THREE DIMENSIONAL RENDERING

T3D ultrasound was introduced in Obstetrics and Gynecology in 1989. Although the three-dimensional reconstruction of the fetus’s face and body is the most striking feature of this methodology, its diagnostic potential remains low.
Its advantages are:

• - The acquisition of fetal volume, which undoubtedly contains a larger body of information compared to the corresponding ultrasound scan;
  - The availability of graphic windows with greater discriminating ability than the classical B-mode images. The most important one is the multiplanar image/rendering, which allows a comparative evaluation of voxel point on three orthogonal planes. It allows the simultaneous visualization of the voxel point of a spatially complex structure (i.e., the fetal brain or heart, a uterine malformation, etc), on three orthogonal planes.

Three-dimensional rendering requires further evaluation, to fully unravel its diagnostic potential, especially since the introduction of real time 3D (which is different from real-time volume). Real-time 3D enables the observation of fetal motorial activity and facial expressions. You will now be able to see some images illustrating the diagnostic elements that can be obtained by 3D plastic reconstruction.

Pregnancy
at 8th week

Pregnancy at the 8th week of gestation; 3D rendering of the transvaginal volume. The following are detectable in the gestational sac:
• The fetus: Cephalic limits, trunk and beginning of limb formation.
• The yolk sac below the caudal fetal pole
• The onphalomesentric duct

Pregnancy at 8th week

Pregnancy
at 10th week

10th gestation week. 3D rendering of the transvaginal volume showing the fetus isolated from the uterus and totally visible. In particular:
• The fetal head - the image shows that at this gestational age the bregmatic and lambdoidea fontanels are not yet separated. A 360° rotation in the 3D reconstruction shows the ears and the facial surface;
• Neck – a clear rear view of the cervical column;
• Trunk – a rear view of the ribs, dorso-lumbar column, and sacrum;
• Limbs - their position with respect to the fetal trunk is clearly visible;
• Early fetal positions - the head is bent at a right compared to the trunk, the right hand is exploring the lower limbs.

20th gestation week. 3D rendering of transabdominal volume. The following features are clearly visible:
• Cranium: Anterolateral and posterolateral fontanelle; part of the coronal suture (lower); temporal and spheno-parietal sutures; lambdoidea suture (upper). See also the paragraph on 'Skeleton' in EXPERT ZONE.
• Facial area; a view of right side and the scarcely visible – albeit already present – facial expression. Note the leanness of the face due to the lack of development of cheeks, which will be evident after the 28th - 34th week, as weight increases in the third trimester.
• Neck – a lateral-posterior view.
• Trunk - right view: Note the scapula as it is articulated with the humerus.
• Upper right limb: Articulation of the elbow, hand and fingers as they touch the forehead.

Pregnancy
at 20th week

3D rendering of transabdominal volume. Fetal position – the fetus is grasping the umbilical cord with both hands.

The facial expression is less visible due to the shadow of the hands and arms, whereas the face is clearly visible.

20th gestation week. 3D rendering of the transabdominal volume. The fetus is sucking its finger; scarce facial expression. The coronal suture is clearly visible between the frontal and left parietal bones.

Pregnancy
at 20th week

Pregnancy
at 25th week

25th gestation week. 3D rendering of the transabdominal volume. Left view of fetus's face showing the eyes, nose and mouth. Notice the position of the limbs as if to protect the face from the scan. Notice the coronal suture and parieto-temporal joining in the pteric fontanelle.

28th gestation week. 3D rendering of the transabdominal volume. Fetal face. Notice the position of the lips and cheeks, which begin to become more evident than in the previous week.

Pregnancy at 28th week

32nd gestation week. Transabdominal volume. 3D rendering. Fetal face - notice how the cheeks and lips are fuller compared to the previous weeks, as the fetal growth continues in the third trimester.

Pregnancy at 32nd week

The increase in subcutaneous fat in the cheeks and lips allows more facial movements and better defined facial expressions. Notice the resemblance with the fetus at birth (see below)

32nd gestation week. Transabdominal volume. 3D rendering. The fetus protects itself from the pressure of the ultrasound, with the right hand. Notice the fingers and the facial expression with the mouth open.

Pregnancy
at 32nd week

Pregnancy
at 34th week

34th gestation week. Transabdominal volume. 3D rendering. Facial expression showing irritation, probably due to the ultrasonographic examination. The arms are crossed in a defense attitude. Notice the well-developed cheeks.

Pregnancy
at 33rd week

33rd gestation week. Transabdominal volume. 3D rendering. The fetus is caught in the act of scratching its right ear. The facial features are clearly visible. Notice the normal position of the limbs, especially the hands.

Pregnancy
at 32nd week

Same case as the previous one. Details of left ear. The parts of the auricle are distinguishable and assessable. Notice the normal representation of the tragus and anti-tragus lobe.

34th gestation week. 3D rendering of the transabdominal volume. Image of the fetus yawning. Notice the expression of the face - as if it were frowning: The facial movements actively involve the orbicular muscles, the masseter and the buccinatories.

Pregnancy at 34th week

Pregnancy at 36th week

36th gestation week. 3D rendering of the transabdominal volume. Fetus in sucking position. Notice the expression of the face - at this stage of the pregnancy the activity of the muscles involved in facial expressions is complete.

32nd gestation week. 3D rendering of the transabdominal volume. Fetal penis, with the scrotal sac clearly visible.

Pregnancy at 32nd week

Pregnancy at 32nd week

32nd gestation week. 3D rendering of the transabdominal volume. Fetal vulva. Notice the labia majora and minora.

Pregnancy at 15th week

MOVIE

Pregnancy at 15th week gestation. Live 3d. It is possible to appreciate fetal movements and initial behavioural activities during this period. Please wait for download: it takes about 1 minute.

Pregnancy at 32nd week

MOVIE

Pregnancy at 32nd week gestation. Movements of arms, mimic of the face and intrauterine behaviour are here appreciated. Please wait for download: it takes about 1 minute and half.

Yawning...

MOVIE Live 3D

This movie shows the fetus crying

MOVIE Live 3D

Hand movements...

MOVIE Live 3D

WHAT IS THREE DIMENSIONAL ULTRASOUND?

The three dimensional ultrasound is a new technique that improves the diagnostic potential of ultrasound in various medical fields. This website describes the experience gained by our group in the field of obstetrics and gynaecology, particularly focusing on our studies of the fetal brain, heart, skeleton, and on the advantages of the early diagnosis of fetal malformations, comparing the use of 3D ultrasound with the conventional bidimensional technique.

WHEN WAS 3D ULTRASOUND FIRST INTRODUCED?

The first ultrasound equipment on the market, for volume acquisition and multiplanar examination, was presented in Paris, at the World Congress for Diagnostic Imaging in 1989. Successively in 1991 Combison 530 allows the first 3D rendering of fetal face. Since then, there has been much improvement – the most remarkable one being the introduction of digital equipment, which, compared to the initial analog technology, provide much better images.

WHEN WAS IT INTRODUCED IN ITALY?

In 1995, more or less. Our group, together with another team from Bari, were the first in Italy to use 3D ultrasound to perform research in obstetrics and gynaecology.

ITALIAN 3D ULTRASOUND TEXT

In 1998 our group edited the first Italian text and atlas on Three Dimensional Ultrasound In Obstetrics And Gynaecology, published by CIC (Centro Italiano Congressi), which also publish the Italian Journal of Ultrasound, edited by SIEOG (Italian Society of Ultrasound in Obstetrics and Gynecology). In addition we also organised two workshops on 3D ultrasound in Obstetrics and Gynaecology in 1998 and 1999, the latter one sponsored by SIEOG.

WHICH ARE THE FIELDS OF APPLICATION FOR 3D AND MP ULTRASOUND IN OBSTETRICS AND GYNAECOLOGY?

In obstetrics the technique can be employed to study:
• The fetal brain and its malformations
• The fetal heart and its malformations
• The facial features (lips, dental palate and arc)
• The fetal ears (auricle)
• The spinal column and its malformations
• Limbs, hands and feet.
In gynaecology the technique can be employed to study:
• The uterus, its related malformations and pathologies
• The ovaries and related pathologies.