【作者】 王丹丹；

【导师】 李辉；

【作者基本信息】 中国医科大学 ， 妇产科学， 2010， 硕士

【摘要】 目的通过研究空间-时间相关成像技术(Spatio-temporal Image Correlation, STIC)在胎儿先天性心脏病(Congenital Heart Defect, CHD)中的声像表现特点,探讨STIC技术在常见先天性心脏病诊断的临床应用价值及其在临床应用推广的可行性。方法选取2008年11月至2009年12月于中国医科大学附属盛京医院进行胎儿超声心动图检查的孕妇433例,妊娠20-37周,年龄22～43岁。每例胎儿均进行常规二维超声心脏检查并作出临床诊断,之后应用STIC技术获取胎儿心脏容积数据并采用双盲法进行离线分析,所得出的结论与产前二维超声、产后新生儿心脏超声诊断及因CHD引产的胎儿尸体解剖结果进行对照,核对产前STIC诊断胎儿CHD的准确性。对二维超声诊断正常心脏的胎儿取样3次用于探讨STIC技术临床应用的可行性分析；对CHD胎儿不限次数取样至获取最佳图像质量用于探讨STIC技术诊断CHD的临床价值。进行可行性分析的评价方法为：根据Devore旋转技术,即是否能清晰显示心脏各部分结构,如四腔心切面、左心室流出道、右心室流出道、三血管气管、肺静脉回流、体静脉回流和完整主动脉弓,将所获得的STIC容积信息分为临床效果最佳、临床可用及临床不可用。最后应用SPSS 13.0软件行统计学分析,对结果所获得的百分率进行x2检验,P<0.05具有统计学意义。结果433例胎儿中,经二维超声诊断401例为正常胎儿心脏,32例为CHD。对比STIC临床诊断与产前二维超声、产后新生儿心脏超声诊断及因CHD引产的胎儿尸体解剖结果发现,二维超声漏诊2例室间隔缺损(Ventricular SeptalDefect,VSD)、误诊1例正常胎儿为VSD及1例大动脉转位(Transposition of Aorta, TOA)胎儿为右室双出口(Double Outlet of Right Ventricular, DORV),而STIC技术补充1例二维超声漏诊VSD,纠正2例二维超声误诊患者的诊断,漏诊1例VSD。以随访到且明确诊断的308例患者为研究对象计算二维超声及STIC技术诊断胎儿CHD的敏感度分别为：93.9%,99.6%；特异度分别为97.0%,100%。对STIC技术采集的二维超声诊断为正常胎儿心脏容积信息进行临床效果评价,临床效果最佳为52例(13.0%),临床可用为227例(56.6%),临床不可用122例(30.4%)；将研究的前半年和后半年两个时间段的STIC图像临床效果评价结果进行比较,后半年的临床效果最佳率和临床可用率明显提高(P<0.05)。结论STIC技术在诊断胎儿心脏畸形中有其特有的价值及优势,可作为二维心脏超声技术的有效补充手段。但STIC技术在临床实践中获取临床最佳效果率较低,限制了其在临床上的广泛应用和推广,增加对STIC技术采集和应用的熟练程度及技巧则会明显改善信息采集的成功率和质量。更多还原

【Abstract】 ObjectiveTo investigate the value of spatio-temporal image correlation (STIC) technique in the diagnosis of congenital heart defect, and a systematic analysis of the feasibility of STIC in the routine fetal echocardiography.MethodsA total of 433 fetus were enrolled in this study who were diagnosed by fetal echocardiography and analyzed by STIC technique. We got three effective STIC volumes from the normal fetal heart diagnosed by fetal echocardiography and kept taking volumes until ideal STIC volumes were obtained for the fetal CHD. The obtaining data were achieved as insufficient quality for clinic, sufficient quality for clinic and high quality for clinic according to the heart structures obtained that was reported as Devore. The accuracy of the fetal echocardiography and STIC technique in the diagnosis of the fetal CHD was checked by comparing the results to the autopsy of CHD and neonatal echocardiography after they were born. SPSS 13.0 software was used to analyze the percentages got from the study.Results401 cases were diagnosed as normal fetal heart by fetal echocardiography,32 cases as CHD. STIC was pointed out that there were special value and superiority in the diagnosis of congenital heart defects. Postpartum follow up and biopsy confirmed that 2 VSD missed diagnosis,1 VSD and 1 DORV misdiagnosis by fetal echocardiography, while STIC technique had 1 VSD missed diagnosis, confirmed one VSD which was diagnosed as normal fetal heart by echocardiography, corrected one VSD diagnosed as a normal heart and one TOA which was misdiagnosed as DORV by echocardiography. Among the 308 cases who were diagnosed exactly according to the follow up, the sensitivity of the fetal echocardiography and STIC technique in the diagnosis of CHD were 93.9% and 99.6% separately, and the specificity were 97.0% and 100% separately. Among the 401 normal fetus who were diagnosed as normal heart by echocardiography,52(13.0%) cases were with high quality for clinic,227(56.6%) had sufficient quality for clinic and 122(30.4%) had insufficient quality for clinic. There was difference between the front and later study period.ConclusionsThe superiority and special value of STIC technique in the diagnosis of fetal CHD had been confirmed by our study, and quality of the STIC can be improved by increasing the collecting skill.更多还原