Manufacturing Models of Fetal Malformations Built From 3-Dimensional Ultrasound, Magnetic Resonance Imaging, and Computed Tomography Scan Data Heron Werner, PhD,*Þ Liliam Cristine Rolo, PhD,þ Edward Araujo Ju ´nior, MD, PhD,þ and Jorge Roberto Lopes Dos Santos, PhD§ Abstract: Technological innovations accompanying advances in medicine have given rise to the possibility of obtaining better-defined fetal images that assist in medical diagnosis and contribute toward genetic counseling offered to parents during the prenatal period. In this article, we show our innovative experience of diagnosing fetal malformations through correlating 3-dimensional ultrasonography, magnetic resonance imaging, and computed tomography, which are accurate techniques for fetal assessment, with a fetal image recon- struction technique to create physical fetal models. Key Words: fetal malformations, manufacturing methods, 3-dimensional ultrasound, magnetic resonance imaging, computed tomography (Ultrasound Quarterly 2014;30:69Y75) T echnological innovations accompanying advances in medi- cine have given rise to the possibility of obtaining better- defined fetal images, which has made it easier to identify and comprehend fetal abnormalities that may be present, while still in the intrauterine environment. In this manner, fetal imaging not only assists in medical diagnosis but also contributes toward genetic counseling offered to parents during the prenatal period, which promotes better selection of therapeutic management when this is possible. Currently, ultrasound is the primary method for fetal assessment during pregnancy because it is pa- tient friendly, useful, and cost-effective and considered to be safe. Fetal 3-dimensional (3D) images can be obtained by 3D ultra- sonography (3DUS) in rendering mode, magnetic resonance imaging (MRI), and computed tomography (CT). From the images obtained through these technologies, with automated image reconstruction, it has become possible to create physical models for normal fetuses and for fetuses with malformations. 1,2 Thus, this pictorial essay had the aim of illustrating im- ages of fetuses with malformations that were identified through these methods during prenatal assessments. Description of the Technique All fetuses examined in the present study initially underwent ultrasonography screening first. The ultrasonography apparatus used was equipped with endovaginal and/or transabdominal high- resolution transducers (4 Y8 MHz) (Voluson 730 Pro/Expert; General Electric Medical Systems, Zipf, Austria). Subsequently, for better viewing and diagnostic clarifi- cation, and depending on the fetal malformation observed on ultrasonography, the imaging examination was supplemented with MRI or CT. For example, in cases of soft tissue, thoracic, or central nervous system abnormalities, MRI was used, whereas in cases of skeletal dysplasia, CT was used. Because MRI does not present radiation, it can be used without contraindications during pregnancy. Its diagnostic ac- curacy improves with increasing gestational age and is not disturbed by marked oligohydramnios, maternal obesity, or fetal static, which are responsible for low image quality on ultraso- nography. 3 However, CT subjects the fetus to radiation and for this reason is indicated only when there is a need for better clarification of skeletal and thoracic abnormalities that were inadequately observed on ultrasonography. Magnetic resonance imaging was performed using appa- ratus with a 1.5-T scanner (Magneton Avanto and Aera; Siemens, Erlangen, Germany). The protocol used was T2-weighted se- quence (half fourier acquisition single shot turbo spin echo; repetition time shortest, time to echo 140 milliseconds; field of view = 300Y200 mm; matrix 256 Â 256; slice thickness 4 mm, 40 slices, and acquisition time 18 seconds in 3 planes of the fetal body). In addition, we applied 3D T2-weighted true fast im- aging with steady-state precession (TrueFISP) sequence in the sagittal plane (repetition time 3.02 milliseconds, time to echo 1.34 milliseconds, voxel size 1.6 Â 1.6 Â 1.6 mm 3 , frac- tional anisotropy 70, parallel acqusition techniques 2) with 96 to 136 slices of thickness 1.0 to 1.6 mm and acquisition time of 26 seconds. The total duration of the examination did not exceed 40 minutes. To perform CT, 64-channel multislice scanner was used (Philips, Solingen, Germany) with the following parameters: 40 mAs, 120 kV, 64 slices per rotation, 0.75 pitch, and 0.75-mm slice thickness. The mean radiation dose received by the fetus was 3.12 mGy. PICTORIAL ESSAY Ultrasound Quarterly & Volume 30, Number 1, Month 2014 www.ultrasound-quarterly.com 69 Received for publication July 25, 2013; accepted October 2, 2013. *Radiology, Imaging Diagnostics Clinic (CPDI); and †Department of Radi- ology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro; ‡Department of Obstetrics, Federal University of Sa ˜o Paulo (UNIFESP), Sa ˜o Paulo; and §National Institute of Technology, Rio de Janeiro, Brazil. The authors declare no conflict of interest. Reprints: Edward Araujo Ju ´nior MD, PhD, Department of Obstetrics, Federal University of Sa ˜o Paulo (UNIFESP), Rua Carlos Weber, 956 apt. 113 Visage, Vila Leopoldina, Sa ˜o Paulo, Brazil, CEP 05303-000 (e<mail: araujojred@terra.com.br). Copyright * 2014 by Lippincott Williams & Wilkins