时空关联成像在胎儿心脏检查中的应用研究

摘要

目的 探讨时空关联成像(STIC)技术在胎儿心脏扫查及胎儿心血管畸形诊断中的应用价值.方法 选择孕龄在19～36 周的110例正常胎儿及32例已行二维超声心动图并拟诊为先天性心血管畸形的胎儿,应用STIC技术采集心脏容积数据,部分胎儿(24例)采集四腔心切面及胸部正中矢状面容积数据,存盘后进行脱机重建研究及回顾性分析,对二维常规超声与STIC方法获得的胎儿心脏图像进行比较.结果 110例中97例正常胎儿心脏超声检查获得满意的容积数据.97例正常胎儿心脏四腔心、五腔心、左心室流出道、右心室流出道(大动脉短轴)、三血管-气管切面、上下腔静脉长轴切面的显示满意率(分别为100%、97.6%、93.8%、91.7%、92.7%、89.6%)与常规二维扫查图像的满意率(分别为100%、100%、97.9%、96.9%、95.8%、93.8%)比较差异无统计学意义,而在73例只扫查胎儿四腔心切面为基础的容积数据获得的主动脉弓长轴、动脉导管弓切面的显示满意率(分别为6.8%、19.1%、)与常规二维扫描图像显示满意率(分别为91.7%、94.5%、)比较差异有统计学意义(P<0.05),在24例扫查胎儿四腔心切面加胸部矢状切面为基础的容积数据获得的主动脉弓长轴、动脉导管弓切面图像显示满意率(分别为91.6%、87.5%、)与常规二维扫描图像显示满意率(分别为100%、100%、)比较差异无统计学意义(P>0.05).32例行二维超声心动图诊断为先天性心脏病胎儿,共涉及心血管畸形51处,二维筛查时漏诊1处永存左上腔,容积数据后处理分析能完全重现并诊断,并能显示更多的非标准切面.结论 STIC技术扫描胎儿心脏四腔心切面加胸部正中矢状切面为基础的容积数据能获得完整的心脏切面,能对胎儿心血管畸形二维超声心动图诊断进行补充.%Objective To explore the application value of spatio-temporal image correlation ( STIC ) technology in fetal cardiac scanning and cardiovascular malformations. Methods Heart volume data by four-dimensional ultrasound was done with STIC in 110 healthy fetuses ranging between 19 and 36 weeks of gestation,and 32 cases was diagnosed as fetal cardiovascular malformations. The volume of data was collected at the level of four-chamber view and sagittal view in some of the fetus. An offline analysis of obtained volume datasets was performed to examine and retrospectively analyze. The statistically significant difference in the obtained image between the two methods was compared and the basic imaging method was explored and analyzed.Results A total of 110 volume datasets were collected from healthy fetal heart with spatio-temporal image correlation ( STIC ). Among 97 cases, there was no significant difference in qualified rate of image quality ( 4C, five chamber heart, LVOT, RVOT,3VT, superior and inferior vena ) between STIC and two-dimensional ultrasound in 97cases ( P ＞0. 05 ). As to the qualified rate of image quality ( the long axis of the aortic arch and arterial arch ) between STIC and two-dimentional ultrasound , there was significant difference in volume data at the level of four-chamber view of 73 cases( P ＜0. 05 ). No significant difference in volume data was observed at the level of sagittal view in 24 cases ( P ＞0. 05 ). Thirty-two cases have been diagnosed as fetal congenital heart disease, including 51 cases of cardiovascular malformations. The volume data processing and analysis could be fully reproduced and diagnosed in case a persistent left superior vena was missed during the two-dimension screening, in which more nonstandard aspect can be shown. Conclusion The STIC technology can obtain a complete heart section in volume of data collection at the level of four-chamber view and sagittal view, and which may provide diagnosis information of cardiovascular malformations than two-dimensional ultrasound.