1818 The Journal of Maternal-Fetal and Neonatal Medicine, 2012; 25(9): 1818–1821 © 2012 Informa UK, Ltd. ISSN 1476-7058 print/ISSN 1476-4954 online DOI: 10.3109/14767058.2011.644364 Objective: To assess the fetal lumbosacral spine by three-dimen- sional (3D) ultrasonography using volume contrast imaging (VCI) omni view method and compare reproducibility and agreement between three different measurement techniques: standard mouse, high definition mouse and pen-tablet. Methods: A comparative and prospective study with 40 pregnant women between 20 and 34 + 6 weeks was realized. 3D volume datasets of the fetal spine were acquired using a convex transabdominal transducer. Starting scan plane was the coronal section of fetal lumbosacral spine by VCI-C function. Omni view manual trace was selected and a parallel plane of fetal spine was drawn including interest region. Intraclass correlation coefficient (ICC) was used for reproducibility analysis. The relative difference between three used techniques was compared by chi-square test and Fischer test. Results: Pen-tablet showed better reli- ability (ICC = 0.987). In the relative proportion of differences, this was significantly higher for the pen-tablet (82.14%; p < 0.01). In paired comparison, the relative difference was significantly greater for the pen-tablet (p < 0.01). Conclusion: The pen-tablet showed to be the most reproductive and concordant method in the measurement of body vertebral area of fetal lumbosacral spine by 3D ultrasonography using the VCI. Keywords: Fetal spine, reliability, agreement, pen-tablet, three-dimensional ultrasound, volume contrast imaging Introduction Spina bifda is the most common congenital abnormality of the spine with an incidence of 1/1000 live births. Usually detected at second trimester routine scan, spina bifda is commonly asso- ciated with Arnold-Chiari II syndrome. Other less common congenital spine abnormalities, also diagnosed at second trimester scan, include structural defects of fetal spine, abnormal vertebral curvature secondary to fetal defects [1,2] and nondevelopment vertebral defects like caudal regression syndrome and sacral agenesis [3]. Despite the incidence of hemivetebrae in 1/1000 live births [4], it is poorly reported at worldwide literature [1,2,4]. Tree-dimensional (3D) ultrasonography increased fetal vertebral examination providing a coronal view, inaccessible at two-dimensional (2D) ultrasonography. Wallny et al. [5] frst reported fetal spine examination by 3D ultrasonography using multiplanar method. Tese authors used a coronal plane to obtain spinal canal area. Following, Schild et al. [6] determined lumbo- sacral vertebral volumes by multiplanar method and established reference intervals. Volume contrast imaging (VCI; General Eletric, Medical System, Kretz, Zipf, Austria) is a new technique that enriches B mode imaging contrast and resolution of 2D ultrasonography providing a better evaluation of fetal structures. VCI technique is a real time volume datasets using small sweep angles. Volume datasets include surface rendering boxes that can be selected by operator in 3, 5, 10 or 15 mm options. VCI technique can be applied on plane A of multiplanar view, like 2D-ultrasonography sagittal starting scan plane, or on coronal plane (C-plane) that is orthogonal to original 2D plane [7]. Recently, Omni view (General Eletric, Medical System, Kretz, Zipf, Austria) sofware, increased examination of nonlinear struc- tures like fetal spine using linear or curves planes determined by operator. Tis sofware has successfully been used for fetal brain evaluation [8]. Despite vertebral area is useful for diagnosis of vertebral anomalies, especially hemivertebrae, there are no preview studies until the present time describing VCI technique for vertebral area evaluation of fetal spine. Of line analysis of fetal spine volumes datasets using 4D-view sofware (General Eletric, Medical System, Kretz, Zipf, Austria) usually take place by standard computer mouse (S-mouse). Tis tool provides 400 points per inch image resolution. Otherwise, higher resolution tools are available like a high-defnition mouse (HD-mouse) that provides 1000 points per inch and the pen-tablet (5080 points per inch). Comparative studies demonstrate that pen-tablet has a higher accuracy and speed time contour than S-mouse in human organ measurements [9,10]. However, there are no literature reports comparing S-mouse and pen-tablet measurements for fetal sonographic analysis. Te aim of this study is to evaluate reproducibility and agree- ment between three diferent measurement techniques S-mouse, SHORT REPORT Delineation of vertebral area on the coronal plane using three- dimensional ultrasonography advanced volume contrast imaging (VCI) Omni view: intrarater reliability and agreement using standard mouse, high definition mouse, and pen-tablet Edward Araujo Júnior 1 , Luis Henrique Martinez 1 , Christiane Simioni 1 , Wellington P. Martins 2,3,4 , Luciano M. Nardozza 1 & Antonio F. Moron 1 1 Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil, 2 Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil, 3 Escola de Ultra-sonografa e Reciclagem Médica de Ribeirão Preto (EURP), Ribeirão Preto, SP, Brazil, and 4 Instituto Nacional de Ciência e Tecnologia (INCT) de Hormônios e Saúde da Mulher, Ribeirão Preto, SP, Brazil Correspondence: Edward Araujo Júnior, Department of Obstetrics, Federal University of São Paulo (UNIFESP), Rua Carlos Weber, 950 apto. 113 Visage, Alto da Lapa, São Paulo–SP, Brazil, CEP 05303-000. Telephone/Fax: 55-11-37965944. E-mail: araujojred@terra.com.br