First-Trimester Crown-Rump Length and Embryonic Volume of Fetuses with Structural Congenital Abnormalities Measured in Virtual Reality

Background With the introduction of three-dimensional (3D) ultrasound it has become possible to measure volumes. The relative increase in embryonic volume (EV) is much larger than that of the crown-rump length (CRL) over the same time period. We examined whether EV is a better parameter to determine growth restriction in fetuses with structural congenital abnormalities. Study Design, Subjects, and Outcome Measures CRL and EV were measured using a Virtual Reality (VR) system in prospectively collected 3D ultrasound volumes of 56 fetuses diagnosed with structural congenital abnormalities in the first trimester of pregnancy (gestational age 7+5 to 14+5 weeks). Measured CRL and EV were converted to z-scores and to percentages of the expected mean using previously published reference curves of euploid fetuses. The one-sample t-test was performed to test significance. Results The EV was smaller than expected for GA in fetuses with structural congenital abnormalities (-35% p<0.001, z-score -1.44 p<0.001), whereas CRL was not (-6.43% p=0.118, z-score -0.43 p=0.605). Conclusions CRL is a less reliable parameter to determine growth restriction in fetuses with structural congenital abnormalities as compared with EV. By measuring EV, growth restriction in first-trimester fetuses with structural congenital abnormalities becomes more evident and enables an earlier detection of these cases

Evaluation of First-Trimester Physiological Midgut Herniation Using Three-Dimensional Ultrasound

Introduction: The aim of this study was to investigate the development of midgut herniation in vivo using three-dimensional (3D) ultrasonographic volume and distance measurements and to create reference data for physiological midgut herniation in ongoing pregnancies in a tertiary hospital population. Materials and Methods: The transvaginal 3D ultrasound volumes of 112 women, seen weekly during the first trimester of pregnancy, were obtained and subsequently analysed in a virtual reality environment. The width of the umbilical cord insertion, the maximum diameter of the umbilical cord, and the volume of midgut herniation were measured from 6 until 13 weeks gestational age (GA). Results: All parameters had a positive relation with GA, crown-rump length, and abdominal circumference. In approximately 1 of 10 volumes no midgut herniation could be observed at 9 and 10 weeks GA. In 5.0% of the fetuses the presence of midgut herniation could still be visualised at 12 weeks GA. Conclusion: Reference charts for several dimensions of physiological midgut herniation were created. In the future, our data might be used as a reference in the first trimester for comparison in case of a suspected pathological omphalocele

First trimester physiological development of the fetal foot position using three-dimensional ultrasound in virtual reality

Aim: In anatomic studies of the embryo, it has been established that during the development of the lower limb, several changes in foot position can be observed defined as a temporary ‘physiological clubfoot’. The aim of this study was to develop and test a measurement tool for objective documentation of the first trimester foot position in vivo and made an attempt to create a chart for first trimester foot position. Methods: We developed a virtual orthopedic protractor for measuring foot positioning using three-dimensional virtual reality visualization. Three-dimensional ultrasound volumes of 112 pregnancies of women examined during the first trimester were studied in a BARCO I-Space. The frontal angle (plantar flexion) and the lateral angle (adduction) between the leg and foot were measured from 8 until 13 weeks gestational age. Results: We observed that the frontal angle steadily decreases, whereas the lateral angle first increases, resulting in transient physiological clubfeet position at 10- to 11-week gestation, followed by a decrease to a normal foot position. Conclusion: A transient clubfoot position is present during the normal development of the lower limbs, and it has been measured in vivo for the first time. This study emphasizes that a diagnosis of congenital clubfoot should not be made in the first trimester of pregnancy

Embryonic staging using a 3D virtual reality system

BACKGROUND: The aim of this study was to demonstrate that Carnegie Stages could be assigned to embryos visualized with a 3D virtual reality system. METHODS: We analyse

Innovative three-dimensional imaging: opportunities for virtual embryoscopy

Three-dimensional images of patients are currently viewed and assessed using two-dimensional media and techniques. These two-dimensional techniques do not offer depth perception, while this is required for optimal interpretation of three-dimensional and four-dimensional ultrasound, MRI and CT images. The I-Space virtual reality system offers depth perception and allows the user to take length and volume measurements. I-Space offers a spectacular new way of studying embryonic and foetal growth and development in vivo. This may contribute to prenatal diagnostics being brought forward from the second and third trimesters to the first trimester of pregnancy

Innovative virtual reality measurements for embryonic growth and development

Background Innovative imaging techniques, using up-to-date ultrasonic equipment, necessitate specific biometry. The aim of our study was to test the possibility of detailed human embryonic biometry using a virtual reality (VR) technique. Methods In a longitudinal study, three-dimensional (3D) measurements were performed from 6 to 14 weeks gestational age in 32 pregnancies (n = 16 spontaneous conception, n = 16 IVF/ICSI). A total of 125 3D volumes were analysed in the I-Space VR system, which allows binocular depth perception, providing a realistic 3D illusion. Crown-rump length (CRL), biparietal diameter (BPD), occipito-frontal diameter (OFD), head circumference (HC) and abdominal circumference (AC) were measured as well as arm length, shoulder width, elbow width, hip width and knee width. Result SCRL, BPD, OFD and HC could be measured in more than 96 of patients, and AC in 78. Shoulder width, elbow width, hip width and knee width could be measured in more than 95 of cases, and arm length in 82 of cases. Growth curves were constructed for all variables. Ear and foot measurements were only possible beyond 9 weeks gestation. Conclusions This study provides a detailed, longitudinal description of normal human embryonic growth, facilitated by a VR system. Growth curves were created for embryonic biometry of the CRL, BPD, HC and AC early in pregnancy and also of several 'new' biometric measurements. Applying virtual embryoscopy will enable us to diagnose growth and/or developmental delay earlier and more accurately. This is especially important for pregnancies at risk of severe complications, such as recurrent late miscarriage and early growth restriction

First-trimester detection of surface abnormalities: A comparison of 2- and 3-dimensional ultrasound and 3-dimensional virtual reality ultrasound

The aim was to determine the diagnostic performance of 3-dimensional virtual reality ultrasound (3D-VR-US) and conventional 2- and 3-dimensional ultrasound (2D/3D-US) for first-trimester detection of structural abnormalities. Forty-eight first trimester cases (gold standard available, 22 normal, 26 abnormal) were evaluated offline using both techniques by 5 experienced, blinded sonographers. In each case, we analyzed whether each organ category was correctly indicated as normal or abnormal and whether the specific diagnosis was correctly made. Sensitivity in terms of normal or abnormal was comparable for both techniques (P =.24). The general sensitivity for specific diagnoses was 62.6% using 3D-VR-US and 52.2% using 2D/3D-US (P =.075). The 3D-VR-US more often correctly diagnosed skeleton/limb malformations (36.7% vs 10%; P =.013). Mean evaluation time in 3D-VR-US was 4:24 minutes and in 2D/3D-US 2:53 minutes (P <.001). General diagnostic performance of 3D-VR-US and 2D/3D-US apparently is comparable. Malformations of skeleton and limbs are more often detected using 3D-VR-US. Evaluation time is longer in 3D-VR-US