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To assess the fetal cardiac function and ventricular volumes by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods in fetuses from pre-gestational diabetic women. This was a prospective and cross-sectional study that evaluated 53 fetuses from pre-gestational diabetic women and 53 fetuses from healthy mothers between 20 and 34 weeks of gestation. Only fetuses with no structural or genetic abnormalities and singleton pregnant women were included in this study. The fetal cardiac volumes were assessed by STIC and VOCAL methods. The ejection fraction, stroke volume, and cardiac output were calculated from these measurements to evaluate fetal cardiac function. The Mann-Whitney U test was performed to compare the two groups. For calculation of intra- and interobserver reproducibility's, we used concordance correlation coefficients. The mean differences in the right atrial volumes between the diabetic and normal groups ranged from 0.05 mL to 0.1 mL (p = 0.917 and 0.355, respectively). The median of left atrium (LA) volume measurement in pre-gestational diabetic group was significantly lower than healthy mothers (LA: 0.62 vs. 0.68 mL; p < 0.001). The fetal right and left ventricular volumes were similar in both groups. No significant differences in ejection fraction, stroke volume and cardiac output were observed (p value range 0.086-0.815). The majority of fetal atrial/ventricular volumes showed good intra- and interobserver reliabilities. Conversely, the majority cardiac function parameters showed poor intra- and interobserver agreements. STIC and VOCAL methods gave reproducible quantitative results for fetal atrial and ventricular volumes. Significant differences in fetal left atrial volumes were observed between the two groups, which be related to LA atrial dysfunction and /or left ventricle (LV) compliance, reflecting earlier stages of cardiac dysfunction.

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Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.

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OBJECTIVE: The aim of this study was to assess the capacity of three-dimensional ultrasound (3DUS) for predicting lethality in fetuses with skeletal dysplasia. METHODS: Twenty-four fetuses between 20 and 32 weeks of gestation were assessed. Bilateral lung volume scans were performed three times in each fetus during one ultrasound session. The virtual organ computer-aided analysis method was used to obtain a sequence of six sections of each lung around a fixed axis, and a rotation angle of 30° was adopted. Fetal lung volume measurements were analyzed according to the reference range. After birth, lung hypoplasia was diagnosed considering clinical and radiological criteria. RESULTS: Of all cases of skeletal dysplasia, 18 (75%) were lethal. Among the lethal cases, after postnatal diagnosis, four were osteogenesis imperfecta type II, three were thanatophoric dysplasia and two were campomelic dysplasia. The remaining nine cases remained without a definitive diagnosis. The accuracy of 3DUS in predicting lethality in fetuses with skeletal dysplasia was high, with a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 66.7%. The kappa index of 0.174 showed a good agreement between the possibility of lethality when the 3DUS volume measurement was altered and real lethality after birth (p < 0.001). CONCLUSION: This study suggests that the 3DUS lung volume measurement is a good predictor of lethal pulmonary hypoplasia in fetuses with skeletal dysplasia, with high accuracy.

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OBJECTIVES: To assess intracranial structure volumes by 3-dimensional (3D) sonography in fetuses with growth restriction. METHODS: We conducted a prospective cross-sectional case-control study involving 59 fetuses with growth restriction (38 fetuses with estimated weight <3rd percentile and 21 fetuses with estimated weight between 3rd and 10th percentiles, according to Hadlock et al [Radiology 1984; 150:535-540]) and 54 controls between 24 and 34 weeks' gestation. The following fetal intracranial structure volumes were assessed: cerebellum, brain, and frontal region. The volume was assessed by 3D sonography using the extended imaging virtual organ computer-aided analysis method with 10 sequential planes. Analysis of variance was used to compare fetal groups. The intraclass correlation coefficient was used to assess intraobserver and interobserver reproducibility. RESULTS: Statistical significance between the brain, frontal region, and cerebellar volumes and a relationship between the frontal region and the brain in fetuses with estimated weights below the 3rd percentile and controls were observed (P < .001; P < .001; and P = .002; and P = .008, respectively). Good intraobserver and interobserver reproducibility was observed for the fetal brain, frontal region, and cerebellar volumes, with intraclass correlation coefficients of 0.998, 0.997, 0.997, 0.999, 0.997, and 0.998, respectively. CONCLUSIONS: The intracranial structure volumes assessed by 3D sonography using the extended imaging virtual organ computer-aided analysis method were reduced in fetuses with growth restriction (estimated weight <3rd percentile).

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El proceso de preparación, análisis y mantenimiento del material clínico, utilizado para la investigación en Psicología Clínica, resulta especialmente vulnerable en relación a potenciales fallas de orden ético. Es necesario tener en cuenta cuáles son los riesgos asociados a la utilización de sistemas informáticos en cada una de las instancias propias de la investigación. La preparación del material clínico se asocia especialmente al cuidado de generar bases de datos en las cuales queden incluidos los permisos de uso de dicho material. Es necesario tener en cuenta los distintos actores del proceso clínico, comenzando por el paciente, el psicoterapeuta y la institución en la cual se lleva adelante dicho tratamiento. Cada uno de estos actores tiene intereses diferenciados que deben ser identificados y preservados por el investigador. Los sistemas informáticos de gestación y documentación del material deben tener en cuenta dicho proceso.De la misma forma los análisis del material no deben descuidar la preservación de la privacidad y características originales del mismo.Un enmascaramiento defectuoso, puede provocar serios inconvenientes para el investigador y aquellos a los cuales él debe preservar. El almacenamiento del material clínico resulta el punto más vulnerable del sistema, ya que oscila entre la perdida de material único e irrepetible y el riesgo de no contar con un contexto de cuidados adecuados para el mismo.Es importante que el investigador y el resto del sistema involucrado en el uso de material clínico para investigación cuenten con sistemas de evaluación y protección de los derechos de cada uno de los participantes.(AU)

The process of preparation, analysis, and keeping of clinical equipment used for research in Clinical Psychology is especially vulnerable to potential ethical liability. Its necessary to consider the risks associated with the use of computers in each of theinstances of research. The preparation of clinical material is mostly associated with the concern to generatedatabases with authorizations incorporated for the use of such material. Its necessary to take into account the different actors of the clinical process, starting with thepatient, the psychotherapist and the institution in which the treatment takes place. Each of these actors has distinctive interests that must be identified and preserved by the researcher. Computer systems of conception and documentation of the material must take into account that process. Likewise, the analyses of material shouldn´t overlook the preservation of privacy norits original features. A faulty facade can cause serious problems to the researcher and to those whom hemust preserve. Clinical material storage is the most vulnerable issue of the system since it ranges from the loss of unique and unrepeatable material to the risk of not counting on an appropriate satisfactory care context. It´s important that the researcher and the rest of the system involved in the use of clinical material for research have systems of evaluation and protection of the rightsof each of the participants.(AU)

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El proceso de preparación, análisis y mantenimiento del material clínico, utilizado para la investigación en Psicología Clínica, resulta especialmente vulnerable en relación a potenciales fallas de orden ético. Es necesario tener en cuenta cuáles son los riesgos asociados a la utilización de sistemas informáticos en cada una de las instancias propias de la investigación. La preparación del material clínico se asocia especialmente al cuidado de generar bases de datos en las cuales queden incluidos los permisos de uso de dicho material. Es necesario tener en cuenta los distintos actores del proceso clínico, comenzando por el paciente, el psicoterapeuta y la institución en la cual se lleva adelante dicho tratamiento. Cada uno de estos actores tiene intereses diferenciados que deben ser identificados y preservados por el investigador. Los sistemas informáticos de gestación y documentación del material deben tener en cuenta dicho proceso.De la misma forma los análisis del material no deben descuidar la preservación de la privacidad y características originales del mismo.Un enmascaramiento defectuoso, puede provocar serios inconvenientes para el investigador y aquellos a los cuales él debe preservar. El almacenamiento del material clínico resulta el punto más vulnerable del sistema, ya que oscila entre la perdida de material único e irrepetible y el riesgo de no contar con un contexto de cuidados adecuados para el mismo.Es importante que el investigador y el resto del sistema involucrado en el uso de material clínico para investigación cuenten con sistemas de evaluación y protección de los derechos de cada uno de los participantes.

The process of preparation, analysis, and keeping of clinical equipment used for research in Clinical Psychology is especially vulnerable to potential ethical liability. It’s necessary to consider the risks associated with the use of computers in each of theinstances of research. The preparation of clinical material is mostly associated with the concern to generatedatabases with authorizations incorporated for the use of such material. It’s necessary to take into account the different actors of the clinical process, starting with thepatient, the psychotherapist and the institution in which the treatment takes place. Each of these actors has distinctive interests that must be identified and preserved by the researcher. Computer systems of conception and documentation of the material must take into account that process. Likewise, the analyses of material shouldn´t overlook the preservation of privacy norits original features. A faulty facade can cause serious problems to the researcher and to those whom hemust preserve. Clinical material storage is the most vulnerable issue of the system since it ranges from the loss of unique and unrepeatable material to the risk of not counting on an appropriate satisfactory care context. It´s important that the researcher and the rest of the system involved in the use of clinical material for research have systems of evaluation and protection of the rightsof each of the participants.

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