Background Prenatal echocardiographic assessment of fetal cardiac function has become increasingly important. Fetal two-dimensional speckle-tracking echocardiography (2D-STE) allows the determination of global and segmental functional cardiac parameters. Prenatal diagnostics is relying increasingly on artificial intelligence, whose algorithms transform the way clinicians use ultrasound in their daily workflow. The purpose of this study was to demonstrate the feasibility of whether less experienced operators can handle and might benefit from an automated tool of 2D-STE in the clinical routine. Methods A total of 136 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by targeted ultrasound. 2D-STE was performed separately by beginner and expert semiautomatically using a GE Voluson E10 (FetalHQ®, GE Healthcare, Chicago, IL, USA). Several fetal cardiac parameters were calculated (end-diastolic diameter (ED), sphericity index (SI), global longitudinal strain (EndoGLS), fractional shortening (FS)) and assigned to gestational age (GA). Bland-Altman plots were used to test agreement between both operators. Results The mean maternal age was 33 years, and the mean maternal body mass index prior to pregnancy was 24.78 kg/m 2. The GA ranged from 16.4 to 32.0 weeks (average 22.9 weeks). Averaged endoGLS value of the beginner was -18.57 % ± 6.59 percentage points (pp) for the right and -19.58 % ± 5.63 pp for the left ventricle, that of the expert -14.33 % ± 4.88 pp and -16.37 % ± 5.42 pp. With increasing GA, right ventricular endoGLS decreased slightly while the left ventricular were almost constant. The statistical analysis for endoGLS showed a Bland-Altman-Bias of -4.24 pp ± 8.06 pp for the right and -3.21 pp ± 7.11 pp for the left ventricle. The Bland-Altman-Bias of the ED in both ventricles in all analyzed segments ranged from -0.49 mm ± 1.54 mm to -0.10 mm ± 1.28 mm, that for FS from -0.33 pp ± 11.82 pp to 3.91 pp ± 15.56 pp and that for SI from -0.38 ± 0.68 to -0.15 ± 0.45. Conclusions Between both operators, our data indicated that 2D-STE analysis showed excellent agreement for cardiac morphometry parameters (ED and SI), and good agreement for cardiac function parameters (EndoGLS and FS). Due to its complexity, the application of fetal 2D-STE remains the domain of scientific-academic perinatal ultrasound and should be placed preferably in the hands of skilled operators. At present, from our perspective, an implementation into clinical practice ‘on-the-fly’ cannot be recommended.

Neck tumors are rare fetal conditions. They can receive their growth stimuli by activating missense mutations characterizing disorders with benign overgrowth, collectively known as PIK3CA-Related-Overgrowth-Spectrum. This results in segmental overgrowth with phenotypic variation, genetic heterogeneity or tissue specific distribution. Thus, clinical and molecular diagnosis as well as treatment remains challenging.

Attempting a comprehensive examination of the fetal heart remains challenging for unexperienced operators as it emphasizes the acquisition and documentation of sequential cross-sectional and sagittal views and inevitably results in diminished detection rates of fetuses affected by congenital heart disease. The introduction of three-/four-dimensional spatial-temporal image correlation 3D/4D STIC technology facilitated a volumetric approach for thorough cardiac anatomic evaluation by the acquisition of cardiac 4D datasets by analyzing and correlating numerous images from different heart cycles obtained during an automated sweep and subsequently displaying them in an endless cine loop sequence. However, postanalysis with manipulation and repeated slicing of the volume usually requires experience and in-depth anatomic knowledge, which limits the widespread application of this advanced technique in clinical care and unfortunately leads to the underestimation of its diagnostic value to date. Fetal intelligent navigation echocardiography (FINE), a novel method that automatically generates and displays 9 standard fetal echocardiographic views in normal hearts, has shown to be able to overcome these limitations. Very recent data on the detection of congenital heart defects (CHDs) revealed a sensitivity and specificity of 98 % and 93 %, respectively. In this two-part manuscript, we focused on the performance of FINE in delineating abnormal anatomy of typical right and left heart lesions and thereby emphasized the educational potential of this technology for more than just teaching purposes. We further discussed recent findings regarding these morphological changes seen in a pathophysiological and/or functional context.