基于容积超声的胎儿心脏计算机辅助诊断技术获取胎儿超声心动图基本诊断切面的应用价值

Clinical value of sonography based volume computer aided display heart(SonoVCADheart)in the display of key diagnostic elements in basic fetal echocardiographic views

目的:评价基于容积超声的胎儿心脏计算机辅助诊断(sonography based volume computer aided display heart,SonoVCADheart)技术在获取胎儿超声心动图基本诊断切面中的应用价值。方法:选取2019年1月8-22日在浙江大学医学院附属邵逸夫医院就诊的80例中晚孕单胎胎儿(57例心脏正常,23例心脏异常),使用容积探头快速采集4~5个以四腔心切面为基础切面的心脏四维容积数据。三位不同经验的医师(医师A:从事胎儿心脏超声诊断15年以上;医师B和C:经过正规胎儿超声心动图培训6个月但经验不丰富)分别采用SonoVCADheart分析处理,对诊断切面的要素化内容进行评分、诊断,并且计算成功率,然后进行统计分析。结果:57例正常胎儿共获取279个容积数据包,平均4.89个/胎儿;23例异常胎儿共获取109个容积数据包,平均4.74个/胎儿。所有容积数据均用于分析,8个诊断切面中所有要素均≥2分的容积百分比分别为:正常组70.61%~74.91%、异常组53.21%~55.96%。不同时间同一医师评分、经验不足医师之间评分及分别与经验丰富医师评分结果差异均无统计学意义(P>0.05);正常、异常组间的评分除了三位医师上下腔静脉-右心房切面以及医师A和C的主动脉弓切面外差异均有统计学意义(P<0.05);分析并完成诊断所需时间比较:医师A与医师B、C差异均有统计学意义(P<0.05),医师B和C差异无统计学意义(P>0.05);医师A采用SonoVCADheart诊断与二维超声诊断时间比较:异常组差异有统计学意义(P<0.05),正常组差异无统计学意义(P>0.05);异常组SonoVCADheart诊断符合率为89.91%~90.83%。结论:SonoVCADheart技术对于显示胎儿心脏的8个标准诊断切面具有较高的重复性及良好的稳定性,能够为胎儿超声心动图检查提供重要的关键的诊断切面,在图像采集和显示的标准化方面具有潜在临床应用价值。

Objective To evaluate the clinical value of sonography based volume computer aided display heart(SonoVCADheart)in the display of key diagnostic elements in basic fetal echocardiographic views.Methods 4D volume data based on fetal four-chamber view of 80 singleton fetuses(including 57 normal fetuses and 23 fetuses with heart abnormalities)were collected by using a volumetric probe from the Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from January 8-22,2019.Four to five volume datasets based on four-chamber view of the heart were rapidly acquired from each fetus.Three doctors(Doctor A:Engaged in fetal echocardiography diagnosis for more than 15 years,Doctor B and C:6 months of regular fetal echocardiography training but lack of experience)with different fetal echocardiographic experiences performed off-line processing using SonoVCADheart combined tomographic ultrasound imaging(TUI)at different times to obtain eight standard echocardiographic diagnostic views,and to score the elementary contents of each echocardiographic view.The scores of the same doctor at different times,the scores of less experienced doctors and experienced doctor,and the scores between normal and abnormal fetuses,and the time required for analysis and diagnosis among all doctors were analyzed and compared,respectively.The diagnostic coincidence rates of SonoVCADheart for fetuses with cardiac malformations were also assessed.Results A total of 279 volume datasets obtained from 57 normal fetuses,an average of 4.89/fetus,and 109 volume datasets obtained from 23 fetuses with cardiovascular abnormalities,an average of 4.74/fetus,and all volume datasets were used for SonoVCADheart analysis.The volume percentage of all the elements in the 8 diagnostic views with image quality≥2 points shown by SonoVCADheart in the normal fetuses was about 70.61%-74.91%,in the abnormal fetuses was about 53.21%-55.96%.There were no significant differences in the scores between the same doctor at different times,the scores between inexperienced doctors,and the scores among experienced and less experienced doctors(all P>0.05).There were significant differences in the scores between normal and abnormal fetuses except for all of the superior and inferior vena cava view and the aorticarch view of doctors A and C(all P<0.05).The time required for experienced doctor A and inexperienced doctors B and C to obtain 8 diagnostic views and to complete the diagnosis was statistically significant(P<0.05).There was no significant difference in the time required for the inexperienced doctors B and C to obtain 8 diagnostic sections and to complete the diagnosis(P>0.05).There was statistically significant difference in the diagnosis time required for doctor A using SonoVCADheart and two-dimensional echocardiography in fetuses with cardiovascular malformations(P<0.05).However,there was no statistically significant difference in the time required in the normal fetus between SonoVCADheart and two-dimensional echocardiography(P>0.05).The diagnostic coincidence rate of SonoVCADheart for fetuses with cardiac malformations is about 89.91%-90.83%.Conclusions SonoVCADheart is a repeatable and stable novel fetal heart processing tool enabling displaying eight standard diagnostic sections of the fetal heart,and has potential clinical application value in the standardization of image acquisition and sequence display.