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Objectives: To assess intracranial structure volumes by 3-dimensional (3D) sonography in fetuses with growth restriction., Methods: We conducted a prospective cross-sectional case-control study involving 59 fetuses with growth restriction (38 fetuses with estimated weight <3rd percentile and 21 fetuses with estimated weight between 3rd and 10th percentiles, according to Hadlock et al [Radiology 1984; 150:535-540]) and 54 controls between 24 and 34 weeks' gestation. The following fetal intracranial structure volumes were assessed: cerebellum, brain, and frontal region. The volume was assessed by 3D sonography using the extended imaging virtual organ computer-aided analysis method with 10 sequential planes. Analysis of variance was used to compare fetal groups. The intraclass correlation coefficient was used to assess intraobserver and interobserver reproducibility., Results: Statistical significance between the brain, frontal region, and cerebellar volumes and a relationship between the frontal region and the brain in fetuses with estimated weights below the 3rd percentile and controls were observed (P < .001; P < .001; and P = .002; and P = .008, respectively). Good intraobserver and interobserver reproducibility was observed for the fetal brain, frontal region, and cerebellar volumes, with intraclass correlation coefficients of 0.998, 0.997, 0.997, 0.999, 0.997, and 0.998, respectively., Conclusions: The intracranial structure volumes assessed by 3D sonography using the extended imaging virtual organ computer-aided analysis method were reduced in fetuses with growth restriction (estimated weight <3rd percentile)., (© 2015 by the American Institute of Ultrasound in Medicine.)

Objective: This study aims to determine reference curves for fetal atrioventricular valve areas by means of three-dimensional ultrasound using the spatiotemporal image correlation (STIC) software., Methods: This was a cross-sectional prospective study on 328 normal fetuses between the 18th and the 33rd weeks of pregnancy. In order to obtain valve areas, the four heart chambers plane was used with the fetus in a dorsal posterior position. To construct reference ranges, a linear regression model was used, adjusted according to the coefficient of determination (R(2)). To calculate the reproducibility of the tricuspid valve area, the intraclass coefficient correlation (ICC) was used., Results: The mean areas of the tricuspid and mitral valves ranged from 0.19 ± 0.08 and 0.20 ± 0.10 cm(2) in the 18th week to 0.93 ± 0.31 and 1.06 ± 0.39 cm(2) in the 33rd week, respectively. The intra-observer and interobserver reproducibility was excellent with ICC = 0.997 and 0.933, respectively., Conclusions: Reference curves for fetal atrioventricular valve areas were determined and presented good reproducibility., (© 2012 John Wiley & Sons, Ltd.)

OBJECTIVES; The purpose of this study was to establish reference ranges for vertebral body areas of the fetal lumbosacral spine in the coronal plane on 3-dimensional sonography using volume contrast imaging with OmniView (GE Healthcare, Zipf, Austria). METHODS; An observational cross-sectional study was conducted on 576 healthy pregnant women at gestational ages of 20 weeks to 34 weeks 6 days. Volume contrast imaging with OmniView was used to measure the vertebral body areas (L1-L5, S1, and S2) by positioning a curved line along the fetal lumbosacral spine. To create reference ranges, first- and second-degree linear regression models adjusted using residual analysis and the coefficient of determination (R(2)) were created. To assess reproducibility, two examiners evaluated 40 random volumes using the intraclass correlation coefficient. RESULTS; The mean areas of the vertebral bodies were 102.72 (range, 25-254), 107.29 (range, 30-245), 105.10 (range, 31-231), 99.09 (range, 31-211), 87.74 (range, 11-178), 65.80 (range, 18-161), and 46.54 (range, 12-129) mm(2) for L1, L2, L3, L4, L5, S1, and S2, respectively. In the intraobserver and interobserver reproducibility assessments, intraclass correlation coefficients of greater than 0.80 were found for all fetal vertebral body areas. CONCLUSIONS; Reference values for fetal lumbosacral spine vertebral body areas were determined by 3-dimensional sonography using volume contrast imaging with OmniView, and they were shown to be reproducible.

Objective: To assess the fetal lumbosacral spine by three-dimensional (3D) ultrasonography using volume contrast imaging (VCI) omni view method and compare reproducibility and agreement between three different measurement techniques: standard mouse, high definition mouse and pen-tablet., Methods: A comparative and prospective study with 40 pregnant women between 20 and 34 + 6 weeks was realized. 3D volume datasets of the fetal spine were acquired using a convex transabdominal transducer. Starting scan plane was the coronal section of fetal lumbosacral spine by VCI-C function. Omni view manual trace was selected and a parallel plane of fetal spine was drawn including interest region. Intraclass correlation coefficient (ICC) was used for reproducibility analysis. The relative difference between three used techniques was compared by chi-square test and Fischer test., Results: Pen-tablet showed better reliability (ICC=0.987). In the relative proportion of differences, this was significantly higher for the pen-tablet (82.14%; p<0.01). In paired comparison, the relative difference was significantly greater for the pen-tablet (p<0.01)., Conclusion: The pen-tablet showed to be the most reproductive and concordant method in the measurement of body vertebral area of fetal lumbosacral spine by 3D ultrasonography using the VCI.

Objective: To compare the agreement of multiplanar and rendering modes in the assessment fetal atrioventricular valves (mitral and tricuspid) areas by three-dimensional (3D) ultrasonography using the software spatio-temporal image correlation (STIC)., Methods: We conducted a prospective cross-sectional study with normal pregnant women, with single fetuses, between 18-33 weeks. To measure the areas, we used the plan of four-chamber view. In the case of multiplanar, the plane was rotated on the axis "Z" form the heart to position at 9h. For rendering, the green line (region of interest - ROI) was placed from the atria of the heart perpendicular to the crux. The agreement was assessed by a Bland-Altman (limits of agreement) using the relative difference between the measures: ((rendering mode) - (multiplanar mode)) / (average)., Results: 328 fetuses were evaluated. We have not identified the occurrence of systematic error between methods: the average relative difference was 1.62% (-2.07% to 5.32%, confidence interval 95%) in the mitral and 1.77% (- 1.08% to 4.62%) in the tricuspid valve. The limits of agreement between methods were -65.26% to 68.51% for the mitral and -49.91% to 53.45% for the tricuspid., Conclusions: There was no systematic error between modes and thus the observed values for the area of fetal atrioventricular valves can be used for comparisons needs to be corrected. However, relatively large variations may be observed when repeating the measurement area by different modes.

Objective: To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC)., Methods: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30º. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95., Results: The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05)., Conclusions: The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.

Objectives: The purpose of this study was to determine reference values for the length and area of the fetal corpus callosum between 20 and 33 weeks' gestation using 3-dimensional sonography., Methods: A cross-sectional study was performed in 293 healthy pregnant women between 20 and 33 weeks' gestation. The length and area of the corpus callosum were obtained via the transfontal view with the metopic suture as an acoustic window using 3-dimensional sonographic aquisitions. Linear and weighted polynomial regression models were used, which were adjusted by residual analysis and the R(2) determination coefficient. Intraobserver and interobserver reproducibilities were analyzed by an intraclass correlation coefficient., Results: The mean corpus callosum length ± SD varied from 19.52 ± 2.24 to 40.36 ± 2.87 mm, whereas the mean area varied from 0.44 ± 0.11 to 1.47 ± 0.21 cm(2) at 20 and 33 weeks, respectively. The length and area were highly correlated with gestational age: corpus callosum length = -52.41 + 4.71 × gestational age - 0.06 × gestational age(2) (R(2) = 0.868); and corpus callosum area = -2.47 + 0.16 × gestational age - 0.000037 × gestational age(2) (R(2) = 0.765). The intraobserver and interobserver reproducibilities were excellent, with intraclass correlation coefficients of 0.98 and 0.94 for the length and 0.99 and 0.90 for the area, respectively., Conclusions: Reference values for the length and the area of the fetal corpus callosum between 20 and 33 weeks' gestation were determined with high reproducibility.

Objectives: The aim of this study was to establish nomograms for fetal stroke volume (SV), cardiac output (CO), and ejection fraction (EF) using four-dimensional ultrasound with spatio-temporal image correlation (STIC) modality., Methods: The fetal heart was scanned using STIC modality, starting with classic four-chamber view plane, during fetal quiescence with abdomen uppermost, at an angle of 20-30°, without color Doppler flow mapping. In post-processing virtual organ, computer-aided analysis technique was used to obtain a sequence of six sections of each ventricular volume in end-systolic volume (ESV) and end-diastolic volume (EDV). The SV (SV = EDV-ESV), CO (CO = SV × fetal heart rate), and EF (EF = SV/EDV) for each ventricle were then calculated. Intra- and interobserver agreement were then calculated., Results: Two hundred sixty-five fetuses, ranging in gestational age (GA) from 20 to 34(+6) weeks, were included in the study. The left and right SV and CO increased exponentially with gestation and EF remained fairly stable through gestational. Mean left and right SV increased from 0.211 ml and 0.220 ml at 20 weeks to 1.925 ml and 2.043 ml, respectively, at 34 weeks. Mean left and right CO increased from 30.25 ml/min and 31.52 ml/min at 20 weeks to 268.49 ml/min and 287.80 ml/min, respectively, at 34 weeks. Both left and right mean EF remained constant at around 0.63 with advancing GA. Nomograms were created for LSV, RSV, LCO, RCO, LEF, and REF vs. gestational age. Intra- and interobserver agreement reached 95%., Conclusions: Four-dimensional ultrasound using STIC represents a simple and reproducible method for estimating fetal cardiac function. STIC seems to overcome many of the pitfalls of conventional ultrasound methods and has the potential to become the method of choice.

Background: Early detection of septal changes such as septal hypertrophy commonly present in fetuses of diabetic mothers would help reduce the high rates of infant mortality., Objective: Determine reference ranges for the fetal ventricular septal area through three-dimensional ultrasound (US3D) using the STIC method (Spatio-Temporal Image Correlation)., Methods: We conducted a cross-sectional study with 69 pregnant women between the 18th and 33rd weeks of pregnancy. We used as a reference the four-chamber plane with the ROI (Region of Interest) positioned from the ventricles; the septum area were manually marked. To assess the correlation of the interventricular septum area with gestational age (GA), we constructed scatter plots and calculated Pearson's correlation coefficient (r), and the adjustment was performed by the coefficient of determination (R²). We calculated averages, medians, standard deviations (sd), as well as maximum and minimum values. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC). The interventricular septum thickness was measured and it was correlated with gestational age and the septal area rendered in 52 patients using the ICC., Results: The interventricular septum area was highly correlated with gestational age (r = 0.81), and the average increased from 0.47 cm² in the 18th week to 2.42 cm² in the 33rd of gestation. The intraobserver reproducibility was excellent with ICC = 0.994. No significant correlation was observed between the interventricular septum measurement and the GA (R² = 0.200), as well as there was no correlation with the septal area rendered with ICC = 0.150., Conclusion: Reference intervals for the interventricular septum area between the 18th and the 33rd pregnancy week were determined to be highly reproducible.

Purpose: to evaluate the areas of the atrioventricular valves (tricuspid and mitral) of normal fetuses by the use of three-dimensional ultrasound (3DUS) and the spatiotemporal image correlation (STIC) method., Methods: a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI) positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r) was calculated. Means, medians, standard deviations (SD) and maximum and minimum values were calculated. The simple linear regression model was used to determine reference ranges of valve areas according to the gestational age by the Altman method, with the level of significance set at p<0.05. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC) and the Bland-Altman graph., Results: the mitral and tricuspid valve areas were correlated to the gestational age (r=0.80 for the tricuspid and r=0.79 for the mitral valve) and the mean value of the tricuspid and mitral valves increased from 0.22 ± 0.10 cm² and 0.23 ± 0.10 cm² on the 18th week to 0.92 ± 0.29 cm² and 1.08 ± 0.41 cm² on the 33rd of pregnancy, respectively. The intraobserver reproducibility resulted in an ICC=0.993 (95%CI 0.987; 0.996) and the mean difference was 0.01 cm² (SD ± 0.2 cm² and CI95% ± 0.4 cm²)., Conclusion: reference intervals for the areas of the mitral and tricuspid valve between the 18th and the 33rd week of gestation were determined and proved to be highly reproducible.

Objective: To evaluate the concordance between two-dimensional ultrasonography (2DUS), three-dimensional ultrasonography (3DUS) and magnetic resonance imaging (MRI) in the assessment of lung volume in fetuses with urinary tract malformations (UTM)., Methods: This was a cross-sectional study involving 12 pregnancies between 19 and 34 weeks, with various fetal UTM. Pulmonary volume was obtained by 2DUS using the following equation: total lung volume = [right lung antero-posterior diameter (X) x transverse diameter (Y) x cranial-caudal diameter x 0.152 + left lung (X1) x (Y1) x (Z1) x 0.167]. Pulmonary volume by 3DUS was obtained using the virtual organ computer-aided analysis (VOCAL) method with a 30 degrees (VOL30), 18 degrees (VOL18) and 12 degrees (VOL12) rotation. A fast sequence of transverse lung section was also obtained by MRI. The intraclass correlation coefficient was used to evaluate the correlation between the three methods. The paired student t-test was used to compare the means., Results: There was a strong correlation between the three methods, and the highest correlations were between MRI and VOL18 for the right (ICC = 0.913) and left (ICC = 0.947) lungs. A strong correlation was also found between the lung volumes obtained through MRI and VOL12 as well as VOL18 (p = 0.544 and 0.286, respectively). However, for the left lung there was only a correlation between MRI and VOL12 (p = 0.49)., Conclusions: There is a good concordance between 3DUS (VOL12) and MRI in the evaluation of lung volume in fetuses with UTM.

We assessed the vascular indices of the anterior territory of the middle cerebral artery (MCA) in normal pregnancies using 3-D power Doppler (3DPD). A cross-sectional study was carried out on 90 normal pregnancies between 24 and 35 weeks. All examinations were performed by a single operator using a volumetric transducer. The anterior territory of the MCA was scanned and the volumes were captured using 3DPD. The sphere mode of the VOCAL program was used to calculate the following vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). Models of polynomial regression and Pearson's correlation coefficient were used to evaluate the correlation between gestational age (GA) and the vascular indices. The 3DPD vascular indices had a low correlation with gestational age (VI - r = 0.324, p = 0.002; FI - r = 0.375, p < 0.001; VFI - r = 0.374, p < 0.001). There was a low correlation between GA and the 3DPD vascular indices of the anterior territory of the MCA.

Objective: To establish normative data for the peak systolic velocity of the middle cerebral artery (MCA-PSV) of fetuses in the second half of pregnancy using multiples of the median and percentile reference range., Methods: A cross-sectional study was performed in 90 healthy fetuses at between 23 and 35 weeks of gestation. A bi-dimensional axial scan of the brain, including the thalami and cavitas septi pellucidi was obtained. The circle of Willis was visualized using color flow mapping. Pulsed-wave Doppler velocimetry of the MCA was performed close to the artery's origin, with a beam-vessel angle below 20 degrees . A table with the multiples of the median (MoM) of the MCA-PSV for each gestational age was generated and Pearson's correlation coefficient (r) was calculated. Regression modeling across gestational age was performed to obtain the reference values., Results: There was a strong correlation between the MCA-PVS and gestational age (r = 0.70; p < 0.001). Values for the MCA-PSV for the following MoM were calculated: 1.0, 1.29, 1.50, and 1.55. The MCA-PSV 2.5(th) and 97.5(th) centiles ranged from 24.33 cm(2)/s to 78.36 cm(2)/s, respectively, between weeks 23 and 35., Conclusions: A nomogram for the fetal MCA-PSV during the second half of pregnancy was generated.