应用三维超声测量正常胎儿与先天性心脏病胎儿全脑容积的研究

目的 探讨正常胎儿三维全脑容积与胎儿孕周、双顶径（BPD）和头围(HC)相关性及其与先天性心脏病（CHD）胎儿的差异。方法 超声科行常规产科超声心动图检查中，选择未发现明显异常的胎儿为正常胎儿组，选择发现CHD的胎儿并在产后新生儿超声和终止妊娠胎儿尸体解剖诊断为CHD为CHD胎儿组。采用GE Voluson Expert E8彩色多普勒超声诊断仪，二维腹部凸阵探头（频率为3.0~6.0 MHz）测量胎儿BPD和HC,RAB 4-8-D三维容积探头（频率为4~8 MHz）测量胎儿三维全脑容积，应用虚拟器官计算机辅助分析技术进行分析，计算胎儿三维全脑容积。比较CHD胎儿组与正常胎儿组三维全脑容积间有无差异。结果 正常胎儿组三维全脑容积随孕周、BPD和HC的增大而增长，三维全脑容积随孕周及BPD的增长符合S曲线，随HC的增长符合幂函数。两组全样本和＜30孕周样本的BPD和HC差异均无统计学意义；而在≥30孕周样本中，CHD胎儿组的BPD和HC均＜正常胎儿组，差异有统计学意义。两组全样本和≥30孕周样本中，CHD胎儿组的三维全脑容积＜正常胎儿组，差异有统计学意义；而＜30孕周样本CHD胎儿组和正常胎儿组三维全脑容积差异均无统计学意义。结论 ①三维超声可应用于测量胎儿三维全脑容积；②正常胎儿三维全脑容积随孕周、BPD、HC的增长而增长；③CHD胎儿三维全脑容积较正常胎儿减小。

Study of the brain volume in normal fetuses and fetuses with congenital heart disease detected by three-demensional ultrasound

Objective To investigate the relationships between the brain volume, bigparital diameter, gestainal age and head circumference measured by virtual organ computer-aided analysis of three-dimensional ultrasound in normal fetuses and CHD fetused, and analyze the difference between normal and CHD fetuses. Methods The fetuses without significant congenital heart disease were collected as the normal group.The CHD group included the fetuses who was diagnosed as congenital heart disease by fetal echocardiography and then comfirmed by autopsy after pregancy or the echocardiography in the neonatal period. The GE Voluson E8 Expert Doppler ultrasonic diagnostic apparatus was used. Fetal development and the fetal cardiac were conventionally examed by using the convex array probe(frequency of 3.0-6.0 MHz). The 3D images were obtained by using the RAB 4-8-D three-dimensional probe (frequency of 4.0-8.0 MHz), and then brain volume was calculated using VOCAL.And the differences of brain volume between normal fetuses and congenital heart disease (CHD) fetuses were compared. Results In normal fetuses, fetal brain volume increased with GA, BPD and HC, scattering as S curve for GA and BPD and a power function for HC. There was no significant difference in BPD or HC between the normal and CHD groups(P>0.05), while at the same time, the brain volume of CHD group was smaller than normal group (P<0.05). In all the fetuses with GA below 30 weeks, there was no significant difference in BPD, HC or the brain volume between the normal and CHD groups (P>0.05). While in fetuses with GA over 30 weeks, all these three measured values were significantly lower in CHD fetuses compared with normal ones. Conclusion The fetal brain volume measurements using three-dimensional ultrasound were operable and repeatable. In normal fetuses, fetal brain volume increased with the increase of GA, BPD and HC. The brain volume of CHD fetus was smaller than that of normal fetus, the difference was statistically significant.