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中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (09) : 866 -873. doi: 10.3877/cma.j.issn.1672-6448.2020.09.009

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显示胎儿完全型大动脉转位诊断切面的应用价值
庞海苏1, 赵博文2,†(), 黄超2, 陈冉2, 潘美2, 彭晓慧2, 王蓓2   
  1. 1. 310016　杭州，浙江大学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，浙江大学邵逸夫研究所；310007　杭州市中医院超声科
    2. 310016　杭州，浙江大学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，浙江大学邵逸夫研究所
  • 收稿日期:2019-09-17 出版日期:2020-09-01
  • 通信作者: 赵博文

Clinical value of Fetal Intelligent Navigation Echocardiography (5D Heart) to display diagnostic views of fetal complete transposition of the great arteries

Haisu Pang1, Bowen Zhao2,†(), Chao Huang2, Ran Chen2, Mei Pan2, Xiaohui Peng2, Bei Wang2   

  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; Department of Ultrasound, Hangzhou TCM Hospital, Hangzhou 310007, China
    2. 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:2019-09-17 Published:2020-09-01
  • Corresponding author: Bowen Zhao
  • About author:
    Corresponding author: Zhao Bowen, Email:
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庞海苏, 赵博文, 黄超, 陈冉, 潘美, 彭晓慧, 王蓓. 胎儿心脏超声智能导航技术显示胎儿完全型大动脉转位诊断切面的应用价值[J]. 中华医学超声杂志（电子版）, 2020, 17(09): 866-873.

Haisu Pang, Bowen Zhao, Chao Huang, Ran Chen, Mei Pan, Xiaohui Peng, Bei Wang. Clinical value of Fetal Intelligent Navigation Echocardiography (5D Heart) to display diagnostic views of fetal complete transposition of the great arteries[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 866-873.

目的

评价胎儿心脏超声智能导航技术（5D Heart）在显示胎儿完全型大动脉转位（cTGA）诊断切面中的应用价值。

方法

采集2018年1月至7月浙江大学医学院附属邵逸夫医院的15例完全型大动脉转位胎儿的心脏容积数据，由1名经验丰富的胎儿心脏超声医师负责心脏容积数据的采集。2名经验相对不足的胎儿心脏超声医师选取每例病例容积数据中图像质量最好的1个，运用5D Heart软件进行在机分析，并应用内置的VIS-Assistance?对诊断平面进行优化处理；其中1名医师在2周后重复上述图像分析过程，所得图像均予以存储。对各诊断切面以及诊断要素进行评分并计算显示率，比较分析同1名图像分析医师在不同时间处理图像所得结果的可重复性以及2个图像分析医师评分结果的一致性。

结果

对15个容积数据进行5D Heart联合VIS-Assistance?处理，4个诊断切面（三血管气管切面、四腔心切面、左心室流出道切面、右心室流出道切面）的显示率分别为86.7%，93.3%，80.0%，86.7%；诊断切面中的各主要诊断要素显示率>73.3%；同1图像分析医师在前后不同时间分析图像所得的诊断切面显示率及诊断要素显示率差异无统计学意义（P均>0.05）；2名经验相对不足的图像分析医师所得的诊断切面显示率及诊断要素显示率差异无统计学意义（P均>0.05）。

结论

胎儿心脏超声智能导航技术对胎儿cTGA的重要诊断切面的显示率较高，具有较好的可重复性及一致性，能够协助经验不足的医师进行胎儿cTGA的产前筛查。

关键词: 先天性心脏病, 胎儿大动脉转位, 胎儿超声心动图, 胎儿心脏智能导航技术
Objective

To evaluate the value of Fetal Intelligent Navigation Echocardiography (5D Heart) in displaying the diagnostic views of fetal complete transposition of the great arteries (cTGA).

Methods

The fetal heart volume datasets of 15 fetuses with cTGA were collected at Sir Run Run Shaw Hospital from January to July 2018, and an experienced sonographer in fetal echocardiography was responsible for the collection. Only the heart volume dataset with the best image quality per case was selected by two sonographers with relatively insufficient experiences in performing fetal echocardiography and analyzed using 5D Heart software and the built-in VIS-Assistance. The images were analyzed 2 weeks later by one of the two sonographers. All the images were stored. Then, the image qualities of diagnostic views and diagnostic elements of each view were graded and the visualization rates were calculated. The consistency of visualization rates of one sonographer in different periods of time and those between two sonographers were compared.

Results

The visualization rates of the four diagnostic views, namely, three-vessel view (3VT), four-chamber view (4CV), left ventricular outlet view (LVOT), and right ventricular outlet view (RVOT), by using 5D Heart software combining VIS-Assistance were 86.7%, 93.3%, 80.0%, and 86.7%, respectively. The visualization rates of the diagnostic elements in the diagnostic views were greater than 73.3%. No significant differences were found when comparing the visualization rates of one sonographer in different periods of time and the visualization rates between two relatively inexperienced sonographers (P>0.05).

Conclusion

5D Heart technology has a high visualization rate of the diagnostic views in fetus with cTGA, with high repeatability and consistency, and it can assist inexperienced sonographers to screen for fetal cTGA.

Key words: Congenital heart disease, Complete transposition of the great arteries, Fetal echocardiography, Fetal intelligent navigation echocardiography
图1 5D Heart显示的正常胎儿心脏超声的9个诊断切面。图a为三血管气管切面；图b为四腔心切面；图c为五腔心切面；图d为左心室流出道切面；图e为右心室流出道切面；图f为胃泡水平腹部横切面；图g为动脉导管弓切面；图h为主动脉弓切面；图i为上下腔静脉右心房切面；每个切面自动标记解剖结构、胎儿左、右及头尾侧
图2 以四腔心切面为例进行切面图像质量评分。图a为1分；图b为2分；图c为3分
表1 各个切面每个诊断要素显示率
诊断切面 诊断要素 诊断要素显示率（%）
三血管气管切面 仅见一只大血管 86.7
上腔静脉 93.3
四腔心切面 四个房室腔 100.0
卵圆孔瓣 60.0
十字交叉 100.0
室间隔 100.0
调节束 100.0
房室瓣 100.0
房室瓣距离 100.0
左心室流出道切面 起自解剖右心室的大血管未见分支/　起自解剖左心室的大血管可见分支 73.3
两条大血管平行走形 73.3
大动脉短轴切面 主动脉、肺动脉交叉环抱关系消失 80.0
表2 医师A 2次评分检验结果[分，M（QR）]
评分 3VT Four chamber LVOT RVOT
第1次 2.000（2.000~3.000） 3.000（2.000~3.000） 2.000（2.000~2.000） 2.500（2.000~2.000）
第2次 2.000（2.000~3.000） 3.000（2.000~3.000） 2.000（2.000~3.000） 1.000（2.000~3.000）
Z值 -0.000 -0.447 -0.577 -0.447
P值 1.000 0.655 0.564 0.655
表3 2名医师（医师A及医师B）评分结果比较[分，M（QR）]
医师 3VT Four chamber LVOT RVOT
医师A 2.000（2.000~3.000） 3.000（2.000~3.000） 2.000（2.000~3.000） 2.000（2.000~2.000）
医师B 2.000（2.000~3.000） 3.000（2.000~3.000） 2.000（2.000~3.000） 2.000（2.000~3.000）
Z值 -1.000 -1.000 -1.890 -0.816
P值 0.317 0.371 0.059 0.414
图3 应用5D Heart联合VIS-Assistance?技术显示1例24周cTGA胎儿的9个心脏超声诊断切面。图a为三血管气管切面（仅见一条大血管，上腔静脉位于右侧）；图b为四腔心切面（无明显异常）；图c为五腔心切面（无明显异常）；图d为左心室流出道切面（平行走行的两条大血管，起源于右心室的血管未见分支/起源于左心室的血管可见分支进入胎儿肺组织）；图e为右心室流出道切面（主肺动脉交叉环抱关系消失）；图f为胃泡切面（无明显异常）；图g为动脉导管弓切面（无法正常显示）；图h为主动脉弓切面（无法正常显示）；图i为上下腔静脉及右心房切面（无明显异常）
1
Villafane J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: the current era of the arterial switch operation [J]. J Am Coll Cardiol, 2014, 64(5): 498-511.
2
Clark EB. Pathogenetic mechanisms of congenital cardiovascular malformations revisited [J]. Semin Perinatol, 1996, 20(6): 465-472.
3
Anderson RH, Becker AE, Losekoot TG, et al. Anatomically corrected malposition of great arteries [J]. Br Heart J, 1975, 37(10): 993-1013.
4
Raboisson MJ, Samson C, Ducreux C, et al. Impact of prenatal diagnosis of transposition of the great arteries on obstetric and early postnatal management [J]. Eur J Obstet Gynecol Reprod Biol, 2009, 142(1): 18-22.
5
Blyth M, Howe D, Gnanapragasam J, et al. The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis [J]. BJOG, 2008, 115(9): 1096-1100.
6
Bertagna F, Rakza T, Vaksmann G, et al. Transposition of the great arteries: factors influencing prenatal diagnosis [J]. Prenat Diagn, 2014, 34(6): 534-547.
7
Khoshnood B, De Vigan C, Vodovar V, et al. Trends in prenatal diagnosis, pregnancy termination, and perinatal mortality of newborns with congenital heart disease in France, 1983-2000: a population-based evaluation [J]. Pediatrics, 2005, 115(1): 95-101.
8
Lammer EJ, Chak JS, Iovannisci DM, et al. Chromosomal abnormalities among children born with conotruncal cardiac defects [J]. Birth Defects Res A Clin Mol Teratol, 2009, 85(1): 30-35.
9
Song MS, Hu A, Dyamenahalli U, et al. Extracardiac lesions and chromosomal abnormalities associated with major fetal heart defects: comparison of intrauterine, postnatal and postmortem diagnoses [J]. Ultrasound Obstet Gynecol, 2009, 33(5): 552-559.
10
Yagel S, Cohen SM, Rosenak D, et al. Added value of three-/four-dimensional ultrasound in offline analysis and diagnosis of congenital heart disease [J]. Ultrasound Obstet Gynecol, 2011, 37(4): 432-437.
11
Espinoza J, Lee W, Comstock C, et al. Collaborative study on 4-dimensional echocardiography for the diagnosis of fetal heart defects: the COFEHD study [J]. J Ultrasound Med, 2010, 29(11): 1573-1580.
12
Kusanovic JP, Nien JK, Goncalves LF, et al. The use of inversion mode and 3D manual segmentation in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL) [J]. Ultrasound Obstet Gynecol, 2008, 31(2): 177-186.
13
Gonçalves LF, Espinoza J, Romero R, et al. Four-dimensional ultrasonography of the fetal heart using a novel Tomographic Ultrasound Imaging display [J]. J Perinat Med, 2006, 34(1): 39-55.
14
Jurgens J, Chaoui R. Three-dimensional multiplanar time-motion ultrasound or anatomical M-mode of the fetal heart: a new technique in fetal echocardiography [J]. Ultrasound Obstet Gynecol, 2003, 21(2): 119-123.
15
Bega G, Lev-Toaff A, Kuhlman K, et al. Three-dimensional ultrasonographic imaging in obstetrics: present and future applications [J]. J Ultrasound Med, 2001, 20(4): 391-408.
16
Tripodi E, Tripodi A, Sturlese E. Fetal echocardiography: a comparison of different techniques [J]. Clin Exp Obstet Gynecol, 2000, 27(3-4): 225-226.
17
Van Velzen C, Haak M, Reijnders G, et al. Prenatal detection of transposition of the great arteries reduces mortality and morbidity [J]. Ultrasound Obstet Gynecol, 2015, 45(3): 320-325.
18
Chaoui R. The four-chamber view: four reasons why it seems to fail in screening for cardiac abnormalities and suggestions to improve detection rate [J]. Ultrasound Obstet Gynecol, 2003, 22(1): 3-10.
19
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations [J]. J Ultrasound Med, 2013, 32(6): 1083-1101.
20
Salomon L, Alfirevic Z, Berghella V, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan [J]. Ultrasound Obstet Gynecol, 2011, 37(1): 116-126.
21
Yeo L, Romero R. Intelligent navigation to improve obstetrical sonography [J]. Ultrasound Obstet Gynecol, 2016, 47(4): 403-409.
22
Garcia M, Yeo L, Romero R, et al. Prospective evaluation of the fetal heart using fetal intelligent navigation echocardiography (FINE) [J]. Ultrasound Obstet Gynecol, 2016, 47(4): 450-459.
23
Ravi P, Mills L, Fruitman D, et al. Population trends in prenatal detection of transposition of great arteries: impact of obstetric screening ultrasound guidelines [J]. Ultrasound Obstet Gynecol, 2018, 51(5): 659-664.
24
Yeo L, Luewan S, Romero R. Fetal intelligent navigation echocardiography (FINE) detects 98% of congenital heart disease [J]. J Ultrasound Med, 2018, 37(11):2577-2593.
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