Introduction
Thorough assessment of the cardiovascular anatomy with two-dimensional
ultrasonography requires the operator to scan these vascular structures
in multiple scanning planes to obtain a mental reconstruction of their
spatial relationships1. The introduction of
four-dimensional echocardiography using STIC facilitated examination of
the fetal heart by navigating through the volume data set in an
unlimited number of cutting planes. Since then, STIC technology has been
widely used for cardiac evaluation in a diagnostic setting. A growing
body of scientific work has shown that application of STIC technology
potentially aids in improving congenital heart defects (CHD)
detection2,3. However, more than a decade ago, studies
on the effectiveness of STIC echocardiography failed to confirm its
superior clinical value for CHD detection compared to conventional 2D
ultrasound both in experienced and less experienced
hands4,5. As fetal echocardiography using STIC
requires extra time and effort and exhibits a strong operator
dependency, its usefulness, particularly in a screening setting, has
been doubted.
With the advancement of an intelligent navigation approach applied on
STIC volumes, 4D echocardiography has been considerably simplified. With
marking of the proposed anatomical structures, all nine diagnostic
planes for comprehensive cardiac evaluation are semiautomatically
reconstructed. One of the advantages of intelligent over manual
navigation in volumetric sonography is the short time required for
acquiring the volume, marking and displaying all the cardiac view, along
with the added benefit of ‘guided’ orientation and identification of
anatomical structures6.
In part II of this paper, we focused on the additional diagnostic value
of fetal intelligent navigation echocardiography (FINE) in the
evaluation of the altered anatomy in left-sided cardiac lesions
simultaneously displayed in axial and longitudinally planes. We will
further discuss recent advances in 4D echocardiography and give a
concise overview of future perspectives on this technique for evaluating
fetal anatomy.