时间-空间相关成像技术评价胎儿心脏形态结构的初步研究

目的评估3D／4D时间-空间相关成像（STIC）是否能比常规二维胎儿超声心动图提供更多胎儿心脏的切面及信息。方法采用3D／4DSTIC超声系统对26例孕龄16～41周的正常胎儿进行心脏和胸部的自动扫查，获得容积数据后进行脱机分析，主要对胎儿心脏的解剖结构进行多平面的观察和三维重建，重点观察胎儿心脏的流出道等结构。结果26例胎儿皆成功获得满意二维和三维四腔心切面的图像。通过STIC技术获得的容积数据显示了一系列相互垂直的三维平面图像（即A平面、B平面、C平面），对其中的每一幅图像都可通过旋转、平移进行控制、分析。切割或三维重建图像可获得比常规二维胎儿超声心动图检查更多的切面及信息。结论3D／4DSTIC技术比常规二维胎儿超声心动图检查能更快地提供更多的观察心脏解剖结构的切面和信息。     

断层超声显像技术联合时间空间相关成像技术在胎儿心脏筛查中的初步应用

目的 探讨断层超声显像(TUI)技术和时间空间相关成像技术在胎儿心脏筛查中的应用价值.方法 采用时间空间相关成像技术采集60例孕龄19～34周正常胎儿心脏容积图像,再应用断层超声显像技术脱机进行分析,再现四腔心、左室流出道、右室流出道和三血管气管切面.结果 所有60例胎儿均获得了满意的TUI图像,其中51例可直接获得上述4个筛查切面,9例需沿Y轴稍微旋转图像.结论 断层超声显像和时间空间相关成像技术可应用于胎儿心脏筛查,可降低胎儿心脏筛查的难度.     

4-D Assessment of Endometrial Vascularity Using Spatiotemporal Image Correlation: A Study Comparing Spherical Sampling and Whole-Tissue Analysis

Our aim in the study described here was to assess the feasibility of spatiotemporal image correlation power Doppler quantification of the endometrium with two techniques: spherical samples and whole tissue. We scanned 51 women in the midluteal phase of the menstrual cycle: STIC assessment of the whole endometrium was not possible in 10% of cases, whereas spherical analysis was possible in all. The time taken for data set analysis was much longer for the whole endometrium compared with spherical analysis (1478.9 ± 291 s vs. 266.8 ± 39.3 s, p < 0.05). Intra-class correlation coefficients for the vascularization flow index (VFI) were similar for both methods. Volumetric vascularity indices were higher when spherical sampling was conducted. Significant cycle-to-cycle variability in the vascularity indices was present, with coefficients of variation exceeding 20% for both techniques. We found that STIC power Doppler quantification of the whole endometrium is possible in the majority of cases, however, it is time consuming and limited by significant cycle-to-cycle variability.     

Satisfactory Visualization Rates of Standard Cardiac Views at 18 to 22 Weeks' Gestation Using Spatiotemporal Image Correlation

Objective. The purpose of this study was to determine the frequency with which 3 standard screening views of the fetal heart (4-chamber, left ventricular outflow tract [LVOT], and right ventricular outflow tract [RVOT]) can be obtained satisfactorily with the spatiotemporal image correlation (STIC) technique. Methods. A prospective study of 111 patients undergoing anatomic surveys at 18 to 22 weeks was performed. Two ultrasound machines with fetal cardiac settings were used. The best volume set that could be obtained from each patient during a 45-minute examination was graded by 2 sonologists with regard to whether the 4-chamber, LVOT, and RVOT images were satisfactory for screening. Results. All 3 views were judged satisfactory for screening in most patients: 1 sonologist graded the views as satisfactory in 70% of the patients, whereas the other found the views to be satisfactory in 83%. The position of the placenta did not alter the probability of achieving a satisfactory view, but a fetus in the spine anterior position was associated with a significantly lower probability that the views were regarded as satisfactory for screening (odds ratio, 0.28; 95% confidence interval, 0.09–0.70; P < .05). Conclusions. This study suggests that STIC may assist with screening for cardiac anomalies at 18 to 22 weeks' gestation.     

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.     

Three-Dimensional HDlive Rendering Images of the Fetal Heart

Our objective is to describe our experience with reconstruction of normal fetal cardiac structures and congenital heart anomalies using the 3-D HDlive rendering mode with spatiotemporal image correlation (STIC). Four normal fetuses and three fetuses with congenital heart anomalies (Ebstein’s anomaly, hypoplastic left heart syndrome and tetralogy of Fallot) at 25–35 wk of gestation were studied using the 3-D HDlive rendering mode with STIC. In normal fetuses, the natural appearance of the dynamic motion of the foramen ovale flap and both atrioventricular valves was clearly visualized in real time in the four-chamber view. Moreover, new, realistic sensations of each leaflet of atrioventricular valves and semilunar valves of the pulmonary artery were obtained in the en face view of both atrioventricular valves and great vessels. In the case of Ebstein’s anomaly, the procedure rendered the natural and anatomically realistic appearance of significantly low attachment of the tricuspid valve and atrialized portion of the right ventricle. In hypoplastic left heart syndrome, thickened tricuspid and dysplastic pulmonary valves were clearly revealed. In tetralogy of Fallot, an overriding aorta and ventricular septal defect were realistically depicted. The 3-D HDlive rendering mode with STIC provides entirely new visual experiences for obstetricians and pediatric cardiologists owing to the anatomically realistic depiction of normal and abnormal fetal cardiac structures of the beating heart.     

三血管观在胎儿复杂心脏病超声诊断中的应用

方法回顾性总结89例胎儿先天性心脏病和80例正常胎儿的三血管观,分析各种胎儿心脏病三血管观的异常变化。结果正常胎儿三血管观显示率为97.5%,心脏病胎儿显示率为91.0%;正常三血管观图像表现为从左至右依次为肺动脉、主动脉和上腔静脉,内径依次递减;89例胎儿先天性心脏病中47例显示三血管观异常,分为4种类型:(1)血管内径异常(19例);(2)血管前后方位排列异常(6例);(3)血管左右方位排列异常(10例);(4)血管数量异常(12例)。结论三血管观检查方法简便可靠,可以提高胎儿心脏病的检出率和准确性。     

Application of the 3‐Vessel View in Routine Prenatal Sonographic Screening for Congenital Heart Disease

Objectives. The purpose of this study was to evaluate the diagnostic accuracy of prenatal screening for congenital heart disease (CHD) based on a combination of the 4‐chamber view and 3‐vessel view in an unselected population. Methods. A prospective study on 8025 scanned fetuses was performed. All singleton pregnancies scheduled for routine prenatal sonographic screening at 20 to 24 weeks' gestation and subsequently delivered in our unit were included. Data were recorded regarding visualization of the 4‐chamber view, outflow tracts, and 3‐vessel view. Suspected CHD was confirmed by postmortem or postnatal echocardiography. We obtained follow‐up data for the neonates and calculated the diagnostic accuracy of the examinations. Results. Major CHD was identified in 32 cases (4.0%), of which 26 (81.3%) were diagnosed antenatally and 6 (18.7%) postnatally. Four cases (0.5%) had false‐positive findings. Twenty‐one cases were identified by the 4‐chamber view and 5 by an abnormal 3‐vessel view. The sensitivity of the 4‐chamber view alone was 65.6%, and the specificity was 99.9%. The sensitivity of the combination of the 4‐chamber view and 3‐vessel view was 81.3%, and the specificity was 99.9%. Conclusions. The 3‐vessel view is a reliable and easy method to be used in a routine antenatal clinic along with the 4‐chamber view.     

应用ICF-CY类目确定适用于先天性心脏病患儿功能评定的项目

目的确定先天性心脏病患儿功能评估的《国际功能、残疾和健康分类(儿童和青少年版)》(ICF-CY)分类。方法从MEDLINE/PubMed、EMBASE 数据库中筛选近10 年有关儿童与青少年先天性心脏病的临床研究,提取指标所包含的概念,与ICF-CY建立联系。结果在224 篇合格的文献中,所提取的健康状况测量指标,与12 个一级类目,28 个二级类目相关联。其中身体功能17 个,身体结构2 个,活动和参与6 个,环境因素3 个。结论ICF-CY为确定先天性心脏病患儿全面的功能评估提供了有用的框架;对于先天性心脏病研究结果的可比性而言,测量内容的一致性是必要的。     

血浆miR-324-5p对单纯性先天性心脏病早期诊断的应用评估

目的：研究单纯性先天性心脏病（CHD）患者血浆中 miR-324-5p表达变化,评价其在 CHD诊断方面的临床应用价值。方法收集2012年6月～2013年2月76例CHD患儿及13例健康正常对照血清标本,应用 Real-time PCR检测血浆中miR-324-5p表达变化,通过受试者工作曲线（ROC）,评价血浆 miR-324-5p在 CHD诊断方面的临床应用价值。结果与正常对照相比,单纯性CHD患者外周血浆miR-324-5p表达升高（P＝0.032）;受试者工作曲线（ROC）分析显示,曲线下面积（AUC）为0.731,最佳诊断临界值为0.1161,敏感度为64.5％,特异度为84.6％。结论血浆 miR-324-5p作为CHD早期排除诊断的生物学标志物并具有一定的临床应用价值,但还需要与其它指标联合应用。     

计算机辅助容积超声诊断在正常胎儿心脏检查中的应用

目的 探讨计算机辅助容积超声诊断(sonoVCAD)在正常胎儿心脏检查中的应用价值.方法 对120例胎儿心脏进行常规二维超声扫查及三维容积扫查,并对容积数据利用sonoVCAD软件分析,分别记录2种方法 对左室流出道、右室流出道、胃泡、腔静脉连接右房及动脉导管弓切面的显示率.结果 2种模式对左室流出道切面及胃泡切面的显示率均为100%,但sonoVCAD模式对右室流出道切面的显示率略高于普通二维模式,对腔静脉连接右房切面及动脉导管弓切面的显示率则显著高于普通二维模式.结论 利用sonoVCAD技术可自动获取胎儿心脏筛查中所需的重要切面,并在某些切面的显示率明显高于普通二维模式.通过影像采集的标准化减少了人为失误的可能性并减少了扫查时间,在临床应用中有重要价值.