"How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology."

The antenatal evaluation of the fetal central nervous system (CNS) is among the most difficult tasks of prenatal ultrasound (US) requiring technical skills in relation to ultrasound and image acquisition and knowledge of CNS anatomy and how this changes with gestation. According to the International Guidelines, the basic assessment of fetal CNS is most frequently performed on the axial planes, while the coronal and sagittal planes are required for the multiplanar evaluation of the CNS within the context of fetal neurosonology. It can be even more technically challenging to obtain "non-axial" views with two-dimensional (2D) US. The modality of three-dimensional (3D) US has been suggested as a panacea to overcome the technical difficulties of achieving non-axial views. The lack of familiarity of most sonologists in the use of 3D US and its related processing techniques may preclude its use even where it could play an important role in complementing antenatal 2D US assessment. Furthermore, once a 3D volume has been acquired, proprietary software allows it to be processed in different ways, leading to multiple ways of displaying and analyzing the same anatomical imaging or plane. These are difficult to learn and time consuming in the absence of specific training. In this manuscript we describe the key steps in volume acquisition of a 3D US volume, manipulation and processing with reference to images of the fetal CNS using a newly developed context-preserving rendering technique.