四维超声时空关联成像技术辅助诊断胎儿心脏畸形的临床研究

Clinical research of the four dimensional ultrasound space-time correlation imaging ( STIC) technique to diagnose fetal heart malformation

目的探讨四维超声时空关联成像(STIC)技术辅助筛查胎儿心脏畸形的价值。方法选取120例疑似胎儿先天性心脏病孕妇为研究对象,先采用二维超声技术筛查,再行STIC技术采集数据,脱机分析。对终止妊娠或死亡胎儿以病理结果为金标准,活产胎儿以新生儿超声诊断为金标准。观察二维超声技术与四维超声STIC技术的诊断结果。结果 120例胎儿中,81例经引产后病理检查确诊为心脏畸形,其余39例活产胎儿经超声诊断,有38例确诊为心脏畸形。产前二维超声确诊为胎儿心脏畸形111例,其中产后经金标准确诊103例;产前二维超声诊断为正常9例,产后经金标准确诊正常1例。产前二维超声联合四维超声STIC技术确诊为心脏畸形胎儿119例,产后金标准确诊118例;产前联合诊断为正常1例,产后金标准确诊1例。二维超声诊断准确率为86.67%、灵敏度为86.55%;二维超声联合四维超声STIC技术的诊断准确率99.17%、灵敏度为99.16%,两组灵敏度与准确率差异有统计学意义(P<0.05),两组特异度相比差异无统计学意义(P>0.05)。结论先对疑似胎儿心脏畸形采用二维超声筛查,再行四维超声STIC技术诊断可提高诊断准确率。

Objective To probe into the values of four dimensional ultrasound space-time correlation imaging（ STIC） technical assistance in screening of fetal heart malformation. Methods A total of 120 cases of pregnant women whose fetuses were suspected congenital heart disease were selected as the research objects. All of them were screened by two-dimensional ultrasound technique and four dimensional ultrasound STIC technique. The collection data were analyzed offline. The pathological results were regarded as the gold standard for the dead fetus. The ultrasonic diagnosis results of newborn were regarded as the gold standard for the living fetus. The diagnostic results of two-dimensional ultrasound and four dimensional ultrasound STIC were observed. Results Among the 120 cases of fetus,81 cases after induced labor were diagnosed as cardiac malformation by pathological examination. Among the other 39 living birth fetus,38 cases were diagnosed as cardiac malformation by ultrasound. Among the 111 cases that were diagnosed by prenatal twodimensional ultrasound as fetal heart malformation,103 cases were confirmed by the postpartum gold standard. Among the 9 cases that were diagnosed by two-dimensional prenatal ultrasound as normal,1 case was confirmed by the postpartum gold standard. Among 119 cases that were diagnosed as fetal heart malformation by prenatal two-dimensional ultrasound combined with four dimensional ultrasound STIC,118 cases were confirmed by the postpartum gold standard. And,1 case that was diagnosed as normal by combination technique was confirmed by the postpartum gold standard. The diagnostic accuracy and the sensitivity of the two-dimensional ultrasound was 86. 67% and 86. 55%,respectively. The diagnostic accuracy and the sensitivity of the two dimensional ultrasound combined with four dimensional ultrasound STIC was 99. 17% and 99. 16%,respectively. The difference in the sensitivity and the accuracy between the two groups was statistically significant（ P 〈0. 05）. There was no significant difference in the specificity between the two groups（ P 〈0. 05）. Conclusion The two-dimensional ultrasound combined with four dimensional ultrasound STIC can improve the diagnostic accuracy for suspected fetal heart malformation.