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First experiences with HDVI? in obstetric ultrasound
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First experiences with HDVI? in obstetric ultrasound - 1

First experiences with High Definition Volume Imaging (HDVITM) in obstetric ultrasound Dr. Veronika Frisova, Ph.D Profema-Fetal Medicine Centre Ltd. & Department of Imaging Methods, 2nd Faculty of Medicine at Charles University and Faculty Hospital Motol, Prague, Czech Republic INTRODUCTION In recent years, three-dimensional (3D) ultrasound has been accepted as a valuable tool in prenatal diagnosis of fetal anomalies [1-3]. 3D ultrasound allows reconstruction of planes which are difficult or impossible to visualize directly by 2D technique [16]. Recent developments allow faster volume acquisition reducing movement artifacts which can disrupt the 3D volume dataset. The application of multiple display modes makes understanding and analysis of fetal anatomy easier for clinicians [3]. High Definition Volume Imaging (HDVI™) is a next generation technology for the improvement of 3D image quality to the level of 2D image quality. 3D ultrasound has been found to be particularly useful for evaluation of the fetal face, CNS and spine in the 2nd and 3rd trimesters [1-3]. 3D examination of the fetal face has received the greatest amount of attention from parents, media and also clinicians [2]. This technique was found to provide beneficial clinical information mainly in the assessment of the integrity of the fetal palate [1, 2, 7]. According to the ISUOG guideline for fetal neurosonogram the fetal brain should be evaluated in all three orthogonal planes [8]. While it is usually easy to visualize the traditional transverse sections of the fetal brain with conventional 2D ultrasound, the so-called median plane is often very difficult to obtain. This plane is very important as it provides unique information about mid-sagittal intracranial structures such as the corpus callosum and the cerebellar vermis [5]. 3D ultrasound imaging improves the fetal brain examination as it allows simultaneous display of all three orthogonal planes [1-3, 8, 9]. For the fetal spine the addition of maximum mode rendering to the multi-planar view facilitates the diagnosis of hemivertebra with other vertebral anomalies and allows rapid and easy assessment of the fetal ribs [1-3]. As for the clinical usefulness of 3D ultrasound in the first trimester, the results remain mixed [3]. Some studies report about its benefits both in the assessment of fetal anatomy [10] and in the measurement of nuchal translucency [10, 11], while others have found the image quality to be unsatisfactory and thus inadequate for clinical usage [3].

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First experiences with HDVI? in obstetric ultrasound - 2

CASE REPORTS Case 1: Mid-sagittal plane of a normal fetal brain at 21 weeks using 3D rendering in OVIX™ Fig. 1a) 3D rendering with OVIX™ Fig. 1b) 3D rendering with OVIX™ and HDVITM Case 1: Application of the Oblique View eXtended (OVIX™) thin slice 3D rendering allowed easy reconstruction of the mid-sagittal plane of the fetal brain from a volume which was acquired in the axial plane. Application of HDVI™ markedly improved the contrast and resolution resulting in easier and more detailed assessment. In the HDVI™-applied transcerebellar plane, the borders of the lateral ventricle, thalami...

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First experiences with HDVI? in obstetric ultrasound - 3

Case 3: Examination of the fetal brain in a fetus with agenesis of the corpus callosum at 21 weeks Fig. 3b) 3D multi-planar mode with HDVITM Case 3: This 3D volume was acquired in the coronal plane. The application of HDVI™ markedly improved the image quality of the volume to the point where the signs of agenesis of the corpus callosum could be clearly seen. The complete absence of the corpus callosum in the mid-sagittal plane and the typical indirect signs of this anomaly: bullhorn shape of lateral ventricles, absence of cavum septi pellucidi, wide opening of the interhemispheric fissure...

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First experiences with HDVI? in obstetric ultrasound - 4

CONCLUSION We have found several areas in fetal medicine in which application of this novel HDVI™ technology was useful. This unique technique improved the speed and accuracy of the examination and increased our diagnostic confidence. Major anatomical landmarks could be identified more clearly and manipulation of 3D volume datasets in multi-planar mode with 3D rendering of anatomical structures was facilitated. Furthermore, evaluation of subtle details of the fetal anatomy and more accurate measurements of the fetal structures were made possible with HDVI™. LITERATURE 1. Goncalves, L.F., et...

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