超声时间-空间关联成像技术及三维超声在胎儿先天性心脏畸形及心外畸形诊断中的应用价值

Application of Spatio-temporal Image Correlation and Three-dimensional Ultrasound in the Diagnosis of Fetal Congenital Heart Defects and Extracardiac Malformations

背景产前超声诊断胎儿先天性心脏畸形(CHD)的复杂程度及是否合并心外畸形对胎儿预后有重要影响,超声时间-空间关联成像(STIC)技术对胎儿心脏检查有较好诊断准确性,但关于超声新技术辅助二维超声检查中胎儿预后的研究却鲜见报道。目的探讨超声STIC技术及三维超声在胎儿CHD及心外畸形诊断中的临床应用价值。方法 2015年3月——2017年11月北京大学民航临床医学院共有7707例孕妇行孕中晚期产前常规二维超声检查,共检出32例CHD胎儿,运用超声STIC及三维超声进行超声容积数据的采集及分析,并与新生儿超声心动图或病理解剖结果进行比较,分析胎儿CHD及其合并的心外畸形类型与临床预后。结果 CHD胎儿的检出率为0.4%(32/7707);心脏有1处畸形合并心外畸形胎儿的检出率为13.3%(2/15),与心脏有2处及以上畸形合并心外畸形胎儿的检出率[35.3%(6/17)]比较,差异无统计学意义(P=0.229)。32例CHD胎儿中存活14例,心脏有1处畸形胎儿的存活率为86.7%(13/15),高于心脏有2处及以上畸形胎儿的存活率[5.9%(1/17)](P<0.05)。CHD合并心外畸形胎儿的存活率为12.5%(1/8),与CHD不合并心外畸形胎儿的存活率[54.2%(13/24)]比较,差异无统计学意义(P=0.053)。产前超声STIC及三维超声结果均与病理解剖结果一致。在1例胎儿心脏多发畸形的病例中,二维超声显示似有肺静脉异位引流,超声STIC显示胎儿心脏存在完全性肺静脉异位引流。结论发生2处及以上心脏畸形胎儿与仅发生1处心脏畸形合并心外畸形胎儿的检出率间无明显差异,发生2处及以上心脏畸形的胎儿存活率更低。应用三维超声及超声STIC可更全面、立体显示胎儿CHD及其合并的心外畸形,结合常规二维超声检查,可为临床决策提供更准确的超声检查依据。

Background In prenatal ultrasound diagnosis,fetal congenital heart defects(CHDs) and extracardiac malformations have an important impact on fetal prognosis.Spatio-temporal image correlation ultrasound(STIC) has a good diagnostic accuracy for fetal heart examination.However,it is rare to report on the fetal prognosis in the examination of twodimensional ultrasound combined with new ultrasound technology.Objective To examine the potential of STIC and threedimensional (3D) ultrasound in the diagnosis of fetal CHDs and extracardiac malformations.Methods The conventional two-dimensional(2D) ultrasound examination during the second and third trimester was conducted among 7 707 pregnant women registered in Peking University Civil Aviation School of Clinical Medicine from March 2015 to November 2017.Thirty-two fetuses were diagnosed with CHD.STIC and 3D ultrasound were performed for the acquisition and analysis of ultrasound volume data.Ultrasound results were used to analyze fetal CHD and extracardiac malformation and outcome,after comparison with neonatal echocardiography or pathological anatomy results.Results The detection rate of fetal CHD was 0.4%(32/7 707). The detection rates of fetuses with only one cardiac malformation with extracardiac malformation and those with two or more cardiac malformations with extracardiac malformation were 13.3%(2/15) and 35.3%(6/17),respectively,showing no significant difference (P=0.229).There were 14 survivors in the study.The survival rate of the fetuses with only one cardiac malformation was much higher than that of those with two or more cardiac malformations〔86.7%(13/15) vs 5.9%(1/17)〕(P<0.05).The survival rates of the fetuses with CHD plus extracardiac malformation and those with CHD were 12.5%(1/8) and 54.2%(13/24),respectively,showing no significant difference(P=0.053).Results of the prenatal 3D ultrasound and STIC agreed with pathological anatomy results.By 2D ultrasound,one case of multiple cardiac malformations was found with uncertain anomalous pulmonary venous drainage,but by STIC,it was identified with total anomalous pulmonary venous drainage. Conclusion Detection rate of fetuses with two or more cardiac malformations with extracardiac malformation was similar to that of those with only one cardiac malformation with extracardiac malformation,but the former group had a lower survival rate.3D ultrasound and STIC can display fetal CHD and combined extracardiac malformations more completely and stereoscopically. Combined with conventional 2D ultrasound,they provide more accurate ultrasonic evidence for early diagnosis and treatment of fetal congenital malformations.