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Sonographic grading of fetal intracardiac echogenic foci in a population at low risk of aneuploidy
Author(s) -
Wax Joseph R.,
Cartin Angelina,
Pinette Michael G.,
Blackstone Jacquelyn,
Michaud Janet,
Byers Susan,
Boutin Nancy
Publication year - 2003
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.10127
Subject(s) - medicine , fetus , aneuploidy , intracardiac injection , grading (engineering) , population , echogenicity , ultrasound , ventricle , radiology , pregnancy , obstetrics , gynecology , biochemistry , chemistry , genetics , civil engineering , environmental health , biology , engineering , chromosome , gene
Purpose We screened pregnant women at low risk of a fetal chromosomal abnormality for the presence of fetal intracardiac echogenic foci (ICEF) and graded those foci by using sonographic gain reduction. Our objectives were to determine the interobserver reliability of the technique and the association of ICEF, by grade, with fetal aneuploidy. Methods Pregnant women who were 18–35 years old, at low risk for fetal chromosomal abnormalities, and referred for targeted sonography at 16–24 weeks' menstrual age were eligible to participate. All patients whose fetuses had ICEF were offered fetal chromosomal analysis. The presence of ICEF was ascertained by an apical 4‐chamber view of the fetal heart and graded independently by 2 examiners blinded to each other's assessment. Grading was based on the difference in echogenicity of the ICEF and the thoracic spine as the ultrasound gain was reduced; in grade 1, the ICEF image was lost before that of the thoracic spine; in grade 2, the ICEF and thoracic spine images disappeared at the same gain setting; and in grade 3, the thoracic spine image was lost before that of the ICEF. Results During the 6‐month study period, 383 eligible women were examined, and ICEF were seen in 35 fetuses (9.1%): 25 (71.4%) in the left ventricle, 1 (2.9%) in the right ventricle, and 9 (25.7%) in both ventricles. ICEF grading was successfully performed in all 33 of the women with fetal ICEF who elected to participate. Twenty‐one (63.6%) had grade 1, 9 (27.3%) had grade 2, and 3 (9.1%) had grade 3 ICEF. Interobserver agreement was noted in 27 (90.0%) of 30 available paired second‐trimester observations (kappa = 0.8), indicating excellent agreement. Two fetuses (6.1%) with grade 1 ICEF but no other risk factors for aneuploidy had chromosomal abnormalities, as compared with 1 fetus (0.3%) in the control group, which had no ICEF ( p = 0.02). Conclusions Sonographic grading of ICEF is feasible and reliable. The presence of fetal ICEF in a population otherwise at low risk for aneuploidy seems to warrant the performance of fetal chromosomal analysis. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 31:31–38, 2003