四腔心与三血管气管切面联合HD-flow筛查早孕期胎儿心血管畸形的应用价值  

Applying Four-Chamber View and Three-Vessel Trachea View Combined With HD-Flow to Screening Fetal Cardiovascular Malformations in First-Trimester Pregnancy

作　　者：黄羽君 朱云晓[1] 林冬梅[1] 谭莹[1] 袁鲲 刘文芬 HUANG Yu-jun;ZHU Yun-xiao;LIN Dong-mei;TAN Ying;YUAN Kun;LIU Wen-fen(Department of Medical Ultrasonics,The Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 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：《中山大学学报（医学科学版）》2022年第1期146-151,共6页Journal of Sun Yat-Sen University:Medical Sciences

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(202050715041216)。

摘　　要：【目的】评估在未经选择人群中应用四腔心切面(Four-chamber view,4CV)与三血管气管切面(3VTV)联合高分辨率血流显像技术(HD-flow)筛查早孕期(11~13;周)胎儿心血管畸形的诊断价值。【方法】2018年5月至2019年12月期间,在我院进行早孕期(11~13;周)超声检查的胎儿1 145例,应用HD-flow对胎儿4CV、3VTV进行观察分析,记录检查结果和妊娠结局,通过对照引产后尸解或出生后超声心动图诊断结果,比较以上两个切面及联合切面筛查早孕期胎儿心血管畸形的敏感性、特异性、阳性预测值及阴性预测值。【结果】本研究共纳入948例胎儿,共发现心血管畸形19例:早孕期超声诊断与随访结果符合12例(12/19),其中7例为复杂性先天性心脏病(CHD),共22个结构异常;早孕期超声诊断与随访结果不完全一致1例(1/19),为复杂性CHD;早孕期超声未发现房/室间隔异常6例(6/19)。19例中早孕期超声4CV显示异常6例,3VTV显示异常11例,4CV或3VTV(联合切面)显示异常13例。4CV、3VTV及联合切面对于早孕期胎儿心血管畸形的诊断敏感性分别为:31.5%、57.9%、68.4%,4CV+3VTV联合切面敏感性高于4CV,差异有统计学意义(P=0.016);其特异性及阳性预测值均为100%(P>0.05),阴性预测值分别为98.6%、99.1%、99.4%(P>0.05)。【结论】在早孕期超声检查时联合4CV与3VTV叠加HD-flow较单一4CV切面能提高对胎儿心血管畸形的检出率,尤其有助于检出预后不良的重大心血管畸形。【Objective】To evaluate the value of four-chamber view(4 CV)and three-vessel trachea view(3 VTV)combined with HD-flow in screening for fetal cardiovascular mailformations(CVMs)in unselected population during early pregnancy(11~13;weeks).【Methods】From May 2018 to December 2019,1145 fetuses were ultrasonic scanned routinely at 11~13;weeks at our hospital. The 4 CV and 3 VTV of fetal hearts were assessed by Power Doppler with flow direction(high definition flow,HD-flow),and the sonographic findings and follow-up outcomes were documented. Suspected CVMs were confirmed by the postpartum echocardiography or autopsy results. The sensitivities,specificities,PPVs and NPVs of diagnostic tests were compared among the two views and combined views.【Results】There were 948 fetuses included in this study,with 19 cases of CVMs. The sonographic findings of 12 cases(12/19)with 22 CVMs were consistent entirely with the follow-up outcomes,including 7 cases of complex CVMs. In 1 case(1/19)with complex CVM,the diagnosis was not entirely consistent to the autopsy result. The 6 cases(6/19)of abnormal atrioventricular septum were not detected in early pregnancy. In the 19 cases of CVMs,abnormalities were found by displaying 4 CV in 8 cases,by displaying3 VTV in 11 cases,and by displaying 4 CV combined with 3 VTV in 13 cases. The sensitivity of 4 CV,3 VTV,4 CV+3 VTV was 31.5%,57.9%,68.4%,with significant difference between 4 CV and 4 CV+3 VTV(P=0.016). The specificity and PPVs were all 100%(P>0.05). The NPVs of them were 98.6%,99.1% and 99.4%,with no statistical difference(P>0.05).【Conclusions】Displaying the 4 CV combined with 3 VTV of fetal heart in the first-trimester ultrasound examination resulted in higher detect ratio of fetal cardiovascular malformations rather than scanning only with the 4 CV,especially for those serious CVMs with poor prognosis,which is important for clinical management appropriately.

关 键 词：心血管畸形 早孕期超声 产前诊断 四腔心切面 三血管气管切面 

分 类 号：R445.1[医药卫生—影像医学与核医学]