二维超声心动图联合四维时空关联成像在胎儿复杂心脏畸形筛查中的应用

目的：探讨二维超声心动图联合四维时空关联成像技术（spatio-temporal image correlation，STIC）在产前筛查胎儿复杂心脏畸形中的应用价值。方法：回顾性分析2010年1月-2012年12月在本院行产前超声检查、经引产后胎儿心脏病理或产后新生儿超声心动图检查确诊为复杂心脏畸形的34例中晚孕期胎儿超声资料，比较常规二维超声心动图与二维联合STIC对胎儿复杂心脏畸形结构异常的细节诊断符合率。结果：34例复杂心脏畸形中有95处心脏结构异常。常规二维超声心动图与二维联合STIC对心脏结构异常的细节诊断总符合率分别为71.6%（68/95）和97.9%（93/95），比较差异有统计学意义（Х^2=22.80，P〈0.01）；两种检查方法吻合度较弱（Kappa=0.103，P〈0.01）。结论：二维联合STIC优于常规二维超声心动图检查，能为产前诊断胎儿复杂心脏畸形提供更多、更准确的诊断信息，可显著提高胎儿复杂心脏畸形的细节诊断符合率。

The Application Value of Two-dimensional Ultrasound Heartbeat Graph Joint Four-dimensional STIC in Prenatal Screening of Fetal Complex Heart Malformation

Objective：To explore the application value of two-dimensional ultrasound heartbeat graph joint four-dimensional spatio-temporal image correlation（STIC）in prenatal screening of fetal complex heart malformation.Method：The data of 34 patients with late pregnancy fetal ultrasound were retrospectively analyzed from January 2010 to December 2012 in our hospital.These complex heart malformation during the middle and late fetal were diagnosed by fetal cardiac ultrasound heartbeat graph after delivery or postpartum neonatal pathological.The results of conventional two-dimensional ultrasound heartbeat graph were compared with that of two-dimensional ultrasound heartbeat graph joint four-dimensional spatio-temporal image correlation（STIC）.Result：Ninety-five cardiac structural abnormalities were found in 34 cases with complex cardiac anomalies.The diagnosis coincidence rate of conventional two-dimensional ultrasound heartbeat graph was 71.6%（68/95）,and that of two-dimensional ultrasound heartbeat graph joint four-dimensional STIC was 97.9%（93/95）.There was significant difference between two groups（χ^2=22.80,P〈0.01）,and the agreement of two methods was weak（Kappa=0.103,P〈0.01）.Conclusion：Two-dimensional ultrasound heartbeat graph joint four-dimensional STIC is better than two-dimensional ultrasound heartbeat graph,and can provide more accurate information for prenatal diagnosis of fetal cardiac malformations.It aslo increased diagnosis coincidence rate of complex heart malformation fetus.