Three-dimensional ultrasound examination of the fetal hands: normal and abnormal.

Purpose: To assess particular features of fetal hand evaluation using three-dimensional ultrasound, and to determine whether any advantage is offered by three-dimensional over two-dimensional ultrasound in fetal hand evaluation.

Methods: Three-dimensional fetal data were collected prospectively from 44 hands in 40 fetuses from a predominantly high-risk patient population. All had a concurrent two-dimensional ultrasound examination of the hands. Diagnoses from two- and three-dimensional ultrasound examinations were compared and additional information from the three-dimensional volume assessment was noted. Three-dimensional assessment of distal forearm bones, wrist position, finger configuration and number of metacarpals and digits was recorded.

Results: Hands were appropriately identified as normal (32/32) or abnormal (12/12) by both two- and three-dimensional ultrasound. Three-dimensional ultrasound provided additional information when compared to two-dimensional ultrasound in both normal and abnormal hands, including the provision of three orthogonal planes with one volume acquisition, allowing rotation of the volume so that hands could be evaluated in planes not possible during two-dimensional imaging, assessment of a hand with loosely curled fingers as normal, the ability to evaluate thumb and fingers simultaneously, and improved assessment of abnormal hands.

Conclusions: Three-dimensional ultrasound offers the potential to provide greater information in fetal hand evaluation for both normal and abnormal hands.