A Review of Three-dimensional Ultrasound Applications in Fetal Growth Restriction

Factors Predicting Fetal Growth Restriction and Fetal Cardiac Remodeling

Objective

This study aimed to investigate factors influencing fetal growth restriction (FGR) occurrence and assess the clinical significance of fetal cardiac parameters in FGR prediction.

Methods

Pregnant women with clinically suspected FGR (n=179) and uncomplicated pregnancies (n=53) were included. All had undergone routine obstetric ultrasonography and fetal echocardiography. Umbilical artery flow (UAF) and fetal cardiac parameters (left atrial transverse diameter (LAd), right atrial transverse diameter (RAd), left ventricular transverse diameter (LVd), right ventricular transverse diameter (RVd), foramen ovale width, atrial septum diameter, interventricular septal thickness, left ventricular posterior wall thickness, right ventricular free wall thickness, aortic diameter, pulmonary artery diameter, mitral E velocity, mitral A velocity, tricuspid E velocity, tricuspid A velocity, aortic valve peak flow velocity, and pulmonary valve peak flow velocity) were detected. Follow up was conducted until birth, various fetal clinical parameters were collected: maternal body mass index (BMI), hypertensive disorders complicating pregnancy (HDCP), abnormal umbilical artery flow, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, emergency cesarean delivery, maternal height, maternal age, gestational diabetes mellitus (GDM), hypothyroidism, assisted reproductive technology (ART), parity, and neonatal gender. Participants were categorized into confirmed FGR (n=119) and control (n=113) groups based on neonatal birth weight.

Results

Significant differences were observed between groups in maternal BMI, HDCP, abnormal UAF, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, and emergency cesarean delivery. FGR was positively related to abnormal UAF, placental or umbilical cord anomalies, preterm birth and emergency cesarean delivery and negatively to maternal BMI (r=-0.276). Compared to the control group, the FGR group exhibited significantly larger RAd, RVd, RA/LA, and RV/LV.

Conclusion

Fetal growth-restricted fetuses have enlarged right heart structures. Fetal cardiac examinations are valuable for early FGR diagnosis, potentially improving neonatal body weight and reducing adverse pregnancy outcomes.

Fetal brain imaging: A comparison between fetal ultrasonography and intra uterine magnetic resonance imaging (a systematic review and meta-analysis)

OBJECTIVE

The aim of this study was to compare ultrasound (US) and intra uterine MRI (IUMRI) of the brain in the diagnosis of fetal brain abnormalities.

METHODS

The present systematic review is done based on guidelines for preferred reporting items for systematic reviews and meta-analysis. All major articles comparing fetal US with IUMRI in fetuses with suspected brain abnormalities were qualified. Articles published before 2010 were excluded from the study. An I²  > 20% was considered as a sign of significant change. The statistical analysis was done using STATA -15 and Meta-Disk 1.4 applications.

RESULTS

Five articles were considered for meta-analysis. The sensitivity of US and IUMRI in diagnosing fetal abnormalities were 86% and 95%, respectively. The corresponding rates for specificity were 77% and 80%. IUMRI and US were concordant in 72.5% (95% CI: 68%-77%) of diagnoses. However, IUMRI added information in 21.7% of cases, while US added value was only 1.48.

CONCLUSION

Our results approved the good diagnostic performance of both US and IUMRI in confirming fetal brain normal development and emphasized that US is an appropriate screening technique in pregnancy. In cases of detected abnormalities in US, IUMRI is suggested as it was the most accurate imaging method and added information about the diagnosis in 22.2% of cases.

The prevalence and the adding value of fetal MRI imaging in midline cerebral anomalies

Background

Foetal MR imaging is widely accepted as an adjunct to foetal ultrasonography; however, there are many controversies regarding its importance and indications. Therefore, this study aimed to evaluate foetuses with different midline cerebral abnormalities, to determine the prevalence of these anomalies, to define the role of foetal MRI, and to compare MRI and ultrasound (US) result with postnatal MRI findings. Seventy-eight pregnant women who had foetuses with CNS abnormalities detected by sonogram were included. Foetuses with midline anomalies were selected and evaluated by anomaly scan foetal US, pre- and postnatal MRI.

Results

Midline brain anomalies were found in 47.4% of foetuses with brain anomalies. Holoprosencephaly was found in 24.3% of midline anomaly foetuses, corpus callosum abnormalities (ACC) were detected in 40.5%, midline intracranial mass lesions in 2.7%, and midline posterior fossa anomalies in 32.4%. An agreement between MRI and US in the main diagnosis was in 56.76% of cases; MRI added information to US findings in 43.2% of cases, and US added information to MRI findings in 8.1% of cases.

Conclusion

In evaluating midline cerebral anomalies, US and MRI are complementary techniques. US is the primary survey, and MRI can add additional information and/or change the main diagnosis.

The potential utility of high-intensity ultrasound to treat osteoarthritis

Osteoarthritis (OA) is a widespread musculoskeletal disease that reduces quality of life and for which there is no cure. The treatment of OA is challenging since cartilage impedes the local and systemic delivery of therapeutic compounds (TCs). This review identifies high-intensity ultrasound (HIU) as a non-contact technique to modify articular cartilage and subchondral bone. HIU enables new approaches to overcome challenges associated with drug delivery to cartilage and new non-invasive approaches for the treatment of joint disease. Specifically, HIU has the potential to facilitate targeted drug delivery and release deep within cartilage, to repair soft tissue damage, and to physically alter tissue structures including cartilage and bone. The localized, non-invasive ultrasonic delivery of TCs to articular cartilage and subchondral bone appears to be a promising technique in the immediate future.

Prenatal diagnosis of fetal gastroschisis using three-dimensional ultrasound: comparison between the 20th and 21st centuries

OBJECTIVE

In order to compare the trends and improvements of prenatal diagnosis of gastroschisis, we herein retrospectively reviewed our cases of fetal gastroschisis detected by three-dimensional ultrasound (3D US) between the two centuries.

MATERIALS AND METHODS

We reviewed our computer database of prenatal diagnosis on gastroschisis in National Cheng Kung University Hospital from October 1994 to November 2011. All the fetuses were initially scanned by two-dimensional (2D) US to locate the region of interest (ROI). Then, the 3D probe was used to scan all the ROI systematically and mechanically, and all the images were stored on laser discs for further 3D visualization and reconstruction. To compare the characteristics at prenatal diagnosis of gastroschisis between the 20th and 21st centuries in our hospital, the Chi-square test and Student t test were used. The p values less than 0.05 and 0.1 were considered statistically significant.

RESULTS

In total, 26 fetuses with gastroschisis were depicted by 3D US in utero (10 cases were diagnosed in the 20th century and 16 cases in the 21st century). The ranges of gestational age at prenatal diagnosis of gastroschisis by 3D US in the 20th century were between 14 and 34 weeks (mean: 21.6 weeks) and between 14 and 33 weeks (mean: 21.9 weeks) in the 21st century. Moreover, seven cases (70%) were diagnosed before the third trimester in the 20th century, whereas 13 cases (81%) were diagnosed before the third trimester in the 21st century.

CONCLUSION

Although without statistical significance, higher prenatal diagnosis rate before the third trimester in the 21st century was noted. The improvement of 3D US has remarkable advantages in adding novel visual depiction of a 3D lesion of a 3D fetus in 3D US after reconstruction and thus assists substantially in prenatal diagnosis, genetic consultation, and perinatal management of gastroschisis.