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Chiou SC, Hsieh MH, Chen HY, Lin JD, Chen CC, Hsu WH, Jeng LB, Chang CT, Chen RH, Wang TY, Haung WL. The reproducibility of the virtual organ computer-aided analysis program for evaluating 3-dimensional power Doppler ultrasonography of diffuse thyroid disorders. J Endocrinol Invest 2009; 32:139-46. [PMID: 19411812 DOI: 10.1007/bf03345703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to evaluate the intra- observer and inter-observer reproducibility of 3-dimensional (3D) power Doppler ultrasonography with the virtual organ computer-aided analysis (VOCAL) program for measuring thyroid volume and vascular indices in patients with diffuse thyroid disorders. MATERIALS AND METHODS Patients with diffuse goiters were examined by 3D ultrasonography from August 2005 to July 2006. The parameters for vascular assessment included the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and thyroid size, and were obtained using the VOCAL program. This program used plane A and a 30 degrees rotational step. Intra-observer and inter-observer repeatability are presented as intra-class correlation coefficient (intra-CC) and inter-class correlation coefficient (inter-CC), with values >0.70 being acceptable. RESULTS Sixty-three patients in total were enrolled for this study, including 19 patients with simple goiter and 44 patients with autoimmune thyroid disease (AITD) (23 Graves' disease, 21 Hashimoto's thyroiditis). Thyroid volume and 3 vascular indices showed excellent reproducibility in the AITD group (intra- CC>0.9373 and inter-CC>0.8763) and its subgroups. The VI had excellent consistent reproducibility in the simple goiter group (intra-CC>0.8987 and inter-CC>0.8881), but the other parameters did not. CONCLUSIONS Based on this study, 3D power Doppler ultrasonography with the VOCAL program is a reliable tool for evaluating diffuse thyroid disorders due to an autoimmune process. The VI is the most reliable parameter.
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Affiliation(s)
- S-C Chiou
- Division of Endocrinology and Metabolism, China Medical University Hospital, Taichung, Taiwan.
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Britto ISW, de Silva Bussamra LC, Araujo Júnior E, Tedesco GD, Nardozza LMM, Moron AF, Aoki T. Fetal lung volume: comparison by 2D- and 3D-sonography in normal fetuses. Arch Gynecol Obstet 2009; 280:363-8. [PMID: 19132381 DOI: 10.1007/s00404-008-0908-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 12/19/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Ingrid Schwach Werneck Britto
- Department of Gynecology and Obstetrics, Medical Science College of Santa Casa of São Paulo (FCMSCSP), São Paulo, SP, Brazil
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Rousian M, Verwoerd-Dikkeboom CM, Koning AHJ, Hop WC, van der Spek PJ, Exalto N, Steegers EAP. Early pregnancy volume measurements: validation of ultrasound techniques and new perspectives. BJOG 2008; 116:278-85. [DOI: 10.1111/j.1471-0528.2008.02006.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Manganaro L, Perrone A, Sassi S, Fierro F, Savelli S, Di Maurizio M, Tomei A, Francioso A, La Barbera L, Giancotti A, Ballesio L. Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience. Prenat Diagn 2008; 28:745-8. [DOI: 10.1002/pd.2041] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Büsing KA, Kilian AK, Schaible T, Dinter DJ, Neff KW. MR lung volume in fetal congenital diaphragmatic hernia: logistic regression analysis--mortality and extracorporeal membrane oxygenation. Radiology 2008; 248:233-9. [PMID: 18566175 DOI: 10.1148/radiol.2481070934] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess the results of logistic regression analysis that were based on magnetic resonance (MR) image fetal lung volume (FLV) measurements to predict survival and the corresponding need for extracorporeal membrane oxygenation (ECMO) therapy in fetuses with congenital diaphragmatic hernia (CDH) before and after 30 weeks gestation. MATERIALS AND METHODS Written informed consent was obtained and the study was approved by the local research ethics committee. FLV was measured on MR images in 95 fetuses (52 female neonates, 43 male neonates) with CDH between 22 and 39 weeks gestation by using multiplanar T2-weighted half-Fourier acquired single-shot turbo spin-echo MR imaging. On the basis of logistic regression analysis results, mortality and the need for ECMO therapy were calculated for fetuses before and after 30 weeks gestation. RESULTS Overall, higher FLV was associated with improved survival (P < .001) and decreasing probability of need for ECMO therapy (P = .008). Survival at discharge was 29.2% in neonates with an FLV of 5 mL, compared with 99.7% in neonates with an FLV of 25 mL. The corresponding need for ECMO therapy was 56.1% in fetuses with an FLV of 5 mL and 8.7% in fetuses with an FLV of 40 mL. Prognostic power was considerably lower before 30 weeks gestation. CONCLUSION Beyond 30 weeks gestation, logistic regression analysis that is based on MR FLV measurements is useful to estimate neonatal survival rates and ECMO requirements. Prior to 30 weeks gestation, the method is not reliable and the FLV measurement should be repeated, particularly in fetuses with small lung volumes, before a decision is made about therapeutic options.
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Affiliation(s)
- Karen A Büsing
- Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
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Abstract
PURPOSE OF REVIEW Several technological advances have greatly improved three-dimensional sonography, which have improved acquisition and display capabilities. This review describes these technical changes as well as current applications of 3D sonography in prenatal diagnosis. RECENT FINDINGS Recently published papers have emphasized the potential of getting a precise 'any plane of choice' from a three-dimensional volume, as a new way of scanning, based on the off-line analysis of a volume dataset. Surface mode has been used to demonstrate malformations and genetic diseases. The maximum rendering mode, which highlights bones, has great potential for imaging the nasal bones and the frontal bones with the metopic suture. Organ volume can be measured, but the utility of this in clinical practice remains to be determined. Three-dimensional ultrasound needs to be standardized. SUMMARY Three-dimensional ultrasonography is the most rapidly developing technique in fetal imaging. New features will permit the transition from the era of 'sonography in two-dimensional planes' to 'volume ultrasound'.
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Affiliation(s)
- Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Büsing KA, Kilian AK, Schaible T, Debus A, Weiss C, Neff KW. Reliability and Validity of MR Image Lung Volume Measurement in Fetuses with Congenital Diaphragmatic Hernia and in Vitro Lung Models. Radiology 2008; 246:553-61. [DOI: 10.1148/radiol.2462062166] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kusanovic JP, Nien JK, Gonçalves LF, Espinoza J, Lee W, Balasubramaniam M, Soto E, Erez O, Romero R. The use of inversion mode and 3D manual segmentation in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:177-86. [PMID: 18254130 PMCID: PMC2398614 DOI: 10.1002/uog.5242] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Volume measurements by three-dimensional (3D) ultrasonography are considered more accurate than those performed by two-dimensional (2D) ultrasonography. The purpose of this study was to compare the agreement of three techniques, as well as the inter- and intraobserver agreements for volume measurements of fetal fluid-filled structures. METHODS Fifty 3D volume datasets of fetal stomachs and bladders were explored. Volume measurements were performed independently by two observers using: (1) Virtual Organ Computer-aided AnaLysis (VOCAL); (2) inversion mode; and (3) 'manual segmentation'. Reliability was evaluated using intraclass correlation coefficient (ICC), and Bland-Altman plots were generated to examine bias and agreement. The time required to complete the measurements was compared using Student's t-test or the Wilcoxon Signed Rank Test, and P-values < 0.025 or < 0.05 were considered statistically significant. RESULTS All volume datasets could be measured using the three techniques. A high degree of reliability was observed between: (1) VOCAL and inversion mode (ICC, 0.995; 95% CI, 0.992-0.997); (2) VOCAL and manual segmentation (ICC, 0.997; 95% CI, 0.995-0.998); and (3) inversion mode and manual segmentation (ICC, 0.995; 95% CI, 0.992-0.997). There was good agreement between VOCAL and inversion mode (mean, - 2.4%; 95% limits of agreement, - 20.1 to 15.3%), VOCAL and manual segmentation (mean, - 8.3%; 95% limits of agreement, - 28.8 to 12.2%) as well as between inversion mode and manual segmentation (mean, 5.9%, 95% limits of agreement: - 14.3 to 26%). Manual segmentation and inversion mode measurements were obtained significantly faster than those by VOCAL. CONCLUSIONS Volume measurements of fetal fluid-filled structures of relatively regular shape with inversion mode and manual segmentation are feasible. Both techniques have good agreement with VOCAL and are significantly faster than VOCAL. Inversion mode is a reliable method for volume calculations of fluid-filled organs, whereas manual segmentation can be used when volume measurements by VOCAL or inversion mode are technically difficult to obtain, such as solid structures with poorly defined borders as the volume dataset is rotated, like the uterine cervix.
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Affiliation(s)
- Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Jyh Kae Nien
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Luís F. Gonçalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Wesley Lee
- Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - M. Balasubramaniam
- Division of Biostatistics, William Beaumont Hospital Research Institute, Royal Oak, Michigan, USA
| | - Eleazar Soto
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University, Center for Molecular Medicine and Genetics, Detroit, Michigan, USA
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Predicting pulmonary hypoplasia with 2- or 3-dimensional ultrasonography in complicated pregnancies. Am J Obstet Gynecol 2008; 198:140.e1-6. [PMID: 18166330 DOI: 10.1016/j.ajog.2007.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 04/14/2007] [Accepted: 06/05/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare 3-dimensional (3D) lung volume measurements with 2-dimensional (2D) biometric parameters in predicting pulmonary hypoplasia in complicated pregnancies. STUDY DESIGN In this prospective study, 1-4 scans of the fetal lungs were obtained in 33 pregnancies complicated by various disorders or complications with regard to pulmonary hypoplasia. The 3D lung volumes vs gestational age or estimated fetal weight, the thoracic circumference vs gestational age or femur length, the thoracic/abdominal circumference ratio, and the thoracic/heart area ratio were measured. RESULTS Of the 33 infants, 16 (48.5%) were diagnosed with pulmonary hypoplasia on postmortem examination or the clinical and radiological presentation. Three dimensional lung volume measurements had a better diagnostic accuracy for predicting pulmonary hypoplasia (sensitivity, 94%; specificity, 82%; positive predictive value [PPV], 83%; negative predictive value [NPV], 93%), compared with the best 2D biometric measurement thoracic/heart area ratio (sensitivity, 94%; specificity, 47%; PPV, 63%; NPV, 89%). CONCLUSION 3D lung volume measurements seem to be useful in predicting pulmonary hypoplasia prenatally.
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Araujo Júnior E, Nardozza LMM, Rodrigues Pires C, Filho HAG, Moron AF. Comparison of two- and three-dimensional ultrasonography in lung volume measurement of normal fetuses. J Perinat Med 2007; 35:415-21. [PMID: 17504009 DOI: 10.1515/jpm.2007.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The purpose of this study was to compare the two- and three-dimensional methods for measuring fetal lung volume of normal fetuses. METHODS A cross-sectional study was performed with 51 normal pregnant women between 20 and 35 weeks. The ellipsoid formula (X*Y*Z*0.52) was used for volume calculation with the two-dimensional (2D) method. With the VOCAL (Virtual Organ Computer-aided Analysis) method, a rotation angle of 30 degrees was used. Intraclass correlation coefficient (ICC), paired Student's t-test and Bland-Altman plots were used to compare the techniques. To calculate the intraobserver variability we used the ICC and compared the means between the two measures using the paired Student's p-test. RESULTS VOCAL and 2D methods were highly correlated (ICC=0.919 and 0.873 for the right and left lungs, respectively), however, there was a disagreement. The fetal lung volume means calculated by the 2D method were always overestimated in relation to the means obtained by the VOCAL, for the right lung (24.02 mL x 19.15 mL; P<0.001), as well as for the left (16.03 mL x 13.77 mL; P=0.002). As for the intraobserver variability, a good reproducibility was observed for the volume measurement of the left lung by the 2D technique (mean=0.40 mL; P=0.57) and by the VOCAL (mean=-0.22 mL; P=0.63). The 2D method, however, presented low reproducibility for the right lung (mean=1.73 mL; P=0.31). CONCLUSION The two-dimensional method had low agreement and low reproducibility in relation to the three-dimensional method for measurement of fetal lung volume in normal fetuses.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Sao Paulo's Federal University (Unifesp/EPM), Sao Paulo, SP, Brazil.
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Hata T, Kuno A, Dai SY, Inubashiri E, Hanaoka U, Kanenishi K, Yamashiro C, Tanaka H, Yanagihara T. Three-dimensional sonographic volume measurement of the fetal lung. J Obstet Gynaecol Res 2007; 33:793-8. [DOI: 10.1111/j.1447-0756.2007.00658.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jani JC, Peralta CFA, Ruano R, Benachi A, Done E, Nicolaides KH, Deprest JA. Comparison of fetal lung area to head circumference ratio with lung volume in the prediction of postnatal outcome in diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:850-854. [PMID: 17937452 DOI: 10.1002/uog.5167] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To compare prediction of postnatal survival in isolated diaphragmatic hernia by prenatal two-dimensional (2D) versus three-dimensional (3D) sonographic assessment of the contralateral lung. METHODS The lung area to head circumference ratio (LHR) of the contralateral lung was measured and expressed as a percentage of the normal mean for gestation (O/E) in 47 fetuses with isolated diaphragmatic hernia at 26 (range, 21-36) weeks of gestation. The lung area was measured by tracing the limits of the lungs (LHR trace) and by multiplying the longest diameter by its perpendicular (LHR diameters). The contralateral lung volume was measured by the Virtual Organ Computer-Aided anaLysis method and the O/E was calculated. Regression analysis was used to determine the significance of the LHRs and volume in the prediction of postnatal survival. RESULTS The survival rate was 59.6% (28 of 47). There were significant associations between O/E LHR trace and O/E LHR diameters, and between each O/E LHR and O/E volume, but multiple regression analysis demonstrated that significant prediction of survival was provided only by O/E LHR trace and intrathoracic herniation of the liver. CONCLUSIONS In diaphragmatic hernia prenatal prediction of postnatal outcome is better by 2D measurement of LHR trace than it is by 3D measurement of lung volume.
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Affiliation(s)
- J C Jani
- Unit of Prenatal and Gynecological Ultrasound and Fetal Therapy, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium
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Hata T, Kuno A, Dai SY, Inubashiri E, Hanaoka U, Kanenishi K, Yamashiro C, Tanaka H, Yanagihara T. Three-dimensional sonographic volume measurement of the fetal spleen. J Obstet Gynaecol Res 2007; 33:600-5. [PMID: 17845315 DOI: 10.1111/j.1447-0756.2007.00618.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The objective of this longitudinal study was to evaluate the growth of the fetal spleen in normal pregnancies, using three-dimensional ultrasound. METHODS Three-dimensional sonographic examinations were performed on 14 appropriate-for-gestational-age fetuses. Fetal splenic volume was measured every 2-3 weeks after 20 weeks of gestational age until delivery. RESULTS Curvilinear relationships were found between the gestational age and splenic volume (R(2) = 80.2%, P < 0.0001), and normal ranges of splenic volume measurements for estimating the growth of the fetal spleen during normal pregnancy were generated. We found that the splenic volume calculation based on the equation for the volume of the ellipsoid by conventional two-dimensional ultrasound in previous investigations is about twice as large as that using three-dimensional ultrasound in our study, whereas the present data described in this study is quite comparable with previous data from an autopsy series. CONCLUSION Our findings suggest that the standard curve for the fetal splenic volume using three-dimensional ultrasound provides a superior means for evaluating the normal splenic growth in the fetus and for identifying splenic abnormalities in utero. However, the data and its interpretation in our study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size would be needed to confirm these findings.
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Affiliation(s)
- Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, Kagawa, Japan.
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Jani JC, Cannie M, Peralta CFA, Deprest JA, Nicolaides KH, Dymarkowski S. Lung Volumes in Fetuses with Congenital Diaphragmatic Hernia: Comparison of 3D US and MR Imaging Assessments. Radiology 2007; 244:575-82. [PMID: 17641375 DOI: 10.1148/radiol.2442061158] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare three-dimensional (3D) ultrasonography (US) and magnetic resonance (MR) imaging in the assessment of lung volumes in fetuses with congenital diaphragmatic hernia. MATERIALS AND METHODS Informed consent was obtained for this ethics committee-approved study. Left and right lung volumes were measured by using the 30 degrees virtual organ computer-aided analysis 3D US technique and a transverse multiplanar T2-weighted MR imaging technique in 43 fetuses with isolated congenital diaphragmatic hernia. Regression analysis was used to determine the significance of the association between the two methods. RESULTS The 43 fetuses were assessed in a total of 78 examinations. Median gestational age at the examinations was 28 weeks (range, 18-38 weeks). In all examinations, it was possible to visualize and measure both the ipsilateral and the contralateral lungs with MR imaging. In contrast, with 3D US, the contralateral lung could be measured in all examinations, but the ipsilateral lung could be measured in only 44 (56%) examinations. For the contralateral lungs, there was a significant association between 3D US and MR imaging measurements (r = 0.86, P < .001). Although the mean lung volume measured with 3D US was 25% lower than that measured with MR imaging, the ratio of observed volume to expected normal mean volume for gestation was not significantly different between the two methods (3D US, 0.48; MR imaging, 0.52). In the 44 examinations in which the ipsilateral lung could be measured with both methods, 3D US volumes were not significantly different from MR imaging volumes, and the association was weaker (r = 0.39, P < .05) in the ipsilateral lungs than in the contralateral lungs. CONCLUSION For congenital diaphragmatic hernia, 3D US provides a reliable measurement of the contralateral but not the ipsilateral lung.
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Affiliation(s)
- Jacques C Jani
- Unit of Prenatal and Gynaecological Ultrasound and Fetal Therapy, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, 3000 Leuven, Belgium
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Kazan-Tannus JF, Dialani V, Chiang G, Feldman HA, Brown J, Levine D. MR volumetry of brain and CSF in fetuses referred for ventriculomegaly. AJR Am J Roentgenol 2007; 189:145-51. [PMID: 17579164 PMCID: PMC1995423 DOI: 10.2214/ajr.07.2073] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to validate the method of performing fetal brain volumetry. In particular, our objectives were to assess which imaging plane is most reproducible for the performance of brain volumetry measurements and to ascertain inter- and intraobserver variability in determining brain volume in fetuses referred for ventriculomegaly (VM). SUBJECTS AND METHODS In this prospective study, 50 consecutive fetuses at 17-37 weeks of gestational age referred for MRI for VM underwent fast spin-echo T2-weighted imaging. Supratentorial brain parenchyma, lateral ventricles, and extraaxial and cerebellar volumetric measurements were manually obtained in three planes by three radiologists. Inter- and intraobserver variability were assessed. The relationship between volumes and gestational age, and lateral ventricular diameter were assessed. RESULTS Volumes increased with gestational age. The presence of VM correlated with increased lateral ventricle diameter. The effect of imaging plane was negligible. Inter- and intraobserver variability were low. CONCLUSION Supratentorial parenchyma and lateral ventricular volumes can be reliably measured on fetal MRI, and imaging plane was not an important factor in measurement. Further studies are needed to correlate these indexes with long-term postnatal outcomes.
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Affiliation(s)
| | - Vandana Dialani
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue
| | - Gloria Chiang
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Henry A. Feldman
- Clinical Research Program, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - Jeff Brown
- Pharmacoepidemiology Group, Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215
| | - Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue
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Yang SH, Nobuhara KK, Keller RL, Ball RH, Goldstein RB, Feldstein VA, Callen PW, Filly RA, Farmer DL, Harrison MR, Lee H. Reliability of the lung-to-head ratio as a predictor of outcome in fetuses with isolated left congenital diaphragmatic hernia at gestation outside 24-26 weeks. Am J Obstet Gynecol 2007; 197:30.e1-7. [PMID: 17618746 DOI: 10.1016/j.ajog.2007.01.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 10/31/2006] [Accepted: 01/16/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between lung-to-head ratio (LHR) and gestational age (GA) in fetuses with isolated left congenital diaphragmatic hernia and to determine the applicability and reliability of LHR to predict postnatal outcome beyond 24-26 weeks of gestation. STUDY DESIGN The institutional review board approved this retrospective review of the University of California, San Francisco, Fetal Treatment Center database for cases with left congenital diaphragmatic hernia who were referred between March 1995 and June 2004. LHR was determined at the initial evaluation. One hundred seven live-born fetuses at 20-34 weeks of gestation (excluding cases that were lost to follow-up, with factors that potentially could influence the LHR measurement or postnatal outcome, or that were terminated electively). RESULTS The median GA at LHR measurement was 25.6 weeks; the median LHR was 1.01; the median GA at birth was 37.7 weeks; and the overall survival rate was 59% (64/107). The median LHR of nonsurvivors was significantly lower than that of survivors, but neither GA at LHR measurement nor at delivery was significantly different between the groups. Multiple logistic regression analysis confirmed LHR to be an independent predictor of postnatal survival, and receiver-operator characteristic curve analysis demonstrated that an LHR of > or = 0.97 has the highest performance in predicting postnatal survival. When fetuses were grouped by GA at initial LHR measurement to determine reliability of LHR, specifically with respect to GA, in the 26-34 and 24-26 weeks of gestation groups, median LHR of survivors was significantly higher than that of nonsurvivors, and receiver-operator characteristic curve analysis confirmed LHR to be a reliable predictor of postnatal survival. However, for fetuses at 20-24 weeks of gestation, there was a trend toward a higher LHR in survivors, although this did not reach statistical significance. CONCLUSION A significant positive linear relationship exists between LHR and GA at the time of measurement, such that LHR reliably predicts postnatal survival in fetuses with left congenital diaphragmatic hernia at 24-34 weeks of gestation and less reliable at 20-24 weeks. However, given the limitations of a retrospective, cross-sectional study, further prospective longitudinal studies that will investigate the change of LHR with GA and its association with fetal outcome are necessary.
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Affiliation(s)
- Soon Ha Yang
- Fetal Treatment Center, University of California, San Francisco, San Francisco, CA 94143-0570, USA
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Gerards FA, Twisk JWR, Bakker M, Barkhof F, van Vugt JMG. Fetal lung volume: three-dimensional ultrasonography compared with magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:533-6. [PMID: 17380559 DOI: 10.1002/uog.3931] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES An accurate and reliable method for measuring fetal lung volumes would be helpful in predicting the outcome in cases with suspected impaired lung growth. Recent studies show that it is possible to obtain fetal lung volume estimations with magnetic resonance imaging (MRI) and three-dimensional (3D) ultrasonography. The purpose of this study was to assess the agreement of lung volumes measured with 3D ultrasonography and MRI in uncomplicated pregnancies. METHODS This was a prospective study in which MRI and 3D ultrasonography examinations were conducted on the same day to measure the fetal lung volumes of 10 women with uncomplicated pregnancies. Intraclass correlation was used to evaluate the agreement between fetal lung volume measurements obtained by MRI and 3D ultrasonography. A proportionate Bland-Altman plot was constructed. RESULTS The intraclass correlation coefficient between MRI and 3D ultrasonography measurements for the right lung was 0.92 (95% CI 0.71-0.98) and for the left lung was 0.95 (95% CI 0.82-0.99). The proportionate limits of agreement between the methods were for the right lung -32.57% to 20.03% and for the left lung -21.26% to 17.13%. CONCLUSIONS There is good agreement between lung volumes measured by MRI and those measured by 3D ultrasonography.
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Affiliation(s)
- F A Gerards
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Kurjak A, Miskovic B, Andonotopo W, Stanojevic M, Azumendi G, Vrcic H. How useful is 3D and 4D ultrasound in perinatal medicine? J Perinat Med 2007; 35:10-27. [PMID: 17313305 DOI: 10.1515/jpm.2007.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The purpose of this paper is to review and analyze the published literature on the use of three-dimensional (3DUS) and four-dimensional (4DUS) ultrasound in perinatal medicine. METHODS We systematically searched Medline through PubMED (January 2000-January 2006), including EMBASE/Excerpta Medica database as well as the Cochrane Database of Systematic Reviews. The search terms used to identify clinical application of 3DUS and 4DUS studies in perinatal medicine were technical development, special features, and recommendation for fetal imaging, research on 3DUS or 4DUS, and the usage of invasive 3DUS or 4DUS procedures. The reference bibliographies of relevant books were also manually searched for supplementary citations. Inclusion criteria were as follows: (1) studies related to the use of 3DUS or 4DUS in perinatal medicine; (2) full text were available in English; (3) publication format of original scientific articles, case reports, editorials or literature reviews and chapters in the books. RESULTS Five hundred and seventy-five articles were identified, and among those, 438 were relevant to this review. CONCLUSIONS 3DUS and 4DUS provided additional information for the diagnosis of facial anomalies, evaluation of neural tube defects, and skeletal malformations. Additional research is needed to determine the clinical utility of 3DUS and 4DUS for the diagnosis of congenital heart disease, central nervous system (CNS) anomalies and detection of fetal neurodevelopmental impairment assessed by abnormal behavior in high-risk fetuses.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Sveti Duh General Hospital, Zagreb, Croatia
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Gerards FA, Twisk JWR, Fetter WPF, Wijnaendts LCD, Van Vugt JMG. Two- or three-dimensional ultrasonography to predict pulmonary hypoplasia in pregnancies complicated by preterm premature rupture of the membranes. Prenat Diagn 2007; 27:216-21. [PMID: 17191262 DOI: 10.1002/pd.1646] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study was to compare 3D lung volume measurements with 2D biometric parameters in predicting pulmonary hypoplasia in pregnancies complicated by preterm premature rupture of the membranes (PPROM). METHODS In this prospective study, 18 pregnancies complicated by PPROMs at a mean 21 weeks' gestation (range 14-32 weeks) were examined. The 3D lung volume measurements and the following 2D biometric parameters were measured: thoracic circumference (TC) versus gestational age or femur length (FL), the TC/abdominal circumference (AC) ratio and the thoracic area/heart area (TA/HA) ratio. The sensitivity, specificity, positive and negative predictive value of each measurement to diagnose pulmonary hypoplasia were compared. Pulmonary hypoplasia was diagnosed on the basis of clinical, radiological and/or pathologic criteria. RESULTS The incidence of pulmonary hypoplasia was 33.3%. The best diagnostic accuracy for predicting pulmonary hypoplasia was achieved using the 3D lung volume measurements versus gestational age (sensitivity 83%, specificity 100%, positive predictive value 100% and negative predictive value 92%). CONCLUSIONS Three-dimensional lung volume measurements seem to be promising in predicting pulmonary hypoplasia prenatally in pregnancies complicated by PPROM.
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Affiliation(s)
- Franca A Gerards
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Balassy C, Kasprian G, Brugger PC, Weber M, Csapo B, Mittermayer C, Hörmann M, Prayer D. MRI investigation of normal fetal lung maturation using signal intensities on different imaging sequences. Eur Radiol 2006; 17:835-42. [PMID: 17180330 DOI: 10.1007/s00330-006-0409-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 05/24/2006] [Accepted: 07/20/2006] [Indexed: 11/29/2022]
Abstract
To purpose of this paper is to study the relation between normal lung maturation signal and changes in intensity ratios (SIR) and to determine which magnetic resonance imaging sequence provides the strongest correlation of normal lung SIs with gestational age. 126 normal singleton pregnancies (20-37 weeks) were examined with a 1.5 Tesla unit. Mean SIs for lungs, liver, and gastric fluid were assessed on six different sequences, and SIRs of lung/liver (LLSIR) and lung/gastric fluid (LGSIR) were correlated with gestational age for each sequence. To evaluate the feasibility of SIRs in the prediction of the state of the lung maturity, accuracy of the predicted SIRs (D*) was measured by calculating relative residuals (D*-D)/D for each sequence. LLSIRs showed significant changes in every sequence (p<0.05), while LGSIRs only on two sequences. Significant differences were shown for the mean of absolute residuals for both LLSIRs (p<0.001) and for LGSIRs (p=0.003). Relative residuals of LLSIRs were significantly smaller on T1-weighted sequence, whereas they were significantly higher for LGSIRs on FLAIR sequence. Fetal liver seems to be adequate reference for the investigation of lung maturation. T1-weighted sequence was the most accurate for the measurement of the lung SIs; thus, we propose to determine LLSIR on T1-weighted sequence when evaluating lung development.
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Affiliation(s)
- Csilla Balassy
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Deprest J, Jani J, Cannie M, Debeer A, Vandevelde M, Done E, Gratacos E, Nicolaïdes K. Prenatal intervention for isolated congenital diaphragmatic hernia. Curr Opin Obstet Gynecol 2006; 18:355-67. [PMID: 16735838 DOI: 10.1097/01.gco.0000193000.12416.80] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We aim to review the recent literature regarding early prenatal prediction of outcome in babies diagnosed with isolated congenital diaphragmatic hernia, as well as results of fetal therapy for this condition. RECENT FINDINGS Current survival rates in population-based studies are around 55-70%. Highly specialized centers report 80% and more, but discount the hidden mortality, mainly in the antenatal period. Fetuses presenting with liver herniation and a lung-to-head ratio of less than 1.0 measured in midgestation have a poor prognosis. Other volumetric techniques are being evaluated for use in midtrimester. Recently, a randomized trial failed to show benefit from prenatal therapy, but lacked power to document the potential advantage of prenatal therapy in severe cases. We proposed percutaneous fetal endoluminal tracheal occlusion with a balloon at 26-28 weeks through a 3.3 mm incision. In severe cases, fetal endoluminal tracheal occlusion increased lung size as well as survival, with an early (7 day) survival, late neonatal (28 day) survival and survival at discharge of 75, 58 and 50%, respectively, comparing favorably with 9% in contemporary controls. Airways can be restored prior to birth improving neonatal survival (83.3% compared with 33.3%). The procedure carries a risk for preterm prelabour rupture of the fetal membranes, although that may decrease with experience. SUMMARY Fetuses with severe congenital diaphragmatic hernia can be identified in the second trimester. Fetal endoluminal tracheal occlusion can be considered as a minimally invasive fetal therapy, improving outcome in such highly selected cases.
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Affiliation(s)
- Jan Deprest
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium.
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Ruano R, Joubin L, Aubry MC, Thalabard JC, Dommergues M, Dumez Y, Benachi A. A nomogram of fetal lung volumes estimated by 3-dimensional ultrasonography using the rotational technique (virtual organ computer-aided analysis). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:701-9. [PMID: 16731886 DOI: 10.7863/jum.2006.25.6.701] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The purpose of this study was to build a nomogram of normal fetal lung volumes throughout gestational age estimated by 3-dimensional ultrasonography using the rotational technique (Virtual Organ Computer-Aided Analysis [VOCAL]; GE Healthcare, Kretztechnik, Zipf, Austria). METHODS Fetal lung volume was assessed in 146 healthy fetuses by 3-dimensional ultrasonography using the technique of rotation of the multiplanar imaging (VOCAL). Inclusion criteria were healthy women with singleton normal pregnancies, normal fetal morphologic ultrasonographic findings, reliable dating established by dates and by ultrasonographic measurement of the crown-lump length in the first trimester, and gestational age from 20 to 37 weeks. Exclusion criteria were discordance between clinical and ultrasonographic dating, patients lost to follow-up, and birth weight disorders. Each patient was scanned once during pregnancy. RESULTS The right, left, and total mean pulmonary volumes ranged, respectively, from 5.37, 4.66, and 9.95 cm3 at 20 weeks to 46.06, 37.34, and 84.35 cm3 at 37 weeks. The logistic transformation analysis yielded the following formulas: right lung volume = exp(4.07/[1 + exp(21.90 - gestational age/5.44)]); left lung volume = exp(3.82/(1 + exp[22.03 - gestational age/5.17)]); and, total lung volume = exp(4.72/[1 + exp(20.30 - gestational age/6.05)]). CONCLUSIONS A new nomogram of fetal lung (right, left, and total) volumes throughout gestational age using the rotational technique (VOCAL) is described, and reference values have been generated.
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Affiliation(s)
- Rodrigo Ruano
- Maternité, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France.
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Peralta CFA, Jani J, Cos T, Nicolaides KH, Deprest J. Left and right lung volumes in fetuses with diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:551-4. [PMID: 16586479 DOI: 10.1002/uog.2752] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To compare the volume of the ipsilateral and contralateral lungs in fetuses with congenital diaphragmatic hernia (CDH). METHODS Left and right lung volumes were measured using three-dimensional (3D) ultrasonography in 42 fetuses with CDH at median 26 (range, 20-32) weeks of gestation. Each value was then expressed as a difference, in standard deviations, from the normal mean for gestation, previously established from the study of 650 normal fetuses at 12-32 weeks (Z-score). The Mann-Whitney U-test was used to determine the significance of the differences between the measurements in fetuses with CDH and normal fetuses and between the ipsilateral and contralateral lungs in fetuses with left- and right-sided CDH. RESULTS There were 34 fetuses with left-sided CDH and eight with right-sided CDH. In CDH both the ipsilateral and contralateral lung volumes were substantially lower than in normal fetuses. In left CDH the left lung volume was 4.03 (median; range, 3.11-4.78) SDs below the normal mean for gestation, and the respective values for the right lung were 3.04 (median; range, 1.78-4.31) SDs (P < 0.001 for both). In right CDH, the left lung volume was 2.91 (median; range, 1.62-4.07) SDs below the normal mean for gestation and the respective values for the right lung were 4.35 (median; range, 3.07-4.99) SDs (P < 0.001 for both). In both left and right diaphragmatic hernia the deficit in the volume of the ipsilateral lung was significantly greater than the deficit in the contralateral lung. CONCLUSIONS In fetuses with CDH both the ipsilateral and contralateral lung volumes are substantially lower than in normal fetuses.
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Gerards FA, Engels MAJ, Twisk JWR, van Vugt JMG. Normal fetal lung volume measured with three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:134-44. [PMID: 16404712 DOI: 10.1002/uog.2672] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To construct reference intervals for fetal lung volumes measured longitudinally using three-dimensional (3D) ultrasound, and to evaluate the effect of gender on lung size. METHODS This was a prospective, longitudinal study in the obstetric outpatient department of the VU University Medical Center, Amsterdam. Seventy-eight women with uncomplicated pregnancies were scanned three to four times at gestational ages of 18-34 weeks. 3D models of the lung were constructed using the ultrasound machine's software. After the infants were delivered the entire group was reanalyzed with regard to fetal gender. Centiles for the lung volumes of the entire group and for each gender separately were estimated using multilevel modeling. RESULTS Charts and tables of right and left fetal lung volumes, using gestational age and estimated fetal weight as the independent variables, are presented. There was a significant difference in lung volume between male and female fetuses at each gestational age. Charts and tables of right and left fetal lung volumes for each gender at gestational ages of 18-34 weeks are also presented. CONCLUSIONS We present valid references for volumetric measurements of the right and left fetal lungs in male and female fetuses. The feasibility and reliability of fetal lung volume measurements using 3D ultrasound is good.
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Affiliation(s)
- F A Gerards
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Kasprian G, Balassy C, Brugger PC, Prayer D. MRI of normal and pathological fetal lung development. Eur J Radiol 2006; 57:261-70. [PMID: 16413987 DOI: 10.1016/j.ejrad.2005.11.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 10/25/2022]
Abstract
Normal fetal lung development is a complex process influenced by mechanical and many biochemical factors. In addition to ultrasound, fetal magnetic resonance imaging (MRI) constitutes a new method to investigate this process in vivo during the second and third trimester. The techniques of MRI volumetry, assessment of signal intensities, and MRI spectroscopy of the fetal lung have been used to analyze this process and have already been applied clinically to identify abnormal fetal lung growth. Particularly in conditions such as oligohydramnios and congenital diaphragmatic hernia (CDH), pulmonary hypoplasia may be the cause of neonatal death. A precise diagnosis and quantification of compromised fetal lung development may improve post- and perinatal management. The main events in fetal lung development are reviewed and MR volumetric data from 106 normal fetuses, as well as different examples of pathological lung growth, are provided.
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Affiliation(s)
- Gregor Kasprian
- University Clinic of Radiodiagnostics, Medical University of Vienna, Allgemeines Krankenhaus, AKH, Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Wladimiroff JW. Fetal lung volumetry: a step closer to a clinically acceptable predictor of lung hypoplasia? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:124-7. [PMID: 16435335 DOI: 10.1002/uog.2717] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- J W Wladimiroff
- Department of Obstetrics and Gynecology, Erasmus Medical School, Rotterdam, The Netherlands
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Peralta CFA, Cavoretto P, Csapo B, Falcon O, Nicolaides KH. Lung and heart volumes by three-dimensional ultrasound in normal fetuses at 12-32 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:128-33. [PMID: 16388511 DOI: 10.1002/uog.2670] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To establish reference intervals for the fetal right, left and total lung volumes and heart volume between 12 and 32 weeks of gestation. METHODS Fetal lung and heart volumes were measured using three-dimensional (3D) ultrasound in 650 normal singleton pregnancies at 12-32 weeks. The VOCAL (Virtual Organ Computer-aided AnaLysis) technique was used to obtain a sequence of six sections of each lung and the heart around a fixed axis, each after a 30 degrees rotation from the previous one. The rotation axis for the lungs extended from the apex to the upper limit of the diaphragm dome, and the rotation axis for the heart extended from its apex to its connection to the great vessels. The contour of each of these organs was drawn manually in the six different rotation planes to obtain the 3D volume measurement. In 60 cases the fetal lungs and heart volumes were measured by the same sonographer twice and also by a second sonographer once in order to compare the measurements and calculate intra- and interobserver agreement. RESULTS The total lung volume and heart volume increased with gestation, from respective mean values of 1.6 and 0.6 mL at 12 weeks to 10.9 and 4.3 mL at 20 weeks and 49.3 and 26.6 mL at 32 weeks. The right to left lung volume ratio did not change significantly with gestation (median, 0.7), whereas the heart to total lung volume ratio increased with gestation from about 0.3 at 12 weeks to 0.5 at 32 weeks. In the Bland-Altman plot, the difference between paired measurements by two sonographers was, in 95% of the cases, less than 0.05, 0.5 and 1.9 mL for each lung at 12-13, 19-22 and 29-32 weeks, respectively, and the corresponding values for the heart volumes were 0.04, 0.4 and 2.3 mL. CONCLUSIONS In normal fetuses the lung and heart volumes increase between 12 and 32 weeks of gestation. The extent to which in pathological pregnancies possible deviations in these measurements from normal prove to be useful in the prediction of outcome remains to be determined.
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Affiliation(s)
- C F A Peralta
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK
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Gonçalves LF, Lee W, Espinoza J, Romero R. Three- and 4-dimensional ultrasound in obstetric practice: does it help? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1599-624. [PMID: 16301717 PMCID: PMC7062383 DOI: 10.7863/jum.2005.24.12.1599] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The purpose of this article was to review the published literature on 3-dimensional ultrasound (3DUS) and 4-dimensional ultrasound (4DUS) in obstetrics and determine whether 3DUS adds diagnostic information to what is currently provided by 2-dimensional ultrasound (2DUS) and, if so, in what areas. METHODS A PubMed search was conducted for articles reporting on the use of 3DUS or 4DUS in obstetrics. Seven-hundred six articles were identified, and among those, 525 were actually related to the subject of this review. Articles describing technical developments, clinical studies, reviews, editorials, and studies on fetal behavior or maternal-fetal bonding were reviewed. RESULTS Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, especially facial clefts. There is also evidence that 3DUS provides additional diagnostic information in neural tube defects and skeletal malformations. Large studies comparing 2DUS and 3DUS for the diagnosis of congenital anomalies have not provided conclusive results. Preliminary evidence suggests that sonographic tomography may decrease the examination time of the obstetric ultrasound examination, with minimal impact on the visualization rates of anatomic structures. CONCLUSIONS Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, evaluation of neural tube defects, and skeletal malformations. Additional research is needed to determine the clinical role of 3DUS and 4DUS for the diagnosis of congenital heart disease and central nervous system anomalies. Future studies should determine whether the information contained in the volume data set, by itself, is sufficient to evaluate fetal biometric measurements and diagnose congenital anomalies.
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Affiliation(s)
- Luís F. Gonçalves
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Wesley Lee
- Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:429-34. [PMID: 15948307 DOI: 10.1002/pd.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Deprest J, Jani J, Cannie M, Van Schoubroeck D, Verbeken E, Devlieger H, Dymarkowski S. Progress in intrauterine assessment of the fetal lung and prediction of neonatal function. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:108-111. [PMID: 15685667 DOI: 10.1002/uog.1845] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- J Deprest
- Lung Development Study Group, Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium.
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