静态三维及实时三维超声对胎儿心脏成像的对比研究

目的采用静态三维及实时三维超声(或四维超声心动图)对胎儿心脏进行成像并对比,以探讨静态三维和实时三维超声在胎儿心脏检查中的应用价值。方法选取200名来我院行常规超声检查并准备行二维超声心动图的孕妇,使用GE Kretz Voluson E8彩色多普勒超声系统对胎儿心脏行快速静态三维扫查及时间空间关联成像技术(STIC)扫查获取其静态及动态容积数据,并对获得的数据进行重建观察并对比分析,比较两种方法重建心脏各切面的显示率。结果静态三维与实时三维超声对胎儿心脏各切面的显示率差异无统计学意义(P>0.05)。在孕18³3+周,静态三维超声与实时三维超声对胎儿心脏各切面的完整显示率差异无统计学意义(P>0.05);3433+周,静态三维超声与实时三维超声对胎儿心脏各切面的完整显示率差异无统计学意义(P>0.05);34³7+周,两者的完全显示率虽然有统计学意义(P<0.05),但两者显示率都很低。所有病例中发现主动脉弓离断1例,永存动脉干1例,漏诊1例室间隔缺损。结论静态三维超声与实时三维超声均能很好地重现胎儿心脏检查所需的各切面,并能多个切面和多个角度重建分析,可减少胎儿心脏检查中对检查者经验的依赖和发现心脏结构异常的时间。两者均对于大动脉的起源及位置关系异常的诊断率相对较高,而对部分结构上的缺损(如小的室间隔缺损)则诊断率不高。

A Comparative Study Between Static Three-Dimensional Echocardiography and Real-Time Three-Dimensional Echocardiography in Visualizing Fetal Hearts

Objective To compare the capability between static three-dimensional echocardiography and real-time three-dimensional echocardiography （spatio-temporal image correlation, STIC） in visualizing fetal hearts, and to evaluate the applied value of static three-dimensional imaging and real-time three-dimensional ultrasound imaging of the fetal hearts. Methods 200 cases of pregnant women in our hospital were selected. All cases received fast static 3D scanning and spatio-temporal image correlation （STIC） scanning to obtain the static and dynamic volume data, and the observed data were reconstructed to compare the display rate of each section of hearts between the two methods. Results The display rate of each section of hearts had no significant difference between the two methods （P 〉0.05）. The complete display rate of each section of heart at 18 - 33^＋ gestational weeks had no significant difference between the two methods （P〉0.05）; at 34 - 37^＋ gestational weeks, the complete display rate had significant difference between the two methods （P〈0.05）, but the complete display rates of both methods were low. Among 200 cases, we found one case of interrupted aortic arch, one case of persistent tnmcus arteriosus, and one case of ventricular septal defect was misdiagnozed. Conclusions Three-dimensional ultrasound static and real-time three-dimensional echocardiography can well reproduce the section of fetal hearts, and carry out reconstruction and analysis from multiple facets and multiple perspectives, which will reduce the experience dependence in fetal heart examination and the time to find out abnormal cardiac structure. Both methods have high diagnostic rate in the anomalies of origin and location relationship of main artery, but low diagnostic rate in the defect of part structure such as small ventricular septal defect.