【作者】 苏淇琛；

【导师】 吕国荣；

【作者基本信息】 福建医科大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 目的比较多普勒、M型与四维时空关联成像(STIC)测定胎儿左心每搏输出量的可重复性及测量者间的一致性。方法2名经验相当的超声科医师分别应用多普勒、M型与四维STIC测定30例26～30周正常单胎胎儿左心室搏出量,计算组内相关系数(ICC),进行Bland-Altman图分析,评估上述测量方法的可重复性和测量者间一致性。测量时,由记录者将测量结果遮盖,使测量者不知道结果。先由检查者1将本人所作的30例胎儿图像进行分析,测量计算出左心室搏出量。随后检查者2对检查者1所作的30例胎儿图像也进行分析,测量计算出左心室搏出量。结果①同一测量者用3种方法测定胎儿左室搏出量比较差异无显著差异(P均>0.05);②两名观察者间3种方法测量重复性比较,其ICC值STIC法最高(多普勒法ICC:0.93,95%可信区间:0.86-0.95;M型法ICC:0.89,95%可信区间:0.82-0.91;STIC法ICC:0.95,95%可信区间:0.88-0.97);③应用Bland-Altman分析观察者间一致性,STIC法的系统偏倚及一致界限较多普勒法和M型法好(多普勒法平均差值:-0.04ml,95%可信区间-0.22～0.14ml;M型法平均差值:-0.06ml,95%可信区间-0.20～0.08ml;STIC法平均差值:-0.01ml,95%可信区间-0.11～0.09ml)。结论3种方法均可用于测量胎儿左室搏出量,但STIC法测量的可重复性和一致性最高,值得进一步研究与应用。目的探讨有或无四维超声时空关联成像(STIC)操作经验的医师对胎儿室间隔缺损(VSD)检出的影响。方法选取来我院行产前超声筛查的连续的96例可疑CHD胎儿,由2名不同STIC操作经验的超声医师进行产前筛查。其中1名有STIC操作经验(2.5年),另1名为初学者(仅经过短时培训)。记录2名医师胎儿室间隔缺损的检出例数,对检出情况进行比较。结果96例胎儿中,2名医师共同检出的VSD病例39例,只有医师1单独检出的病例为3例,只有医师2单独检出的病例为1例。2名医师检测VSD的检出情况比较无显著差异(χ2 =0.25,P>0.05)。结论应用四维STIC检查胎儿VSD可降低对检查人员经验的依赖,与传统二维超声相比具有技术优势。更多还原

【Abstract】 Objective To compare the reproducibility and agreement of two-dimensional (2D) ultrasonography with Doppler capability, 2D ultrasonography with M mode, four-dimensional (4D) with spatiotemporal image correlation (STIC) on the evaluation left ventricular stroke volume (LVSV) in normal fetuses.Methods 2D Doppler, 2D M mode, and 4D STIC were used to measure LSV of 30 normal fetuses at 26 to 30 weeks. Intraclass correlation coefficient (ICC) was used to evaluate the agreement by the three techniques, and proportionate Bland–Altman plots constructed.Results There was not significant difference in LSV value among the three methods within the same observer (P all >0.05). The ICC of the LVSV by the 4D STIC was the highest between the observers (2D Doppler ICC: 0.93 and 95%CI: 0.86-0.95, 2D M mode ICC: 0.89 and 95%CI: 0.82-0.91, 4D STIC ICC: 0.95 and 95%CI: 0.88-0.97). The 4D STIC was the best method demonstrated by Bland & Altman plot between the observers (2D Doppler Mean difference: -0.04ml and 95%CI: -0.22～0.14ml, 2D M mode Mean difference: -0.06ml and 95%CI: -0.20～0.08ml, 4D STIC Mean difference: -0.01ml and 95%CI: -0.11～0.09ml).Conclusions There is a good reproducibility among LVSV measured by 2D Doppler, 2D M mode, or by 4D STIC. But the 4D STIC represents best reproducibility and agreement to estimate fetal LVSV and promises to become the method of choice. Objective To determine the operation experience of four-dimensional ultrasound with spatio-temporal image correlation impacted on the detection condition of fetal ventricular septal defect (VSD).Methods 96 fetuses at high risk of CHD were examined by four-dimensional(4D) with spatio-temporal image correlation(STIC) were evaluated by two blinded independent examiners. One examiner had operated 4D STIC about two and a half years (examiner 1), and the other one was inexperienced (examiner 2). The detection condition of fetal VSD was calculated and compared.Results 42 cases of fetal VSD were detected by examiner 1, and 40 cases were detected by examiner 2. Furthermore, 3 cases were detected by examiner 1 alone, and 1 cases were detected by examiner 2 alone. Compared to the detection condition of fetal VSD by 4D STIC,inexperienced sonographers and experienced sonographer were not significantly different(χ2 =0.25,P>0.05).Conclusions 4D STIC shows less rely on the experience of sonographers, and represents a better technique to detect fetal VSD and promises to become the method of choice.更多还原