多普勒、M型及四维时空关联成像检测胎儿左心室每搏输出量的对比观察

Observation on fetal cardiac left ventricular stroke volume using four-dimensional with spatiotemporal image correlation compared with two-dimensional Doppler and M mode ultrasonography

目的比较多普勒、M型与四维时空关联成像(STIC)测量胎儿左心每搏输出量的重复性及测量者间的一致性。方法 2名超声科医师采用双盲法分别应用多普勒、M型与四维STIC测定30胎26～30周正常单胎胎儿左心室输出量,计算组内相关系数(ICC),进行Bland-Altman图分析,评估上述测量方法的重复性和测量者间一致性。结果①同一测量者用3种方法测定胎儿左心室输出量的差异无统计学意义(P均>0.05);②2名观察者间3种方法测量重复性比较,其ICC值STIC法最高(多普勒法ICC:0.93,95%可信区间:0.86～0.95;M型法ICC:0.89,95%可信区间:0.82～0.91;STIC法ICC:0.95,95%可信区间:0.88～0.97);③应用Bland-Altman分析2名观察者测量的一致性,STIC法的系统偏倚及一致界限较多普勒法和M型法好(多普勒法平均差值:-0.04ml,95%可信区间-0.22～0.14ml;M型法平均差值:-0.06ml,95%可信区间-0.20～0.08ml;STIC法平均差值:-0.01ml,95%可信区间-0.11～0.09ml)。结论 3种方法均可用于测量胎儿左心室输出量,以STIC法测量的可重复性和一致性最高,是一种较好的选择。

Objective To compare the reproducibility and agreement of two-dimensional （2D） ultrasonography with Doppler capability,2D ultrasonography with M mode and four-dimensional （4D） with spatiotemporal image correlation （STIC） on the evaluation left ventricular stroke volume （LVSV） in normal fetuses. Methods 2D Doppler,2D M mode,and 4D STIC were used to measure LVSV of 30 normal fetuses at 26 to 30 weeks. Intraclass correlation coefficient （ICC） was used to evaluate the agreement among three techniques,and proportionate Bland-Altman plots constructed. Results There was no significant difference in LVSV value among the three methods within the same observer （all P0.05）. ICC of the LVSV of 4D STIC was the highest among the 3 methods （2D Doppler ICC： 0.93 and 95%CI： 0.86—0.95; 2D M mode ICC： 0.89 and 95%CI： 0.82—0.91; 4D STIC ICC： 0.95 and 95%CI： 0.88—0.97）. 4D STIC was the best method demonstrated with Bland-Altman plot among the 3 methods （2D Doppler mean difference： -0.04 ml and 95%CI： -0.22—0.14 ml; 2D M mode mean difference： -0.06 ml and 95%CI： -0.20—0.08 ml; 4D STIC mean difference： -0.01 ml and 95%CI： -0.11—0.09 ml）. Conclusion There is a good reproducibility among LVSV measured with 2D Doppler,2D M mode or 4D STIC. 4D STIC represents best reproducibility and agreement to estimate fetal LVSV and promises to become a better choice.