正常胎儿心脏三维全容积超声多平面成像率及影响因素分析

Analysis of multiplane imaging rate and influencing factors in normal fetal heart by real-time three-dimensional full volume ultrasonography

目的分析正常胎儿心脏三维全容积数据后处理成像各切面的成像方法,探讨三维成像的影响因素,对比二维超声与三维超声各切面观成像率的差异。方法 147例经产后随访或超声复查证实无心脏畸形的正常胎儿,同时进行常规胎儿超声心动图和三维超声心动图数据采集,记录6个切面(四心腔、左室流出道、大动脉短轴、动脉导管弓、主动脉弓、下腔静脉与右房连接等)的成像情况,分析三维超声成像的影响因素及影响程度,比较二维及三维超声各切面的成像率。结果胎儿三维全容积数据在四心腔、左室流出道、大动脉短轴、主动脉弓长轴、导管弓长轴及下腔静脉与右房连接切面的成像率分别为95.2%、73.5%、51.0%、45.6%、46.9%及74.8%。对成像的影响有统计学意义的因素为胎位、肢体遮挡、胎盘遮挡、羊水覆盖。去除存在主要影响因素(胎位及肢体遮挡)的病例后,各切面的成像率分别为100%、93.9%、83.7%、75.5%及77.6%,前后成像率差异有统计学意义(P<0.05);比较无主要影响因素的病例,三维超声与二维超声在四心腔、左室流出道及下腔静脉右室连接切面成像率差异无统计学意义(P>0.05)。结论实时和容积三维超声心动图数据采集过程中要考虑各种因素对数据质量的影响,无主要影响因素的三维数据,心脏各切面观成像率较高,在四心腔、左室流出道及下腔静脉与右房连接三切面上可达到二维超声成像率的效果。

Objective To analyze the imaging method of normal fetal heart in each section by three - dimensional full -volume ultrasonography, to investigate the influencing factors of three -dimensional imaging, and to compare the difference of each section imaging rate between 2D and 3D ultrasonography. Methods One hundred and forty - seven normal fetus without cardiac anomalies confirmed by postpartum follow up and ultrasonic re - examination were enrolled in this study. Their data of fetal conventional echocardiography and three -dimensional echocardiography were analyzed. The imaging of six sections（ four- chamber,left ventrical outflow tracts, short axis of large artery, arterial duct arch, aortic arch, connection between inferior caval vein and right artrium, etc. ） were obtained. The influencing factors and influencing degree for three - dimensional ultrasound imaging were analyzed, and the imaging rate of each section by 2D and 3D ultrasound was compared. Results The imaging rate of six views was 95.2% , 73.5% ,51.0% ,45.6% ,46.9% ,74.8%, respectively. The influencing factors of imaging included fetal position, shelter of limb, placenta and amnionic fluid. After excluding the cases with main influencing factors（ fetal position and shelter of limb） ,the imaging rate of each section was 100%, 93.9% ,83.7% ,75.5% ,77.6%, respectively. There was significant difference of imaging rate between before and after exclusion of the influencing factors （ P 〈 0.05 ） ; Comparing the cases with no influencing factors, there was no significant difference of imaging rate in four - chamber, left ventricle outflow tracts and connection between inferior caval vein with right artrium views between 2D and 3D ultrasound（ P 〉 0.05 ）. Conclusion The influence of data quality in collection process should be considered during real - time and volume three - dimensional echocardiography, the imaging rate of all views is improved without main influencing factors, which is near to that of 2D in the views of four - chamber view, left ventrical outflow tracts and connection between inferior caval vein and right artrium.