Fully Automated Biometric Parameter Measurement in Prenatal Ultrasound Screening for Total Anomalous Pulmonary Venous Connection

Total anomalous pulmonary venous connection (TAPVC) is a severe congenital heart disease, yet its prenatal detection rate remains suboptimal. To support prenatal ultrasound screening of TAPVC, the post-left atrium space (PLAS) index and the left-atrial posterior-space-to-diagonal (LAPSD) ratio measured in the four-chamber view (4CV) have been proposed as useful biometric parameters. In this study, we developed a novel approach that integrates automated 4CV extraction (AE) from fetal cardiac ultrasound videos with automated measurement of these indices. The heart, crux, and descending aorta were segmented using DeepLabv3+, UNet3+, and SegFormer. The screening performance of the AE-based methods was comparable to that of manual 4CV extraction, as demonstrated by similar mean areas under the receiver operating characteristic curve (AUCs). In a clinical comparison study, the mean AUC values for residents, fellows, experts, AE-DeepLabv3+, AE-UNet3+, and AE-SegFormer were 0.784, 0.801, 0.996, 0.903, 0.928, and 0.940, respectively, for the PLAS index and 0.797, 0.801, 0.996, 0.919, 0.916, and 0.940, respectively, for the LAPSD ratio. Although experts demonstrated the best overall performance, the fully automated methods consistently outperformed both the residents and fellows. This approach may support less experienced examiners, improve screening accuracy, streamline clinical workflows, and ultimately enhance the prenatal detection of TAPVC.