3D Ultrasound. Outline. What is 3D US? Volume Sonography. 3D Ultrasound in Obstetrics: Current Modalities & Future Potential. Alfred Abuhamad, M.D.

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1 in Obstetrics: Current Modalities & Future Potential Outline What is 3D US? What are obvious advantages of 3D US? What is the future of 3D US? Alfred Abuhamad, M.D. Eastern Virginia Medical School 2D US 3D US What is 3D US? Z Y X Volume of Data Infinite # of Planes Voxel Volume Sonography 1

2 Surface rendering Four-Chamber view What are obvious advantages of 3D US? Review Planes Unobtainable by 2D Ultrasound Review planes unobtainable by 2D Surface rendering cardiac valves 2

3 Midline Anomalies of fetal Brain 3D median planes are more easily obtained Allow for accurate diagnosis of anomalies Valuable approach for rapid assessment Ultrasound Obstet Gynecol, 2006 Oct;28(5):742 Review planes unobtainable by 2D Cranial Sutures Review planes unobtainable by 2D Patterns of normal and abnormal development described Premature closure of coronal sutures in Apert syndrome Development of sutures in Trisomy 21 described Ultrasound Obstet Gynecol, 2006 Mar;27(3):286 Ultrasound Obstet Gynecol, 2006 Jan;27(1):28 Ultrasound Obstet Gynecol, 2005 Dec;26(7):761 3

4 Cleft Lip / Palate Flipped face view Reverse face view Underside view Ultrasound Obstet Gynecol 2007 Feb;29(2):159 Ultrasound Obstet Gynecol 2005 Jan;25(1):12 J Ultrasound Med 2006 Nov;25(11):1423 Cleft Lip / Palate Prospective study, low risk 1856 second trimester pregnancies Diagnosis at first scan: 87 % (3D) vs 78 % (2D) J Evid Based Dent Pract 2006 Dec;6(4):278 Review Topographic Anatomy (skin) 4

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6 Rotate volumes to view all sides Rotate Volumes To View All Sides Highlight elements within volume Highlight Elements Within Volumes Display Of Vasculature 6

7 Accurate Volume Measurements Volume Measurements Fetal Lung Volumes Lung Volume / Pulmonary Hypoplasia 3D US had best diagnostic accuracy PPV: 100%, NPV: 92% Superior to 2D biometric parameters Prenat Diagn, 2007 Mar;27(3):216 Ruano JUM 2006:25;701 7

8 Volume Measurements Estimation of Fetal Weight Estimation of Fetal Weight Fractional limb volume (EFW) Upper arm volume (IUGR) J Ultrasound Med Dec;20(12):1283 Ultrasound Med Biol Nov;31(11):1435 Post-Processing Tools 2D 3D Color Doppler 3D Color Glass body mode B-Flow Mode 8

9 VSD B VSD RV IVS IVS LV C VSD A IVS TOF - TUI PA rpa lpa CAT AO PA CAT CAT Inverse mode CAT HD Color TR L PA SVC AO PA AO DA ARSA L DA ARSA A B Fig

10 PA-VSD DORV TGA 2D Ultrasound Impact of 2D Ultrasound TAPVC- Infracardiac type 10

11 Trondheim, Norway Isolated Congenital Heart Disease Experienced Less Experienced Total Total, n Detected, n, (%) 8 (44) 6 (27) 14 (35) Why? Ultrasound Obstet Gynecol 2006; 28:8 Compare Ultrasound with MR & CT! 11

12 CT & MR Standardization Reproducibility Image recognition With improvement in technology Image gets better automatically The practice of ultrasound Four Chamber View Limitations Of 2D US Imaging Operator dependency Lack of standardization Lack of reproducibility Gap between technology & skills 12

13 Screening For CHD What is needed is: -Standardization & Simplification of the US exam 3D US allows for that 2 Important Concepts in 3D Sonography 3D Sonography Concept 1: Acquired volume of a structure contains all the anatomical 2D planes for a complete evaluation of this structure 3D Sonography Concept 2: For every organ, 2D anatomical planes that are needed for a complete evaluation are organized in a constant anatomic relationship to each others. 13

14 3D Sonography Standardization Obtain a volume of an organ Computerized program to automatically display all 2D planes that are required for a complete evaluation of this particular organ. Automated Sonography To Resolve the effect of Variability Automation + TUI 3D Automation Introduces simplification to complex organs Enhances standardization Potential for image recognition 14

15 3D Matrix Technology 3D US