Three-dimensional ultrasonography of normal fetal heart: comparison with two-dimensional imaging.

Thirty-one high-risk patients (16 to 35 weeks' gestation) underwent two-dimensional and three-dimensional ultrasonography to compare two-dimensional and non-cardiac-gated three-dimensional ultrasonography of the normal fetal heart. After normal two-dimensional studies, three-dimensional sonographic volumes were acquired without cardiac gating in transverse and longitudinal planes. Standard cardiac views were derived from three-dimensional data, analyzed, and rated as follows: (1) not identifiable, (2) identifiable but inadequate for diagnosis, (3) adequate, and (4) excellent. Two-dimensional ultrasonography demonstrated better yields of diagnostically acceptable images of basic echocardiographic views (four-chamber view, 100% for two-dimensional sonography versus 10 to 71% for three-dimensional sonography; right ventricular outflow tract, 42% for two-dimensional versus 6 to 26% for three-dimensional ultrasonography; left ventricular outflow tract, 71% for two-dimensional versus 13 to 45% for three-dimensional sonography). In one subject three-dimensional ultrasonography was superior to two-dimensional sonography in demonstrating an outflow tract. Aortic and ductal arches were not imaged with the two-dimensional technique but were available from the acquired three-dimensional volumes in 3 to 32% and 23%, respectively. False-positive and false-negative findings were observed on three-dimensional ultrasonograms. Overall, compared to two-dimensional ultrasonography, non-cardiac-gated three-dimensional sonography yielded inadequate reconstructed image quality of basic echocardiographic views (four-chamber view, right ventricular outflow tract, left ventricular outflow tract). Three-dimensional ultrasonography, however, shows potential for allowing nonechocardiographers to acquire some diagnostically acceptable views of the aortic and ductal arches.     

A novel algorithm for comprehensive fetal echocardiography using 4-dimensional ultrasonography and tomographic imaging.

OBJECTIVE: Tomographic ultrasound imaging (TUI) is a new display modality that allows simultaneous visualization of up to 8 parallel anatomic planes. This study was designed to determine the role of a novel algorithm combining spatiotemporal image correlation and TUI to visualize standard fetal echocardiographic planes. METHODS: Volume data sets from fetuses with and without congenital heart defects (CHDs) were examined with a novel algorithm that allows simultaneous visualization of the 3-vessel and trachea view, the 4-chamber view, and outflow tracts. Visualization rates for these planes as well as the ductal arch and 5-chamber view were calculated. RESULTS: (1) Two hundred twenty-seven volume data sets from fetuses without (n = 138) and with (n = 14) CHDs were reviewed; (2) among fetuses without CHDs, the 4-chamber view, 5-chamber view, ductal arch, 3-vessel and trachea view, left outflow tract, and short axis of the aorta were visualized in 99% (193/195), 96.9% (189/195), 98.5% (192/195), 88.2% (172/195), 93.3% (182/195), and 87.2% (170/195) of the volume data sets, respectively; (3) these views were visualized in 85% (17/20), 80% (16/20), 65% (13/20), 55% (11/20), 55% (11/20), and 70% (14/20) of the volume data sets, respectively, from fetuses with CHDs; and (4) simultaneous visualization of the short axis of the aorta, 3-vessel and trachea view, left outflow tract, and 4-chamber view was obtained in 78% (152/195) of the volume data sets from fetuses without CHDs and in 40% (8/20) of those with CHDs. CONCLUSIONS: The 3-vessel and trachea view, the 4-chamber view, and both outflow tracts can be simultaneously visualized using a novel algorithm combining spatiotemporal image correlation and TUI.     

Selection and identification of standard cardiac views from three-dimensional volume scans of the fetal thorax.

The feasibility of fetal echocardiographic examination using three-dimensional ultrasonography was investigated in 54 healthy pregnant women with uncomplicated pregnancies between 17 and 37 weeks of gestation. In 46 cases (85.2%), good quality three-dimensional volumes of the fetal heart were obtained from both apical and lateral four-chamber views. By reslicing apical volumes, the reformatted sections of the long axis view of the left ventricle and the aortic crest were seen in 40 (87%) and 38 (83%) of 46 cases, respectively. The short axis was seen in 26 (57%) and ductal arch in 30 (65%) cases. The examination of lateral volumes was much less successful. The short axis was seen in 11 (24%) cases, and the aortic crest in 22 (48%), whereas the analysis of the longitudinal views was not possible. The best results were obtained at a gestational age between 22 and 27 weeks. Three-dimensional fetal echocardiography allowed the examination of the four chambers of the heart and left outflow tract during the late second trimester. The technique may become useful for the screening and diagnosis of congenital cardiac defects in the future.     

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.     

eSTIC技术与STIC技术显示胎儿心脏诊断切面的对比研究

目的评价电子矩阵时间-空间相关成像（eSTIC）技术显示胎儿心脏诊断切面是否较时间-空间相关成像（STIC）技术具有优势。 方法2019年1月至6月在绍兴市妇女儿童医院超声科进行产前超声检查的孕妇中，随机选择四腔心观上脊柱在5点至7点的18~24周正常胎儿64例。分别应用电子矩阵容积探头、传统机械容积探头采集同一胎儿心脏容积数据，存盘并脱机分析。应用正交三平面模式、断层超声显像模式显示胎儿心脏8个诊断切面：标准四腔心观、左心室流出道观、右心室流出道观、三血管-气管观、腹部横切观、动脉导管弓长轴观、主动脉弓长轴观、上下腔静脉-右心房观。将各个切面观重建图像的质量分为优、一般、差三级，质量为优、一般定义为合格，质量差定义为不合格。应用配对χ²检验对比2种方法显示心脏各诊断切面的合格率，应用配对秩和检验对比2种方法获得的心脏各诊断切面的成像质量的差异。 结果2种技术均采集容积数据64个，采集成功率均为100%。eSTIC、STIC对于标准四腔心观、左心室流出道观、右心室流出道观、三血管-气管观、腹部横切观的显示合格率差异均无统计学意义（P均＞0.05），但对于动脉导管弓长轴观、主动脉弓长轴观、上下腔静脉-右心房观，eSTIC显示合格率均优于STIC（均为93.8% vs 71.9%），差异均具有统计学意义（χ²均=11.925，P均=0.001）。eSTIC所有诊断切面重建图像的质量均优于STIC，差异有统计学意义（P均＜0.05）。 结论eSTIC能显著提高胎儿心脏诊断切面重建图像的成像质量。与STIC相比，eSTIC对胎儿心脏纵向诊断切面的显示更具优势。     

Three-dimensional ultrasonographic imaging of the neonatal brain in high-risk neonates: preliminary study.

The aim of this investigation was to compare the utility of three-dimensional ultrasonography versus two-dimensional ultrasonography in imaging the neonatal brain. Thirty patients in the neonatal intensive care unit underwent two-dimensional and three-dimensional ultrasonography. The resultant two- and three-dimensional images recorded on film and three-dimensional volumes (reviewed on a workstation) were evaluated independently. Comparable numbers of normal and abnormal studies were diagnosed by each modality. Axial images were considered useful in approximately 50% of three-dimensional cases. Image quality, overall and in the far-field, was rated higher on two-dimensional images. Three-dimensional sonographic acquisition time in the neonatal intensive care unit (1.7 min+/-0.7 standard deviation) was significantly shorter than that for two-dimensional sonography (9.0+/-4.5 min). The total time for evaluation on the three-dimensional workstation (4.4+/-1.1 min) was significantly less than that for two-dimensional images on film (10.6+/-4.7 min). In conclusion, three-dimensional ultrasonography is a promising, diagnostically accurate, and efficient imaging tool for evaluation of the neonatal brain; however, visualization must improve before it can replace two-dimensional ultrasonography.     

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.     

Tomographic ultrasound imaging of the fetal heart: a new technique for identifying normal and abnormal cardiac anatomy.

OBJECTIVE: In 2003 and 2004, the American College of Radiology, the American Institute of Ultrasound in Medicine, and the American College of Obstetricians and Gynecologists published guidelines for the standard ultrasound examination of the fetus. Each group recommended that the outflow tracts of the fetal heart be examined if technically feasible. One method to accomplish this task is to perform a free-hand sweep of the transducer beam directed in a transverse plane from the 4-chamber view to the fetal neck. One problem with this approach is that the examiner may not direct the beam transversely and, therefore, may not accurately identify the outflow tract anatomy. METHODS: A new technology, tomographic ultrasound imaging (TUI), allows the examiner to obtain a volume data set that simultaneously displays multiple images at specific distances from the 4-chamber view. This study examined TUI technology for identifying normal and abnormal fetal cardiac anatomy with the use of either static or spatiotemporal image correlation volume data sets. RESULTS: The 4 views used in the screening examination of the outflow tracts of the fetal heart (4-chamber, 5-chamber, 3-vessel, and tracheal views) could be identified with the use of TUI technology in fetuses between 13 and 40 weeks' gestation. Examples of fetuses with abnormal cardiac anatomy of the outflow tracts (tetralogy of Fallot, transposition of the great vessels, and pulmonary stenosis) all showed abnormal anatomy on TUI. CONCLUSIONS: Tomographic ultrasound imaging technology enables the fetal examiner to evaluate the 4-chamber view and the outflow tracts in a systematic manner to identify normal and abnormal cardiac anatomy.     

Automated sonography: defining the spatial relationship of standard diagnostic fetal cardiac planes in the second trimester of pregnancy.

OBJECTIVE: This study defines the spatial relationship of the diagnostic planes of the fetal heart to the 4-chamber view plane in the second trimester of pregnancy as a first step in the automation process. METHODS: Three-dimensional static volumes of the fetal chest were acquired at the level of the 4-chamber view on 75 fetuses between 18 and 23 weeks' gestation. The spatial relationship of the diagnostic cardiac planes to the 4-chamber view plane were determined for each gestational week by using rotations along the x-, y-, and z-axes and a parallel slide (millimeters) when applicable. RESULTS: The 5-chamber view (cardiac 1 plane) was best obtained by an initial parallel slide of the reference plane (plane A) toward the fetal head followed by a rotation along the y-axis. The right ventricular outflow tract (cardiac 2) and the abdominal circumference (cardiac 3) planes were best obtained by a parallel slide only: toward the fetal head in cardiac 2 and toward the fetal abdomen in cardiac 3. CONCLUSIONS: This study shows the spatial relationship of fetal cardiac diagnostic planes to the 4-chamber view plane in the second trimester of pregnancy in 3-dimensional volumes. Testing the clinical applicability of automated software based on these formulas is the next step.     

Feasibility of performing a virtual patient examination using three-dimensional ultrasonographic data acquired at remote locations.

OBJECTIVE: To evaluate the feasibility of performing three-dimensional ultrasonographic studies that meet American Institute of Ultrasound in Medicine and American College of Radiology ultrasonographic examination guidelines with review off-line and at remote locations. METHODS: One hundred patients were studied at 2 institutions using high-end two-dimensional clinical ultrasonographic scanners and commercially available three-dimensional ultrasonography for a variety of organ systems (first- and second-trimester fetus, abdomen, and female pelvis). We evaluated several parameters, including measurements, completeness of organ visualization, abnormalities identified, image quality, number of volumes required, and discrepancies between interpretations. RESULTS: Overall, three-dimensional ultrasonography could produce diagnostic-quality results comparable with those of two-dimensional ultrasonography. Three-dimensional ultrasonographic image quality was lower than that of two-dimensional ultrasonography. Two- and three-dimensional ultrasonographic measurements were comparable (<5% difference), as was the extent of organ visualization, although some structures were challenging for both two- and three-dimensional ultrasonography. In general, organs completely imaged in the scanner field of view required 1 to 1.5 volumes, whereas larger organs required between 3 and 6 volumes. Differences among reviewers' interpretations highlighted the need for standardization of acquisition and reviewing protocols for sonographers and physicians. CONCLUSIONS: Our results show that it is clinically feasible to acquire three-dimensional ultrasonographic data at one site and to obtain accurate interpretation by off-line review at another within the context of providing high-quality clinical diagnostic studies.     

Three‐Dimensional Fast Acquisition With Sonographically Based Volume Computer‐Aided Analysis for Imaging of the Fetal Heart at 18 to 22 Weeks' Gestation

Objective. The purpose of this study was to determine how frequently cardiac images derived from 3‐dimensional (3D) volume sets, acquired by fast acquisition and evaluated with sonographically based volume computer‐aided analysis (sonoVCAD), were satisfactory for prenatal screening at 18 to 22 weeks' gestation. Methods. A prospective study of 100 women with singleton pregnancies was undertaken. Three fast acquisition 3D volume sets were obtained from each patient. Four reviewers independently evaluated the 4‐chamber and 5 extracted VCAD views. Factors contributing to unsatisfactory screening were also evaluated. Results. The frequency with which adequate views for cardiac screening could be obtained varied widely; some single views, such as that of the stomach, were well seen frequently, whereas others, such as the ductal arch, were well seen significantly less frequently (P < .05). A satisfactory screening examination, defined as a visualized 4‐chamber, left ventricular outflow tract, right ventricular outflow tract, and axial stomach view, was obtained for 43% to 65% of patients (dependent on reviewer). Logistic regression revealed that obesity (odds ratio, 3.0; 95% confidence interval, 1.7–5.0) and a fetus with the spine toward the maternal abdomen (odds ratio, 1.7; 95% confidence interval, 1.1–2.5) were independently associated with an unsatisfactory screening examination Conclusions. Three‐dimensional fast acquisition volumes evaluated with sonoVCAD did not allow a satisfactory fetal cardiac screening examination to be obtained a high percentage of the time in a general obstetric population during the second trimester. Certain patient factors, such as body habitus and fetal position, are associated with unsatisfactory 3D imaging.     

Three-dimensional ultrasonography of the fetal distal lower extremity: normal and abnormal.

The objective of this study was to compare two-dimensional and three-dimensional ultrasonographic evaluation of fetal distal lower extremities. Data from two-dimensional and three-dimensional ultrasonographic examinations from 40 distal lower extremities in 33 fetuses from a predominantly high-risk patient population were compared. Three-dimensional ultrasonography routinely provided three orthogonal planes (coronal, sagittal, and axial) for distal lower extremity evaluation. Specific features of distal lower extremity evaluation were not different using two-dimensional and three-dimensional ultrasonography. Rotation of the rendered volume provided assistance in assessing all but one of 40 distal lower extremities. Time from image acquisition to assessment for two views (coronal and sagittal) was longer with three-dimensional ultrasonography (8.2 min) than with two-dimensional ultrasonography (3.2 min). Confidence in the diagnosis of abnormal distal lower extremities was slightly improved using three-dimensional ultrasonography compared to two-dimensional ultrasonography. Pregnancy management was assisted in three of the four cases with isolated limb anomalies. In conclusion, three-dimensional ultrasonography improves the ability to evaluate the fetal distal lower extremity because of the multiplanar nature of volume assessment and the ability to rotate volume data sets. In addition, it provides assistance in counseling families, particularly for cases involving isolated limb anomalies.     

Fetal intracardiac echogenic foci: visualization depends on the orientation of the 4-chamber view.

OBJECTIVE: To compare the frequency of visualization of echogenic intracardiac foci in different cardiac views. METHODS: Women having ultrasonographic examinations between October 1997 and July 1998 were prospectively evaluated if a fetal echogenic intracardiac focus was seen in either ventricle. RESULTS: Echogenic intracardiac foci were seen in 89 fetuses in whom both the apical and lateral 4-chamber heart views were obtained. Eight-six fetuses (97%) had a single focus (83 in the left ventricle and 3 in the right ventricle), and 3 (3%) had 2 foci. Echogenic intracardiac foci were seen in the apical 4-chamber view in 89 (100%) and in the lateral 4-chamber view in only 26 (29%; P = .001). CONCLUSIONS: Echogenic intracardiac foci are not easily seen in the lateral 4-chamber view. Studies that suggest an increased risk of aneuploidy when echogenic foci are seen should specify the orientation of the 4-chamber view used.     

Fetal face visualization using three-dimensional ultrasonography.

Evaluation of the fetal face is an essential part of the sonographic examination for high risk pregnancies. Even under optimal conditions, the complex curvature of the face makes it difficult to obtain adequate images with two-dimensional ultrasonography, and many cross-sectional images are required to obtain a complete impression. The purpose of this paper is to show preliminary work in assessing the utility of three-dimensional ultrasonographic visualization of the fetal face. Fetal facial features were evaluated with three-dimensional sonography by scanning with a volume transducer and compared to conventional two-dimensional ultrasonographic images in 27 fetuses (gestational ages 10 to 39 weeks). Surface rendered three-dimensional sonographic images of the fetal face were obtained in 24 of 27 fetuses. In four cases the upper lip was clearly imaged on three-dimensional ultrasonography when it could not be seen on two dimensional ultrasonography. Information requiring multiple planes with two-dimensional ultrasonography could be demonstrated on a single image from three-dimensional ultrasonography. Images of abnormal faces were seen with both two- and three-dimensional ultrasonography in two cases of cleft lip and one case of holoprosencephaly. Volume data acquisition required approximately 10 sec and reconstruction required approximately 5 sec with instantaneous review of planes through the volume data set. Surface rendering required 2 to 10 min depending on the angular viewing range. Three-dimensional ultrasonography has the potential to provide improved visualization of the fetal face compared with conventional two-dimensional sonographic imaging.     

Potential pitfalls and methods of improving in utero diagnosis of transposition of the great arteries, including the baby bird's beak image.

OBJECTIVE: The goal of this study was to analyze our recent experience with fetuses with transposition of the great arteries (TGA) to identify potential pitfalls and possible methods to better detect conotruncal anomalies such as TGA. METHODS: We analyzed all nonreferral obstetric ultrasound examinations in which we performed basic, targeted, or formal fetal echocardiography with a newborn diagnosis of TGA. RESULTS: Nine neonates had TGA. Five of these cases were diagnosed prenatally, and 4 of these had complex congenital heart abnormalities. In these 4 cases, there were abnormalities in the cardiac axis (n = 3), abnormal valves or ventricular size (n = 2), and ventricular septal defects (n = 3) that were detected on the 4-chamber view of the heart. In all cases that were not detected prenatally, both prospective and retrospective reviews of the 4-chamber heart appeared normal. The prospective analyses of the outflow tracts were all interpreted as normal, whereas the retrospective review showed subtle abnormalities such as the "baby bird's beak" image. In review of these cases, there was failure to show the "crisscross" relationship of the outflow tracts. In 1 case, 5 short axis views of the heart, retrospectively showed the artery originating from the left ventricle and bifurcated, representing the pulmonary artery. CONCLUSIONS: Transposition of the great arteries may be associated with complex cardiac disease that could be detected on the 4-chamber view of the heart. When the 4-chamber view is normal, it is important to identify the crisscross relationship of the outflow tracts. If this is not done, it is important to document that the pulmonary artery bifurcates and originates from the right ventricle. Five short axis views of the heart may be helpful to detect conotruncal abnormalities.     

Automatic Cardiac Output Measurement (ACOM): Clinical applications of a new noninvasive tool

This study sought to validate a new noninvasive method to measure cardiac output, in the clinical setting, using color Doppler flow integration. This method, the automatic cardiac output measurement (ACOM), using color Doppler was recently developed and validated in vitro. ACOM was performed at the aortic valve and in the left ventricular outflow tract in 106 subjects (60 men, mean age 52 ± 18) and compared with the echocardiographic pulsed-wave Doppler and a 2-D volume method. In 14 patients the noninvasive methods were correlated with the thermodilution technique. ACOM was feasible in 101 subjects (95%). The correlation factor between the values obtained with ACOM in the apical 5-chamber view and apical long-axis view was 0.75 at the aortic valve and 0.74 in the left ventricular outflow tract. Interoperator variability for ACOM in the apical 5-chamber and apical long-axis views were 0.93 and 0.75, respectively. The best comparison of ACOM with the pulsed-wave echo-Doppler technique occurred in the apical long-axis view (n = 79, r = 0.62), whereas the correlation with the 2-D volume method was poor. The most favorable comparison of ACOM with the thermodilution technique (n = 14) was also obtained in the apical long-axis view (5.408 ± 1.72 vs. 3.356 ± l.281/min. [mean ± SD], r = 0.71). Assuming the thermodilution technique as ‘gold standard’, the pulsed-wave echo-Doppler technique showed a better correlation (5.408 ± 1.72 vs. 4.664 ± l.281/min., r = 0.84). ACOM is a useful, reproducible, noninvasive tool for rapid automated measurements of cardiac output. There is, however, an underestimation when compared with the pulsed-wave Doppler echocardiography and the thermodilution techniques. Good 2-D echocardiographic images, adequate color filling of the outflow tract and high frame rates are prerequisites for accurate values. Further refinements of this new technique are needed to enhance its clinical value in the future.     

胎儿实时三维超声心动图临床应用的初步研究

目的探讨实时三维超声心动图（Live-3DE）在胎儿心血管超声成像中的应用的可行性。方法对21例孕龄17～36周的正常胎儿进行Live-3DE研究，观察胎儿多个常规检查切面及形态结构的相互关系，由2名胎儿超声心动图经验丰富的医师独立对胎儿解剖结构及关系能否显示进行评估，并对两者评估结果的一致性进行Kappa检验。结果19例胎儿取得清晰直观的四腔心观，五腔心观及左室流出道切面。7例取得肺动脉一动脉导管切面，5例取得三血管切面，3例取得主动脉弓切面。1例左心室强回声结构胎儿，RT-3DE清晰显示位于左室腱索乳头肌水平强回声结构的立体观。2名观察者之间的一致性在观察胎儿四腔心观，五腔心观，三血管切面，室间隔，卵圆窝，二尖瓣，三尖瓣等结构，以及二尖瓣与三尖瓣的关系，降主动脉与左房关系时为良好至优秀（K值为0．63～1．00），在观察左室流出道及右室内调节束时为中等（K值分别为0．48和0．42）。结论初步应用显示Live-3DE能够用于正常胎儿心血管结构及相关关系的立体三维显示，其在胎儿复杂先天性心血管畸形显示中的应用价值有待进一步深入研究。     

房间隔缺损的经胸多平面三维超声心动图剖析诊断研究

目的:探讨影响继发孔房间隔缺损(ASD)经胸三维超声心动图(3DTTE)重建的采样途径和三维剖析诊断方案。方法:选取ASD 21例,应用经胸多平面探头分别在胸骨旁、心尖部和剑突下采集图像,脱机三维重建,利用任意剖切功能,显示ASD及周边结构,测量缺损最大长轴径和短轴径。结果:20例ASD三维重建成功。从右房侧正对房间隔选择性剖切,正面动态成像了ASD完整的形状和在房隔的空间部位,除心尖部外,余部位采样测量ASD大小与手术测值均具有高度相关性。额面四腔顺序剖切能较好地观察ASD与周边结构的关系。结论:3DTTE能理想重建ASD,右房侧剖切剖视能完整显示ASD,结合额面四腔心剖视有利于ASD解剖分型。     

初学者应用胎儿心脏超声智能导航技术显示正常胎儿9个切面的初步研究

目的探讨初学者应用胎儿心脏超声智能导航技术（FINE,5D Heart）在胎儿心脏超声检查中的应用价值。 方法选取2015年1月至2015年3月间在浙江大学医学院附属邵逸夫医院行胎儿超声心动图检查的中孕期孕妇80例,由一名胎儿超声心动图专家首先获取9个常规二维超声切面,而后利用时空关联成像（STIC）技术,扫描获得满意的以心尖四腔心为初始切面的心脏容积数据。两位不同胎儿超声心动图检查资历医师应用5D Heart软件对STIC容积图像进行后处理,获得9个切面,分析各切面图像质量,采用Kappa一致性检验,对各切面合格数行观察者内的一致性分析,并与2D图像分别行观察者之间一致性分析。记录并分析应用5D Heart软件所耗时间,采用t检验分析各观察者前后两次耗时差异。 结果纳入研究80例中,9个切面二维图像的总体合格例数：75~80例（合格率93.8%~100.0%）;两位观察者前、后两次图像合格例数73~80（合格率91.3%~100.0%）。两位观察者前、后两次分析的一致性：在四腔心切面、胃泡水平腹部横切面,诊断结果完全一致（Kappa=1）;三血管气管切面（Kappa=0.851~0.882）,一致性优;五腔心切面（Kappa=0.787~0.882）,一致性良-优;主动脉弓切面（Kappa=0.738~0.787）、左心室流出道切面（Kappa=0.709~0.787）、右心室流出道切面（Kappa=0.655~0.794）、上下腔静脉长轴切面（Kappa=0.647~0.649）、动脉导管弓切面（Kappa=0.640~0.707）,一致性良。两位观察者分析与2D图像的一致性：四腔心切面、胃泡水平腹部横切面,两位观察者与2D分析结果完全一致（Kappa=1）;五腔心切面（Kappa=0.851~0.902）,一致性优;动脉导管弓切面（Kappa=0.749~0.820）、主动脉弓切面（Kappa=0.707~0.882）、右心室流出道切面（Kappa=0.661~0.851）、三血管气管切面（Kappa=0.655~0.851）,一致性良-优;左心室流出道切面（Kappa=0.737~0.749）、上下腔静脉长轴切面（Kappa=0.655~0.794）,一致性良。统计俩位观察者首次图像分析平均耗时为（2. 64±1.35）min,各观察者间耗时,差异无统计学意义（P>0.05）。 结论初学者应用5D Heart技术重现的9个切面,基本能够达到与直接获得二维切面相同的合格率与质量,该技术简单易学,重复性好,容易被初学者掌握和应用,有利于胎儿心脏超声检查的推广。     

Quality of 2‐ and 3‐Dimensional Fast Acquisition Fetal Cardiac Imaging at 18 to 22 Weeks

Objective. The purpose of this study was to evaluate the frequency with which 6 different fetal cardiac views taken during a fetal ultrasound examination at 18 to 22 weeks' gestation can be obtained satisfactorily for cardiac anomaly screening using either a 2‐dimensional (2D) static or 3‐dimensional (3D) fast acquisition technique. Methods. A prospective study of 100 low‐risk women undergoing an anatomic survey was performed. Standard static 2D and 3D fast acquisition volumes were obtained on all patients. The 2D and 3D images were assigned, in a random order, to be independently graded by 3 reviewers. The degree of inter‐reviewer agreement was assessed through the use of the Cohen κ statistic. The factors contributing to satisfactory imaging were evaluated by random effects logistic regression. Results. A significant proportion of both 2D and 3D images were judged unsatisfactory for screening purposes. However, 2D images were significantly more likely, for all cardiac views, to be judged satisfactory (P < .05). The odds ratios for the 2D technique's being more likely than the 3D technique to provide images satisfactory for screening were 2.6 for the 4‐chamber view, 2.4 for the right ventricular outflow tract, 4 for the left ventricular outflow tract, 3.2 for the 3‐vessel view, 8.6 for the aortic arch, and 2.2 for the ductal arch. Conclusions. In this prospective study, static 2D imaging was significantly more likely than fast acquisition 2D imaging to yield cardiac views of high enough quality to satisfactorily screen for anomalies.