疑似胎儿心脏畸形的超声及MRI筛查结果分析

Analysis of Screening Results of Ultrasound and MRI in Suspected Fetal Heart Malformations

目的分析超声(US)及核磁共振(MRI)检查在胎儿心脏畸形(FCDH)中的诊断价值。方法分析我院2017年1月至2018年1月间100例疑似FCHD产妇超声US及MRI检查资料,以病理检查结果作为金标准,评估US与MRI在胎儿心脏畸形中的应用价值。结果 100例产妇共娩出91例胎儿,选择引产者9例,新生儿超声筛查与胎儿尸检共检出87例心脏畸形,检出率为87.00%,其中单心房/室畸形11例(11.00%),房/室发育不良13例(13.00%),心室双出口15例(15.00%),法洛四联症12例(12.00%),大血管转位9例(9.00%),心脏瓣膜畸形18例(18.00%),其他9例(9.00%);单纯超声、MRI与联合诊断在单心/房、房/室发育不良、心室双出口、法洛四联症、大血管转位等心脏畸形中的诊断符合率无显著性差异(P>0.05),在心脏瓣膜畸形、其他及整体诊断符合率中具有显著性差异(P<0.05);单纯超声检查灵敏度为81.61%、特异度为61.54%、准确度为79.00%,单纯MRI检查灵敏度为71.26%、特异度为53.85%、准确度为69.00%,超声联合MRI检查灵敏度为95.40%、特异度为61.54%、准确度为91.00%。结论 US能实现多切面心脏结构观察,在判断血流方向、心脏瓣膜运动等细节中优于MRI,MRI能有效显示大血管走向,在提示心脏大血管及周围器官位置的关系中优于超声,能弥补US检查的不足,US联合MR能有效提高FCDH检出率及准确性,值得临床推广。

Objective To analyze the diagnostic value of ultrasound(US)and magnetic resonance imaging(MRI)in fetal congenital heart disease(FCDH).Methods The US and MRI data of 100 cases of puerperas with suspected FCDH from January 2017 to January 2018 in our hospital were analyzed.The pathological examination results were used as the gold standard to evaluate the application value of US and MRI in fetal heart malformations.Results In 100 cases of puerperas,91 cases were fetuses delivered and 9 cases were with induced labour,and 87 cases of fetuses with heart malformations were detected by ultrasonic screening and fetal autopsy with the detection rate of 87%,including 11 cases(11%)of single atrium/ventricular malformation,13(13%)of atrial/ventricular dysplasia,15(15%)of double outlet ventricle,12(12%)of tetralogy of fallot,9 cases(9%)of transposition of the great vessels,18 cases(18%)of valvular heart malformation and 9 cases(9%)of others(P>0.05).There was no significant difference in the diagnostic coincidence rate in the diagnosis of single atrium,atrial/ventricular dysplasia,double outlet ventricle,tetralogy of fallot,and great vessels transposition by pure US,MRI and combined diagnosis(P>0.05),and there were significant differences in the diagnostic coincidence rate of valvular heart malformation and others(P<0.05).The sensitivity,specificity and accuracy were 81.61%,61.54%and 79.00%by pure US,and were 71.26%,53.85%and 69.00%by pure MRI,and were 95.40%,61.54%and 91.00%by US combined with MRI.Conclusion US is superior to MRI in judging the direction of blood flow and the movement of heart valves.MRI can effectively show the direction of large blood vessels.US is superior in indicating the location of large blood vessels and peripheral organs.It can make up for the deficiency of US.US combined MR can effectively improve the detection rate and accuracy of FCDH.Worthy of clinical promotion.