Feasibility Study on Prenatal Cardiac Screening Using Four-Dimensional Ultrasound with Spatiotemporal Image Correlation: A Multicenter Study.

Liqing Zhao,Yurong Wu,Cao Li,Sun Chen,Ping Chen,Yunyun Ren,Jianmei Niu,Kun Sun,Fatima Crispi

doi:10.1371/journal.pone.0157477

Abstract

ObjectiveThis study aimed at investigating the feasibility of using the spatiotemporal image correlation (STIC) technology for prenatal cardiac screening, finding factors that influence the offline evaluation of reconstructed fetal heart, and establishing an optimal acquisition scheme.MethodsThe study included 452 gravidae presenting for routine screening at 3 maternity centers at 20–38 gestational weeks. The factors influencing the quality of STIC volume data were evaluated using t test, chi-square test, and logistic regression analysis. The predictive power was evaluated using the receiver operating characteristic (ROC) curve.ResultsAmong the 452 fetuses enrolled, 353 (78.1%) were identified as successful and 99 (21.9%) as failure of evaluation of the reconstructed fetal heart. The total success rate of qualified STIC images was 78.1%. The display rates of reconstructed cardiac views were 86.5% (four-chamber view), 92.5% (left ventricular outflow tract view), 92.7% (right ventricular outflow tract view), 89.9% (three-vessel trachea view), 63.9% (aortic arch view), 81.4% (ductal arch view), 81% (short-axis view of great vessels), 80.1% (long-cava view), and 86.9% (abdominal view). A logistic regression analysis showed that more than 28 gestational weeks [OR = 0.39 (CI 95% 0.16, 0.19), P = 0.035], frequent fetal movements [OR = 0.37 (CI 95% 0.16, 0.87), P = 0.022], shadowing [OR = 0.36 (CI 95% 0.19, 0.72), P = 0.004], spine location at 10–2 o’clock [OR = 0.08 (CI 95% 0.02, 0.27), P = 0.0], and original cardiac view [OR = 0.51 (0.25, 0.89), P = 0.019] had a significant impact on the quality of STIC. The area under the ROC curve was 0.775.ConclusionsFetal cardiac-STIC seems a feasible tool for prenatal screening of congenital heart diseases. The influence factors on the quality of STIC images included the intensity of training, gestational age, fetal conditions and parameter settings. The optimal acquisition scheme may improve the application and widespread use of cardiac STIC.

Highlights

An accurate antenatal diagnosis of congenital heart disease (CHD) is important for an appropriate prenatal counseling, which could involve considerable planning for the location and time of delivery and optimal perinatal care [1, 2]
Fetal cardiac-spatiotemporal image correlation (STIC) seems a feasible tool for prenatal screening of congenital heart diseases
The influence factors on the quality of STIC images included the intensity of training, gestational age, fetal conditions and parameter settings

Summary

Introduction

An accurate antenatal diagnosis of congenital heart disease (CHD) is important for an appropriate prenatal counseling, which could involve considerable planning for the location and time of delivery and optimal perinatal care [1, 2]. The accuracy of the antenatal diagnosis of CHD has improved with the development of a better image quality and the introduction of a new technology such as the spatiotemporal image correlation (STIC) technology. He et al reported a high sensitivity (97.4%) and specificity (99.6%) using the STIC technology combined with two-dimensional (2D) ultrasound for a definite diagnosis of fetal heart malformations [7]. When the STIC volume data are acquired, any reconstructed plane of the fetal heart can be theoretically reviewed. The present study has not performed a large multicenter data study on the use of STIC in prenatal screening or diagnosis since the introduction of the technology in 2003 [11]

Methods

Results

Conclusion