Prospective evaluation of the fetal heart using Fetal Intelligent Navigation Echocardiography (FINE)

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Garcia M1,2, Yeo L1,2,3, Romero R1,4,5,6, Haggerty D1,2, Giardina I7, Hassan SS1,2,3, Chaiworapongsa T1,2,3, Hernandez-Andrade E1,2,3. 1Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA. 2Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA. 3Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA. 4Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. 5Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA. 6Department of Molecular Obstetrics and Genetics, Wayne State University, Detroit, MI, USA. 7Department of Obstetrics and Gynecology, University of Perugia, Perugia, ITALY.
KEYWORDS: 4D; STIC; Virtual Intelligent Sonographer Assistance, VIS-Assistance® ; cardiac; fetal heart; prenatal diagnosis; spatiotemporal image correlation; ultrasound

ABSTRACT
Objectives To prospectively evaluate the performance of Fetal Intelligent Navigation Echocardiography (FINE) applied to spatiotemporal image correlation (STIC) volume datasets of the normal fetal heart. Methods In all patients with normal fetal hearts (19-30 gestational weeks), an attempt was made to acquire STIC volume datasets of the apical four-chamber view if the following criteria were met: 1) fetal spine located between the 5- and 7-o’clock positions; 2) minimal or absent shadowing (including a clearly visible transverse aortic arch); 3) absent fetal breathing, hiccups, or movement; and 4) adequate image quality. Each STIC volume successfully acquired was evaluated by STICLoop™ to determine its appropriateness before applying the FINE method. Visualization rates for fetal echocardiography views using diagnostic planes and/or Virtual Intelligent Sonographer Assistance (VIS-Assistance®) were calculated.
Results One or more STIC volumes (n=365 total) were successfully obtained in 72.5% (150/207) of women undergoing ultrasound examination. Of the 365 volumes evaluated by STICLoop™, 96.2% (n=351) were determined to be appropriate. From these, only one STIC volume per patient (n=150) was analyzed using the FINE method, and nine fetal echocardiography views were generated using: 1) diagnostic planes in 76-100% of cases; 2) VIS-Assistance® in 98-100% of cases; and 3) a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases.
Conclusions In women with normal fetal hearts (19-30 gestational weeks) undergoing prospective sonographic examination, STIC volumes can be successfully obtained in 72.5%. In such cases, the FINE method can be applied to generate nine standard fetal echocardiography views using a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases. This suggests that FINE could be implemented in fetal cardiac screening programs.