胎儿心脏超声智能导航技术产前筛查右位主动脉弓伴左位动脉导管的可行性研究

A feasibility study of fetal intelligent navigation echocardiography in the prenatal screening of right aortic arch with left-sided ductus arteriosus

目的探讨胎儿心脏超声智能导航技术(FINE)联合虚拟超声辅助技术(VIS-Assistance®)产前筛查右位主动脉弓(RAA)伴左位动脉导管(LDA)的可行性。方法回顾性分析2018年1月至2020年1月浙江大学医学院附属邵逸夫医院32例中晚孕RAA伴LDA胎儿心脏容积数据。高年资A医生应用FINE采集时间-空间相关成像(STIC)容积数据。低年资B医生和中等年资C医生分别应用VIS-Assistance®技术获取主动脉横弓位于气管右侧和"U"形血管环这两个诊断要素及三血管气管诊断切面。比较不同经验医生获取诊断要素、诊断切面的显示成功率、图像质量评分并验证一致性。于产后随访患儿有无临床受压症状。结果纳入研究病例34例,2例因无法取得满意容积数据被排除,对32例胎儿容积数据进行分析。两个诊断要素及一个关键性诊断切面结果如下:诊断要素1(主动脉横弓位于气管右侧),B医生与C医生VIS-Assistance®处理前图像显示成功率分别为84.4%和87.5%,VIS-Assistance®处理后显示成功率分别为93.8%和93.8%。诊断要素2("U"形血管环),B医生与C医生VIS-Assistance®处理前显示成功率分别为78.1%和87.3%,VIS-Assistance®处理后显示成功率分别为90.6%和90.6%。三血管气管诊断切面B医生与C医生VIS-Assistance®处理前显示成功率分别为65.6%和71.9%,VIS-Assistance®处理后显示成功率分别为84.4%和87.5%;C医生诊断切面VIS-Assistance®处理前后显示成功率差异有统计学意义(P<0.05);三血管气管切面B医生与C医生图像质量评分VIS-Assistance®处理前分别为3.00(2.50,3.00)分和3.00(2.50,3.50)分,VIS-Assistance®处理后分别为3.25(3.00,3.50)分和3.50(3.00,3.50)分,VIS-Assistance®处理后图像质量评分高于VIS-Assistance®处理前(均P<0.05)。Bland-Altman分析显示两位医生应用VIS-Assistance®技术具有较好的一致性。随访显示32例胎儿生后均未出现明显临床受压症状。结论应用FINE联合VIS-Assistance®技术能够简单、可靠获取诊断RAA伴LDA的关键性切面——三血管气管切面,并清晰显示所有诊断要素,具有较高的重复性及稳定性。VIS-Assistance®技术可以提高经验不足医生诊断切面获取成功率及图像质量评分,因此可以作为产前筛查RAA伴LDA的一种有效补充手段。

Objective To investigate the feasibility of applying Fetal Intelligent Navigation Echocardiography (FINE) combined with Virtual Intelligent Sonographer Assistance (VIS-Assistance®) in the prenatal screening of right aortic arch (RAA) with left-sided ductus arteriosus (LDA).Methods A total of 32 fetuses with RAA and LDA during middle and late pregnancy in Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital from Jauary 2018 to Jauary 2020 were included in this retrospective study, and the datas about fetal cardiac three-dimensional volume were analyzed. The time-space correlation imaging (STIC) volume data were collected by using FINE by Senior doctor A. The two diagnostic elements of the transverse aortic arch on the right side of the trachea and the "U" -shaped vascular ring, as well as the three-vessel tracheal diagnostic section were obtained by low-aged doctor B and middle-aged doctor C by using VIS-Assistance® technology. And then the detection rates of diagnostic sections and diagnostic elements for fetuses with RAA and LDA were calculated. The postpartum outcomes of fetuses with RAA and LDA were followed up.Results Thirty-two fetuses were included in the study after excluding 2 cases due to the poor quality images, and the datas about fetal cardiac three-dimensional volume of the 32 fetuses were analyzed. The detection rate of one diagnostic element (the aortic arch on the right side of the trachea) were 84.4% vs 87.5% before VIS-Assistance®, and 93.8% vs 93.8% after VIS-Assistance® for each doctor B and doctor C , respectively. Another diagnostic element ( "U" -shaped vascular ring) were 78.1% vs 87.3% before VIS-Assistance®, and 90.6% vs 90.6% after VIS-Assistance® for doctor B and doctor C, respectively. But no significant difference was found before and after VIS-Assistance® between the two each doctors(all P>0.05). The detection rate of three-vascular tracheal diagnosis view were 65.6% vs 71.9% before VIS-Assistance® and 84.4% vs 87.5% after VIS-Assistance® for doctor B and doctor C, respectively. There was significant difference before and after VIS-Assistance® of doctor C(P<0.05). The scores of image quality after VIS-Assistance® were significantly higher than that before VIS-Assistance® for doctor B and doctor C, respectively [3(2.5, 3) vs 3.25(3.0, 3.5), and 3(2.5, 3.5) vs 3.5(3.0, 3.5)]. The agreement between two doctors performing VIS-Assistance® was investigated using Bland-Altman analysis and the result showed that within 95% of the differences fall in the agreement interval. No obvious clinical symptoms of compression were found in 32 neonates after follow-up.Conclusions The application of FINE combined with VIS-Assistance® technology can easily and reliably obtain the key diagnostic view of RAA with LDA (three-vessel and tracheal view), and clearly display all diagnostic elements, having high repeatability and stability. VIS-Assistance® technology can improve the detection rate and image quality even if the doctor was lack of experience. So it can be used as an effective supplementary means for prenatal screening of RAA and LDA.