超声血管增强技术联合断层超声显像技术在胎儿先天性心脏病诊断中的应用

Application of ultrasound vascular enhancement technology combined tomographic ultrasound imaging in the diagnosis of fetal congenital heart diseases

目的探讨超声血管增强技术(VET)联合断层超声显像技术(TUI)在胎儿先天性心脏病诊断中的应用价值。方法应用VET-TUI技术对二维超声筛查诊断为先天性心脏病的17例孕22～30周中晚孕期胎儿进行检查,在获取满意的胎儿心脏容积数据后通过TUI模式,对胎儿心脏进行断层分析,并与产后临床检查结果进行对照分析。结果产前应用VET-TUI技术17例胎儿均获得满意的心脏容积数据及胎儿心脏断层成像图像,17例先天性心脏病胎儿中单一性先天性心脏病3例,复合性先天性心脏病14例。17例胎儿心脏畸形包括心内膜垫缺损5例、永存左位上腔静脉7例(其中1例下腔静脉离断合并异常连接)、右心室双出口4例(包括左侧心室解剖右心室双出口)、肺动脉狭窄6例、室间隔缺损8例、主动脉弓缩窄2例、大动脉转位1例、主动脉闭锁2例、右位主动脉弓3例、左心室发育不良2例、右心室发育不良1例、单心室1例、三房心1例、镜面右位心1例。产前超声诊断与引产后尸检结果相符合10例(10/17),与产后超声心动图复查结果相符合5例(5/17),误诊2例(1例超声诊断永存动脉干,尸检证实为升主动脉闭锁,1例超声诊断单心室,尸检证实为左心室发育不良)。结论应用VET-TUI技术可增加超声图像的清晰度,使胎儿心脏与大血管容积图像清晰直观,易于辨别,较常规二维超声心动图能提供更多胎儿心脏细微解剖结构的诊断信息。

Objective To explore the clinical application of ultrasound vascular enhancement technology combined tomographic ultrasound imaging（VET-TUI）in fetal congenital heart disease.Methods Seventeen cases diagnosed as congenital heart disease by two-dimensional ultrasound in fetuses at gestational ages between 22 to 30 weeks were screened by VET-TUI.Fetal hearts were tomographically analyzed by TUI after obtaining heart volume data with high quality and the results were compared with postnatal examination results.Results Fetal heart volume data and tomographic images with high quality were obtained from all 17 cases by VET-TUI,among which three cases of simple congenital heart defects and 14 cases of complex congenital heart defects were diagnosed,including five cases of endocardial cushion defect,seven cases of left superior vena cava（including one case of interrupted inferior vena cava with anomalous connection）,four cases of double outlet right ventricle（including cases on the left side）,six cases of pulmonary stenosis,eight cases of ventricular septal defect,two cases of aortic arch stenosis,one case of transposition of great arteries,two cases of aortic atresia,three cases of right-sided aortic arch,two cases of left ventricular dysplasia,one case of right ventricular dysplasia,one case of single ventricle,one case of cor triatriatum and 1 case of mirror-image dextrocardia.Ten cases diagnosed by VET-TUI were confirmed by autopsy（10/17）and 5 cases were confirmed by postnatal echocardiography（5/17）.However,two cases previously diagnosed as persistent truncus arteriosus and single ventricle by VET-TUI were identified as aortic atresia in ascending aorta and left ventricular dysplasia by autopsy,respectively.Conclusions VET-TUI technology enhances the resolution of ultrasonic images,making the volume images of fetal hearts and major vessels more clearly and easily distinguished.It provides more anatomical diagnostic information for fetal hearts than traditional two-dimensional echocardiography.