产前超声应用微血流灌注成像技术诊断胎儿下腔静脉畸形的价值

The value of prenatal ultrasound in the diagnosis of fetal inferior vena cava malformations by microvascular flow imaging

目的探讨产前超声应用微血流灌注(MV-Flow)成像技术诊断胎儿下腔静脉畸形的价值。方法选择2020年6月至2021年6月成都市妇女儿童中心医院超声科22787例孕妇行20~24周胎儿系统超声检查中,产前诊断为下腔静脉畸形的胎儿,应用MV-Flow技术和多切面分段观察法观察下腔静脉,发现下腔静脉畸形时启用时间-空间关联成像(STIC)技术明确诊断。产后引产儿尸体解剖或儿童超声检查追踪观察,对比3种检查方法的产前诊断准确性,并比较操作耗时。结果产前诊断67例下腔静脉畸形,均经产后证实。应用MV-Flow技术观察下腔静脉,声像表现为:下腔静脉中断时肝静脉未汇入下腔静脉而直接汇入右心房,左下腔静脉呈"S"形走行,双下腔静脉呈"h"形走行。MV-Flow技术、多切面分段观察和STIC技术3者的诊断准确性一致。MV-Flow技术平均用时(10.16±2.48)s/例,多切面分段观察平均用时(34.75±11.04)s/例,STIC技术平均用时(225.11±36.67)s/例,三者比较差异有统计学意义(Z=126,P<0.01)。结论产前超声应用MV-Flow技术观察下腔静脉,产前诊断准确率高,操作简便,适合推广应用。

Objective To explore the value of prenatal ultrasound in the diagnosis of fetal inferior vena cava malformations by microvascular flow imaging(MV-Flow).MethodsBetween June 2020 and June 2021,22787 pregnant women from Chengdu Women′s and Children′s Center Hospital undergoing fetal system ultrasound examinations between 20 and 24 weeks were retrospectively analyzed and patients who were prenatally diagnosed with inferior vena cava malformations were chosen.MV-Flow equipment and a multi-section observation technique were used to monitor the inferior vena cava.Spatio-temporal image correlation(STIC)was used to make a definite diagnosis of inferior vena cava malformation.Ultrasound examinations of children or postnatal autopsies were monitored.Comparisons were made between the three systems′operational times and prenatal diagnosis accuracy.ResultsPrenatal and postnatal examinations were used to diagnose and confirm 67 occurrences of inferior vena cava anomalies.The sonographic results of MV-Flow technology demonstrated that when the IVC was disrupted,the hepatic vein instead flowed directly into the right atrium.An"S"-shaped route could be seen in the left IVC,while a"h"-shaped course could be seen in the double IVC.MV-Flow,multi-section observation,and STIC all had comparable diagnostic efficacy.The average time of MV-Flow,multi-section observation,and STIC were(10.16±2.48)s/case,(34.75±11.04)s/case and(225.11±36.67)s/case,respectively.The difference was statistically significant(Z=126,P<0.01).ConclusionMV-Flow,used in prenatal ultrasonography to detect the inferior vena cava,offers good prenatal diagnosis accuracy,is easy to use,and may be widely applied.