Collaborative study on 4-dimensional echocardiography for the diagnosis of fetal heart defects: The COFEHD study

Jimmy Espinoza, Wesley Lee, Christine Comstock, Roberto Romero, Lami Yeo, Giuseppe Rizzo, Dario Paladini, Fernando Viñals, Reuven Achiron, Liat Gindes, Alfred Abuhamad, Elena Sinkovskaya, Evie Russell, Simcha Yagel

Research output: Contribution to journalArticlepeer-review


Objective: Congenital anomalies are the leading cause of infant mortality in the United States, and congenital heart defects (CHDs) are the most common type of birth defects. Recently, 4-dimensional ultrasonography (4DUS) with spatiotemporal mage correlation (STIC) has been introduced for fetal echocardiography. Accumulating evidence indicates that 4DUS with STIC may facilitate the examination of the fetal heart. Our objectives were to determine the accuracy of 4DUS for the diagnosis of CHDs and the agreement among centers. Methods: This study ncluded 7 centers with expertise in 4D fetal echocardiography. Fetuses with and without confirmed heart defects were scanned between 18 and 26 weeks, and their volume data sets were uploaded onto a centralized file transfer protocol server. Intercenter agreement was determined using a k statistic for multiple raters. Results: Ninety volume data sets were randomly selected for blinded analysis. Overall, the median (range) sensitivity, specificity, positive and negative predictive values, and false-positive and-negative rates for the identification of fetuses with CHDs were 93% (77%-100%), 96% (84%-100%), 96% (83%-100%), 93% (79%-100%), 4.8% (2.7%-25%), and 6.8% (5%-22%), respectively. The most frequent CHDs were conotruncal anomalies (36%). There was excellent intercenter agreement (k = 0.97). Conclusions: (1) Four-dimensional volume data sets can be remotely acquired and accurately interpreted by different centers. (2) Among centers with technical expertise, 4DUS is an accurate and reliable method for fetal echocardiography.

Original languageEnglish
Pages (from-to)1573-1580
Number of pages8
JournalJournal of Ultrasound in Medicine
Issue number11
StatePublished - 1 Nov 2010
Externally publishedYes


  • 4-dimensional ultrasonography
  • Congenital heart defects
  • Fetal echocardiography
  • Prenatal diagnosis


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