实时三维全容积成像定量正常胎儿左心室容积的研究  

Full-volume three-dimensional echocardiographic assessment of left ventricular volume in healthy human fetuses

作　　者：俞莉丽[1] 赵博文[1] 潘美[1] 杨园[1] 黎鹏[1] 杨倩[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所,杭州310016

出　　处：《中华超声影像学杂志》2010年第7期604-608,共5页Chinese Journal of Ultrasonography

基　　金：资助项目：浙江省自然科学基金项目（Y2080080）

摘　　要：目的 探讨实时三维全容积成像定量正常胎儿左心室容积的可行性和准确性.方法 对孕20～40周正常胎儿222例进行超声心动图检查,应用Philips iE33超声心动图仪采集二维及实时三维图像,采用QLAB软件脱机定量左室舒张末期容积（end-diastolic volume,EDV）和收缩末期容积（end-systolic volume,ESV）,使用Cardiac 3DQ Advanced半自动边界检测法,与Cardiac 2DQ双平面Simpson法及M型Teichholz法测值比较.结果 剔除图像质量较差的36例,排除双胎5例,共有181例正常单胎胎儿纳入分析,三种方法两两比较,实时三维全容积成像SABD法与二维双平面Simpson法所测EDV、ESV相关性最好,r分别为0.987和0.988,Bland-Altman分析两者一致性最好,存在较小的偏差,EDV为0.332 ml,ESV为0.135 ml.采用Bland-Altman分析三种测量方法,实时三维全容积成像SABD法的重复性最好（观察者间EDV的偏倚为0.079 ml,ESV为0.042 ml;观察者内EDV的偏倚为0.033 ml,ESV为0.016ml）.EDV的观察者内和观察者间的变异系数：SABD法分别为2.85%和4.22%,二维双平面Simpson法分别为8.37%和8.98%,M型Teichholz法分别为30.63%和54.70%;ESV的观察者内和观察者间的变异系数：SABD法分别为2.34%和6.14%,二维双平面Simpson法分别为6.26%和11.7%,M型Teichholz法分别为43.06%和66.03%.结论 实时三维全容积成像能够更准确地定量正常胎儿的左室容积,有助于深入了解发育中的胎儿心脏结构和功能.Objective To evaluate the feasibility and accuracy of full volume three-dimensional echocardiography（FV3DE） for quantifying the left ventricular volume in healthy fetuses. Methods Two hundred and twenty-two normal fetuses with gestational ages between 20 and 40 weeks were investigated. Full volume three-dimensional, two-dimensional （2D） and M-mode images were acquired by Philips iE33 system and data was processed offline using QLAB analysis software. Left ventricular end-systolic volume（ESV） and end-diastolic volume （ EDV） were measured using semiautomated border detection echocardiographic techniques, and compared with 2D biplane Simpson＇s method and M-mode Teichholz formula. Results Thirty-six fetuses with poor three-dimensional images and 5 twin pregnancies were excluded,the study subjects consisted of 181 singleton fetuses. The highest concordance correlation （ r =0.987 for EDV, r =0.988 for ESV） P 〈0. 001） was noted between 2D biplane Simpson＇s and FV3DE-derived values with a small bias （0. 332 ml for EDV,0. 135 ml for ESV）. The Bland-Altman analysis showed that FV3DE had the best reproducibility than M-mode Teichholz formula and 2D biplane Simpson＇s method. Intra- and interobserver error of EDV were 2.85% and 4.22% for FV3DE,8.37% and 8.98% for 2D biplane Simpson＇s rule,30. 63% and 54. 70% for M-mode Teichholz formula. Intra- and interobserver error of ESV were 2.34% and 6. 14% for FV3DE,6. 26% and 11.7% for 2D biplane Simpson＇s rule,43.06% and 66.03% for M-mode Teichholz formula. Conclusions FV3DE is a novel technique that can be more accurate than conventional methods in quantification of fetal left ventricular volumes, it may provide new insight into evolving fetal cardiac structure and function.

关 键 词：超声检查 产前 胎儿 心室容积 左 

分 类 号：R445.1[医药卫生—影像医学与核医学]