二维超声联合四维超声时间空间相关成像筛查二胎先天性心脏病的价值

Value of two-dimensional ultrasound combined with four-dimensional ultrasound with spatio-temporal image correlation in the screening of congenital heart disease in the second fetus

目的研究二维超声联合四维超声时间空间相关成像(STIC)筛查二胎先天性心脏病(CHD)的价值。方法回顾性抽取2019年1月至2021年12月驻马店市第一人民医院收治的疑似存在CHD的116例二胎孕妇的临床资料,均在产前筛查中进行二维超声和四维超声STIC检查,以引产或随访结果为"金标准",统计二维超声、四维超声STIC及二者联合诊断的诊断结果、诊断效能、预测值。结果116例疑似存在CHD的二胎孕妇中,经引产或随访结果确诊阳性29例,阴性87例;二维超声诊断出真阳性18例,真阴性82例;四维超声STIC诊断出真阳性21例,真阴性85例;二者联合诊断出真阳性28例,真阴性87例。二者联合诊断灵敏度(96.55%,28/29)、准确度(99.14%,115/116)高于二维超声诊断(62.07%,18/29;86.21%,100/116)和四维超声STIC诊断(72.41%,21/29;91.38%,106/116),漏诊率(3.45%,1/29)低于二维超声诊断(37.93%,11/29)和四维超声STIC诊断(27.59%,8/29),P<0.05。二者联合诊断阳性预测值(100.00%,28/28)、阴性预测值(98.86%,87/88)高于二维超声诊断78.26%(18/23;88.17%,82/93)和四维超声STIC诊断(91.30%,21/23;91.40%,85/93),P<0.05。结论二维超声联合四维超声STIC应用于二胎CHD产前筛查中,可提升诊断灵敏度和准确度,减少漏诊情况的发生,且预测值良好。

Objective To study the value of two-dimensional ultrasound combined with four-dimensional ultrasound with spatio-temporal image correlation(STIC)in the screening of congenital heart disease(CHD)in the second fetus.Methods The clinical data of 116 pregnant women with the second fetus suspected of CHD treated in Zhumadian First People’s Hospital from January 2019 to December 2021 were retrospectively selected.All participants received 2-dimentioanl ultrasound and 4-dimentioanl ultrasound with STIC examinations during the prenatal screening.Taking the results of induced labor or follow-up as the gold standard,the diagnostic results,diagnostic efficacy and predictive value of 2-dimentioanl ultrasound,4-dimentioanl ultrasound with STIC,and combination of the two examinations were statistically analyzed.Results Among the 116 pregnant women with the second fetus suspected of CHD,29 cases were diagnosed as positive,and 87 cases were diagnosed as negative by induced labor or follow-up;2-dimentional ultrasound identified 18 cases of true positive and 82 cases of true negative;4-dimentional ultrasound identified 21 cases of true positive and 85 cases of true negative;the combination of the two methods identified 28 cases of true positive and 87 cases of true negative.The sensitivity(96.55%,28/29)and accuracy(99.14%,115/116)of 2-dimentional ultrasound combined with 4-dimentional ultrasound with STIC were higher than those of 2-dimentional ultrasound examination alone(62.07%,18/29;86.21%,100/116)and 4-dimentional ultrasound with STIC examination alone(72.41%,21/29;91.38%,106/116),P<0.05.The missed diagnosis rate of combined diagnosis method(3.45%,1/29)was lower than that of 2-dimentional ultrasound examination alone(37.93%,11/29)and 4-dimentional ultrasound with STIC examination alone(27.59%,8/29),P<0.05.The positive predictive value(100.00%,28/28)and negative predictive value(98.86%,87/88)of the combined diagnosis method were higher than those of 2-dimentional ultrasound examination alone(78.26%,18/23;88.17%,82/93)and 4-dimentional ultrasound with STIC examination alone(91.30%,21/23;91.40%,85/93),P<0.05.Conclusions The application of 2-dimentional ultrasound combined with 4-dimentional ultrasound with STIC,in the prenatal screening of women with the second fetus suspected of CHD,can improve the diagnostic sensitivity and accuracy,and reduce the occurrence of missed diagnosis,with good predictive value.