四维超声STIC技术在胎儿心脏畸形辅助诊断中的应用价值

目的 探讨实时动态四维时间-空间关联成像技术(STIC)在胎儿心脏畸形辅助诊断中的应用及其诊断准确率。 方法 选取超声心动图筛查出胎儿先天性心脏病可疑的孕妇，再应用STIC技术进行数据采集、脱机分析。对终止妊娠或娩出后死亡胎儿，以尸检病理诊断为确诊结果；对活产胎儿以新生儿超声诊断为确诊结果。比较实时四维超声STIC和二维超声对胎儿心脏畸形诊断的准确率。 结果 产前筛查人群12 782例，纳入受试对象217例，有效对象203例，其中112例经引产后尸解病理证实或上级三甲医院超声确诊，其余娩出的活产胎儿经超声或CT、MRI明确诊断。超声心动图诊断心脏畸形的准确率为94.09%，漏诊率为4.43%，误诊率为1.48%；四维超声STIC诊断心脏畸形的准确率为98.52%，漏诊率为0.99%，误诊率为0.49%；四维超声STIC诊断心脏畸形的准确率高于超声心动图(χ2=5.61，P＜0.05)，漏诊率低于超声心动图(χ2=4.58，P＜0.05)，而漏诊率比较差异无统计学意义(χ2=0.25，P＞0.05)。 结论 实时四维超声STIC技术在胎儿心脏畸形辅助诊断中具有较好的临床应用价值，有助于弥补二维超声诊断不完善、不精确的缺憾，提高了产前胎儿心脏畸形诊断的准确性，从而为产前筛查提供了更加可靠的科学依据。 

Spatio-tem-poral image correlation fot the prenatal auxiliary diagnosis of congenital malformations

Objective To explore the application and accuracy of spatio-tem-poral image correlation(STIC)in prenatal diagnosis for cardiac malformations. Methods Fetal echocardiography was performed to screen fetal cardiac abnormalities,and STIC was followed for the suspicious fetus.The terminational or deathfetus underwent histopathological examination,while the live birth received neonatal ultrasound diagnosis.The diagnostic accuracy on cardiac malformations was compared between STIC and two-dimensional ultrasound. Results Total 12 782 cases were screened,217 cases were involved,and final valid cases were 203,in which 112 cases were diagnosed by autopsy pathology,91 cases by neonatal ultrasound or CT,MRI.The diagnostic accuracy of ultrasonic cardiogram on fetal cardiac malformations was 94.09%,missed diagnosis rate was 4.43%,and misdiagnosis was 1.48%;the diagnostic accuracy of STIC was 98.52%,missed diagnosis rate was 0.99%,and misdiagnosis rate was 0.49%.The diagnostic accuracy STIC was higher than that of ultrasonic cardiogram(χ2=5.61,P＜0.05),but the missed diagnosis rate was lower(χ2=4.58,P＜0.05),yet there was no statistical difference on misdiagnosis rate between two measures(χ2=0.25,P＞0.05). Conclusion Real-time 4D STIC has better clinical application value on auxiliary diagnosis in fetus with cardiac malformations,and it is not only beneficial to remedy the defects of two-dimensional ultrasound,but also can improve the accuracy on the auxiliary diagnosis of fetal cardiac malformations,so provides more reliable and scientific basis for prenatal screening.