断层超声显像技术联合时间空间相关成像技术在胎儿室间隔缺损筛查中的应用

目的 探讨断层超声显像技术联合时间空间相关成像技术评价胎儿室间隔缺损的临床应用价值.方法 采用二维胎儿超声心动图筛查先天性心脏病高危胎儿及采用断层超声显像技术联合时间空间相关成像技术采集和分析心脏容积数据.结果 断层超声显像技术联合时间空间相关成像技术与二维胎儿超声心动图诊断胎儿室间隔缺损的准确率分别为96.6%、86.4%,两者比较有统计学差异.(χ~2=3.933,P=0.047,P<0.05).结论 断层超声显像技术联合时间空间相关成像技术可以准确、直观地筛查胎儿室间隔缺损.     

超声断层显像与常规二维超声进行胎儿心脏筛查的比较研究

目的 比较超声断层显像(TUI)技术与常规二维超声进行胎儿心脏筛查的图像显示合格率和图像质量,分析TUI进行胎儿心脏筛查的可行性.方法 110例中孕期正常胎儿,利用时空关联成像(STIC)技术,一次性扫描获得整个心脏的容积数据,然后脱机分析,采用TUI法,调整层距、中心层位置后,分别在灰阶模式下及彩色多普勒血流模式下,重现胎儿心脏筛查所需要的四腔心切面,左、右室流出道切面和三血管切面.按事先确定的评分标准,分别对TUI重现图像及常规二维超声所获得切面进行评分比较,并统计图像显示合格率.结果 纳入研究的110例正常胎儿心脏中,在胎位相同的条件下,TUI法重现的四腔心切面,左、右室流出道切面及三血管切面灰阶图的显示率分别为100%、88.9%、80.0%、84.4%,常规二维超声显示率分别为100%、86.2%、50.0%、100%.TUI法重现各切面(灰阶图和血流图)的显示率与常规二维超声各相应切面的显示率比较差异均无统计学意义(P＞0.05).图像质量评分显示,仅在灰阶图中四腔心切面筛查图像评分低于TUI法,常规二维超声中右室流出道切面评分高于TUI法(P＜0.05),其余各切面比较差异均无统计学意义(P＜0.05).结论 TUI法重现的各切面基本能够达到与直接获得的二维切面相同的合格率和图像质量,可以满足中孕期胎儿心脏筛查离线分析的需要.     

断层超声显像技术联合时空间相关成像技术在胎儿心脏筛查中最佳层间距离的研究

目的 探讨孕龄对断层超声显像技术联合时空间相关成像技术(TUI-STIC)在胎儿心脏筛查中切面间距的影响,初步设定不同孕龄TUI-STIC最佳切面间距的范围.方法 正常中晚孕期胎儿226例,根据孕龄分为18～21周、22～25周、26～29周、30～33周、34～37周共5组.采用STIC技术采集胎儿心脏容积图像后,应用TUI技术进行脱机分析,显示胃泡水平腹部横切面、下腔静脉入右心房切面、心尖四腔心切面、胸骨旁四腔心切面、左室流出道切面、右室流出道切面、三血管切面及主动脉弓横部切面,记录TUI-STIC最佳切面间距.比较各组TUI-STIC切面间距,分析孕龄与TUI-STIC切面间距的相关性.结果 226例研究对象的平均TUI-STIC切面间距测值为(3.60±0.88)mm,5组胎儿TUI-STIC最佳切面间距测值分别为(2.33±0.45)mm、(3.04±0.28)mm、(3.82±0.26)mm、(4.41±0.29)mm、(4.91±0.31)mm.各组间胎儿的TUI-STIC切面间距测值具有统计学差异(P＜0.05);胎儿TUI-STIC切面间距与孕龄具有高度的相关性(r=0.958,P＜0.05),线性回归方程为Y=0.166X-0.883.结论 随着胎儿孕龄的增长,TUI-STIC最佳切面间距随之加大.TUI-STIC切面间距与胎儿孕龄呈正相关关系.     

初学者应用超声断层成像技术显示胎儿心脏结构的探索

目的探索超声断层成像（TUI）技术能否提高初学产科超声操作医师对胎儿心脏结构的显示率,了解该技术在胎儿心脏检查中的临床应用价值。方法先由一名熟练的产科超声医师（a）应用二维超声对200例正常中孕期胎儿的心脏进行检查并存储图像;再由一名初学产科超声的医师（b）应用时空关联成像（STIC）技术获取胎儿心脏的容积数据,然后应用TUI程序获得心脏检查各切面并保存;最后由一名超声医师（c）将同一胎儿心脏的二维图像与TUI重现的心脏各切面进行对比并根据切面图像的质量及诊断价值进行评分。结果200例正常胎儿心脏超声检查中,185例获得满意的容积数据。应用TUI技术能够获得胎儿心脏检查所需的切面,获取四腔心、左心室流出道、右心室流出道、三血管及胃泡切面的显示率分别为100．O％、92．2％、87．8％、98．9％及100．0％。TUI法获取各切面与常规二维切面的显示率比较,差异无统计学意义（P〉0．05）,符合产前超声检查的质量要求。结论TUI技术是一种简单易学的胎儿心脏结构超声显示方法,初学者应用该技术能够显示胎儿心脏超声检查的常用切面,该技术降低了培训超声医师检查胎儿心脏的难度,有利于超声检查胎儿心脏的推广应用。     

断层超声显像技术在胎儿超声检查中的初步应用研究

目的探讨断层超声显像技术（tomographic ultrasound imaging，TUI）在胎儿超声成像中应用的可行性和价值。方法对26例孕龄16～41周的正常胎儿进行TUI研究。利用实时三维容积探头获取容积数据，观察胎儿的心脏、颜面部、头颅、胸腹部等解剖结构。实时显示三维图像或在检查结束后脱机分析。结果26例胎儿均获得满意的TUI图像，我们对其中23例心脏、14例颜面部、12例头颅、6例胸腹部用4D View程序进行了脱机后处理及分析，可通过TUI选择断层方向及旋转图像，获得各个方向的连续平行断层图像。结论TUI技术能显示胎儿各个方向上的断层图像，图像的获取受操作者的技术经验、胎儿胎位等因素影响相对较小，比较传统二维、三维超声能提供更直观的图像信息。     

时间-空间相关成像技术“A平面旋转法”在中孕期胎儿心脏结构筛查中的应用

目的 研究时间-空间相关成像技术(STIC)在中孕期胎儿心脏结构筛查中的应用,分析STIC技术应用于中孕期胎儿心脏检查中的最优条件及影响心脏容积数据采集成功的因素,探索后期图像快速处理的方法.方法 150例中孕期胎儿,经常规超声检查心脏结构无异常.采用STIC技术扫描获得整个胎儿心动周期的容积数据并采用“A平面旋转法”重建出左心室流出道切面(LVOT)、右心室流出道切面(RV-OT)、主动脉弓切面(LAV-AOA)、动脉导管弓切面(LAV-DA)、三血管切面(3VT)五个常用切面,根据胎心位置分为尖位四腔心组和侧位四腔心组,分析比较上述两组切面的重建率;分析影响数据采集的相关因素,如最大羊水深度、胎儿孕周、胎儿体重、胎儿心率、胎盘位置等.结果 运用STIC技术采集150例中孕期胎儿心脏容积数据成功123例(82％),未成功27例(18％).各因素对数据采集成功率的影响无统计学差异(P＞0.05).尖位四腔心组、侧位四腔心组两组间STIC重建率无统计学差异(x2 =0.624,P=0.891).结论 在胎儿静止状态下,其他因素对使用STIC技术采集容积数据影响较小,可获得满意容积数据.对不同体位胎儿后期图像处理,运用STIC正交平面技术可得到质量比较满意的图像.因此STIC技术可普遍用于中孕筛查期胎儿心脏检查,具有重要的临床应用价值.     

断层超声显像技术联合时间空间相关成像技术和四腔心平面头侧偏斜法在胎儿心脏畸形筛查中的初步研究

目的探讨断层超声显像技术联合时间空间相关成像技术(TUI-STIC技术)和四腔心平面头侧偏斜法(FCPTC)在胎儿心脏畸形筛查中的应用价值。方法采用时间空间相关成像(STIC)技术在不同体位四腔心切面(心尖四腔心位、胸骨旁四腔心位和心底四腔心位)采集胎儿心脏容积图像,脱机应用断层超声显像(TUI)技术进行分析,显示四腔心、五腔心和三血管切面;同时采用FCPTC法显示四腔心、五腔心和三血管切面。结果心尖四腔心位、胸骨旁四腔心位时TUI-STIC技术和FCPTC法比较无统计学差异(P>0.05);心底四腔心位时TUI-STIC技术和FCPTC法两者比较有统计学差异(χ2=0.039,P<0.05)。结论 TUI-STIC技术和FCPTC法均可应用于胎儿心脏畸形筛查;中孕期心底四腔心位时应用TUI-STIC技术可降低胎儿心脏畸形筛查的难度。     

时间-空间相关成像技术在胎儿心脏超声检查中的应用

目的 探讨时间-空间相关成像(STIC)技术在正常胎儿心脏超声检查中的成像方式及其临床应用价值. 方法分别使用常规二维超声和STIC技术对120例孕龄在22～28周的正常胎儿进行心脏扫查,比较两种方法获得胎儿心脏图像的质量和扫查时间有无统计学差异,并分析STIC技术的成像方法. 结果 120例正常胎儿心脏均获得满意的容积图像,各切面图像的显示合格率与常规二维扫描图像的差异无统计学意义(P>0.05),且能显示出常规二维不能显示的切面.所研究的120例样本中,共有85例可计算常规二维超声筛查时间,平均每个胎儿心脏用时(5.26±2.01)min;共有104例可计算STIC扫描时间,平均每次STIC扫描用时(4.47±2.32)min. 结论 STIC技术比常规二维超声能提供更多的观察心脏解剖结构的切面和信息,可简化图像采集过程,缩短检查时间,减少对检查者经验的依赖,提高工作效率,同时大大减少胎儿心脏接受超声波照射的时间.     

自动四维彩色容积超声在胎儿心脏检查中的应用

目的 探讨自动四维彩色容积超声在正常胎儿心脏检查中的应用价值.方法 对120例孕中期(18～23孕周)胎儿心脏进行四维容积扫查,在显示四腔心切面、启动彩色多普勒后采集胎儿胸部容积数据,利用超声自动多平面成像法自动获取3个诊断切面,分别为切面1(左心室流出道切面)、切面2(右心室流出道切面)及切面3(动脉导管弓切面),并采用超声断层显像法(TUI)显示所有切面的彩色血流图.对所有的容积数据进行分析并确定在每个容积数据中切面1～3是否正确显示.结果 通过自动四维彩色容积超声扫描,切面1～3的显示率分别为100%、96.67%、91.67%.切面1至少可在连续3个TUI图像上可靠显示,切面2和切面3均至少可在连续2个TUI图像上可靠显示.结论 自动四维彩色容积超声可自动获取胎儿心脏检查中所需的重要切面,显示率较高,并可观察相应切面的血流情况,显示效果良好.     

超声断层显像(TUI)技术联合二维超声在产前胎儿先天性心脏病(先心病)筛查

目的:本文通过在产前胎儿先天性心脏病(先心病)筛查中采用超声断层显像(TUI)技术联合二维超声,探索两者联合应用的价值。方法:取2021年1月至2022年12月期间我院收治的2300例产妇作为本次试验研究对象。所有产妇均给予超声断层显像(TUI)技术联合二维超声检测,对胎儿先天性心脏病进行筛查。对筛查结果进行记录和统计,对超声断层显像(TUI)技术联合二维超声检测的准确性进行统计和对比。结果:通过筛查结果显示,2300例胎儿中有10例查出先天性心脏病,超声断层显像(TUI)技术联合二维超声检测的准确度为95%。结论:采用超声断层显像(TUI)技术联合二维超声在产前胎儿先天性心脏病(先心病)筛查的准确度非常高,可对先天性心脏病胎儿进行早期筛查。     

Treatment of fetal supraventricular tachyarrhythmias

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm. The 14th patient underwent successful therapy after birth. All 14 fetuses survived despite severe fetal hydrops at the time of diagnosis in 13 of 14. The four remaining fetuses had either atrial flutter (3) or fibrillation. Two of the fetuses with atrial flutter died at birth, the 3rd survived after electrical cardioversion at birth. The fetus with atrial fibrillation converted to normal sinus rhythm and survived after maternal administration of digoxin. Using M-mode and pulsed Doppler echocardiography, the nature and electrophysiologic mechanism of the arrhythmia may be deduced. The latter information is reviewed along with the fetomaternal pharmacology of various antiarrhythmic agents to devise a rational antiarrhythmic treatment program.     

Fetal small bowel simulating an abdominal mass at sonography

A focal, well-marginated, homogeneous hyperechoic mass was identified within the fetal abdomen of five early gestations varying in age from 16 to 20 weeks ECA (estimated conceptual age). Initially, the possibility of a congenital abdominal tumor mass was raised. Serial sonography subsequently demonstrated progressive dissolution of the masses, each of which assumed the characteristic appearance of normal small bowel by 30 weeks ECA. The recognition of this normal fetal small bowel maturation pattern is important lest it be confused with congenital retroperitoneal or gastrointestinal tract abnormalities.     

胎儿超声心动图检测胎儿房性期前收缩的临床研究

目的：探讨胎儿超声心动图对胎儿房性期前收缩观察价值及其临床意义。方法：采用彩色多普勒超声心动图对404例孕龄16～42周(平均32．5周)的胎儿进行研究．分析胎儿房性期前收缩的超声心动图特征及其检出率。结果：共检出胎儿房性期前收缩41例，检出率为10．1％。其中下传33例，不下传5例．部分下传3例。41例胎儿均不伴有先天性心血管畸形或其它畸形，出生后听诊均未闻及明显心脏杂音或心律不齐。结论：胎儿房性期前收缩为胎儿期最常见的心律失常，不伴有明显心血管畸形或其它胎儿畸形，绝大多数预后良好。     

Fetal echocardiography: Present and future applications

Fetal heart motion was observed by T-M-mode echocardiography from the twelfth to fortieth week of gestation in 47 apparently normal pregnancies. In the earliest case (at 12 weeks), cardiac pulsations were recorded in a fetus in which the heart sounds couldnot be detected by Doppler ultrasound. The left and right ventricular dimensionsand left-to-right ventricular ratios were determined in 24 of the 35 fetuses in which high-quality images were obtained. Interventricular septal motion was evaluated in 30 of these 35 fetuses. Potential clinical applications of echocardiography in evaluating fetal status are also presented.     

In utero ultrasound diagnosis of congenital heart disease

Two hundred and one pregnancies considered at high risk for congenital heart disease (CHD) underwent fetal cross-sectional echocardiographic (CSE) examination. In 190 cases a structurally normal heart was correctly predicted; seven cases of CHD were identified, but in two of them the specific diagnosis was inaccurate. One false positive diagnosis of a small ventricular septal defect was made. There were three false negative diagnoses: two of ventricular septal defects and one of aortic coarctation. We conclude that severe heart malformations can be reliably identified or excluded by CSE in utero, but important anatomical details may be missed. Therefore, prognosis should be based only on the structures identified to multiple-scan planes.     

Ultrasound in the diagnosis and management of urinary tract disorders in the fetus

Ultrasonic echography allows display of the fetal kidneys and urinary bladder from the 16th week of pregnancy, and the possibility of detection of a number of major congenital abnormalities of the urinary tract from that time. In the second half of pregnancy ultrasound has the key role in monitoring the progress of previously diagnosed abnormalities, particularly those of an obstructive nature. Sonologists thereby have an increasing responsibility in the obstetric care of the patient not only in the narrow field of diagnosis but in the wider field of management. Examples of conservative and surgical management of obstructive lesions are given.     

Fetal weight estimates in late pregnancy with emphasis on macrosomia

The effectiveness of three methods (Shepard et al, Hadlock et al, and Hansmann) for estimating fetal weight was evaluated in 150 patients at greater than 36 weeks menstrual age. All infants were greater than 2,500 at birth. Only the method of Hadlock et al did not systematically underestimate birth weight. When separate weight subclasses (2,500 to 4,999 g) were examined, the method of Hadlock et al showed better consistency. All models, however, had significant underestimates for the largest subclasses, 4,000 to 4,999 g. The ability to predict the macrosomic infant (greater than or equal to 4,000 g) was only slightly better using the method of Hadlock et al than by the formula of Shephard et al.     

Mathematical modeling of fetal growth: V. Fetal weight changes at term

Fetal growth after 37 weeks menstrual age was investigated by comparing ultrasound estimates of fetal weight with corresponding weights of newborns. Using a weight estimation equation with minimal systematic error, evidence was found that fetuses delivered at term do not increase in weight the last two weeks before delivery. This change in fetal growth is regarded as a biological process that is needed to prepare the fetus for its life after birth. Only one of three subsets, that of estimated weights below 3000 g, showed significant weight increase after 37 weeks. This subset had, however, on average the longest scan-delivery interval. We conclude that conventional birthweight standards are influenced both by a cessation of fetal growth approximately two weeks before delivery and by an association between fetal size and the duration of gestation.