3D US Research Articles

Two-dimensional ultrasound: can it replace computed tomography in liver volume assessment?

BackgroundLiver volume estimation is considered as an integral part in preoperative evaluation in patients undergoing liver transplantation; computed tomography and magnetic resonance imaging are considered the gold standard methods for liver volume estimation, and both are reliable and valid in determination of liver volume via manual and semi-automated methods. Reliable and accurate set of three simple measurement planes using two-dimensional ultrasound for volumetric assessment of liver was determined, and predictive equation using these three simple measurements was performed, which is simple to perform and easy to calculate, in order to evaluate liver volume and validate these measurements against CT images. Our aim in this study was to evaluate the efficacy and validity of two-dimensional ultrasound in liver volume estimation compared to CT volumetry as a gold standard.ResultsA strong linear positive correlation with no statistical significant difference was found between 2D US and semi-automated CT volumetric, and result was r = 0.7402 and p > 0.05, with an average liver volume of 1572.10 (± 326.43) cm3 and 1559.30 (± 381.02) cm3 respectively.No statistically significant difference was found also between the two modalities in different age groups and different sexes.ConclusionSimple linear two-dimensional ultrasound could be considered an efficient, accurate, and trustable tool for liver volume measurement in clinical practice.

Multi-center results on the clinical use of KANET.

An extensive review of the literature on the diagnostic and clinical accuracy of Kurjak's antenatal neurodevelopmental test (KANET) and the summarized results of the multi-center study involving 10 centers revealed that four-dimensional ultrasonography (4D US) has become a powerful tool and KANET a valuable test that empowers the clinicians worldwide to evaluate the fetal behavior in a systematic way and contribute to the detection of fetuses that might be at high risk for neurological impairments and in particular cerebral palsy (CP). After 10 years of clinical use, many published papers and multi-center studies, hundreds of trained physicians and numerous tests performed all over the world, KANET has proven its value and has been showing encouraging results so far. The aim of this paper is to show the results from the studies done so far and to reveal the clinical value of the KANET. We expect that data from the larger ongoing collaborative study, the short- and long-term postnatal follow-up will continue to improve our knowledge. Ultimately, we all strive to prevent the CP disorders, autism spectrum disorder (ASD) and other neurological impairments and we are convinced that KANET might be helpful in the realization of this important aim.

Diagnosis of non-cardiac fetal malformations during mid-trimester anomaly scan: Does three-dimensional ultrasonography have any added value?

Objective: To determine if there is any added value of 3D US examination in diagnosis of fetal malformations during mid-trimester anomaly scan. Design: A prospective observational study. Setting: Obstetrics and Gynecology Ultrasound Unit, Zagazig University Hospitals. Patients and Methods: Pregnant women referred for mid-trimester anomaly scan were prospectively evaluated by 2D US. Fetuses suspected to have malformation by 2D US or with increased risk of a recurrence or strong family history of a congenital abnormality were evaluated by 3D US. Women confirmed to have fetal malformations postnatally were included. Results:Seven hundred and seventy-six malformations were confirmed postnatally. 2D US established the diagnosis of 752 (96.9%) malformations and 3D US diagnosed 770 (99.2%) malformations and the difference was highly significant [McNemar chi-squared statistic= 16, p=˂0.0001]. Seven hundred and fifty-two malformations were diagnosed by both 2D and 3D US. Eighteen malformations were detected exclusively by 3D US. 3D US was superior to 2D in evaluating cranial, facial and limb malformations. A cleft soft palate, hand abnormalities (n=3) and feet abnormalities (n=2) were missed by both 2D and 3D US. Conclusion: Three dimensional US added value in diagnosis of some types of fetal malformations. Rather than representing an alternative, 3D US is complementary to the conventional 2D US in the field of prenatal diagnosis.

Three-dimensional US Fractional Moving Blood Volume: Validation of Renal Perfusion Quantification.

Background Three-dimensional (3D) fractional moving blood volume (FMBV) derived from 3D power Doppler US has been proposed for noninvasive approximation of perfusion. However, 3D FMBV has never been applied in animals against a ground truth. Purpose To determine the correlation between 3D FMBV and the reference standard of fluorescent microspheres (FMS) for measurement of renal perfusion in a porcine model. Materials and Methods From February 2017 to September 2017, adult pigs were administered FMS before and after measurement of renal 3D FMBV at baseline (100%) and approximately 75%, 50%, and 25% flow levels by using US machines from two different vendors. The 3D power Doppler US volumes were converted and segmented, and correlations between FMS and 3D FMBV were made with simple linear regression (r2). Similarity and reproducibility of manual segmentation were determined with the Dice similarity coefficient and 3D FMBV reproducibility (intraclass correlation coefficient [ICC]). Results Thirteen pigs were studied with 33 flow measurements. Kidney volume (mean Dice similarity coefficient ± standard deviation, 0.89 ± 0.01) and renal segmentation (coefficient of variation = 12.6%; ICC = 0.86) were consistent. The 3D FMBV calculations had high reproducibility (ICC = 0.97; 95% confidence interval: 0.96, 0.98). The 3D FMBV per-pig correlation showed excellent correlation for US machines from both vendors (mean r2 = 0.96 [range, 0.92-1.0] and 0.93 [range, 0.78-1.0], respectively). The correlation between 3D FMBV and perfusion measured with microspheres was high for both US machines (r2 = 0.80 [P < .001] and 0.70 [P < .001], respectively). Conclusion The strong correlation between three-dimensional (3D) fractional moving blood volume (FMBV) and fluorescent microspheres indicates that 3D FMBV shows excellent correlation to perfusion and good reproducibility. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Morrell et al in this issue.

Assessment of 4D Ultrasound Systems for Image-guided Radiation Therapy – Image Quality, Framerates and CT Artifacts

Abstract 4D ultrasound (4D US) is gaining relevance as a tracking method in radiation therapy (RT) with modern matrix array probes offering new possibilities for real-time target detection. However, for clinical implementation of USguided RT, image quality, volumetric framerate and artifacts caused by the probe’s presence during planning and / or setup computed tomography (CT) must be quantified. We compared three diagnostic 4D US systems with matrix array probes using a commercial wire phantom to measure spatial resolution as well as a calibration and a torso phantom to assess different image quality metrics. CT artifacts were quantified in the torso phantom by calculating the total variation and percentage of affected voxels between a reference CT scan and CT scans with probes in place. We found that state-of-the-art 4D US systems with small probes can fit inside the CT bore and cause fewer metal artifacts than larger probes. US image quality varies between systems and is task-dependent. Volume sizes and framerates are much higher than the commercial guidance solution for US-guided RT, warranting further investigation regarding clinical performance for image guidance.

Is Four-Dimensional (4D) Ultrasound Entering a New Field of Fetal Psychiatry?

The aim of is to explore whether by observing the fetus by 4D US it is possible to enter fetal behavior, emotions, mental status, consciousness, awareness and other states connected with fetal mind and ability of self-regulation. It is well known that fetal motoric activity is enabling the development of central and peripheral nervous system and the muscles. It is 4D US which enabled to investigate fetal movement patterns from the first trimester of pregnancy throughout the whole pregnancy. Based on the evaluation of fetal spontaneous motor activity by 4D US, a prenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET) was created. This test has been used to assess almost 2000 fetuses and our results have indicated that KANET has an ability to recognize normal, borderline, and abnormal behavior in fetuses from normal and abnormal pregnancies. The fetus is able to process tactile, vestibular, taste, olfactory, auditory and visual sensations. The fetus responds to painful stimuli with a wide spectrum of reactions. Important external signs of emotion are facial expressions. The existence of a wide range of facial expressions, including grimacing, smiling, crying, similar to emotional expressions in adults, has been revealed by 4D sonography in the 2nd and 3rd trimesters of pregnancy. It is questionable if mental, emotional and behavioral conditions of the fetus were covered in this paper and whether we are able to perceive the fetus as the patient who may develop communication or some other psychiatric disorders which we will be hopefully able to recognize prenatally. Although it seems as the speculation from the point of view of our recent diagnostic possibilities, it is apparent that the day when this will be a reality is rapidly approaching.

3D Super-Resolution US Imaging of Rabbit Lymph Node Vasculature in Vivo by Using Microbubbles.

Background Variations in lymph node (LN) microcirculation can be indicative of metastasis. The identification and quantification of metastatic LNs remains essential for prognosis and treatment planning, but a reliable noninvasive imaging technique is lacking. Three-dimensional super-resolution (SR) US has shown potential to noninvasively visualize microvascular networks in vivo. Purpose To study the feasibility of three-dimensional SR US imaging of rabbit LN microvascular structure and blood flow by using microbubbles. Materials and Methods In vivo studies were carried out to image popliteal LNs of two healthy male New Zealand white rabbits aged 6-8 weeks. Three-dimensional, high-frame-rate, contrast material-enhanced US was achieved by mechanically scanning with a linear imaging probe. Individual microbubbles were identified, localized, and tracked to form three-dimensional SR images and super-resolved velocity maps. Acoustic subaperture processing was used to improve image contrast and to generate enhanced power Doppler and color Doppler images. Vessel size and blood flow velocity distributions were evaluated and assessed by using Student paired t test. Results SR images revealed microvessels in the rabbit LN, with branches clearly resolved when separated by 30 µm, which is less than half of the acoustic wavelength and not resolvable by using power or color Doppler. The apparent size distribution of most vessels in the SR images was below 80 µm and agrees with micro-CT data, whereas most of those detected with Doppler techniques were larger than 80 µm in the images. The blood flow velocity distribution indicated that most of the blood flow in rabbit popliteal LN was at velocities lower than 5 mm/sec. Conclusion Three-dimensional super-resolution US imaging using microbubbles allows noninvasive nonionizing visualization and quantification of lymph node microvascular structures and blood flow dynamics with resolution below the wave diffraction limit. This technology has potential for studying the physiologic functions of the lymph system and for clinical detection of lymph node metastasis. Published under a CC BY 4.0 license. Online supplemental material is available for this article.

Breast cancer research and treatment reconstruction of unilateral breast structure using three-dimensional ultrasound imaging to assess breast neoplasm

PurposeTo develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI.MethodsSixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction.Results(1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p < 0.001). (2) When compared with the other two vertical directions, the direction with the largest gravity change had the greatest difference between MRI and US measurements. (3) The vertical distance from the breast neoplasm to the ipsilateral nipple and skin junction was significantly different (p > 0.05).ConclusionsWe have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.

Utility of indirect sonographic signs (including cavum septum pellucidum ratio) in midgestational screening for partial agenesis of corpus callosum.

This study was undertaken to evaluate the performance of indirect sonographic signs in detecting partial agenesis of the corpus callosum (pACC) at midgestation, focusing on the cavum septum pellucidum (CSP) ratio. A retrospective case-controlled study of singleton pregnancies was conducted, examining fetuses diagnosed with isolated pACC and normal controls. At midgestational age, fetal head volumes were imaged with 3D US and stored for the evaluation of indirect sonographic findings in axial planes. Fifteen normal and 15 abnormal fetuses (with pACC) were analyzed. Based on a CSP ratio < 1.5, detection of pACC increased from 66.7% (10/15) to 80% (12/15). All indirect signs proved highly suspicious for pACC (risk ratios > 1). Use of indirect sonographic signs to screen for pACC at midgestation is challenging. However, a low CSP ratio may improve the detection rate, serving as a new indirect sign.

Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study.

To estimate the diagnostic accuracy of three-dimensional ultrasonography (3D US) compared to hysteroscopy/laparoscopy, in the investigation of uterine congenital anomalies using the ESHRE/ESGE classification of female genital tract congenital anomalies. Prospective blind, comparative, cohort study. University Tertiary Hospital and affiliated private Hospital. Sixty-two women consecutively referred with a suspected diagnosis of uterine congenital anomalies. The ESHRE/ESGE classification of congenital anomalies of the female genital tract was used for the description of abnormal findings. All patients underwent (1) 3D US and (2) hysteroscopy with laparoscopy to establish the final diagnosis. Concordance between 3D US and hysteroscopy with laparoscopy about the type and the classification of uterine anomaly was verified in 61 cases, including all those with septate uterus, dysmorphic uterus, bicorporeal, hemi-uterus or unicorporeal, and aplastic uterus and one out of two with normal uterus. For the diagnosis of septate uteri, which was the most common anomaly, the sensitivity of 3D US was 100%, the specificity was 92.3%, the PPV was 98% and the NPV was 100%, with kappa index 0.950. For bicorporeal, dysmorphic uterus, hemi-uteri or unicorporeal and aplastic uterus the sensitivity, specificity, PPV and NPV were all 100% with K = 1.00. Overall, 3D US showed perfect diagnostic accuracy (Kappa index = 0.945) in the detection of congenital uterine anomalies. 3D US appears to be a very accurate method for the diagnosis of congenital uterine anomalies.

Multi-instance Deep Learning with Graph Convolutional Neural Networks for Diagnosis of Kidney Diseases Using Ultrasound Imaging.

Ultrasound imaging (US) is commonly used in nephrology for diagnostic studies of the kidneys and lower urinary tract. However, it remains challenging to automate the disease diagnosis based on clinical 2D US images since they provide partial anatomic information of the kidney and the 2D images of the same kidney may have heterogeneous appearance. To overcome this challenge, we develop a novel multi-instance deep learning method to build a robust classifier by treating multiple 2D US images of each individual subject as multiple instances of one bag. Particularly, we adopt convolutional neural networks (CNNs) to learn instance-level features from 2D US kidney images and graph convolutional networks (GCNs) to further optimize the instance-level features by exploring potential correlation among instances of the same bag. We also adopt a gated attention-based MIL pooling to learn bag-level features using full-connected neural networks (FCNs). Finally, we integrate both instance-level and bag-level supervision to further improve the bag-level classification accuracy. Ablation studies and comparison results have demonstrated that our method could accurately diagnose kidney diseases using ultrasound imaging, with better performance than alternative state-of-the-art multi-instance deep learning methods.

The Role of 3D &amp; 4D Ultrasonography in Diagnosis of Fetal Head and Neck Congenital Anomalies

The amazing tecnology of 3D imaging enables the examination of the fetal central nervous system simultaneously in the three orthogonal planes, better defining the spatial relationship of CNS structures and malformations. The multiplanar mode is utilized to navigate through the volume, observing information on a particular structure in each of the three symmetrical planes. The aim of this stuyd is to evaluate the role of 3D/4D ultrasound in assessment of fetal head and neck congenital anomalies. This is prospective study including thirty pregnant females during the second trimester of pregnancy with 2D suggestion of fetal head and neck congenital anomalies. 42 anomalies were detected from examination of thirty pregnant females. In addition, a higher incidence of face and neck anomalies over CNS anomalies was noted. (57.2% versus 42.8%). We concluded that 2D US remains the gold standard in assessment of fetal anomalies and 3D/4D US, along these lines, isn't a screening system however an aide to 2D US for those embryos in whom anomalies are as of now decided or associated on the premise with standard sonography.

Fetal syndromes: Diagnosis and management using 3D-4D sonography

<Conclusion>The 3D ultrasound technique with different visualization and manipulation capabilities of stored volume, provides a unique opportunity for a detailed view of normal and abnormal fetal development. If facial anomaly is suspected, this technique will help in the evaluation and gained images will give some answers to question about severity and extent of anomalies. Particularly handy tool may be when communicating the neonatologist, pediatrician, plastic and reconstructive head and neck surgeon and especially when consulting with the parents of the child. However, as in any imaging technique (ultrasound, MSCT, MRI), you need to know the dome and limitations of 3D / 4D rendering and to be aware of possible artifacts and traps. From the first trimester to the next, as soon as it becomes possible to detect congenital anomaly by prenatal ultrasound, the question ariseswhat can and should be done. Many ethical dilemmas present at the time.2, 4 Contemporary medicine faces some major problems when it has the ability to prolong life of severely sick baby with potentially lethal congenital syndromes. Taking specific ultrasonic diagnostics into account, the idea is to find the balance between the advantages and limitations of sonographic assessment. At the same time, it should be possible to optimize recommendations with the expectations of parents of potentially seriously ill baby. Given the complexity of prenatal diagnosis of syndrome, everything involved in the process is also complex. This includes conformation of prenatal diagnosis postnatally and determination of the short and long term prognosis if possible to assist parents who are facing a baby with syndrome. 2, 4 It is essential to point out the necessity of complex, lifelong and costly multidisciplinary care for severely ill baby. All the aforementioned, 3D / 4D US techniques promise to improve the accuracy of clinicians in detection of fetal abnormalities and detecting fetal syndromes as early as possible. There are many advantages in prenatal detection of fetal syndromes already described, but there is also a great room for improvement. Since new 3D / 4D ultrasound technology becomes more available in everyday clinical practice, the clinician should remain well-informed, well trained and monitor new diagnostic capabilities. Continuous education is necessary. In this way, the number of fetal abnormalities and syndromes detected prenatally will probably increase over time.4 Auxiliary tools such as network databases ("online databases") that integrate all the necessary information should be included and used for better diagnostic precision.

Three-dimensional sonographic minute structure analysis of fetal cerebellar vermis development and malformations: utilizing volume contrast imaging.

To obtain three-dimensional ultrasonic (3D US) structural details and biometrics of the fetal cerebellar vermis and evaluate the value of developmental and malformation identification. The 3D US minute structure of the fetal cerebellar vermis in mid-sagittal view was detected in normal fetuses (n = 438; 16-41weeks). Biometric sizes were measured to establish the stage-specific norms and reproducibility analysis. Additionally, 28 fetuses with suspected abnormal posterior fossa contents were assessed to analyze the clinical value. The minute structure of normal fetuses, including cerebellar vermis contours and the fastigial recess of the fourth ventricle, were visible around Week 19. The main lobules and fissures were apparent around Week 22, and all nine lobules, fissures, and the fourth ventricle were clearly displayed by Week 28. Cerebellar vermis biometric sizes (anterior-posterior length, cranio-caudal length, circumference, and surface area (SA)) grew in a linear fashion with high reliability, especially SA measurements (for intraclass, ICC 0.989, 95% CI (0.980-0.994); for interclass, ICC 0.992, 95% CI (0.984-0.996)). On the middle sagittal section of 3D US, the SA reduced at least 50% in the Dandy-Walker group with no recognizable cerebellar vermis structures showing. The SA in vermian hypoplasia malformation reduced during [Formula: see text] to 50% with the primary/secondary fissures absent or partly absent and arborization of the lobules reduced. That would be an important diagnosis and antidiastole clue. Combined with minute structural observation, sonographic diagnoses were accurate in 88% of cases. Minute structures obtained by 3D US were clinically useful in the evaluation of cerebellar vermis development and cerebellar vermis malformations.

EP16.06: Septate and dysmorphic uterus: association with infertility and early pregnancy loss

To diagnose septate or dysmorphic uterus using three dimensional ultrasound (3DUS), following the European Society of Human Reproduction and Embryology European Society for Gynecological Endoscopy (ESHRE ESGE) consensus on the classification of congenital anomalies of the female genital tract and study their association with pregnancy complications and infertility. Thirty women with uterine anomalies suspected after examination by conventional two dimensional ultrasound were evaluated with 3D US. These data were analysed retrospectively to confirm the presence and type of uterine malformation in accordance with the ESHRE ESGE consensus. Detailed reproductive history was taken and follow up for reproductive outcome. Out of 30 women 25 patients had septate uterus (83.33%) and 5 patients had dysmorphic uterus (16.66%). Early pregnancy loss was seen in 20 patients (66.66%), 10 patients had endometriosis with infertility (33.33%). Our study shows increased incidence of early pregnancy loss and infertility in patients with septate or dysmorphic uterus. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

OP02.05: First trimester diagnosis of Sirenomelia

Sirenomelia or Mermaid Syndrome is a rare lethal congenital anomaly with an incidence of 1 in 60000.We report a case diagnosed in first trimester using 2D US and colour Doppler. Omphalocele is seen in this case. This case emphasises the importance of looking for anomalies in first trimester. Diagnosis of Sirenomelia should be easier in first trimester as liquor is in good amount. A 25 years old G2P1 with previous LSCS with unremarkable medical and family history underwent sonography at 12 weeks. The live singleton fetus had single lower limb, omphalocele with herniation of liver and stomach. Lower limb showed two femur, single bone in mid segment and a single bifurcated foot. There was fixed extension and mobility at hip and knee was restricted. CD showed single umbilical artery and reversal of A wave in DV. Upper limb and spine were normal. After counselling about poor prognosis, patient lost to follow-up. The US diagnosis of sirinomelia is based on fusion of lower limbs and associated skeletal, spinal, renal, cardiac and abdominal wall anomalies. Single UA is seen in majority cases. Vascular steal and defective blastogenesis are two proposed theories of etiopathogenesis. Strong correlation is seen with diabetes. Male fetus are more affected. Early diagnosis in first trimester is easy due to good amount of amniotic fluid. In later gestation due to renal agenesis/dysgenesis there is severe oligohydramnios and diagnosis is relatively difficult. Also early diagnosis minimises trauma related to termination in later gestation. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Advanced Imaging for the Diagnosis and Treatment of Coexistent Renal and Müllerian Abnormalities.

Abnormal development of the uterus, cervix, and proximal 2/3 of the vagina results in Müllerian duct anomalies. Because of the close embryologic relationship between the developing female genital and urinary tracts, abnormalities of the urinary tract often accompany Müllerian duct anomalies. Magnetic resonance imaging (MRI) is the current gold standard-imaging modality in the evaluation of the anomalies of the female reproductive tract. This article discusses the imaging evaluation of Müllerian duct and accompanying urinary tract anomalies with a particular focus on the MRI findings. Several studies have shown high concordance between MRI and three-dimensional ultrasound (3D US) in the evaluation of Müllerian duct abnormalities. 3D US is more cost effective than MRI but has not yet been fully substantiated as a comparable modality to MRI. Additionally, 3D US does not help elucidate concomitant anomalies of the urologic system. Müllerian duct anomalies are often associated with abnormalities of the urinary tract. Evaluation with MRI is important for the diagnosis of Müllerian duct anomalies and also helps with potential surgical planning.

T-shaped uterine cavity morphology as assessed by three-dimensional ultrasound (3D US) is associated with lower sustained implantation rates and higher clinical loss rates following frozen embryo transfer

T-shaped uterine cavity morphology as assessed by three-dimensional ultrasound (3D US) is associated with lower sustained implantation rates and higher clinical loss rates following frozen embryo transfer

Only patients with obvious adenomyosis on three-dimensional ultrasound (3D US) are at increased risk of clinical loss following frozen embryo transfer

Only patients with obvious adenomyosis on three-dimensional ultrasound (3D US) are at increased risk of clinical loss following frozen embryo transfer

Role of 4D Ultrasound in the Diagnosis of Intra-Uterine Cranio-Facial Anomalies

AbstractBackground: Craniofacial anomalies account for approx-imately one-third of all birth defects and are a significant cause of infant mortality. They include brain, cranial bone & facial anomalies. Ultrasound examination is an effective modality for the prenatal diagnosis of these anomalies. 3D/4D US offers several image displays for precise demonstration of the normal and abnormal anatomy of the fetus. Subtle or inconclusive Ultrasound abnormalities can be confirmed or ruled out by MRI.Aim of the Work: To evaluate role of the 4D ultrasound in diagnosis of in utero congenital cranio-facial anomalies.Patients and Methods: The study was conducted on 20 pregnant females with suspected congenital head anomalies by 2D ultrasound in Tanta University Hospitals at the Radio-diagnosis department. The cases were collected during a period starting from December 2015 to January 2017. All patients were subjected to 2D and 4D ultrasound examination.Results: As regards to brain anomalies, sensitivity of 4D ultrasound = 94.74%, specificity of 4D ultrasound = 100%, PPV = 100%, NPV = 50.0 % & accuracy = 95%. As regards to cranial bone anomalies, sensitivity of 4D ultrasound = 100%, specificity = 100 %, PPV = 100%, NPV = 100 % & accuracy = 100%. As regards to facial anomalies, sensitivity of 4D ultrasound = 100%, specificity = 100 %, PPV = 100%, NPV = 100 % & accuracy = 100%. So 4D ultrasound is more superior to 2D ultrasound in demonstrating anomalies of the face, cranial bone (mainly through surface rendering mode) and brain (through multiplanar & tomographic views) which may affect the post natal outcome.Conclusion: 4D US is considered now an important diagnostic tool in fetal medicine as it provides many advanced diagnostic options like multiplanar, multiview or tomographic imaging, volume calculation and surface rendering mode which aided in early diagnosis of fetal anomalies and improved postnatal outcome.