13-week pulmonary sonoangiogram by 3D HDlive flow

Abstract

Recent development of three-dimensional (3D)/four-dimensional (4D) sonography has revealed structural and functional early human development in utero and 3D/4D sonography moved prenatal diagnosis of fetal anomalies from the second to the first trimester of pregnancy. HDlive flow is a recent application of 3D ultrasound technology generating a 3D-view of the blood flow and providing a realistic rendering of fine vascular structure. Combination of HDlive silhouette and flow can be described as a ‘see-through fashion’, because of its comprehensive orientation and persuasive localization of inner structure as well as of fetal angiostructure inside the morphological structure. The picture of this month demonstrates normal intracorporeal angiostructure by 3D HDlive silhouette/flow imaging with bidirectional power Doppler at 13 weeks of gestation. The umbilical arteries, umbilical vein, ductus venosus, inferior vena cava, descending aorta as well as rich pulmonary vascularity are clearly demonstrated in a single 3D reconstructed image. This image indicates existence of rich pulmonary vascularity from even before lung maturation in the first trimester. Prenatal prediction of neonatal prognosis in cases with still remains a challenge but previous trials have been done after 20 weeks of gestation. Nowadays, many of pulmonary lesions, such as congenital diaphragmatic hernia (CDH) and congenital cystic adenomatoid malformation (CCAM), have been diagnosed in the first or early second trimesters. Recent advanced imaging technology of HDlive flow showing pulmonary vasculature from the first trimester in this article may have a great potential to investigate fetal lung development and maturity from early gestation and lead to scheduling of prenatal fetal treatment and proper management.