3D Imaging of the Fetal Brain

Audio/Video Link For more info on this topic check out Dr. Trisch's lecture from Medison's "Premier Evening" at FIGO 2000.
*requires RealPlayer - free download

Terry Dubose:  “We’re here at FIGO in Washington, D.C. in the year 2000.  We have with us Dr. Timor-Trisch who is actually one of the fathers of ultrasound, sonoembryology, and a number of areas.  He’s now moved into the cutting edge with three-dimensional sonography.  First tell us, Dr. Timor, where you work and the kind of work you do.”

Dr. Timor-Trisch:  “Right now I work at New York University in the Department of Obstetrics and Gynecology.  I am fortunate to run an obstetrics-gynecology ultrasound unit which is quite unique in the American scenery where most of the scans, but definitely the gynecological scanning, is done by radiology; we do everything in the Department of Obstetrics and Gynecology.”

Terry Dubose:  “Good, now I know the public has gotten a lot of information about three-dimensional ultrasound and getting pretty pictures of the baby - the baby face, and that sort of thing but from your talks I’m gathering that there’s a great deal more to be done than just pretty pictures.”

Dr. Timor-Trisch:  “Yes, basically, three-dimensional ultrasound moved us into a whole new era of ultrasound diagnosis both in gynecology and in obstetrics.  Besides all the aspects that we try to get into now and use this new technique, we maybe are a little bit more interested in scanning the fetal brain.  This is an interest that we have had for a very long time and it really culminated in writing a book on it but right now we are excited about the fact that the fetal brain can be looked at by three-dimensional ultrasound.  That is where I would like to change the public opinion or the public way of looking at three-dimensional ultrasound and that is the fact that it is much more than just looking at the surface rendering which is the pretty baby faces.  We are now moving into the soft tissues in the body of the fetus and one of the places where it is really needed is the fetal brain.  We do it through the anterior fontanel if we can do it, and that is a window to scan the brain which we learned basically from the neonatologists who have been doing it for so many years and that is the way to look at the fetal brain today, in an orderly and very detailed way.”

Terry Dubose:  “Good, here’s a technical question – how long does it take to acquire the volume that you’re looking at and how much problem is there in fetal motion within that?”

Dr. Timor-Trisch:  “Let me start with the second question.  Fetal motion definitely is a problem because the volume is made up of many, many single two-dimensional slices, the high resolution volumes will only be as good as the raw material which is the two-dimensional images.  So we have to catch the fetus at a time that it moves less or we can also stabilize the fetal head by our abdominal hand above the symphysis in order to minimize movement or we wait for a deep sleep period of the fetus, which, of course, is every twenty to thirty minutes.  That is a way to look at it, you have to know a little fetal physiology for that but, basically, you can stabilize the head and minimize movement.  And the second question was…”

Terry Dubose:  “How long it takes.”

Dr. Timor-Trisch:  “The length of the scan, if we are lucky, is less than a minute.  If we have to repeat it and come back because of fetal motion, and do more and more scans, it may take as long as four or five minutes.  We can catch a technically impeccable volume that we can then put on a disk or reanalyze.  But basically, to compare it with 2D, with the 2D images you have to take every single slice and you have to have somebody in the room that helps you freeze the picture, take the picture, and then unfreeze.  I move my plane to another plane and sequentially once again, freeze, picture, unfreeze.  All these things probably take a good ten minutes till I do a meaningful fetal neuro scan.  Using three-dimensional ultrasound, you can get lucky and do it in one minute, and then the patient goes home and then my part comes.  I sit down after hours, at five o’clock, and analyze the volume or if I don’t know what’s going on, I can send it to someone through e-mail through the Internet or just send it by optical disk and get help.”

Terry Dubose:  “Obviously this is a very new modality that will develop rapidly.  If I may use a pun – we’re in the infancy of this and I think it will improve and probably get much faster.”

Dr. Timor-Trisch:  “It definitely is and the skeptics - who are really the enemies of any technology that develops – say, ‘You cannot see well, it’s hard to learn, and the resolution is not as good.’  They are right but you have to put your faith in this and say that if today it looks like it is, even today it’s very useful.  In five years it will be unbelievable, exactly like the old bistable images were thirty years ago when Campbell did the first diagnosis of anencephaly, today we are laughing at that and we know it will develop.  Anybody who does not get into this modality at this time is losing out.”

Terry Dubose:  “Dr. Timor, I appreciate your enthusiasm, and it’s wonderful to have you working in this and bringing it to us.  I appreciate it very much.”

Dr. Timor-Trisch:  “Thank you very much.”

Terry Dubose:  “Thank you for your talk.”