超声断层显像与常规二维超声进行胎儿心脏筛查的比较研究

Comparison of tomographic ultrasound image with routine ultrasonography in fetal heart screening

目的比较超声断层显像（TUI）技术与常规二维超声进行胎儿心脏筛查的图像显示合格率和图像质量，分析TUI进行胎儿心脏筛查的可行性。方法110例中孕期正常胎儿，利用时空关联成像（STIC）技术，一次性扫描获得整个心脏的容积数据，然后脱机分析，采用TUI法，调整层距、中心层位置后，分别在灰阶模式下及彩色多普勒血流模式下，重现胎儿心脏筛查所需要的四腔心切面，左、右室流出道切面和三血管切面。按事先确定的评分标准，分别对TUI重现图像及常规二维超声所获得切面进行评分比较，并统计图像显示合格率。结果纳入研究的110例正常胎儿心脏中，在胎位相同的条件下，TUI法重现的四腔心切面，左、右室流出道切面及三血管切面灰阶图的显示率分别为100％、88．9％、80．0％、84．4％，常规二维超声显示率分别为100％、86．2％、50．0％、100％。TUI法重现各切面（灰阶图和血流图）的显示率与常规二维超声各相应切面的显示率比较差异均无统计学意义（P〉0．05）。图像质量评分显示，仅在灰阶图中四腔心切面筛查图像评分低于TUI法，常规二维超声中右室流出道切面评分高于TUI法（P〈0．05），其余各切面比较差异均无统计学意义（P〉0．05）。结论TUI法重现的各切面基本能够达到与直接获得的二维切面相同的合格率和图像质量，可以满足中孕期胎儿心脏筛查离线分析的需要。

Objective To evaluate the value of tomographic ultrasound imaging（TUI） in the fetal heart screening. Methods One hundred and ten volume datasets acquired from normal fetal heart in the second trimester with spatio-temporal image correlation（STIC） were evaluated offline with TUI. The Bmode and CDFI static images as well as the dynamic loops of one cardiac cycle could be reviewed simultaneously. The visualizing rate and ultrasonic scores of the 4 chamber view,outflow tracts and 3 vessels （and trachea） view obtained from TUI and routine ultrasonography for fetal heart screening were respectively compared. Results Among all 110 cases,the visualizing rate of 4 chamber view,outflow tracts and 3 vessels （and trachea） view were respectively 100 % （67）, 88.9 % （45）, 80.0 % （45）, 84.4 % （32） in Bmode and 100%（33）,86.2%（25）,50.0%（14）,100% （4） in CDFI under the same fetal position. No significant differences of the visualization rate were found between TUI and routine screening either in Bmode or in CDFI（ P 〉0. 05）. The median score of 4 chamber view of TUI in B-mode was little higher than that in routine screening,while the right outflow tract of screening in CDFI significantly higher than that of TUI（ P 〈0.05）. Conclusions The visualizing rates and qualities of TUI are sufficient for fetal heart screening offline as well as routine ultrasonography online in second trimester.