时间-空间关联成像联合超声断层显像模式在产前诊断圆锥动脉干畸形中的应用

The role of spatio-temporal image correlation with tomographic ultrasound imaging in the prenatal diagnosis of conotruncal defects

目的探讨时间一空间关联成像联合超声断层显像模式（TUI—STIC）在产前诊断圆锥动脉干畸形中的应用价值。方法分别对1508例先天性心脏病高危胎儿进行二维超声心动图（2DE）检查并采集TUISTIC心脏容积数据分析，产前检查结果与产后新生儿超声心动图、多排螺旋CT及引产后尸检结果进行对比。结果1508例胎儿中，2DE诊断圆锥动脉干畸形35例，TUI～STIC诊断圆锥动脉干畸形39例。TuI—STIC补充及纠正2DE诊断9例（共占22％），纠正2DE诊断右室双出口亚型3例，其诊断灵敏度为97．5％，特异度100％，阳性预测值100％，阴性预测值99．9％，准确率99％。2DE与TUI—STIC一致性检验Kappa=0．244，P=0．018（P〈0．01），McNemar检验显示差异有统计学意义，P=0．004（P〈0．01）。结论TuI—STIC可以提高心室大动脉连接及位置关系的显示率及异常的发现率，有利于大动脉空间定位，对于完善圆锥动脉干畸形的诊断及鉴别诊断具有较大的应用价值。

Objective To investigate the application value of spatio-temporal image correlation （STIC） combined with tomographic ultrasound imaging （TUI） in the prenatal diagnosis of eonotruncal defeets（CTD）. Methods Two-dimensional（2D） fetal echocardiography to screen and TUI-STIC volumes from 1508 cases of fetuses of high risk with congenital heart disease. Postnatal work-up and pathological results were available for all fetuses with CTD. Results Thirty nine cases with CTD were found by TUISTIC while thirty five cases were found by 2D echocardiography, but TUI-STIC had new findings and corrected the diagnosis in 9 cases as compared with 2D echocardiography. The sensitivity, specificity, positivity predictive value, negative predictive value and accuracy of TUI-STIC in evaluating CTD were 97.5 %,100 %,100 %, 99.9 % and 99 %. The Kappa value of consistency test between 2DE and TUI-SIC was 0. 244（ P 〈0. 01 ）, MeNemar test showed that the difference was statistically significant（ P〈0.01 ）. Conclusions TUI-STIC allows a complete sequential analysis of fetal conotruncal defects and supplying additional information over 2D fetal echocardiography, it could improve the prenatal diagnosis rate. TUISTIC is helpful in diagnosis of prenatal conotruncal defects.