二维超声与STIC技术叠加高分辨血流成像诊断早孕期胎儿迷走右锁骨下动脉  

Application of 2-D ultrasound and spatio-temporal image correlation combined with high-definition flow imaging for detecting fetal aberrant right subclavian artery in early pregnancy

作　　者：林冬梅[1] 黄羽君 谭莹[1] 袁鲲 刘文芬 徐作峰[1] 朱云晓[1] LIN Dong-mei;HUANG Yu-jun;TAN Ying;YUAN Kun;LIU Wen-fen;XU Zuo-feng;ZHU Yun-xiao(Department of Medical Ultrasonics,The Seventh Affiliated Hospital of Sun Yat-sen University,Guangdong 518107,China)

机构地区：[1]中山大学附属第七医院超声科,广东深圳518107

出　　处：《影像诊断与介入放射学》2020年第6期438-444,共7页Diagnostic Imaging & Interventional Radiology

基　　金：2020年深圳市科创委基金面上项目(JCYJ20190814170205768);2020年东莞市社会科技发展(重点)项目(2020050715041216)。

摘　　要：目的探讨经腹实时二维超声与时间-空间相关成像(STIC)技术叠加高分辨率血流显像(HDFI)对未经选择人群中早孕期胎儿迷走右锁骨下动脉(ARSA)的诊断价值。方法2018年11月~2019年9月我科行早孕期(孕11+0~13+6周)超声检查胎儿801例,应用经腹实时二维超声与STIC技术叠加HDFI对胎儿右侧锁骨下动脉(RSA)进行观察,记录观察结果及妊娠结局,比较分析两种检查方法单独与联合使用对早孕期胎儿ARSA诊断的敏感度、特异度、准确度、阳性预测值及阴性预测值。结果根据纳入标准及随访结果,本研究共纳入305例胎儿,其中283例单胎,11例双胎。本研究共检出14例ARSA胎儿,包括12例单纯性ARSA,2例ARSA合并多发严重畸形。早孕期超声共检出12例,实时二维叠加HDFI方法检出11例,STIC联合HDFI方法检出8例,其中7例均能被两种方法检出,两种方法对早孕期ARSA的诊断敏感度分别为78.6%(实时二维超声叠加HDFI)、57.1%(STIC叠加HDFI),差异有统计学意义(P=0.001)。两种方法联合后的诊断敏感度提高至85.7%,与实时二维超声叠加HDFI的敏感度比较,差异无统计学意义(P=0.193),与STIC叠加HDFI的敏感度比较,差异有统计学意义(P<0.001)。此两种方法的联合与单一方法的特异度(均为100%)、准确度(98%~99.3%)、阳性预测值(均为100%)及阴性预测值(98%~99.3%)之间的差异均无统计学差异(P>0.05)。结论在早孕期胎儿超声筛查时,经腹实时二维超声联合STIC技术叠加HDFI对ARSA的检出率较两者单独使用时有一定程度的提高,实时二维叠加HDFI技术较方便、易操作,STIC叠加HDFI技术可作为实时超声的辅助手段。Objective To assess the value of transabdominal real-time 2-D ultrasound and spatio-temporal image correlation(STIC)combined with high-definition flow imaging(HDFI)for detecting fetal aberrant right subclavian artery(RSA)in unselected population during early pregnancy.Methods From November 2018 to September 2019,routine ultrasound was performed on 801 fetuses at 11 to 13+6 gestational weeks.The fetal RSA was observed using both transabdominal 2-D HDFI and STIC-HDFI.The sensitivities,specificities,positive predictive value(PPV)and negative predictive value(NPV)of screening tests were compared between the two methods.Results According to the inclusion criteria and follow-up results,a total of 305 fetuses including 283 singletons and 11 twins were included in this study.Of 14 confirmed aberrant RSA including 12 isolated aberrant RSA and 2 cases with multiple severe malformations,7 isolated aberrant RSA were detected by both two methods,11 by 2-D HDFI,and 8 by STIC-HDFI.The diagnostic sensitivity of 2-D HDFI(78.6%)was significantly higher(P=0.001)than that of STIC-HDFI(57.1%).Combined both methods,the sensitivity(85.7%)was significantly higher than that of STIC-HDFI(P<0.001)without significant difference from that of 2-D HDFI(P=0.193).There was no significant difference in specificity(all 100%),accuracy(98%-99.3%),PPV(all 100%)or NPV(98%-99.3%)between the combined and single methods(P>0.05).Conclusion Real-time transabdominal 2-D ultrasound combined with HDFI and STIC can improve detection of fetal aberrant RSA in the first-trimester pregnancy.

关 键 词：时间-空间相关成像技术 高分辨率血流显像 右侧锁骨下动脉 迷走右锁骨下动脉 胎儿 产前诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]