三维能量多普勒超声检测先天性心脏病胎儿三大脑动脉区域血流灌注的研究

摘要

Objective To investigate the regional cerebral blood flow perfusion in fetuses with congenital heart disease (CHD)by three-dimensional power Doppler ultrasound (3D PD).Methods The vascular index (VI),flow index (FI)and vascular/flow index (VFI)in the main arterial territories [middle cerebral artery (MCA ),anterior cerebral artery (ACA ) and posterior cerebral artery (PCA )] were prospectively compared in 1 12 fetuses with CHD and 1 12 normal fetuses using 3D PD.Correlations between the 3D PD indices and neurodevelopment scores were assessed.Results Compared with the controls,the VI,FI and VFI of the three main arteries were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS)and left sided obstructive lesions (LSOL)(P < 0.001 ).The mean psychomotor development index (PDI)and mental development index (MDI)scores were significantly lower than normal (P <0.001).ACA VI and ACA VFI were positively correlated with PDI (r =0.377,P =0.01 5 and r =0.389,P = 0.012,respectively)but were not correlated with MDI.Conclusions Cerebral blood flow perfusion in three main arteries was significantly increased in fetuses with HLHS/LSOL,and blood flow perfusion in ACA area was significantly increased in fetuses with TGA.ACA-VI,ACA-FI had association with neurodevelopment scores.3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.%目的：应用三维能量多普勒超声对比评价先天性心脏病胎儿和正常胎儿三大脑动脉区域血流灌注的差异。方法采集112例先天性心脏病胎儿和孕龄配对的112例正常胎儿的颅脑三维能量多普勒图像,采用虚拟器官计算机辅助分析(VOCAL)技术30°旋转法勾勒计算三大脑动脉区域,即大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA),计算并比较两组之间血流灌注参数血管化指数(VI)、血流指数(FI)和血管化血流指数(VFI),评估血流灌注各参数与12月龄时贝利婴儿发育量表评分的相关性。结果与正常对照组相比较,三大脑动脉区 VI、FI 和 VFI 在左心发育不良综合征胎儿组和左心梗阻胎儿组明显增加(P <0.001),大脑前动脉区 VI、FI 和 VFI 在大动脉转位胎儿组明显增加(P <0.001),右心梗阻胎儿与正常胎儿之间各血流灌注参数无明显差异(P >0.05)。12月龄时,先心病组精神运动发展指数(PDI)和智力发育指数(MDI)均明显低于正常组(P <0.001)。ACA-VI、ACA-FI 与 PDI 均呈正相关(分别为 r =0.377,P =0.015和 r =0.389,P =0.012),但与 MDI 无明显相关性(P >0.05)。结论左心发育不良综合征和左心梗阻胎儿三大脑动脉区域血流灌注明显增加,大动脉转位胎儿大脑前动脉区血流灌注明显增加。ACA 区域血流灌注参数与婴儿智力发育评分有正相关性。产前应用三维能量多普勒能更早更敏感地评价先心病胎儿局部脑血流灌注,有利于产前咨询和产后及早神经保护干预。