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目的探索实时三维时空关联成像技术(STIC)对20孕周前胎儿先天性心脏病(FCHD)的诊断价值。方法选取2010年6月至2012年7月在厦门大学附属第一医院杏林分院超声科常规超声检查的20孕周前连续病例共510例,均存在有高危因素,作为高危组;其孕22周后常规产前检查时作为对照组。常规二维超声心动图检查后应用STIC技术获取胎儿心脏容积数据,进行脱机分析,使用多平面重建模式(MP)和断层显像模式(TUI)获取美国超声心动图学会提出的胎儿的9个心脏切面,观察FCHD的检出情况,两组胎儿心脏畸形检出情况采用Kappa一致性检验。结果高危组20孕周前共检出胎儿心脏畸形10例,漏诊2例,22孕周后检出12例胎儿心脏畸形。具体种类及检出孕周:左室发育不良2例(孕16+6周、孕18+3周),大动脉转位2例(孕16+4周、孕18+5周),单心室2例(孕16+4周、19+3周),室间隔缺损2例(孕17+1周、孕18+5周),主动脉狭窄1例(孕16+3周),房室共道畸形1例(孕17+3周);漏诊2例为大动脉转位(孕14+3周)、室间隔缺损(孕15+3周);孕22周后筛查时除上述检出外又新增检出1例大动脉转位,共检出胎儿心脏畸形11例,漏诊1例:室间隔缺损(孕15+3周)。两组心脏畸形检出率经Kappa一致性检验为高度一致,Kappa值为86.4%。结论通常在孕22+0～26+6周使用二维及三维超声进行胎儿心脏畸形筛查,现将实时三维STIC技术用于20孕周前高危胎儿,心脏畸形的检出率与孕22周后一致,差异无统计学意义,最早在孕16周时可检出FCHD。因此可借助此技术尝试将心脏畸形筛查时间提前至孕16周,以期更早发现胎儿心脏畸形。
Objective To explore the diagnostic value of real-time three-dimensional spatiotemporal imaging (STIC) for fetal congenital heart disease (FCHD) before 20 gestational weeks. Methods From June 2010 to July 2012, a total of 510 consecutive cases before the routine ultrasound examination of the Department of Ultrasound, the First Affiliated Hospital of Xiamen University, were included in this study. A total of 510 consecutive consecutive cases of high risk were included as high risk group. After routine prenatal examination as a control group. Conventional two-dimensional echocardiography was performed using STIC technique to acquire fetal heart volume data for off-line analysis using the Multiplanar Reconstruction (MP) and Tomographic Pattern (TUI) acquisitions of 9 of the fetuses proposed by the American Society of Echocardiography Heart section, observe the detection of FCHD, two cases of fetal cardiac malformations detected using Kappa consistency test. Results In the high-risk group, 10 cases of fetal cardiac malformations were detected before 20 gestational weeks, 2 cases were missed, and 12 cases of fetal cardiac malformations were detected after 22 weeks of gestation. Specific types and detection of gestational age: left ventricular dysplasia in 2 cases (16 + 6 weeks of pregnancy, 18 + 3 weeks of pregnancy), transposition of the great arteries in 2 cases (16 + 4 weeks pregnant, 18 +5 weeks pregnant) Cases (gestational 16 + 4 weeks, 19 + 3 weeks), 2 cases of ventricular septal defect (17 + 1 weeks pregnant, 18 +5 weeks pregnant), 1 case of aortic stenosis (16 + 3 weeks pregnant) 1 case of malformation (17 + 3 weeks of gestation), 2 cases missed diagnosis of transposition of the great arteries (14 + 3 weeks of pregnancy) and ventricular septal defect (15 + 3 weeks of gestation) One new case of transposition of the great arteries was detected, including 11 cases of fetal heart malformations and 1 case of missed diagnosis of ventricular septal defects (15 + 3 weeks pregnant). The detection rate of cardiac malformations in both groups was highly consistent with Kappa consistency test, with a Kappa value of 86.4%. CONCLUSIONS: Fetal heart deformity screening is usually performed using two-dimensional and three-dimensional ultrasound at gestational weeks 22 + 0-26 + 6. The real-time three-dimensional STIC technique is applied to high-risk fetuses before 20 weeks gestation. After the same, the difference was not statistically significant, as early as the first 16 weeks of pregnancy can detect FCHD. Therefore, this technique can be used to try to advance the time of cardiac malformation screening to 16 weeks of pregnancy, with a view to detect fetal heart malformation earlier.