Echocardiography in the fetus--a systematic comparative analysis of standard cardiac views with 2D, 3D reconstructive and 3D real-time echocardiography.

PURPOSE: The aim of our study was to assess the feasibility and reliability of fetal three-dimensional reconstructive echocardiography using freehand technique (3DR) and 3D real-time echocardiography using matrix technology (RT-3D) in consecutive series of pregnancies and to compare the findings with the gold standard 2D ultrasound, as well as postnatal findings.

MATERIALS AND METHODS: Fifty consecutive pregnant women (gestational age 19+3 to 37+0) including 10 fetuses with cardiac malformations were scanned prospectively with 2D, 3DR and RT-3D. 3D data sets were evaluated by a blinded independent examiner. The visualization rates for standard cardiac views and structures were determined and the quality and diagnostic accuracy of each modality were calculated.

RESULTS: In RT-3D, the visualization rate of fetal cardiac views was equivalent to 2D, but was significantly lower for 3DR (4cv: 2D 98%, RT-3D 100%, 3DR 96% RVOT: 2D 96%, RT-3D 98%, 3DR 84%). Short-axis views or views of the complete aortic or ductal arch were more readily identified in RT-3D than in 2D (2D 70%, RT-3D 82%). 3DR was more susceptible than RT-3D to artifacts during acquisition and post-processing. The sensitivity and overall accuracy were significantly higher for 2D and RT-3D than for 3DR, when prenatal data was compared with postnatal findings.

CONCLUSION: 3D freehand reconstruction has significantly lower visualization rates and overall accuracy compared to 2D and RT-3D. RT-3D echo is a feasible and reliable method for imaging the fetal heart. Offering the opportunity of data post-processing and evaluation, RT-3D is a promising method for improving the accuracy of sonographic analysis of fetal cardiac morphology and function.