时间-空间关联成像联合B-flow在胎儿永存左上腔静脉产前超声诊断中的应用价值

Spatio-temporal image correlation combined with B-flow in prenatal diagnosis of persistent left superior vena cava

目的探讨时间-空间关联成像(STIC)联合B-flow在胎儿永存左上腔静脉产前超声诊断中的应用价值。方法对产前胎儿常规二维超声心动图可疑或明确心脏畸形的132例胎儿进行B-flow显像及STIC数据采集,观察有无左上腔静脉,并将产前超声诊断结果与产后新生儿超声心动图及引产后胎儿尸体解剖病理检查结果进行对比分析。结果 132例胎儿中120例在B-flow显像模式下STIC数据采集成功,采集成功率为90.9%(120/132);120例STIC数据采集成功的胎儿中,常规二维超声心动图诊断永存左上腔静脉15例(15/20)。B-flow-STIC诊断永存左上腔静脉20例。其中5例伴无名静脉缺如,4例合并心脏严重复杂畸形(2例合并完全性房室间隔缺损,1例合并三尖瓣发育不良,1例合并右心室双出口,1例合并右位主动脉弓,5例合并室间隔缺损),6例为单纯性永存左上腔静脉。B-flow-STIC修正常规二维超声心动图诊断5例;其中2例常规二维超声心动图诊断为房间隔缺损,1例常规二维超声心动图诊断为完全性房室间隔缺损,1例常规二维超声心动图诊断为心内型肺静脉异位引流,均经B-flow-STIC修正诊断为永存左上腔静脉;1例常规二维超声心动图漏诊,B-flow-STIC诊断为永存左上腔静脉引流至左心房。结论 STIC联合B-flow可清晰显示胎儿永存左上腔静脉及其空间位置关系,有利于提高永存左上腔静脉产前超声诊断准确性。

Objective To explore whether the use of spatio-temporal image correlation（STIC） combined with B-flow can supply additional information in the prenatal diagnosis of fetal persistent left superior vena cava and to evaluate the application value of B-flow-STIC.Methods Four-dimensional volumes from 132 cases of suspected fetal congenial heart disease by conventional echocardiography at our hospital. Thorough postnatal work-up and pathology available for all fetuses. Results Complete B-flow-STIC collection was obtained and four-dimensional image was successed reconstruction in 120 fetuses （90.9%,120/132）; twenty cases with persistent left superior vena cava were found by B-flow-STIC （20/20） and in which fifteen cases were found by two-dimensional （2D） sonography, complicated congenital cardiac disease in four cases, complete atrioventricular defect in two cases, tricuspid hypoplasia in one case, double outlet right ventricle in one case, right aorta arch in one case, ventricular septal defect in five cases and isolated persistent left superior vena cava in six cases, all cases confirmed by postnatal work-up and pathology. Five cases diagnosed by 2D echocardiography which revised by B-flow-STIC： two cases of them were diagnosed atrial septum defect by 2D echocardiography, one case of them was diagnosed complete atrioventricular septal defect by 2D echocardiography, one case of them was diagnosed intracardic anomalous pulmonary venous connection by 2D echocardiography,one case of them missed by 2D echocardiography,and five cases of above were diagnosed persistent left superior vena cava by B-flow-STIC. Conclusions B-flow-STIC is apparently able to facilitate identification of the anatomical features of fetal persistent left superior vena cava thus supplying additional information over that provided by 2D fetal sonography and it is helpful in diagnosis of prenatal persistent left superior vena cava.