the operational precision meets clinical requirements. Its clinical application potential is to be further explored and validated.

Prenatal Diagnosis and Fetopsy Validation of Complete Atrioventricular Septal Defects Using the Fetal Intelligent Navigation Echocardiography Method.

(1) Background: Artificial Intelligence (AI) is a modern tool with numerous applications in the medical field. The case series reported here aimed to investigate the diagnostic performance of the fetal intelligent navigation echocardiography (FINE) method applied for the first time in the prenatal identification of atrioventricular septal defects (AVSD). This congenital heart disease (CHD) is associated with extracardiac anomalies and chromosomal abnormalities. Therefore, an early diagnosis is essential to advise parents and make adequate treatment decisions. (2) Methods: Four fetuses diagnosed with AVSD via two-dimensional (2D) ultrasound examination in the second trimester were enrolled. In all cases, the parents chose to terminate the pregnancy. Since the diagnosis of AVSD with 2D ultrasound may be missed, one or more four-dimensional (4D) spatiotemporal image correlation (STIC) volume datasets were obtained from a four-chamber view. The manual navigation enabled by the software is time-consuming and highly operator-dependent. (3) Results: FINE was applied to these volumes and nine standard fetal echocardiographic views were generated and optimized automatically, using the assistance of the virtual intelligent sonographer (VIS). Here, 100% of the four-chamber views, and after the VISA System application the five-chamber views, of the diagnostic plane showed the atrioventricular septal defect and a common AV valve. The autopsies of the fetuses confirmed the ultrasound results. (4) Conclusions: By applying intelligent navigation technology to the STIC volume datasets, 100% of the AVSD diagnoses were detected.

Improvement of diagnostic efficiency in fetal congenital heart disease using fetal intelligent navigation echocardiography by less-experienced operators.

OBJECTIVE: This study investigated the feasibility and accuracy of fetal intelligent navigation echocardiography (FINE) for the prenatal diagnosis of congenital heart disease (CHD) by inexperienced and experienced operators. METHOD: In this prospective study, all volume data sets from 120 fetuses with a broad spectrum of CHD were acquired using spatiotemporal image correlation technology. The prenatal diagnostic procedures were performed by two operators with different experience (beginner: 1 year and expert: 15 years) using FINE and traditional fetal echocardiography. Data were analyzed on the time of examination and acquisition of results. RESULTS: Diagnoses made by FINE and traditional echocardiography were completely consistent with the final diagnosis of CHD in 98 (81.66%) versus 20 (16.66%) (P < 0.001) beginners and 87.50% (n = 105) versus 101 (84.16%) experts, respectively. On the contrary, there was significant difference using traditional echocardiography (16.66% versus 84.16%, P < 0.001) by two examiners. Furthermore, the examination time decreased when using FINE compared with using traditional echocardiography (beginner operators: 4.54 ± 1.03 min versus 20.58 ± 3.36 min, P < 0.001; expert operators: 3.89 ± 0.96 min versus 12.73 ± 1.62 min, P < 0.001). CONCLUSION: Based on our results, a prenatal diagnosis of CHD can be made with high feasibility and accuracy using FINE compared with traditional fetal echocardiography for beginner operators.

Development and application of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology / 中华放射医学与防护杂志

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

The Sea Route Planning for Survey Vessel Intelligently Navigating to the Survey Lines.

Marine surveying is an important part of marine environment monitoring systems. In order to improve the accuracy of marine surveying and reduce investment in artificial stations, it is necessary to use high-precision GNSS for shipborne navigation measurements. The basic measurement is based on the survey lines that are already planned by surveyors. In response to the needs of survey vessels sailing to the survey line, a method framework for the shortest route planning is proposed. Then an intelligent navigation system for survey vessels is established, which can be applied to online navigation of survey vessels. The essence of the framework is that the vessel can travel along the shortest route to the designated survey line under the limitation of its own minimum turning radius. Comparison and analysis of experiments show that the framework achieves better optimization. The experimental results show that our proposed method can enable the vessel to sail along a shorter path and reach the starting point of the survey line at the specified angle.

A phantom study on the feasibility of recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology in Cyberknife Synchrony-based respiratory tracking / 中华放射医学与防护杂志

Objective:To explore the feasibility of recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology in the Cyberknife Synchrony-based respiratory tracking.Methods:CT scans of an inflatable pig lung after anti-rot processing were obtained. Then, eight simulated tumor lesion sites were designed in the left and right lung lobes using intelligent navigation software, with four classified as the sputum bronchial environment group and four classified as the wet bronchial environment group. Based on the implantation principle of Cyberknife fiducial markers, 32 recoverable fiducial markers were implanted around various simulated tumor lesions via bronchus under intelligent guidance. Then, the end-expiratory state of the pig lung was simulated, the pig lung was scanned again to obtain CT images of the implanted recoverable fiducial markers, and the number of successfully implanted fiducial markers was recorded. Eight deliverable Synchrony treatment protocols were designed using the Cyberknife planning system (Multiplan v4.6), and then the pig lung with simulated respiratory movements was exposed to radiation. After radiation, the implanted recoverable fiducial markers were retrieved using the bronchoscopy technique, and the number of successfully retrieved fiducial markers was recorded. Moreover, the translational errors, rotational errors, and rigid body errors were extracted from the Cyberknife log file and analyzed.Results:No recoverable fiducial markers slipped or fell during the experiment. Thirty-two recoverable fiducial markers were successfully implanted and recovered under the guidance of intelligent navigation bronchoscopy, with implantation and recovery success rates of both 100%. Moreover, the tracking rate and rigid body errors of the fiducial markers were 100% and less than 5 mm, respectively. The data from the Cyberknife log file indicated that there was no significant difference between the sputum bronchial environment group and the wet bronchial environment group in the translational errors in the left-right direction, the rotational errors in the roll direction, and the rotational errors in the pitch direction ( P>0.05). Compared to the wet bronchial environment group, the sputum bronchial environment group had slightly higher translational errors in front-back ( Z=-3.57, P<0.01) and cranio-caudal ( Z=-2.53, P<0.05) directions, lower rotational errors along the yaw axis ( Z = -3.88, P < 0.01), and lower rigid body error ( Z=-3.32, P<0.01), and the differences were all statistically significant. Conclusions:The recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology is feasible. Recoverable fiducial markers are stable in the bronchus of the phantom, and the Cyberknife tracking precision can meet clinical requirements. Therefore, the recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology has promising prospects in clinical and teaching applications.

A preliminary study on the prenatal diagnosis of fetal conotruncal defects using intelligent navigation echocardiography.

OBJECTIVE: To compare the accuracy, efficiency, and consistency between experienced and less-experienced professionals using intelligent navigation echocardiography. METHODS: In this prospective study, we enrolled 93 second- and third-trimester fetuses with conotruncal defects (CTD) from July 2017 to February 2018. One or more spatiotemporal image correlation volume data sets were collected per case. The fetuses with CTD were diagnosed by the following two groups of professionals (n = 20 in each) with different experience levels using intelligent navigation echocardiography and two-dimensional ultrasound: group A with 15 years of experience and group B with 1 year of experience. The diagnostic consistency and accuracy of the technologies between the two groups were analyzed. RESULTS: Satisfactory consistency was noted in the two groups (group A, τ = 0.855, P < 0.05, and group B, τ = 0.821, P < 0.05), and no significant difference in accuracy (χ2  = 3.218, P > 0.05) in using intelligent navigation echocardiography was reported between the two groups. However, there a significant difference in accuracy (χ2  = 0.021, P < 0.05) when using two-dimensional ultrasound was observed between the two groups. CONCLUSION: Intelligent navigation echocardiography was found to be efficient and accurate for the diagnosis of CTD and good consistency existed in the experienced and less-experienced professionals.

Diagnostic performance of fetal intelligent navigation echocardiography (FINE) in fetuses with double-outlet right ventricle (DORV).

The main objective of this study was to investigate the diagnostic performance of FINE in generating and displaying 3 specific abnormal fetal echocardiography views such as left ventricular outflow tract (LVOT) view, right ventricular outflow tract (RVOT) view, and 3-vessels and trachea (3VT) view in fetuses with double-outlet right ventricle (DORV). In this prospective study, thirty fetuses diagnosed with DORV by fetal echocardiography in the second and third trimesters were enrolled. One or more STIC volume data-sets were collected from the 4-chamber view as initial view for each fetus, one optimal volume per fetus was selected for on-line analysis using FINE, and the diagnosis plane image was optimized using the Virtual Intelligent Sonographer Assistance (VIS-assistance).The visualization rates of 3 specific abnormal fetal echocardiography views of DORV and key diagnostic elements were calculated. One or more STIC volumes (n = 30 total) were obtained in 25 patients. A single STIC volume per patient was analyzed using the FINE method. FINE was able to successfully generate and display 3 specific abnormal fetal echocardiography views. The display rates of the 3 specific abnormal fetal echocardiography views (3VT, LVOT, RVOT) were 84.0%, 76.0% and 84.0%, respectively. By applying intelligent navigation technology to STIC volume data-sets, the FINE method can successfully generate three specific abnormal cardiac fetal echocardiography diagnostic views in fetuses with DORV, the FINE method can be used for screening and remote consultation of fetal DORV.

Novel foetal echocardiographic image processing software (5D Heart) improves the display of key diagnostic elements in foetal echocardiography.

BACKGROUND: To evaluate the clinical value of foetal intelligent navigation echocardiography (5D Heart) for the display of key diagnostic elements in basic sections. METHODS: 3D volume datasets of 182 normal singleton foetuses were acquired with a four chamber view by using a volume probe. After processing the datasets by using 5D Heart, eight cardiac diagnostic planes were demonstrated, and the image qualities of the key diagnostic elements were graded by 3 doctors with different experiences in performing foetal echocardiography. RESULTS: A total of 231 volume datasets acquired from the 182 normal foetuses were used for 5D Heart analysis and display. The success rate of 8 standard diagnostic views was 88.2%, and the success rate of each diagnostic view was 55.8-99.2% and 70.7-99.0% for the random four chamber view as the initial section and for the apical four chamber view as the initial section, respectively. The success rate of each diagnostic element in the 8 diagnostic sections obtained by 5D Heart was 58.9%~ 100%. Excellent agreement was found between experienced sonographers and less-experienced sonographers (kappa> 0.769). Inter- and intra-observer agreement were substantial to near-perfect, kappa values ranging from 0.612 to 1.000 (Cohen's kappa). CONCLUSIONS: 5D Heart can significantly improve the image quality of key diagnostic elements in foetal echocardiography with low operator dependency and good reproducibility.

Is Fetal Intelligent Navigation Echocardiography Helpful in Screening for d-Transposition of the Great Arteries?

OBJECTIVES: To evaluate the performance of fetal intelligent navigation echocardiography (FINE) applied to spatiotemporal image correlation (STIC) volumes in generating 3 specific abnormal cardiac views (left ventricular outflow tract, right ventricular outflow tract, and 3-vessel and trachea) used to screen for d-transposition of the great arteries (d-TGA). METHODS: In this prospective study, 1 or more STIC volumes were obtained from the 4-chamber view in 34 second- and third-trimester fetuses with d-TGA. Each appropriate STIC volume was evaluated by STICLoop (Samsung Medison, Seoul, Korea) before applying the FINE method. One optimal volume per fetus was selected by observers. The visualization rates of the 3 specific abnormal cardiac views of d-TGA and their diagnostic elements were calculated, and the reliability between 2 observers was verified by the intraclass correlation coefficient. RESULTS: Fetal intelligent navigation echocardiography applied to STIC volume data sets of fetuses with d-TGA successfully generated the 3 specific abnormal cardiac views in the following manner for 2 observers: 75.0% (n = 21) for the left ventricular outflow tract, 89.2% (n = 25) for the right ventricular outflow tract, and 85.7% (n = 24) for the 3-vessel and trachea view. Twenty-four (85.7%) of the STIC volume data sets showed 2 or 3 of the abnormal cardiac views. The interobserver intraclass correlation coefficients between the 2 observers ranged from 0.842 to 1.000 (95% confidence interval), indicating almost perfect reliability for the 2 observers. CONCLUSIONS: In cases of d-TGA, the FINE method has a high success rate in generating 3 specific abnormal cardiac views and therefore can be performed to screen for this congenital defect.

Assessment of the quality of fetal heart standard views using the FAST, STAR, and FINE four-dimensional ultrasound techniques in the screening of congenital heart diseases.

OBJECTIVE: To compare the quality of standard fetal echocardiographic views obtained by four-dimensional ultrasound with those obtained by the simple targeted arterial rendering (STAR) technique, four-chamber view swing technique (FAST), and fetal intelligent navigation echocardiography (FINE/5D Heart® ) technique. METHODS: This was a cross-sectional prospective study that included pregnant women between 22 and 34 weeks of gestation, with normal fetuses. Fetal heart volumes were acquired using spatio-temporal image correlation (STIC) with the fetal spine between 2 and 9 o'clock. The FAST/STAR techniques consist of the manipulation of STIC volumes by drawing OmniView™ lines to obtain echocardiographic views. The FINE/5D Heart® technique uses intelligent navigation to automatically generate echocardiographic views. The quality of the images was classified as excellent, good, acceptable, and unacceptable. The analysis was performed using the Bonferroni multiple comparisons test. RESULTS: The study included 101 pregnant women aged between 16 and 44 years. There was no mean difference in image quality between the techniques regarding fetal spine position in all echocardiographic views (P > .05). However, in the five-chamber, left ventricular outflow tract, right ventricular outflow tract, ductal arch, superior vena cava/inferior vena cava, and abdomen/stomach views, there was a statistically significant mean difference quality between the techniques, regardless of the spine position (P < .05). The best mean image quality was obtained by the FINE technique (P ≤ .016 for all fetal echocardiographic views). CONCLUSION: The quality of the echocardiographic views obtained using the FINE technique was superior to that of those generated by the FAST/STAR techniques in normal fetuses.

Spatiotemporal image correlation combined with 5D Heart intelligent navigation technique in normal fetal heart screening / 中国医学影像技术

Objective: To explore the application value of spatiotemporal image correlation (STIC) combined with 5D Heart intelligent navigation echocardiography in ultrasonic screening of normal fetuses. Methods: Ultrasonic screening of fetal heart was performed in 114 normal fetuses using conventional two-dimensional ultrasound and STIC combined with 5D Heart intelligent navigation technique by doctor A. The time taken for image collection using these two methods were recorded and the same nine sections were scored. One week later, image quality of STIC combined with 5D Heart was scored again by doctor A again, also by doctor B. The qualified rate of each section was compared between the two methods, and the consistency of image quality score by the same doctor and different doctors was analyzed. Results: Two fetuses were excluded due to obvious fetal movement and inability to determine the position of the intelligent navigation point. The time of collection of fetal heart volume images and conventional two-dimension ultrasound images were (94.76±35.21)s and (595.88±139.29)s, respectively (P0.05). The qualification rate of the abdomen and left ventricular outflow tract sections using STIC combined with 5D Heart was lower than those using the conventional two-dimension ultrasound (both P0.75). Conclusion: STIC combined with 5D-Heart intelligent navigation technique can shorten the examination time. The quality of the nine fetal heart view images can meet the needs of fetal heart ultrasonic screening, feasible and repeatable in normal fetal heart ultrasonic screening.

Application value of fetal heart ultrasound intelligent navigation technique in display of key diagnostic elements in rapid screening views of fetal echocardiography / 中华医学超声杂志（电子版）

Objective To evaluate the application value of fetal heart echocardiography intelligent navigation (5D Heart) in the display of key diagnostic elements in five rapid screening fetal echocardiographic views.Methods Three hundred and eighty-four 3D volume datasets of 220 normal singleton fetuses in the second and third trimesters were acquired.After processing the datasets using 5D Heart,five rapid screening views were acquired,and 21 key diagnostic elements of the five cardiac diagnostic sections were graded.The 2 test was used to compare the difference in the key diagnostics elements of the five rapid screening views between 5D heart and the traditional technique.Pearson correlation was used to compare the detection rate of key diagnostic elements between 5D Heart technique and traditional two-dimensional echocardiography in normal fetuses and fetuses with congenital heart disease.The rank sum test was used to detect the consistency and reliability of the results.Results A total of 384 fetal volume datasets were obtained from 220 fetuses,of whom 317 heart volume datasets were available for analysis,with a success rate of 82.6％.There was no difference in the key diagnostic elements of the five rapid screening views between 5D heart and the traditional technique (x2=5.17,P=0.27).Compared with the abnormal fetal heart group (89.6％),the detection rate of diagnostic elements in the normal fetal heart group was 85.2％ (r=0.94,P=0.02).No significant differences were found when comparing the grading results of one observer in different periods of time,the grading results between two experienced doctors,or the grading results among the experienced doctor and one relatively inexperienced doctor (P ＞ 0.05).Conclusions Fetal cardiac ultrasound intelligent navigation technique has high reliability and repeatability in obtaining fetal rapid screening views and displaying fetal elemental diagnostic information.It has tremendous potential in standardized data collection and analysis of cardiac diagnostic sections in fetuses with congenial heart disease,as well as in training and teaching,remote medical consultation,and screening in primary hospitals.

Value of smart-planes fetal heart in quantitative analysis of aortic and pulmonary artery diameters / 中华超声影像学杂志

Objective To explore the feasibility of smart-planes fetal heart ( S-planes FH ) in the display of the fetal ventricular outflow views ,and to compare diameters of fetal aorta ( AO) and pulmonary artery (PA) measured using two-dimensional echocardiography(2DE) and S-planes FH . Methods One hundred and eighty-five fetuses with gestational age of 17 - 36 weeks were enrolled . Each fetus had undergone conventional 2DE examination and the three-dimensional fetal cardiac volume datasets were obtained . The volume datasets were analyzed offline using S-planes FH . The diameters of AO and PA were measured by 2DE and S-planes FH ,respectively . Pearson correlation analysis was used to evaluate the correlation between the two methods for measuring the diameters of AO and PA . The consistency of the two methods was verified by Bland-Altman analysis . Results Fetal ventricular outflow views were successfully obtained using S-planes FH in 173 ( 93 .5％ ) cases of 185 fetuses whose ventricular outflow views were satisfactorily obtained by fetal 2DE . There were close correlations between the two methods in measuring the diameters of AO and PA ( r = 0 .84 , P = 0 .04; r = 0 .81 , P = 0 .00 ) . Bland-Altman analysis showed a close consistency between the two methods ,and their 95％ confidence intervals were ( -1 .17 ,1 .00) and ( -1 .79 ,1 .02) ,respectively . Conclusions There is a close consistency between S-planes FH and 2DE in measuring fetal AO and PA . S-planes FH may have potential for the evaluation of fetal ventricular outflow .

A preliminary study of Fetal Intelligent Navigation Echocardiography in the prenatal diagnosis of conotruncal defects / 中华超声影像学杂志

Objective To investigate the application of fetal intelligent navigation echocardiography ( FINE ,5D Heart) in the diagnosis of conotruncal anomalies ( CTD ) . Methods For prospective study , volume transducer was used to collect the three-dimensional data of fetal heart at 20th - 30th week of gestation . The STIC volume images were processed by three independent physicians of different hierarchies via 5D Heart software afterwards ,and the quality of the STIC diagnosis as well as the consistence among the physicians were analyzed according to the gold standard of postpartum ultrasonic follow-up or surgery results . Results Twelve out of 16 CTD cases were finally included in the study ,and the volume data were analyzed . Senior physicians A could apply 5D Heart diagnosis to achieve 2D-US diagnosis efficiency and gold standard consistently( P = 0 .157 ,0 .083) ,medium and low seniority physician B and C got roughly equal score using 5D Heart diagnosis( P = 0 .705) ,but the diagnostic performance could not reach 2D-US ( P =0 .000 ,0 .000) and gold standard( P = 0 .000 ,0 .000) . Conclusions Fetal cardiac anomalies of CTD can be diagnosed correctly by an expert using 5D Heart ,which has important application prospects in remote consultation , training and scientific research and teaching of congenital heart disease of fetus .

Value of fetal intelligent navigation echocardiography with color flow imaging in the display of key diagnostic elements in basic fetal echocardiographic views / 中华超声影像学杂志

Objective To evaluate the value of fetal intelligent navigation echocardiography with color flow imaging ( 5D Heart Color) in the display of key diagnostic elements in basic fetal echocardiographic views . Methods The heart volumes datasets of 220 fetuses were collected and the offline analysis was conducted . Pearson correlations was used to compare the detection rate of blood flow element between 5D Heart Color software and color Doppler flow imaging(CDFI) in basic fetal echocardiographic views ,and the detection rate of blood flow between normal fetuses ( control group ) and fetuses with cardiovascular abnormalities( case group) . Bland-Altman analysis was used to prove consistency and reliability of the results . Results Totally 384 fetal heart volume datasets were collected from 220 fetuses ,and 317 volume datasets of 200 cases could be used for the analysis ,with the acquiring success rate of 82 .6％ . 5D Heart Color software and CDFI showed a close correlation in displaying key cardiovascular blood flow information in key fetal echocardiographic diagnosis sections ( r =0 .88 , P <0 .05) ;The detection rates of blood flow elements in control group and case group were 91 .9％ and 87 .3％ ,respectively , with an average of 89 .6％( r = 0 .9 , P < 0 .05 ) . Bland-Altman analysis showed close consistency between inter- and intra-observations in the detection rates of blood flow elements ,and their 95％ confidence intervals were ( -0 .1/+0 .09) and ( -0 .09/+0 .1) ,respectively ,and the points outside the 95％ confidence interval were 5 .4％(17/231) and 5 .7％ (18/231) ,respectively . Conclusions 5D Heart Color software shows similar usefulness in the displaying key blood flow elements ,comparing with CDFI , demonstrating higher reliability and repeatability in displaying fetal echocardiographic diagnosis views and diagnostic blood flow elements .

Clinical value of fetal intelligent navigation echocardiography (5D Heart) in the display of key diagnostic elements in basic fetal echocardiographic views / 中华超声影像学杂志

Objective To evaluate the clinical value of fetal intelligent navigation echocardiography (5D Heart) in the display of key diagnostic elements in basic fetal echocardiographic views.Methods Using volume probe,3D volume datasets of the 209 normal singleton fetuses in the second and third trimesters were acquired from a four-chamber view.After processing the datasets by using 5D Heart,9 cardiac diagnostic planes were acquired and then the image qualities of key diagnosis elements of the heart and great vessels were graded by 3 doctors with different experiences of performing fetal echocardiography.Results Two hundred and sixty-two volume datasets were acquired from 209 normal fetuses,including 53 volume datasets collected when cardiac apex was in different directions,satisfactory datasets failed to be acquired in 27 fetuses because of the maternal obesity,the artifacts of fetal movement,or other influencing factors.Two hundred and thirty-one volume datasets of 182 fetuses could be used for 5D Heart analyzing and displaying,and the displaying rate of 9 standard diagnostic views was up to 88.2％.No significant difference was found when comparing the grading results of one observer in different periods of time,the grading results between two experienced doctors and the grading results among the experienced doctor and one relatively inexperienced doctor (P ＞ 0.05).Conclusions 5D Heart has high reliability and repeatability in obtaining fetal echocardiographic diagnosis views and displaying fetal elemental diagnostic information.

A preliminary study of fetal intelligent navigation echocardiography in the normal fetuses during second and third trimester / 中华超声影像学杂志

Objective To investigate the value of fetal intelligent navigation echocardiography (FINE,5D Heart)in displaying the normal fetal heart structure during 20 to 38 weeks'gestation.Methods Three-dimensional data of fetal heart during 20 to 38 weeks'gestation were acquired using volume transducer prospectively.The STIC volume images were post-processed with 5D heart software by three physicians with different levels of echocardiographic examination and the quality of the section images were analyzed.The intra-and interobserver repeatability was analyzed for the qualification of section images.The correlation between the quality of image and gestational age,body mass index,the placenta position,fetal initial plane position were evaluated using univariate and multivariable logistic regression analysis.Results Two hundreds and five cases of pregnant women were included,and 9 cases were excluded.Volume data acquisition was completed in 180 pregnant women,and the image acquisition rate was 91.8%.The data were assessed twice by three observers and qualified 9 section images were gotten in 156-180 cases(degree of qualification 86.7%-100%).The screening images were satisfied in 152 cases(84.4%),dissatisfied with 28 cases(15.6%).The intra-observer agreement by three observers was absolute concord in four chamber view and abdomen、stomach view;excellent in three vessel trachea view(3VT),five chamber view, left ventricular outflow tract view and superior and inferior vena cava view;good in right ventricular outflow tract view,ductal arch view and aortic arch view.The inter-observer agreement by each of three observers was absolute concord in four chamber view and abdomen、stomach view;excellent in superior and inferior vena cava view;excellent to good in five chamber view,left ventricular outflow tract view,right ventricular outflow tract view;good in 3VT,ductal arch view and aortic arch view.In a univariate analysis,the quality of the image was associated with obesity(χ2=15.338,P =0.000),gestational age(χ2=23.356,P =0.000).Multivariable analysis showed that the obesity(OR=5.587,P =0.001)and gestational age (OR=8.843,P=0.000)were factors affecting the quality of the image.The average time spent in post-processing the images for first time by three observers was(2.77±1.39)min,and there was no significant difference among observers(P > 0.05).Conclusions Fetal intelligent navigation echocardiography (FINE,5D Heart)based on STIC volumes can successfully generate 9 standard fetal echocardiography views in 86.7%-100% of fetuses in the 2nd and 3rd trimesters.This method can simplify examination of the fetal heart and reduce operator dependency.