Spatiotemporal Image Correlation Volume Research Articles

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.

Three-dimensional/four-dimensional spatiotemporal image correlation morphology of the ductus arteriosus in fetuses with pulmonary atresia undergoing neonatal ductal stenting.

The value of prenatal identification of morphology of ductus arteriosus in fetuses with congenital heart defects (CHD) with pulmonary atresia and duct-dependent pulmonary circulation (DDPC) in planning neonatal ductal stenting procedure is untested. The aim of the study is to analyze the utility of three-dimensional/four-dimensional (3D/4D) spatiotemporal image correlation (STIC) fetal echocardiography in delineating the morphology of ductus arteriosus in fetuses with DDPC undergoing neonatal ductal stenting. In this retrospective study (2017-22), prenatal imaging of pulmonary artery (PA) anatomy, aortic arch sidedness, and morphology of ductus arteriosus (ductal origin was classified as vertical/horizontal and ductal course as tortuous/straight) was done using 3D/4D STIC imaging and volume datasets. Prenatal findings were correlated with angiographic findings during stenting and the degree of agreement was calculated. We included 27 fetuses with a prenatal diagnosis of CHD with DDPC who underwent neonatal ductal stenting. The accuracy of prenatal assessment of PA anatomy, branch PA stenosis, and arch sidedness was 100%, 92.6%, and 88.9%, respectively. The accuracy of prenatal assessment of ductal origin and course, compared with angiography, was 85.2% and 88.9%, respectively. Prenatal imaging had a diagnostic accuracy of 100% for vertical straight and horizontal tortuous ducts, 84.6% for vertical tortuous, and 67% for horizontal straight ducts. Duct stenting was successful in 25 (92.6%) babies; two died after the procedure from stent occlusion. Fetal echocardiography using 3D/4D STIC imaging enables accurate delineation of the morphology of ductus arteriosus in fetuses with DDPC, thereby aiding parental counseling and planning neonatal ductal stenting.

Application of Semiautomatic Fetal Intelligent Navigation Echocardiography (FINE) in Twin Pregnancies: Half the Work or Twice the Effort?

To assess the performance of fetal intelligent navigation echocardiography (FINE, 5D Heart™) for automated volumetric investigation of the fetal heart in twin pregnancies. Three hundred twenty-eight twin fetuses underwent fetal echocardiography in the second and third trimesters. Spatiotemporal image correlation (STIC) volumes were obtained for a volumetric investigation. The volumes were analyzed using the FINE software, and the data were investigated regarding image quality and many properly reconstructed planes. Three hundred and eight volumes underwent final analysis. 55.8% of the included pregnancies were dichorionic twin pregnancies, and 44.2% were monochorionic twin pregnancies. The mean gestational age (GA) was 22.1 weeks, and the mean maternal BMI was 27.3 kg/m2. The STIC-volume acquisition was successful in 100.0% and 95.5% of cases. The overall depiction rates of FINE were 96.5% (twin 1) and 94.7% (twin 2), respectively (p = 0.0849, not significant). In 95.9% (twin 1) and 93.9% (twin 2), at least 7 planes were reconstructed properly (p = 0.6056, not significant). Our results indicate that the FINE technique used in twin pregnancies is reliable. No significant difference between the depiction rates of twin 1 and twin 2 could be detected. In addition, the depiction rates are as high as those derived from singleton pregnancies. Due to the challenges of fetal echocardiography in twin pregnancies (i.e., greater rates of cardiac anomaly and more difficult scans), the FINE technique might be a valuable tool to improve the quality of medical care in those pregnancies.

Imaging of placental circulations by 4D sonography with high-definition flow and spatiotemporal image correlation technology.

Conventionally, two- and three- dimensional color Doppler ultrasonography are used to examine the placental vascularization, but there are limitations in the examinations. In this report, spatiotemporal image correlation (STIC) volume acquisition in high-definition flow, displayed in glass-body mode was used to study the placental vascularization in eight pregnancies. At 20 weeks' gestation, STIC technique allowed visualization of blood flow in the intraplacental branches of the umbilical artery (IPB) and the spiral artery jets in a cardiac cycle. In particular, blood flow from a mega jet penetrating more than half of the placental thickness was demonstrated. Small blood flow from a tertiary order branch of the IPB traversing the placenta and sharply diminishing into the uterine wall was also demonstrated. There were differences in the IPB pattern between normal pregnancies and pregnancies at risk of fetal growth restriction/pre-eclampsia. There were also differences in the appearance of IPB between 20- and 33-weeks' gestation. The results of this report support that it is feasible to use STIC technology to study the placental vascularization. This novel application of STIC technology can increase the understanding of the complex vascularization.

Maximal Reduction of STIC Acquisition Time for Volumetric Assessment of the Fetal Heart-Benefits and Limitations of Semiautomatic Fetal Intelligent Navigation Echocardiography (FINE) Static Mode.

(1) Objective: To scrutinize the reliability and the clinical value of routinely used fetal intelligent navigation echocardiography (FINE) static mode (5DHeartStatic™) for accelerated semiautomatic volumetric assessment of the normal fetal heart. (2) Methods: In this study, a total of 296 second and third trimester fetuses were examined by targeted ultrasound. Spatiotemporal image correlation (STIC) volumes of the fetal heart were acquired for further volumetric assessment. In addition, all fetal hearts were scanned by a fast acquisition time volume (1 s). The volumes were analyzed using the FINE software. The data were investigated regarding the number of properly reconstructed planes and cardiac axis. (3) Results: A total of 257 volumes were included for final analysis. The mean gestational age (GA) was 23.9 weeks (14.3 to 37.7 weeks). In 96.9 (standard acquisition time, FINE standard mode) and 94.2% (fast acquisition time, FINE static mode) at least seven planes were reconstructed properly (p = 0.0961, not significant). Regarding the overall depiction rate, the standard mode was able to reconstruct 96.9% of the planes properly, whereas the static mode showed 95.2% of the planes (p = 0.0098). Moreover, there was no significant difference between the automatic measurement of the cardiac axis (37.95 + 9.14 vs. 38.00 + 8.92 degrees, p = 0.8827, not significant). (4) Conclusions: Based on our results, the FINE static mode technique is a reliable method. It provides similar information of the cardiac anatomy compared to conventional STIC volumes assessed by the FINE method. The FINE static mode has the potential to minimize the influence of motion artifacts during volume acquisition and might therefore be helpful concerning volumetric cardiac assessment in daily routine.

Fetal speckle-tracking echocardiography: a comparison between two-dimensional and electronic spatio-temporal image correlation (e-STIC) technique

Background Speckle tracking technology has been applied to assess ventricular deformation throughout the cardiac cycle. An electronic four dimensional probe that allows rapid acquisition of electronic spatio-temporal image correlation volumes (eSTIC) has been recently introduced. Objectives The aim of our study was to investigate whether e-STIC acquisition improves deformation analyses reproducibility. Study design We recruited fetuses between 20 and 40 weeks of gestation. We obtained a 2D video clip and an e-STIC volume of a four-chamber view. We focused on left ventricular global strain (LV-GS) and left ventricular ejection fraction (LV-FE). Intraobserver, interobserver and intermethod agreement were assessed by means of intraclass correlation coefficient (ICC) and illustrated by Bland-Altman plots. Systematic differences between measurements were assessed using a paired t-test. Results The mean difference between LV-GS values obtained with e-STIC and 2D analysis was −0.10 (95% CI −2.28, 2.08). No systematic differences were found between the two techniques for LV-GS values (p-value = .927). The mean difference between LV-FE values obtained with e-STIC and 2D analysis was 7.55 (95% CI 4.16, 10.95; p-value <.001). The inter-rater reliability of LV-GS was moderate-to-substantial for both e-STIC and 2D. The inter-rater reliability of LV-FE obtained via e-STIC was superior to that obtained via 2D analysis. The intra-rater reliability of LV-GS obtained with e-STIC was superior to that obtained with 2D analysis (ICC 0.857; 95% IC 0.761–0.917). The intra-rater reliability of LV-FE obtained via e-STIC was superior to that obtained via 2D analysis (ICC 0.647; IC 0.51–0.783). Conclusions e-STIC seems to be a better technique than 2D analysis for intra-rater reliability of LV-GS. 4D acquisition might improve intrinsic limitations of speckle tracking echocardiography.

Feasibility of Semiautomatic Fetal Intelligent Navigation Echocardiography for Different Fetal Spine Positions: A Matter of "Time"?

We investigated the feasibility of a semiautomatic approach for assessments of the fetal heart (fetal intelligent navigation echocardiography [FINE]) in cases of optimal and unfavorable fetal spine positions. In this study, a total of 1693 spatiotemporal image correlation volumes of first-, second-, and third-trimester fetuses were evaluated by experts using the FINE approach. The data were analyzed regarding proper reconstruction of the diagnostic cardiac planes depending on the fetal spine position. A total of 1531 volumes were included. The volumes were divided into 4 groups depending on the fetal spine position: 5-7 o'clock, 4 + 8 o'clock, 3 + 9 o'clock, and 2 + 10 o'clock. In total, 93.2% of the diagnostic planes were displayed properly. Between 5 and 7 o'clock, 94.9% of the diagnostic planes were displayed properly. The correct depiction rates in the other groups were 92.4% (4 + 8 o'clock; n = 538; P = 0.0027), 88.3% (3 + 9 o'clock; n = 156; P < .0001), and 87.3% (2 + 10 o'clock; n = 41; P = .0139). In total, the highest dropout rates were found in the sagittal planes: ductal arch, 13.9%; aortic arch, 10.5%; and venae cavae, 12.0%. Based on our results, the FINE technique is an effective method, but its feasibility depends on the fetal position. The use of this semiautomatic work flow-based approach supports evaluation of the fetal heart in a standardized manner. Semiautomatic evaluation of the fetal heart might be useful in facilitating the detection of fetal cardiac anomalies.

Three-Dimensional Printed Model Fabrication and Effectiveness Evaluation in Fetuses With Congenital Heart Disease or With a Normal Heart.

The purpose of this study was to investigate the technical feasibility and accuracy of applying 3-dimensional (3D) printing of normal and abnormal fetal hearts based on spatiotemporal image correlation (STIC) volume-rendered data. Spatiotemporal image correlation volume images of 15 healthy fetuses and 15 fetuses with cardiac abnormalities were collected, and Mimics software (Materialise NV, Leuven, Belgium) was used to postprocess the volume data to obtain a 3D digital model of fetal heart and large blood vessel morphologic characteristics and to output the file to a 3D printer for printing the 3D model of the fetal heart and large blood vessels. The effect accuracy of the 3D printed model was qualitatively evaluated by showing the 3D anatomic structure of the model combined with echocardiographic or autopsy results, and the dimensional accuracy of the 3D printed model was quantitatively evaluated by comparing the measured data of the model and echocardiography. In all 30 fetuses, STIC volume data of the fetal heart were successfully reprocessed and printed out, which could visually display the morphologic characteristics of the fetal heart chamber and passage of the great vessels under normal and abnormal pathologic conditions. No significant differences in all of the heart size parameters were found between the 3D digital model, 3D printed model, and routine echocardiographic images (all P > .05). Moreover, the size parameters were concordant well between the methods, and all of the data points fell within the limits of agreement. It is feasible to 3D print the fetal heart using STIC volumetric images as the data source, and the 3D printed model can fully and accurately display abnormal anatomic structures of the heart.

Prenatal diagnosis of transposition of the great arteries: an updated review

Simple transposition of the great arteries (TGA) is a cyanotic heart disease that accounts for 5% to 7% of all congenital heart diseases. It is commonly underdiagnosed in utero, with prenatal detection rates of less than 50%. Simple TGA is characterized by ventriculoarterial discordance, atrioventricular concordance, and a parallel relationship of TGA. The prenatal diagnosis of TGA influences postnatal outcomes and therefore requires planned delivery and perinatal management. For these reasons, it is important to identify the key ultrasound markers of TGA to improve the prenatal diagnosis and consequently provide perinatal assistance. The presence of two vessels instead of three in the three-vessel tracheal view, a parallel course of TGA, and identification of the origin of each of TGA are the key markers for diagnosing TGA. In addition to the classical ultrasound signs, other two-dimensional ultrasound markers such as an abnormal right convexity of the aorta, an I-shaped aorta, and the "boomerang sign" may also be used to diagnose TGA in the prenatal period. When accessible, an automatic approach using four-dimensional technologies such as spatio-temporal image correlation and sonographically-based volume computer-aided analysis may improve the prenatal diagnosis of TGA. This study aimed to review the ultrasound markers that can be used in the antenatal diagnosis of TGA, with a focus on the tools used by ultrasonographers, the obstetric and fetal medicine team, and perinatal cardiologists to improve the diagnosis of this condition.

New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D heart

Congenital heart disease (CHD) is the leading organ-specific birth defect, as well as the leading cause of infant morbidity and mortality from congenital malformations. Therefore, a comprehensive screening examination of the fetal heart should be performed in all women to maximize the detection of CHD. Four-dimensional sonography with spatiotemporal image correlation (STIC) technology displays a cine loop of a complete single cardiac cycle in motion. A novel method known as Fetal Intelligent Navigation Echocardiography (or FINE) was previously developed to interrogate STIC volume datasets using “intelligent navigation” technology. Such method allows the automatic display of nine standard fetal echocardiography views required to diagnose most cardiac defects. FINE considerably simplifies fetal cardiac examinations and reduces operator dependency. It has both high sensitivity and specificity for the detection of CHD. Indeed, FINE has been integrated into several commercially available ultrasound platforms. Recently, eight novel and advanced features have been developed for the FINE method and they will be described herein. Such features can be categorized based upon their broad goals. The first goal is to simplify FINE further, and consists of the following features: (1) Auto fetal positioning (or FINE align); (2) Skip points; (3) Predictive cursor; (4) Static mode volume; and (5) Breech sweep. The second goal is to allow quantitative measurements to be performed on the cardiac views generated by FINE: (6) Automatic cardiac axis; and (7) Cardiac biometry. Finally, the last goal is to improve the success of obtaining fetal echocardiography view(s); and consists of (8) Maestro planar navigation.

Study on diagnostic performance of fetal intelligent navigation echocardiography for congenital heart defect

Objective To explore the sensitivity and specificity of fetal intelligent navigation echocardiography(FINE, 5D Heart) in the prenatal detection of congenital heart defect(CHD), and to compare its diagnostic performance with spatiotemporal image correlation(STIC) loop (STICloop). Methods A total of 250 pregnant women having a singleton pregnancy in the second and third trimesters from April 2018 to May 2019 in Sir Run Run Shaw Hospital, Zhejiang University College of Medicine were enrolled in this prospective study. 2D ultrasound diagnosis has been made before acquiring STIC volume data set. After the appropriateness of each volume data set was preliminarily determined, all identifying informations were concealed and the appropriate volumes were randomly distributed to less experienced sonographer for analysis using 5D Heart software. The sensitivity and specificity, positive and negative likelihood ratios, as well as area under the receiver operating characteristic curve (AUC) of the two methods were determined respectively, and the differences between the two methods were statistically analyzed. Results The diagnostic performance of 5D Heart for the prenatal detection of CHD was: sensitivity of 95.45% (105/110), specificity of 94.29% (132/140), positive likelihood ratio of 16.72, negative likelihood ratio of 0.05, and AUC of 0.95, respectively. Among cases with confirmed CHD, the 5D Heart diagnosis completely matched the final diagnosis in 77.27% (85/110). The diagnostic performance of STICloop for the prenatal detection of CHD was: sensitivity of 90.91% (100/110), specificity of 92.86% (130/140), positive likelihood ratio of 12.73, negative likelihood ratio of 0.10, and AUC of 0.92. The sensitivity and secificity of 5D Heart in diagnosing CHD were both higher than 90%, and it could successfully detect a broad spectrum of severe fetal CHD. Among cases with confirmed CHD, even the STICloop diagnosis completely matched the final diagnosis in 61.81%(68/110), its diagnostic accuracy was relatively lower than 5D Heart (P=0.013). However, there were no statistical differences between the two methods in sensitivity and specificity(all P>0.05). Conclusions The sesitivity and specifity of 5D Heart in diagnosis CHD were both higher than 90%, and it could successfully detect a broad spectrum of severe fetal CHD. STICloop could be used for preliminary screening of CHD, as it has the same high sensitivity and specificity as 5D Heart. Further examination may be recommended when fetal heart abnormalities are suspected. Key words: Echocardiography; Congenital heart defect; Fetal intelligent navigation echocardiography; Spatiotemporal image correlation

Feasibility of three dimensional printing of the fetal heart using spatio-temporal image correlation data

Objective To investigate the feasibility of three dimensional(3D) printing fetal heart from spatio-temporal image correlation (STIC) volume-rendered data. Methods Eight fetuses with normal heart and 3 fetuses with confirmed cardiac anomalies identified by two-dimensional echocardiography from February to May 2019 in Renmin Hospital of Wuhan University were prospectively enrolled in this study. All the fetuses underwent two-dimensional (2D) echocardiography and STIC technology examination. The 3D volume images of fetal heart were post-processed by Mimics software to create images of the fetal heart in standard tessellation language format(STL). The STL file was output to the 3D printer and the 3D printing models of fetal heart and great vessels were obtained. In the process, the numerical values of each index of fetal hearts were measured from 3D digital model, 3D printing models and routine echocardiography images, respectively. The accuracy of 3D modeling was assessed by comparing the measured values of the model with the measured values of the source data. Results In all the fetuses, STIC volume data of the fetal heart were successfully reprocessed and printed out, the anatomical structure and vascular course could be visually displayed. It showed no significant difference in all the heart size parameters between 3D digital model, 3D printing models and routine echocardiography images (all P>0.05). Moreover, the size parameters were concordant well between the two methods, all of the data points fell within the limits of agreement. Conclusions The 3D printing of fetal heart using STIC volume images as the data source is feasible. Key words: Three dimensional printing; Spatio-temporal image correlation; Congenital heart disease; Fetus

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.

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. This was a cross-sectional prospective study that included pregnant women between 22 and 34weeks 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. The study included 101 pregnant women aged between 16 and 44years. 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). 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.

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

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). 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. 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. 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.

Semiautomatic Fetal Intelligent Navigation Echocardiography Has the Potential to Aid Cardiac Evaluations Even in Less Experienced Hands.

To investigate the interobserver and intraobserver variability and corresponding learning curve in a semiautomatic approach for a standardized assessment of the fetal heart (fetal intelligent navigation echocardiography [FINE]). A total of 30 stored spatiotemporal image correlation volume data sets of second-trimester fetuses were evaluated by 3 physicians with different levels of expertise in fetal echocardiography by using the FINE approach. Data were analyzed regarding the examination time and proper reconstruction of the diagnostic cardiac planes. The completions and numbers of correct depictions of all diagnostic planes were evaluated by a blinded expert (time t0). To determine interobserver and intraobserver variability, the volumes were reassessed after a 4-week training interval (time t1). All operators were able to perform the investigation on all 30 volumes. At t0, the interobserver variability between the beginner and both the advanced (P = .0013) and expert (P < .0001) examiners was high. Focusing on intraobserver variability at t1, the beginner showed a marked improvement (P = .0087), whereas in advanced and expert hands, no further improvement regarding proper achievement of all diagnostic planes could be noticed (P > .999; P = .8383). The beginner also showed improvement in the mean investigation time (t0, 82.8 seconds; t1, 73.4 seconds; P = .0895); nevertheless, the advanced and expert examiners were faster in completing the examination (t1, advanced, 20.9 seconds; expert, 28.3 seconds; each P < .0001). Based on our results, the FINE technique is a reliable and easily learned method. The use of this semiautomatic work flow-based approach supports evaluation of the fetal heart in a standardized and time-saving manner. A semiautomatic evaluation of the fetal heart might be useful in facilitating the detection of fetal cardiac anomalies.

Spatio-temporal image correlation (STIC) in evaluation of advanced neuroendocrine tumours.

4D Ultrasound technology merging the Power Doppler option called High-Definition Flow (HDF) with Spatio-Temporal Image Correlation (STIC) is used in gynaecology and obstetrics. It seems to be a promising tool in assessing tissue vascularisation. The aim of the paper was to assess whether HDF STIC technique could be a useful tool for the evaluation of gastro-entero-pancreatic neuroendocrine neoplasm (GEP-NEN) advancement. Forty-eight patients [mean age 57.7 ± 10.3 years; male 40.9% (n = 18)] diagnosed with metastatic GEP-NENs were included in the analysis. All subjects were enrolled in the Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice. We analysed liver metastases. Patients with G3 grading or faintly vascularised lesions were excluded. HDF STIC volumes were acquired during USG examination. 4D indices [volumetric pulsatility index (vPI) and volumetric systolic/diastolic index (vS/D)] were calculated using dedicated software. There were no correlations between vS/D and Ki-67 [p = 0.67; r = -0.19; (-0.28-0.19)], CgA [p = 0.47; r = -0.11; (-0.38-0,19)], 5-HIAA [p = 0.52; r = -0.09 (-0.37-0.2)], serotonin [p = 0.83; r = -0.03 (-0.32-0.26)], and VCAM-1 (p = 0.62; r = 0.09 (-03-0.47)]. The were no correlations between vPI and Ki-67 [p = 0.29; r = -0.16 (-0.45-0.14)], CgA (p = 0.46; r = -0.11 (-0.39-0.19)], 5-HIAA [p = 0.52; r = -0.09 (-0.37-0.2)], serotonin [p = 0.82; r = -0.03 (-0.32-0.26)], and VCAM-1 (p = 0.62; r = -0.09 (-03-0.47)]. There was no significant difference between carcinoid versus non-carcinoid patients if compared by vS/D and vPI (p = 0.62, p = 0.61, respectively). HDF STIC seems not to be an efficient marker to assess advancement of NENs, due to lack of correlation with widely used and approved markers of progression.

Four-Dimensional Ultrasound for Evaluating Newborn Cardiac Output: A Pilot Study of Healthy Infants

Background: There is currently no reliable non-invasive method of measuring cardiac output in neonatal intensive care. Spatiotemporal image correlation (STIC) is a novel four-dimensional (4D) ultrasound technique that was developed to assess the foetal heart, and it may be a useful way to assess neonatal haemodynamics. Objective: This study aimed to evaluate the feasibility and reproducibility of determining neonatal cardiac output using STIC ultrasound in newborn infants. Design: Infants were recruited opportunistically from a neonatal intensive care unit and then examined by 2 independent observers. STIC was used to obtain images of the heart. End-diastolic and end-systolic ventricular volumes were measured using virtual organ computer-aided analysis (VOCAL) and used to calculate cardiac output. Reproducibility was assessed with intraclass correlation coefficients (ICC) and agreement with Bland-Altman analysis. Results: Twenty-four clinically stable infants of 34–43 weeks corrected gestational age were assessed. Both observers successfully acquired 4D STIC volumes in all infants. Left ventricular output showed good reproducibility, with an intra-observer ICC of 0.86 (0.69–0.94) and inter-observer ICC of 0.87 (0.70–0.95). Right ventricular output also showed good reproducibility, with an intra-observer ICC of 0.88 (0.70–95) and inter-observer ICC of 0.84 (0.63–0.93). Conclusions: Determining cardiac output using 4D STIC ultrasound is feasible and reproducible in well newborn infants. With further evaluation, this technique may provide valuable information about haemodynamic status in newborn infants requiring intensive care.

Z-Score Reference Ranges for the Offset of the Tricuspid Septal Leaflet in Normal Fetuses

Objectives: To determine Z-score equations and reference ranges for mitral valve-tricuspid valve distance (MTD) and the MTD index in the fetal heart. Methods: A prospective cross-sectional study was performed in 899 normal singleton fetuses from 14 to 40 weeks’ gestation. The MTD and interventricular septum length (IVSL) were measured offline after electronic cardiac spatiotemporal image correlation volume acquisition. The MTD index was determined as the ratio of MTD to IVSL. Z-score reference ranges of these measurements were determined against gestational age (GA) and estimated fetal weight (EFW), using regression analysis of the mean and standard deviation (SD). Results: Strong positive correlations were found between the MTD and the independent variables. A simple linear regression model was the best description of the mean and SD of MTD based on GA, while a cubic regression best fitted the mean MTD against EFW. In contrast, the MTD index decreased progressively with the independent variables. Fractional polynomials best fitted the MTD index in terms of GA and EFW. Conclusion: Normal reference values and Z-scores of fetal MTD and MTD index were provided against GA and EFW, which may be useful tools for quantitative assessment of some cardiac and extracardiac diseases.

Applying spatial-temporal image correlation to the fetal kidney: Repeatability of 3D segmentation and volumetric impedance indices.

Spatiotemporal image correlation (STIC) can evaluate fetal renal impedance using four-dimensional volumetric indices. We assessed repeatability of three-dimensional kidney segmentation and the repeatability of the resultant indices. In each of 57 healthy pregnant women, three renal artery pulsed-wave Doppler (PWD) traces and three STIC volumes were acquired from the same fetal kidney and segmented by two observers. Vascularisation-flow index (VFI) and fractional moving blood volume (FMBV) were calculated for every STIC frame and used to determine the volumetric pulsatility index (vPI), volumetric resistance index (vRI) and volumetric systolic/diastolic ratio (vS/D). Segmentation performance was assessed using Dice similarity coefficients (DSCs), Hausdorff distances, coefficient of variation (CoV) and the intraclass correlation coefficient (ICC). Intra/Inter volumetric index repeatability was assessed using ICCs. Forty-eight cases (84%) provided full data. Mean intra- and interobserver DSCs were 0.90 and 0.81. Mean intra- and interobserver Hausdorff distances were 3.88 mm and 5.27 mm. Average kidney volumes for observers 1 and 2 were 9.88 mL and 8.54 mL (mean difference 16.1%). Mean intra-observer volumetric CoVs were 5.3% and 8.1%. Intra- and interobserver ICCs for kidney volume (same STIC volume) were 0.97 and 0.85. When assessing volume variation between STIC volumes, intra-observer ICC was 0.97. ICCs were 0.77-0.81 for VFI-derived volumetric indices and 0.61-0.62 for FMBV-derived indices; ICCs for all PWD indices were between 0.58 and 0.59. Periodical variation in vascularity was demonstrated in the fetal kidney, and three-dimensional segmentation was highly repeatable. Derived volumetric impedance indices show moderate variability but outperform corresponding two-dimensional PWD indices in terms of reproducibility.

Fetal Intelligent Navigation Echocardiography (FINE) Detects 98% of Congenital Heart Disease.

ObjectiveFetal intelligent navigation echocardiography (FINE) is a novel method that automatically generates and displays 9 standard fetal echocardiographic views in normal hearts by applying intelligent navigation technology to spatiotemporal image correlation (STIC) volume data sets. The main objective was to determine the sensitivity and specificity of FINE in the prenatal detection of congenital heart disease (CHD).MethodsA case‐control study was conducted in 50 fetuses with a broad spectrum of CHD (cases) and 100 fetuses with normal hearts (controls) in the second and third trimesters. Using 4‐dimensional ultrasound with STIC technology, volume data sets were acquired. After all identifying information was removed, the data sets were randomly distributed to a different investigator for analysis using FINE. The sensitivity and specificity for the prenatal detection of CHD, as well as positive and negative likelihood ratios were determined.ResultsThe diagnostic performance of FINE for the prenatal detection of CHD was: sensitivity of 98% (49 of 50), specificity of 93% (93 of 100), positive likelihood ratio of 14, and negative likelihood ratio of 0.02. Among cases with confirmed CHD, the diagnosis with use of FINE completely matched the final diagnosis in 74% (37 of 50); minor discrepancies were seen in 12% (6 of 50), and major discrepancies were seen in 14% (7 of 50).ConclusionsThis is the first time the sensitivity and specificity of the FINE method in fetuses with normal hearts and CHD in the second and third trimesters has been reported. Because FINE identifies a broad spectrum of CHD with 98% sensitivity, this method could be used prenatally to screen for and diagnose CHD.