Dreidimensionaler Ultraschall in der Pränataldiagnostik: Routine oder gezielte diagnostische Zusatzoption?

Zusammenfassung

Durch die Fortschritte auf dem Gebiet der computertechnologischen Bildverarbeitung ist es in den letzten Jahren möglich geworden, aus Serien von zweidimensionalen (2D) Ultraschallschnittbildern dreidimensionale Rekonstruktionen zu berechnen.

Die Anwendungsmöglichkeiten der dreidimensionalen (3D) Sonographie in der Geburtshilfe erstrecken sich von Darstellungen des fetalen Gesichts- und Halsbereiches über die einzelnen Organsysteme (Zentralnervensystem, Abdomen und Thorax, Urogenitaltrakt), der Darstellung von Skelett und Extremitäten bis hin zur 3D-Fetalechokardiographie.

Die Vorteile der dreidimensionalen Methode liegen in der räumlichen Plastizität der Darstellung und den beinahe unbegrenzten Bearbeitungsmöglichkeiten eines einmal gespeicherten Datensatzes. Die Nachteile liegen in dem zum Teil immer noch hohen technischen und zeitlichen Bildbearbeitungsaufwand und der durch die fetale Motorik bedingten Störanfälligkeit der Methode.

Mit fortschreitender Entwicklung der Computertechnologie und damit verbundener Vereinfachung der Handhabung sowie Verbesserung der zweidimensionalen Bildqualität wird die dreidimensionale Sonographie eine immer wichtigere Rolle in der vorgeburtlichen Diagnostik spielen, obgleich ihr Nutzen derzeit durchaus noch kontrovers diskutiert wird.

Abstract

The rapid development of ultrasound computer technology has made three-dimensional (3D) ultrasound a promising diagnostic tool in obstetric imaging over the last decade. In this article the authors describe the current feasibility of methods for 3D data acquisition and image analysis and assess their clinical application in different organ systems of the fetus. Most advantages of 3D sonographic imaging over conventional ultrasound are related to the limitations of two-dimensional assessment of the multidimensional fetal anatomy. Thus, prenatal 3D ultrasound data sets provide a novel different approach to prenatal evaluation of the fetus as they allow image reconstructions from different viewing perspectives for repeatable evaluation of anatomic structures and disease entities. However, considering the current technical limitations as well as the operator time needed for 3D image processing and analysis its routine clinical relevance in the antenatal situation so far remains unlimited.

Schlüsselwörter

3D-Sonographie - pränatale Diagnostik - fetale Anomalien - fetale Echokardiographie

Key words

3D ultrasound - fetal anomalies - fetal echocardiography - prenatal diagnosis

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