三维超声自动容积导航技术在胎儿颅脑结构测量中的应用

Application of smart planes using three-dimensional ultrasonography in the measurement of fetal brain structure

目的评估产科自动容积导航技术(Smart Planes)在三维容积中自动识别胎儿颅脑切面并获取颅脑测量数据的价值。方法选择2017年7月至11月于广东省妇幼保健院超声科进行Ⅲ级产科彩色多普勒超声检查的孕妇299例,获取三维容积并应用Smart Planes后处理成像,自动获取胎儿的小脑切面(TCP)、丘脑切面(TTP)、侧脑室切面(TVP)和正中矢状面(MSP)及双顶径(BPD)、头围(HC)、侧脑室(LVW)、小脑横径(TCD)和小脑延髓池(CM)等测量数值。使用组内相关系数(ICC)评估二维超声与Smart Planes软件对胎儿颅脑测量的可靠性和一致性。对两种技术完成数据测量所需的时间进行比较,并计算不同操作者测量的一致性。结果 299例胎儿中共有297例(99.3%)应用Smart Planes成功获取4个诊断切面及测量数据。两项技术之间获得的BPD、HC、LVW和TCD测量值一致性较好,ICC分别为0.965,0.948,0.849和0.828,而CM测量ICC为0.725。同一操作者或两名不同操作者间获得的多次测量数据比较重复性较好。使用Smart Planes软件测量各数据所需时间比二维超声测量显著缩短(13.7 s vs 49.0 s,P <0.000 1)。结论应用Smart Planes可快速识别胎儿颅脑诊断切面并获得测量数值,其重复性及稳定性较好,在胎儿颅脑检查中具有一定的临床应用价值。

Objective To evaluate the significance of automatic volume navigation(Smart Planes)in automatically recognize the fetal brain axis plane in three-dimensional volume and to obtain fetal brain measurements.Methods The study was conducted in the Department of Ultrasound at Guangdong Women and Children Hospital between July 2017 and November 2017,enrolled 299 singleton pregnancies undergoing routine second trimester examination. The three-dimensional volume data with the cerebellar section as the initial plane was collected,and the Smart Planes post-processing imaging was used to automatically acquire the fetal cerebellar section,the thalamic section,the lateral ventricle section,the median sagittal plane,biparietal diameter,head circumference,distal posterior lateral ventricle,transverse cerebellar diameter and cisterna magna measurements. Intraclass correlation coefficients(ICCs)were usd to evaluate the reliability and consistency of two-dimensional ultrasound and Smart planes software for fetal brain measurements. Furthermore,the time required for measurements of two techniques was compared and the intraobserver and interobserver agreements of measurements was calculated. Results Smart planes successfully reconstructed 4 diagnostic planes and basic measurements in 297/299(99.3%). The measurements of BPD,HC,LVW and TCD obtained by Smart Planes were highly consistent with those of two-dimensional ultrasound,with the ICC of 0.965,0.948,0.849 and 0.828,respectively. Nevertheless,the agreement between this two techniques was low for CM(ICC=0.725). Good intraobserver and interobserver reproducibility was observed for the repeated measurement data obtained by the same operator or two independent operators. The time required for measurement with Smart planes was significantly shorter than two-dimensional ultrasound measurement(13.7 s vs 49.0 s,P < 0.0001). Conclusion Smart planes is able to quickly identify the fetal brain diagnostic planes and obtain biometric measurements,suggesting a certain clinical application value in fetal brain examination for its repeatability and stability.