Fetal Ultrasound Images Research Articles

Fetal Magnetic Resonance Imaging for the Prenatal Assessment of the Extended Cardiovascular System by CASSEAL (Cardiovascular System Sonographic Evaluation Algorithm)

Purpose: To compare axial view images obtained with fetal ultrasound (US) and magnetic resonance imaging (MRI) when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). Materials and method: CASSEAL is an US algorithm consisting on the acquisition of 9 different axial views of the fetal abdomen and chest, from the umbilical vein to the subclavian arteries. It was designed for a thorough US assessment of the extended fetal cardiovascular system. Feasibility and reproducibility of CASSEAL have already been proven; however, its application in fetal MRI has yet to be established. A fetal MRI was performed to a 25 week-old fetus with ventriculomegaly (11 mm) in order to obtain the 9 axial views required by CASSEAL. Subsequently, a comparison between both imaging techniques was performed for each view. Results: The comparison of the images obtained with these two imaging techniques showed a good correlation in the identification of cardiovascular anatomical structures. Conclusion: CASSEAL US axial views can be obtained in fetal MRI and correlation between the 2 techniques is good. This finding suggests that MRI may be a useful complement to US in the assessment of fetal cardiovascular anomalies using the same views by which sonographers assess fetal cardiovascular structures.

Evaluation of Fetal Lung Ultrasound Images by Digital Texture Analysis Methods

Evaluation of Fetal Lung Ultrasound Images by Digital Texture Analysis Methods

Commentary to ‘Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system)’

[65] Ulman I, Jayanthi VR, Koff SA. The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol 2000;164:1101e5. [66] Braga LH, Mijovic H, Farrokhyar F, Pemberton J, DeMaria J, Lorenzo AJ. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics 2013;131:e251e61. [67] Gimpel C, Masioniene L, Djakovic N, Schenk JP, Haberkorn U, Tonshoff B, et al. Complications and long-term outcome of primary obstructive megaureter in childhood. Pediatr Nephrol 2010;25:1679e86. [68] Davenport MT, Merguerian PA, Koyle M. Antenatally diagnosed hydronephrosis: current postnatal management. Pediatr Surg Int 2013;29:207e14. [69] Kose E, Yavascan O, Turan O, Kangin M, Bal A, Alparslan C, et al. The effect of circumcision on the frequency of urinary tract infection, growth and nutrition status in infants with antenatal hydronephrosis. Ren Fail 2013;35:1365e9. [70] Wong CJ, Moxey-Mims M, Jerry-Fluker J, Warady BA, Furth SL. CKiD (CKD in children) prospective cohort study: a review of current findings. Am J Kidney Dis 2012;60:1002e11. [71] Nyengaard JR, Bendtsen TF. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec 1992;232:194e201. [72] Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol 1981; 241:F85e93. [73] Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition. Ann Int Med 2002;136:604e15. [74] Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 2003;111: e382e7. [75] Quirino IG, Diniz JS, Bouzada MC, Pereira AK, Lopes TJ, Paixao GM, et al. Clinical course of 822 children with prenatally detected nephrouropathies. Clin J Am Soc Nephrol 2012;7:444e51. [76] Carlstrom M. Causal link between neonatal hydronephrosis and later development of hypertension. Clin Exp Pharmacol Physiol 2010;37:e14e23. [77] Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1987;1:713e29. [78] Kogon AJ, Pierce CB, Cox C, Brady TM, Mitsnefes MM, Warady BA, et al. Nephrotic-range proteinuria is strongly associated with poor blood pressure control in pediatric chronic kidney disease. Kidney Int 2014;85:938e44. [79] Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney. A risk-benefit assessment. Drug Saf 1996;15: 200e11. [80] Ruster C, Wolf G. Renin-angiotensin-aldosterone system and progression of renal disease. J Am Soc Nephrol 2006;17: 2985e91. [81] Martens DH, Rake JP, Navis G, Fidler V, van Dael CM, Smit GP. Renal function in glycogen storage disease type I, natural course, and renopreservative effects of ACE inhibition. Clin J Am Soc Nephrol 2009;4:1741e6. [82] Reddy UM, Abuhamad AZ, Levine D, Saade GR, Fetal Imaging Workshop Invited P. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med 2014;33:745e57.

Estimation of prenatal aorta intima-media thickness from ultrasound examination1

Prenatal events such as intrauterine growth restriction and increased cardiovascular risk in later life have been shown to be associated with an increased intima-media thickness (aIMT) of the abdominal aorta in the fetus. In order to assess and manage atherosclerosis and cardiovascular disease risk in adults and children, in recent years the measurement of abdominal and carotid artery thickness has gained a growing appeal. Nevertheless, no computer aided method has been proposed for the analysis of prenatal vessels from ultrasound data, yet. To date, these measurements are being performed manually on ultrasound fetal images by skilled practitioners. The aim of the presented study is to introduce an automatic algorithm that identifies abdominal aorta and estimates its diameter and aIMT from routine third trimester ultrasonographic fetal data.The algorithm locates the aorta, then segments it and, by modeling the arterial wall longitudinal sections by means of a gaussian mixture, derives a set of measures of the aorta diameter (aDiam) and of the intima-media thickness (aIMT). After estimating the cardiac cycle, the mean diameter and the aIMT at the end-diastole phase are computed.Considering the aIMT value for each subject, the correlation between automatic and manual end-diastolic aIMT measurements is 0.91 in a range of values 0.44-1.10 mm, corresponding to both normal and pathological conditions. The automatic system yields a mean relative error of 19%, that is similar to the intra-observer variability (14%) and much lower that the inter-observer variability (42%).The correlation between manual and automatic measurements and the small error confirm the ability of the proposed system to reliably estimate aIMT values in prenatal ultrasound sequences, reducing measurement variability and suggesting that it can be used for an automatic assessment of aIMT.

P23.03: Eye tracking as a tool to assess sonographer behaviour when quality‐scoring fetal ultrasound images

<scp>P</scp>23.03: Eye tracking as a tool to assess sonographer behaviour when quality‐scoring fetal ultrasound images

British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review).

British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review).

Study of Fetal Anatomy using Ultrasound Images

Ultrasound imaging has widespread applications in medical field, especially for the study and assessment of fetus in the womb of pregnant woman. This paper highlights the background information regarding basics of ultrasound imaging, the various anatomical terminologies related to human body and fetus, and various steps to identify the organs of fetus using ultrasound images with major emphasis on the fetus heart detection. The paper serves an information source for any engineering person from non-medical background to carry out his/ her research in fetal ultrasound image analysis.

Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop.

Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.

Detection and Measurement of Fetal Abdominal Contour in Ultrasound Images via Local Phase Information and Iterative Randomized Hough Transform

Due to the characteristic artifacts of ultrasound images, e.g., speckle noise, shadows and intensity inhomogeneity, traditional intensity-based methods usually have limited success on the segmentation of fetal abdominal contour. This paper presents a novel approach to detect and measure the abdominal contour from fetal ultrasound images in two steps. First, a local phase-based measure called multiscale feature asymmetry (MSFA) is de ned from the monogenic signal to detect the boundaries of fetal abdomen. The MSFA measure is intensity invariant and provides an absolute measurement for the signi cance of features in the image. Second, in order to detect the ellipse that ts to the abdominal contour, the iterative randomized Hough transform is employed to exclude the interferences of the inner boundaries, after which the detected ellipse gradually converges to the outer boundaries of the abdomen. Experimental results in clinical ultrasound images demonstrate the high agreement between our approach and manual approach on the measurement of abdominal circumference (mean sign difference is 0.42% and correlation coef cient is 0.9973), which indicates that the proposed approach can be used as a reliable and accurate tool for obstetrical care and diagnosis.

Izolated fetal liver calcifications: prenatal management

SUMMARY Objective: The aim of this study was to determine the incidence and clinical significance of isolated fetal liver calcifications. Material and methods: Between 2008 -2012 we were performed 19200 detailed fetal ultrasonography screening between 18-28 weeks of gestation and cases with isolated fetal liver calcifications were enrolled in the study. A detailed fetal ultrasound imaging for associated abnormalities, the serological status for maternal TORCH (toxoplasma, rubella, cytomegalovirus, herpesvirus), syphilis and parvovirus B-19 was determined. Doppler ultrasound was used to detect a possible flow in the echogenic lesions. Amniocentesis was offered in all cases. All neonates were examined and followed up after birth. Results: We were detected 17 women with isolated fetal liver calcifications. All of the calcifications were isolated, solitary and parenchymal. None of the fetuses was associated with other organs abnormalities or intrauterine infections. Amniocentesis results of 14 women who accepted this procedure were normal. Conclusion: If fetal liver calcifications are isolated, the prognosis will be good.

A Medical Link Between Local Maternity Hospitals and a Tertiary Center Using Telediagnosis With Fetal Cardiac Ultrasound Image Transmission

Information and communication technology has been widely applied to various fields, including clinical medicine. We report here a telediagnosis system using ultrasound image transmission. The effect of telediagnosis, using a medical link between local maternity hospitals and our children's medical center, was verified. The number of fetal telediagnosis for cardiac disease, and cases referred to a perinatal care center and emergent transportation of neonates with congenital heart disease from maternity hospitals, were calculated based on the hospital records. The percentage of patients found to have heart disease was compared between out-patient clinic and telediagnosis cases. Telediagnosis increased, allowing maternity hospital staff to obtain support easily from a specialist when making a diagnosis. Many severe cases were transferred to tertiary centers with the correct diagnosis; consequently, the number of emergent transportations of neonates with severe cardiac anomalies continued to below. Telediagnosis was also useful as an educational tool for maternity hospital staff, who improved their skills during conversations with a specialist. Unlike in the outpatient clinic, consultation by telediagnosis was requested even for cases of mild abnormalities, and the number of false-positives increased, while many cardiac anomalies were found in the early stage. Furthermore, telediagnosis was helpful for pregnant women requiring bed rest, and also had the advantage of allowing a doctor to be able to talk with parents. Establishing a fetal telediagnosis system is a useful strategy to improve neonatal care through a medical link between local maternity hospitals and a tertiary center.

Trends in Diagnostic Ultrasound Acoustic Output From Data Reported to the US Food and Drug Administration for Device Indications That Include Fetal Applications

A survey was conducted of acoustic output data received by the US Food and Drug Administration for diagnostic ultrasound devices whose indications for use include fetal applications to assess trends in maximum available acoustic output over time. Data were collected from 124 regulatory submissions received between 1984 and 2010. Data collection excluded transducers not indicated for diagnostic fetal imaging. The output parameters of ultrasonic power, mean center frequency, and bone thermal index (TIB) were extracted or computed from the submissions for 3 periods: 1984-1989, 1992-1997, and 2005-2010. The data were stratified according to the following imaging modes: M-mode, B/M-mode, pulsed wave Doppler, color flow Doppler, and continuous wave Doppler. Ultrasonic power and maximum TIB values have increased roughly an order of magnitude from pre-1991 to post-1991 periods; the center frequency has decreased somewhat (4.2 to 3.4 MHz). The percentage of Doppler-mode transducers has increased substantially over time, with the majority of the diagnostic fetal imaging transducers currently designed to operate in Doppler modes; this increase is particularly important, since Doppler modes generate much higher TIB levels than B/M-modes. Color flow Doppler ultrasound currently operates at the highest mean ultrasonic power level (with a 14-fold increase over time). The observed trends in increased acoustic output for both Doppler and non-Doppler modes underscore the widely recognized importance of adherence to the ALARA (as low as reasonably achievable) principle and prudent use in fetal ultrasound imaging.

Evaluation and Comparison of Current Fetal Ultrasound Image Segmentation Methods for Biometric Measurements: A Grand Challenge

This paper presents the evaluation results of the methods submitted to Challenge US: Biometric Measurements from Fetal Ultrasound Images, a segmentation challenge held at the IEEE International Symposium on Biomedical Imaging 2012. The challenge was set to compare and evaluate current fetal ultrasound image segmentation methods. It consisted of automatically segmenting fetal anatomical structures to measure standard obstetric biometric parameters, from 2D fetal ultrasound images taken on fetuses at different gestational ages (21 weeks, 28 weeks, and 33 weeks) and with varying image quality to reflect data encountered in real clinical environments. Four independent sub-challenges were proposed, according to the objects of interest measured in clinical practice: abdomen, head, femur, and whole fetus. Five teams participated in the head sub-challenge and two teams in the femur sub-challenge, including one team who tackled both. Nobody attempted the abdomen and whole fetus sub-challenges. The challenge goals were two-fold and the participants were asked to submit the segmentation results as well as the measurements derived from the segmented objects. Extensive quantitative (region-based, distance-based, and Bland-Altman measurements) and qualitative evaluation was performed to compare the results from a representative selection of current methods submitted to the challenge. Several experts (three for the head sub-challenge and two for the femur sub-challenge), with different degrees of expertise, manually delineated the objects of interest to define the ground truth used within the evaluation framework. For the head sub-challenge, several groups produced results that could be potentially used in clinical settings, with comparable performance to manual delineations. The femur sub-challenge had inferior performance to the head sub-challenge due to the fact that it is a harder segmentation problem and that the techniques presented relied more on the femur's appearance.

A novel approach to speckle noise filtering based on Artificial Bee Colony algorithm: An ultrasound image application

In this study a novel approach based on 2D FIR filters is presented for denoising digital images. In this approach the filter coefficients of 2D FIR filters were optimized using the Artificial Bee Colony (ABC) algorithm. To obtain the best filter design, the filter coefficients were tested with different numbers (3×3, 5×5, 7×7, 11×11) and connection types (cascade and parallel) during optimization. First, the speckle noise with variances of 1, 0.6, 0.8 and 0.2 respectively was added to the synthetic test image. Later, these noisy images were denoised with both the proposed approach and other well-known filter types such as Gaussian, mean and average filters. For image quality determination metrics such as mean square error (MSE), peak signal-to-noise ratio (PSNR) and signal-to-noise ratio (SNR) were used. Even in the case of noise having maximum variance (the most noisy), the proposed approach performed better than other filtering methods did on the noisy test images. In addition to test images, speckle noise with a variance of 1 was added to a fetal ultrasound image, and this noisy image was denoised with very high PSNR and SNR values. The performance of the proposed approach was also tested on several clinical ultrasound images such as those obtained from ovarian, abdomen and liver tissues. The results of this study showed that the 2D FIR filters designed based on ABC optimization can eliminate speckle noise quite well on noise added test images and intrinsically noisy ultrasound images.

GENERALIZATION OF RAYLEIGH MAXIMUM LIKELIHOOD DESPECKLING FILTER USING QUADRILATERAL KERNELS

Speckle noise is the most prevalent noise in clinical ultrasound images. It visibly looks like light and dark spots and deduce the pixel intensity as murkiest. Gazing at fetal ultrasound images, the impact of edge and local fine details are more palpable for obstetricians and gynecologists to carry out prenatal diagnosis of congenital heart disease. A robust despeckling filter has to be contrived to proficiently suppress speckle noise and simultaneously preserve the features. The proposed filter is the generalization of Rayleigh maximum likelihood filter by the exploitation of statistical tools as tuning parameters and use different shapes of quadrilateral kernels to estimate the noise free pixel from neighborhood. The performance of various filters namely Median, Kuwahura, Frost, Homogenous mask filter and Rayleigh maximum likelihood filter are compared with the proposed filter in terms PSNR and image profile. Comparatively the proposed filters surpass the conventional filters.

Erworbene ZNS-Läsionen im fetalen MRT

Acquired central nervous system (CNS) lesions are often subtle; therefore, the prenatal diagnosis of these lesions is extremely important. The fetal ultrasound examination and magnetic resonance imaging (MRI) are two important imaging methods that give an insight into these types lesions. The method of choice during pregnancy is still fetal ultrasound; however, fetal MRI is important when there are certain pathologies, e.g. periventricular leukomalacia (PVL) or malformations of the vein of Galen. In this manner clinicians can plan further therapy after childbirth in advance (e.g. cerebral angiography or embolization).

The Poetics of Childbearing

With the ascent of obstetrics, gynecology, and psychoanalysis, the childbearing woman’s subjectivity has been increasingly eclipsed by that of her child-to-be. This article describes the sociohistorical understanding of childbearing and shows how it has become intertwined with four women’s lived experiences of pregnancy and birth based on diaries and interviews they completed for this study. The participants’ childbearing experiences revealed an ambiguous, sensual symbiosis between themselves and others that threatens the Western notion of a free-floating, solipsistic subject exemplified in fetal photographs and ultrasound images.

Hidden mortality of prenatally diagnosed vein of Galen aneurysmal malformation: retrospective study and review of the literature

To evaluate the prognosis of prenatally diagnosed vein of Galen aneurysmal malformation (VGAM) in a large cohort with this condition and to review the literature on prenatally diagnosed VGAM. This was a retrospective study of all cases of prenatally diagnosed VGAM managed in our referral center during a 12-year period. VGAM was categorized as being either isolated or associated with any other abnormality, based on fetal ultrasound and magnetic resonance imaging findings. Poor outcomes comprised termination of pregnancy with confirmation of antenatal findings, perinatal death and severe cardiac and/or neurological impairment in survivors. The literature was also reviewed for similar cases. Twenty-one cases of prenatally diagnosed VGAM were managed in our center. Four (19.0%) cases were isolated and 17 (81.0%) were associated with other anomalies. There were nine terminations (42.9%) and six neonatal deaths (28.6%). Six children (28.6%) were still alive at last follow-up, of whom three had abnormal neurological development. VGAM associated with other anomalies was strongly associated with a poor outcome compared with isolated forms (P < 0.0001). One hundred and nine cases from the literature were also reviewed. Fetuses with prenatally diagnosed VGAM have unexpectedly poor outcomes in the presence of cardiac or cerebral anomalies, while those with strictly isolated VGAM tend to have more favorable outcomes. Our literature review corroborates these findings.

Three-dimensional HDlive rendering images of the TRAP sequence in the first trimester: reverse end-diastolic umbilical artery velocity in a pump twin with an adverse pregnancy outcome.

The twin reversed arterial perfusion (TRAP) sequence, also known as fetus acardius, occurs in 0.3 % of monozygotic twin gestations, which amounts to a frequency of about 1 per 35,000 deliveries [1, 2]. There have been only two reports on antenatal three-dimensional (3D) sonographic diagnosis of the TRAP sequence during pregnancy [3, 4]. The HDlive is a new surface render mode involving the use of skin-like colors, and ‘‘its system uses an adjustable light source, giving the operator the opportunity to create lighting and shadowing effects and thereby increasing depth perception’’ [5]. There have been four reports on fetal, placental, and umbilical cord ultrasound images using the 3D HDlive rendering mode [5–8]. Employing 3D HDlive with new skin-like colors, we can achieve a natural and anatomically realistic appearance of the embryo and fetus in utero. However, there has been no reports on 3D HDlive rendering displays of the TRAP sequence in the first trimester of pregnancy. There have been five reports on reverse end-diastolic velocity in umbilical artery velocimetry with an adverse pregnancy outcome at less than 14 weeks of gestation, which suggested that reverse end-diastolic umbilical artery velocity waveforms might be an ominous sign in early pregnancy [9–13]. However, there are no sonographic findings in the first trimester that can help to distinguish between pregnancies resulting in death of the pump twin from those that will survive until prophylactic intervention at 16–18 weeks in TRAP sequence cases [14]. In this report, we present our experience of a TRAP sequence reconstructed employing the 3D HDlive rendering mode, and discuss the reverse end-diastolic blood flow velocity waveform in the umbilical artery of a pump twin with an adverse pregnancy outcome in the first trimester. A 33-year-old pregnant Japanese woman, gravida 1, para 0, was referred to our ultrasound clinic because of a suspected TRAP sequence at 11 weeks and 6 days of gestation. The 2D sonography and the 3D surface rendering mode (Voluson E8, GE Healthcare, Milwaukee, WI, USA) showed a normal pump twin and small acardiac twin with acrania and absence of the heart and upper limbs (Fig. 1). The crown-rump length of the pump twin was 43.3 mm (consistent with the corresponding age), and no gross fetal anomaly was noted. The longitudinal distance between the upper pole and rump of the acardiac fetus was 27.6 mm. The 3D HDlive rendering mode provided anatomically realistic images for TRAP sequence diagnosis (Fig. 2). Color and pulsed Doppler sonography revealed a reverse end-diastolic umbilical artery velocity in the pump twin at 13 weeks and 1 day of gestation (Fig. 3a). There was a single-artery umbilical cord between the placenta and acardiac fetus, and a reversed tiny absent diastolic umbilical artery velocity was noted (Fig. 3b). Fetal demise of the pump twin was confirmed at 14 weeks’ gestation. Delivery C. Tenkumo H. Tanaka M. Ito E. Uketa N. Mori U. Hanaoka K. Kanenishi T. Hata (&) Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa 761-0793, Japan e-mail: toshi28@med.kagawa-u.ac.jp

7.0 Obstetric management

7.0 Obstetric management