探讨初学者应用胎儿心脏超声智能导航技术（FINE，5D Heart）在胎儿心脏超声检查中的应用价值。

选取2015年1月至2015年3月间在浙江大学医学院附属邵逸夫医院行胎儿超声心动图检查的中孕期孕妇80例，由一名胎儿超声心动图专家首先获取9个常规二维超声切面，而后利用时空关联成像（STIC）技术，扫描获得满意的以心尖四腔心为初始切面的心脏容积数据。两位不同胎儿超声心动图检查资历医师应用5D Heart软件对STIC容积图像进行后处理，获得9个切面，分析各切面图像质量，采用Kappa一致性检验，对各切面合格数行观察者内的一致性分析，并与2D图像分别行观察者之间一致性分析。记录并分析应用5D Heart软件所耗时间，采用t检验分析各观察者前后两次耗时差异。

纳入研究80例中，9个切面二维图像的总体合格例数：75~80例（合格率93.8%~100.0%）；两位观察者前、后两次图像合格例数73~80（合格率91.3%~100.0%）。两位观察者前、后两次分析的一致性：在四腔心切面、胃泡水平腹部横切面，诊断结果完全一致（Kappa=1）；三血管气管切面（Kappa=0.851~0.882），一致性优；五腔心切面（Kappa=0.787~0.882），一致性良-优；主动脉弓切面（Kappa=0.738~0.787）、左心室流出道切面（Kappa=0.709~0.787）、右心室流出道切面（Kappa=0.655~0.794）、上下腔静脉长轴切面（Kappa=0.647~0.649）、动脉导管弓切面（Kappa=0.640~0.707），一致性良。两位观察者分析与2D图像的一致性：四腔心切面、胃泡水平腹部横切面，两位观察者与2D分析结果完全一致（Kappa=1）；五腔心切面（Kappa=0.851~0.902），一致性优；动脉导管弓切面（Kappa=0.749~0.820）、主动脉弓切面（Kappa=0.707~0.882）、右心室流出道切面（Kappa=0.661~0.851）、三血管气管切面（Kappa=0.655~0.851），一致性良-优；左心室流出道切面（Kappa=0.737~0.749）、上下腔静脉长轴切面（Kappa=0.655~0.794），一致性良。统计俩位观察者首次图像分析平均耗时为（2. 64±1.35）min，各观察者间耗时，差异无统计学意义（P>0.05）。

初学者应用5D Heart技术重现的9个切面，基本能够达到与直接获得二维切面相同的合格率与质量，该技术简单易学，重复性好，容易被初学者掌握和应用，有利于胎儿心脏超声检查的推广。

To explore the applicability of fetal intelligent navigation echocardiography (FINE, 5D Heart) in displaying the normal fetal heart structure by a new sonographer and assess the value of this technique in fetal cardiac ultrasonography.

Eighty cases of normal fetal heart at the second trimester were scanned by an echocardiographic expert. STIC volume datasets with satisfactory from apical four-chamber and common 2D modality with 9 standard views of fetal echocardiogram were achieved for each case. The STIC volume images were post-processed with 5D heart software by two physicians with different levels of echocardiographic examination. The quality of the section images of 9 standard views from 2D 5D heart and were analyzed. The intraobserver and interobserver with common 2D modality repeatability were analyzed for the qualification of section images. The time spent in post-processing the images was record and analyzed.

The qualified 9 section images with 2D were 75~80 cases (degree of qualification 93.8%~100.0%). The data were assessed twice by two observers and qualified 9 section images were got in 73~80 cases (degree of qualification 91.3%~100.0%). The intra-observer agreement by two observers was absolute concord in four chamber view and abdomen/stomach view (Kappa=1); excellent in three vessel trachea view (3VT, Kappa=0.851~0.882); good to excellent in five chamber view (Kappa=0.787~0.882); good in aortic arch view (Kappa=0.738~0.787), left ventricular outflow tract view (Kappa=0.709~0.787), right ventricular outflow tract view (Kappa=0.655~0.794), superior and inferior vena cava view (Kappa=0.647~0.649) and ductal arch view (Kappa=0.640~0.707). The inter-observer agreement by each two observers and 2D was absolute concord in four chamber view and abdomen/stomach view (Kappa=1); excellent in five chamber view (Kappa=0.851~0.902); good to excellent in ductal arch view (Kappa=0.749~0.820), aortic arch view (Kappa=0.707~0.882), right ventricular outflow tract view (Kappa=0.661~0.851) and 3VT (Kappa=0.655~0.851); good in left ventricular outflow tract view (Kappa=0.737~0.749), superior and inferior vena cava view (Kappa=0.655~0.794). The average time spent in post-processing the images for first time by three observers was (2.64±1.35) min, and there was no significant difference during the each observers (P>0.05).

5D Heart represents a single method in obtaining 9 fetal diagnosis planes, which can be used easily by a sonographer lack of skills, and has high reliability and repeatability. It is helpful for improving the application of fetal heart screening.