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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (05) : 368 -374. doi: 10.3877/cma.j.issn.1672-6448.2019.05.014

所属专题: 文献 妇产科超声

妇产科超声影像学

胎儿心脏超声智能导航技术在获取胎儿超声心动图快速筛查切面主要诊断要素中的应用价值
张艳1, 赵博文2,(), 方昀2, 潘美2, 王蓓2, 彭晓慧2, 陈冉2, 熊莉2   
  1. 1. 310016 杭州,浙江大学医学院附属邵逸夫医院超声科 浙江省胎儿心脏超声诊断技术指导中心 浙江大学邵逸夫临床医学研究所,现在浙江省宁波市鄞州区第二医院超声科
    2. 310016 杭州,浙江大学医学院附属邵逸夫医院超声科 浙江省胎儿心脏超声诊断技术指导中心 浙江大学邵逸夫临床医学研究所
  • 收稿日期:2018-08-28 出版日期:2019-05-01
  • 通信作者: 赵博文
  • 基金资助:
    浙江省基础公益研究计划项目(LGF18H180004); 浙江省教育厅一般科研项目(Y201738828); 浙江省中医药科学研究基金项目(2018ZB075)

Application value of fetal heart ultrasound intelligent navigation technique in display of key diagnostic elements in rapid screening views of fetal echocardiography

Yan Zhang1, Bowen Zhao2,(), Yun Fang2, Mei Pan2, Bei Wang2, Xiaohui Peng2, Ran Chen2, Li Xiong2   

  1. 1. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
  • Received:2018-08-28 Published:2019-05-01
  • Corresponding author: Bowen Zhao
  • About author:
    Corresponding author: Zhao Bowen, Email:
引用本文:

张艳, 赵博文, 方昀, 潘美, 王蓓, 彭晓慧, 陈冉, 熊莉. 胎儿心脏超声智能导航技术在获取胎儿超声心动图快速筛查切面主要诊断要素中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2019, 16(05): 368-374.

Yan Zhang, Bowen Zhao, Yun Fang, Mei Pan, Bei Wang, Xiaohui Peng, Ran Chen, Li Xiong. Application value of fetal heart ultrasound intelligent navigation technique in display of key diagnostic elements in rapid screening views of fetal echocardiography[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(05): 368-374.

目的

评价胎儿心脏超声智能导航技术(5D Heart)在胎儿超声心动图五个快速筛查切面诊断要素中的应用价值。

方法

选取2016年10月至12月在浙江大学医学院附属邵逸夫医院超声科接受胎儿超声心动图检查的中晚孕期单胎胎儿220例,使用容积探头对220例中晚孕期单胎胎儿采集以四腔心切面为初始切面的三维容积数据共384个,采用5D Heart后处理成像,获取5个快速筛查切面,对5个切面21个要素化内容进行评分,采用χ2检验比较5D Heart与传统技术在5个诊断切面的要素显示是否存在差异,采用Pearson相关分析对5D Heart技术与传统二维超声心动图在正常胎心及异常胎心组中要素显示率作相关性分析。应用秩和检验分别对同一观察者不同时间评分结果,2个经验相对不足的医师评分结果及其分别与经验丰富的医师的评分结果进行比较。

结果

220例胎儿共获取384个容积数据,其中200例胎儿的317个心脏容积数据能够用于分析,获取成功率为82.6%。5D Heart技术与传统技术在胎儿心动图快速筛查5个切面要素的显示量,差异无统计学意义(χ2=5.17,P=0.27);正常胎心组与异常胎心组比较,切面要素显示率分别为89.6%、85.2%(r=0.94,P=0.02)。同一观察者不同时间评分结果比较、两个经验相对不足的医师比较以及分别与经验丰富的医师比较,评分结果差异无统计学意义(均P>0.05)。

结论

胎儿心脏超声智能导航技术在获取胎儿快速筛查切面及显示胎儿超声心动图要素化诊断信息方面具有较高的可靠性及重复性,减少操作者技术经验的依赖性,在CHD胎儿图像规范化采集与分析、科研教学、远程会诊及基层医院筛查中具有重要的应用前景。

Objective

To evaluate the application value of fetal heart echocardiography intelligent navigation (5D Heart) in the display of key diagnostic elements in five rapid screening fetal echocardiographic views.

Methods

Three hundred and eighty-four 3D volume datasets of 220 normal singleton fetuses in the second and third trimesters were acquired. After processing the datasets using 5D Heart, five rapid screening views were acquired, and 21 key diagnostic elements of the five cardiac diagnostic sections were graded. The 2 test was used to compare the difference in the key diagnostics elements of the five rapid screening views between 5D heart and the traditional technique. Pearson correlation was used to compare the detection rate of key diagnostic elements between 5D Heart technique and traditional two-dimensional echocardiography in normal fetuses and fetuses with congenital heart disease. The rank sum test was used to detect the consistency and reliability of the results.

Results

A total of 384 fetal volume datasets were obtained from 220 fetuses, of whom 317 heart volume datasets were available for analysis, with a success rate of 82.6%. There was no difference in the key diagnostic elements of the five rapid screening views between 5D heart and the traditional technique (χ2=5.17, P=0.27). Compared with the abnormal fetal heart group (89.6%), the detection rate of diagnostic elements in the normal fetal heart group was 85.2% (r=0.94, P=0.02). No significant differences were found when comparing the grading results of one observer in different periods of time, the grading results between two experienced doctors, or the grading results among the experienced doctor and one relatively inexperienced doctor (P>0.05).

Conclusions

Fetal cardiac ultrasound intelligent navigation technique has high reliability and repeatability in obtaining fetal rapid screening views and displaying fetal elemental diagnostic information. It has tremendous potential in standardized data collection and analysis of cardiac diagnostic sections in fetuses with congenial heart disease, as well as in training and teaching, remote medical consultation, and screening in primary hospitals.

图1 5D Heart显示正常组5个快速筛查切面。图a四腔心切面;图b左心室流出道切面;图c右心室流出道切面切面;图d胃泡水平腹部横切面;图e三血管气管切面
图1 异常胎心组要素显示率和正常胎心组要素显示率的相关分析
表1 5D Heart与传统方法对快速筛查切面的要素显示情况
表2 5D Heart在正常与异常胎心组的各诊断切面要素显示率比较(个)
表3 常见重要异常要素显示个数及显示率
表4 观察者A两次评分检验结果
表5 两名初级医师(A与B)评分结果比较
表6 经验相对不足的医师A及B与经验丰富的医师C评分检验结果
图2 5D Heart显示法洛四联症胎儿5个快速筛查切面。图a为四腔心切面;图b为左心室流出道切面;图c为右心室流出道切面切面;图d为胃泡水平腹部横切面;图e为三血管气管切面
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