产前四维超声时间空间相关成像(STIC)在筛查胎儿先天性心脏病诊断中的应用研究

Application of Prenatal Four-dimensional Ultrasound Time-space Correlation Imaging(STIC)in Screening of Fetal Congenital Heart Disease

目的:探讨产前四维超声时间空间相关成像(STIC)在胎儿先天性心脏病诊断中的应用价值。方法:回顾性分析2015年1月-2021年12月在东莞市松山湖中心医院行产前筛查的245例疑似患胎儿先天性心脏病的孕妇临床资料,均行二维超声及四维超声STIC检查。以娩出后超声心动图检查为金标准,评估两种检查方法在胎儿先天性心脏病诊断中的灵敏度、特异度、准确度。结果:245例孕妇中经娩出后超声心动图检查检出21例胎儿先天性心脏病,其中二维超声检出率为71.43%(15/21),四维超声检出率为95.24%(20/21);四维超声诊断灵敏度、准确度高于二维超声,差异有统计学意义(P<0.05);kappa检验显示,二维超声与金标准一致性尚可(kappa值=0.701,P=0.000);四维超声与金标准一致性极好(kappa值=0.920,P=0.000)。结论:四维超声STIC在胎儿先天性心脏病诊断中应用价值更高,能提高早期筛查灵敏度、准确度,减少漏诊、误诊发生,以便于临床尽早开展相应干预措施。

Objective:To investigate the value of prenatal four-dimensional ultrasound spatio-temporal image correlation(STIC)in the diagnosis of fetal congenital heart disease.Methods:The clinical data of 245 pregnant women suspected of having fetal congenital heart disease who underwent prenatal screening in Dongguan Songshanhu Central Hospital from January 2015 to December 2021 were analyzed retrospectively.All of them underwent two-dimensional ultrasound and four-dimensional ultrasound STIC.The sensitivity,specificity and accuracy of the two methods in the diagnosis of fetal congenital heart disease were evaluated by using post delivery echocardiography as the gold standard.Results:Among 245 pregnant women,21 cases of fetal congenital heart disease were detected by echocardiography after delivery.The detection rate of two-dimensional echocardiography was 71.43%(15/21),and the detection rate of four-dimensional echocardiography was 95.24%(20/21);the diagnostic sensitivity and accuracy of four-dimensional ultrasound were higher than those of two-dimensional ultrasound(P<0.05);kappa test showed that the consistency between two-dimensional ultrasound and gold standard was acceptable(kappa value=0.701,P=0.000);the consistency between four-dimensional ultrasound and gold standard is excellent(kappa value=0.920,P=0.000).Conclusion:Four dimensional ultrasound STIC has higher application value in the diagnosis of fetal congenital heart disease.It can improve the sensitivity and accuracy of early screening,reduce the occurrence of missed diagnosis and misdiagnosis,and facilitate the early implementation of corresponding clinical interventions.