The dimensions of ultrasound imaging are expanding, and women’s health is one area of medicine benefiting from the value of 3D and 4D. Using volumetric images as an adjunct to 2D ultrasound, physicians are expanding their diagnostic capabilities, boosting diagnostic confidence levels and consulting better with patients. With 4D in particular, physicians are using the element of time to further assess and diagnose obstetrical and gynecological conditions, adding more meaning to the saying — “seeing is believing.”
Volume ultrasound is playing a pivotal role in obstetrical care at Abington Memorial Hospital (AMH) in Abington, Pa. This 570-bed hospital offers a full range of comprehensive, high-level maternity services, delivers more babies than any other hospital in Eastern Pennsylvania, and excels in fetal diagnostics and perinatal testing.
Frank Craparo, MD, chief of the division of maternal/fetal medicine and genetics at AMH, specializes in perinatal consultation and frequently relies on the capabilities of 3D and 4D ultrasound. Craparo recalls one particular case involving conjoined twins in which volume sonography was extremely helpful.
Although the Mom was only in the very early stages of her first trimester, Craparo was reasonably confident from the 2D sonogram that she was going to give birth to conjoined twins. However, Craparo needed a way to help the expectant parents better visualize his diagnosis. At this stage in the twin’s development, they would only appear to be the size of peanuts on a monitor. “When we went to the fourth dimension, it was apparent that we had an early diagnosis of conjoined twins,” says Craparo.
Advanced 3D and 4D imaging techniques are valuable tools used in ultrasound today, particularly in women’s health. While 3D is a static volume image, 4D is a 3D image with the element of time. For example, imaging in 4D allows sonographers and physicians to visualize the fetus in movement.
Volume sonography is proving to have significant clinical utility in improving diagnostic efficiencies, as well as helping to counsel expectant parents. An increasing number of women’s health centers are now using 3D and 4D tools on their premium ultrasound systems as a complement to their 2D imaging capabilities.
Sonographers and perinatologists at AMH image in 3D and 4D using Siemens Medical Solutions’ Acuson Antares with fourSight 4D ultrasound technology. “We use it when we think it will enhance the diagnosis,” says Craparo. “There are certain abnormalities we are suspicious of and the 4D rendering really does assist in clarifying them. A classic example is a cleft lip.”
Birth defects occur in one in 33 births. Volume ultrasound is used for assessing and diagnosing certain congenital fetal abnormalities such as malformations of the face, limbs, skeletal structures and organs. On the other hand, 3D and 4D also are being used in gynecology to detect structural problems of the uterus and diagnose ovarian tumors, endometrial polyps, and fibroids.
“3D and 4D are another layer of our diagnostic capability, and hopefully they will help us expand and refine our abilities to make a diagnosis,” says Craparo.
Enhancing diagnostic capabilities
The Center for Maternal-Fetal Medicine (CMFM) in Las Vegas is on board with 4D ultrasound, too. Providing nearly 65 percent of all the perinatology services to the Las Vegas community, the practice consists of four perinatologists who scan on average 25 to 30 women daily. They utilize the Philips Medical Systems’ iU22 intelligent ultrasound system.
According to Maternal Fetal Medicine Specialist Brian Iriye, MD, the center provides consultation for high-risk ultrasound or problems in pregnancy. “We pride ourselves in keeping our equipment at the latest and greatest, which allows us to improve our diagnostic capacity as well as to have quicker examination time,” says Iriye. “If you have better equipment, you can find the view that you need more quickly and continue with the exam.”
Physicians at CMFM presently image in 4D to get a better view of external anomalies, including fetal facial features and spinal defects, hand and feet abnormalities and skeletal dysplagia. Iriye hopes to one day utilize volume sonography to assess and diagnose congenital heart abnormalities. “I think 3D and 4D for perinatologists are becoming something absolutely necessary,” says Iriye. “Most of our diagnoses are made with 2D imaging. But 3D and 4D only enhance our capability in trying to find fetal