三维超声STIC技术辅助诊断胎儿心脏畸形的研究

Added value of three-dimensional ultrasound with STIC technology in the diagnosis of fetus with cardiac abnormalities

目的对照引产后病理检查结果比较二维超声与三维超声时间-空间相关成像技术(spatio-temporalimage correlation,STIC)判断胎儿心脏结构异常细节的准确性,探讨STIC技术对胎儿心脏畸形的产前诊断价值。方法 2006年1月～2008年10月在中山大学附属第一医院行胎儿心脏二维超声检查、可疑胎儿心脏畸形、并存储完整心脏三维超声STIC容积数据、有胎儿心脏病理检查结果的病例24例;应用4DView软件多平面重建和断层显像模式分析心脏STIC容积数据;对照引产后病理检查结果,比较二维超声和STIC技术对各类心脏结构异常的细节诊断符合率。结果心脏病理解剖显示24例中有92个心脏结构异常。二维超声和STIC技术对心脏结构异常的细节诊断总符合率分别为64.1%和97.8%;二维超声和STIC技术对房室连接异常、房室间隔异常的诊断符合率无明显差异(P>0.05),而对静脉与心房连接异常、动脉与心室连接异常、动脉干及分支异常的诊断,STIC技术则优于二维超声(P<0.05)。结论 STIC技术对胎儿心脏畸形中静脉与心脏连接异常、动脉与心室连接异常、动脉干及分支异常的诊断较二维超声可提供更加丰富的诊断信息,为精确诊断胎儿复杂心脏畸形提供了一个新的方法。

Objective To evaluate the diagnostic accuracy of the spatio-temporal image correlation （STIC） technology of three- dimensional ultrasound （3DUS） for fetal congenital heart disease （CHD）. Methods The study was conducted in the First Affiliated Hospital of Sun Yat-sen University from January 2006 to October 2008. Twenty-four fetuses with suspected cardiac defects on routine 2DUS underwent STIC volume sweep. The diagnosis was confirmed by autopsy. Fetal cardiac STIC volume data set was analyzed by using the software of 4D View （GE, Kretztechnik）. The concordance of fetal cardiac defects diagnosed on 2DUS and STIC was compared to autopsy. Results There were 92 cardiac defects in 24 cases. The overall concordance of various fetal cardiac defects diagnosed on STIC （97.8%） was significantly higher than that of 2DUS （64.1%） （P 〈 0.05）. There was no significant difference between the concordance rates of atrio-ventricular junction and atrio-ventricular septal anomalies diagnosed with STIC and 2DUS （P〉 0.05）. However, concordance rate of STIC （100%, 100%, 97.5%） was significantly （P 〈 0.05） higher than that of 2DUS （37.5%, 54.5%, 57.5%） for diagnosing anomalies of atria-venous junction and ventriculo-arterial junction, arterial trunk and its branch. Conclusion STIC technology of 3DUS may provide considerable diagnostic information for prenatal diagnosis of complex CHD, especially in abnormalities of atria-venous junction, ventriculo-arterial junction, arterial trunk and its branches.