First trimester two- and four-dimensional cardiac scan: intra- and interobserver agreement, comparison between methods and benefits of color Doppler technique

Authors

  • S. Tudorache,

    Corresponding author
    1. Prenatal Diagnostic Unit, Emergency University Hospital, Craiova, Dolj, Romania
    2. University of Medicine and Pharmacy Craiova
    • Correspondence to: Dr S. Tudorache, University of Medicine and Pharmacy Craiova, Department of Obstetrics and Gynecology, 2-4 Petru Rares, Craiova, Dolj, 200349, Romania; Emergency University County Hospital, First Clinic of Obstetrics and Gynecology, 1 Tabaci, Craiova, Dolj, 200642, Romania (e-mail: stefania.tudorache@gmail.com)

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  • M. Cara,

    1. University of Medicine and Pharmacy Craiova
    2. Public Health Department Craiova, Craiova, Dolj, Romania
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  • D. G. Iliescu,

    1. Prenatal Diagnostic Unit, Emergency University Hospital, Craiova, Dolj, Romania
    2. University of Medicine and Pharmacy Craiova
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  • L. Novac,

    1. University of Medicine and Pharmacy Craiova
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  • N. Cernea

    1. Prenatal Diagnostic Unit, Emergency University Hospital, Craiova, Dolj, Romania
    2. University of Medicine and Pharmacy Craiova
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ABSTRACT

Objective

To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural assessment, using two-dimensional (2D) ultrasound (2D-US) and 4D-US (4D spatiotemporal image correlation (STIC) technology), to compare the methods and to assess the advantages of adding color Doppler to each technique.

Methods

Digital videoclips (B-mode and color Doppler) and 4D-STIC volumes (gray-scale and color Doppler) from 632 pregnancies with normal fetal hearts were acquired and stored at the time of detailed first-trimester ultrasound examination. Later analysis on a randomized sample of 100 cases was performed, targeting 11 cardiac structures and features. We compared visualization of fetal heart parameters using 2D-US vs 4D-US and gray-scale vs color Doppler imaging.

Results

STIC volumes were considered satisfactory (adequate visualization of at least 8/11 parameters) in 78% of cases and 2D-US acquisitions in 89% of cases. The intra- and interobserver agreement was good for both 2D and 4D methods (kappa > 0.6), and the percentage overall agreement was very high using both methods (95%). 2D- and 4D-US identification of the fetal cardiac parameters did not differ significantly. The differences between gray-scale and color Doppler imaging were statistically significant in identifying similar key cardiac parameters, for both 2D- and 4D-US (P < 0.05).

Conclusion

Both 2D and 4D methods for assessing first-trimester heart parameters are feasible and repeatable within and between observers. Color Doppler adds valuable information to both methods. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

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