Clinical trial of multiplanar real-time 4- versus 2-dimensional sonographic guidance for transcervical chorionic villus sampling

J Ultrasound Med. 2011 Mar;30(3):309-12. doi: 10.7863/jum.2011.30.3.309.

Abstract

Objectives: Real-time 4-dimensional (4D) sonography can visualize the location of a chorionic villus sampling (CVS) catheter simultaneously in 3 dimensions. We determined the utility of 4D versus 2-dimensional (2D) sonographic guidance for transcervical CVS.

Methods: Chorionic villus sampling was performed on 40 patients at 10 to 13 weeks' gestation (20 in each study group). Primary outcomes were as follows: (1) time in seconds needed to complete the procedure; (2) procedure failure, defined as the inability to obtain an adequate sample by a single catheter insertion or a necessity to switch to the alternative imaging modality; and (3) acquisition of a sample of chorionic villi sufficient for cytogenetic analysis. Wilcoxon rank sum and Fisher exact tests were used for categorical and continuous variables, respectively. Figure 1. A, Two-dimensional guidance of the transcervical chorionic villus sampling procedure. Arrows indicate the chorionic villus sampling catheter. B, Multiplanar 3-dimensional guidance of the procedure.

Results: The procedure time was significantly longer in the 4D group than the 2D group (161.4 versus 80.4 seconds, respectively; P = .001). The success rate at first introduction of the catheter was higher for 2D guidance (90%) than 4D guidance (70%) but was not statistically significant with the study group sizes. Adequate sample sizes were obtained in all patients. The main limiting factor in 4D guidance was a low frame rate.

Conclusions: Our findings show the feasibility of 4D guidance for transcervical CVS, although at the expense of a prolonged procedure time when compared to 2D sonographic guidance. The value of 4D guidance for less experienced operators remains to be determined.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Algorithms
  • Chorionic Villi / diagnostic imaging*
  • Chorionic Villi / pathology*
  • Chorionic Villi Sampling / methods*
  • Female
  • Humans
  • Image Enhancement / methods
  • Image Interpretation, Computer-Assisted / methods*
  • Image-Guided Biopsy / methods*
  • Middle Aged
  • Pregnancy
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography, Interventional / methods*
  • Ultrasonography, Prenatal / methods*
  • Young Adult