二维超声心动图与智能时间-空间相关成像技术对中晚孕胎儿主动脉各段内径测量的一致性分析

Concordance of 2-dimensional and intelligent spatiotemporal image correlation echocardiography in measuring fetal aortic diameters

目的探讨二维超声心动图（2DE）与智能时间-空间相关成像（iSTIC）技术对正常胎儿主动脉各段内径测值的一致性。方法随机选取中晚孕期（22-32周）正常单胎胎儿140例。将胎儿主动脉内径的6个指标进行测量：主动脉根部内径（AO）、升主动脉内径（AAO）、主动脉弓内径（无名动脉分支与左侧颈总动脉之间）EAO Arch（INA to LCCA）]、主动脉弓内径（左侧颈总动脉与左侧锁骨下动脉之间）[AOArch（LCCA to LSA）]、主动脉弓峡部内径（Aortic Isthmus）和降主动脉内径（DAO）。经常规二维超声心动图和iSTIC自动扫描技术采集数据，获得多个胎儿心动周期的容积数据，利用QLAB软件脱机处理，获得主动脉弓长轴切面并测量此6段内径。对两种方法所测此6个参数内径在各个孕周的平均值进行配对t检验，通过Bland—Altman分析验证两种方法的一致性。结果140例胎儿中137例iSTIC采集数据处理后成功获得清晰的图像，成功率为97．85％。Pearson相关分析显示6个参数用两种方法所测值一致性很好，R2分别为0．983、0．978、0．979、0．977、0．978、0．979。经Bland—Altman制图分析两种方法测得6个参数的95％一致性界限分别为（-0．1260／＋0．2299）、（-0．1707／＋0．2241）、（-0．1547／＋0．2190）、（-0．1736／＋0．2024）、（-0．1514／＋0．2039）、（-0．1485／＋0．2228）；分别有5．11%（7／137）、4．38％（6／137）、5．11％（7／137）、5．84％（8／137）、4．38％（6／137）、4．38％（6／137）的点在95％一致性界限之外。结论常规二维超声心动图与iSTIC所测主动脉各测值之间具有很高的一致性。

Objective To evaluate the concordance of two-dimensional echocardiography （2DE） and intelligent spatiotemporal image correlation （iSTIC） in measuring fetal aortic and aortic arch diameters during the second and third trimesters. Methods Data were collected by a prospective cross-sectional study of 140 normal singleton fetuses with the gestational age from 22 to 32 weeks. A total of 6 dimensions of the fetal aortic and aortic arch, including aortic annular diameter （AO）, ascending aorta diameter （AAO）, aortic arch diameter EAO Arch （INA to LCCA）], aortic arch diameter [-AO Arch （LCCA to LSA）], aortic isthmus diameter and descending aorta diameter （DAO）, were measured by two different methods. Concordance was assessed by comparing the measurements acquired by iSTIC with those determined by 2DE and depicted by Bland-Altman plots. Inter-and intra-observer variability was evaluated by the intraclass correlation coefficient （ICC） test. Results A total of 137 iSTIC volumes in 140 cases were found to be suitable for further analysis. Good correlation was observed in the measurements that determined by 2D or iSTIC （Pearson＇s R2 = 0.977 - 0.983）. There was no significant difIerence in the mean values of all the parameters that measured by two methods. Bland-Airman plot showed that the 95% limits of agreement （LOA） in AO, AAO, AO Arch （INA to LCCA）, AO Arch （LCCA to LSA）, aortic isthmus diameter and DAO were （ - 0. 1260/＋ 0.2299）, （ - 0. 1707/＋ 0.2241）, （ - 0. 1547/＋ 0.2190）, （ - 0. 1736/＋ 0.2024）, （ - 0. 1514/＋ 0. 2039） and （ - 0. 1485/＋ 0. 2228）, respectively. The points in the outside of LOA were 5.11% （7/137）,4.38%（6/137）,5.11% （7/137）,5.84% （8/137）,4.38% （6/137） and 4.38% （6/137）, respectively. Conclusions iSTIC has a good agreement with 2DE in measuring fetal aortic and aortic arch dimensions during the second and third trimesters.