摘要目的 探讨胎儿心脏超声智能导航技术 (5D Heart)在20~38周正常中晚孕期胎儿心脏结构显示中的应用价值.方法 前瞻性通过容积探头采集20~38周正常胎儿心脏三维容积数据,三位检查资历不同的胎儿超声心动图医师应用5D Heart软件对 STIC容积图像进行后处理,分析各切面图像质量,对各切面合格率进行观察者内及观察者之间的一致性分析.采用单因素和多因素分析法分析孕妇孕龄、体质指数、胎盘位置、胎儿初始切面位置与图像采集质量之间的关系.结果 符合纳入条件孕妇205例,排除9例,最终纳入研究196例,成功获得容积图像180例,图像获得率91.8%.9个切面三位观察者前、后两次图像合格例数156~180例 (合格率86.7%~100%).筛查图像满意152例(84.4%),不满意28例 (15.6%).三位观察者前、后两次分析的一致性:四腔心切面、胃泡水平腹部横切面,诊断结果完全一致;三血管气管切面、五腔心切面、左室流出道切面、上下腔静脉长轴切面,一致性优;右室流出道切面、动脉导管弓切面、主动脉弓切面,一致性良.三位观察者间一致性分析:四腔心切面、胃泡水平腹部横切面,三位观察者分析结果完全一致;上下腔静脉长轴切面,一致性优;五腔心切面、左室流出道切面、右室流出道切面,一致性良-优;三血管气管切面、动脉导管弓切面、主动脉弓切面,一致性良.单因素分析:孕妇肥胖 (χ2=15.338,P =0.000)、孕周 (χ2=23.356,P =0.000)是图像满意度的独立影响因素.多因素回归分析:肥胖 (OR=5.587,P =0.001)、孕周 (OR=8.843,P =0.000)是筛查图像不满意的独立影响因素.统计三位观察者首次图像分析平均耗时为(2.77±1.39)min,各观察者间耗时差异无统计学意义 (P >0.05).结论 应用胎儿心脏超声智能导航技术在大多数胎儿能够获得9个最为常用和最重要的胎儿先天性心脏病筛查和诊断切面,该技术操作简单,重复性高,容易被初学者掌握和应用.

abstractsObjective To investigate the value of fetal intelligent navigation echocardiography (FINE,5D Heart)in displaying the normal fetal heart structure during 20 to 38 weeks'gestation.Methods Three-dimensional data of fetal heart during 20 to 38 weeks'gestation were acquired using volume transducer prospectively.The STIC volume images were post-processed with 5D heart software by three physicians with different levels of echocardiographic examination and the quality of the section images were analyzed.The intra-and interobserver repeatability was analyzed for the qualification of section images.The correlation between the quality of image and gestational age,body mass index,the placenta position,fetal initial plane position were evaluated using univariate and multivariable logistic regression analysis.Results Two hundreds and five cases of pregnant women were included,and 9 cases were excluded.Volume data acquisition was completed in 180 pregnant women,and the image acquisition rate was 91.8%.The data were assessed twice by three observers and qualified 9 section images were gotten in 156-180 cases(degree of qualification 86.7%-100%).The screening images were satisfied in 152 cases(84.4%),dissatisfied with 28 cases(15.6%).The intra-observer agreement by three observers was absolute concord in four chamber view and abdomen、stomach view;excellent in three vessel trachea view(3VT),five chamber view, left ventricular outflow tract view and superior and inferior vena cava view;good in right ventricular outflow tract view,ductal arch view and aortic arch view.The inter-observer agreement by each of three observers was absolute concord in four chamber view and abdomen、stomach view;excellent in superior and inferior vena cava view;excellent to good in five chamber view,left ventricular outflow tract view,right ventricular outflow tract view;good in 3VT,ductal arch view and aortic arch view.In a univariate analysis,the quality of the image was associated with obesity(χ2=15.338,P =0.000),gestational age(χ2=23.356,P =0.000).Multivariable analysis showed that the obesity(OR=5.587,P =0.001)and gestational age (OR=8.843,P=0.000)were factors affecting the quality of the image.The average time spent in post-processing the images for first time by three observers was(2.77±1.39)min,and there was no significant difference among observers(P > 0.05).Conclusions Fetal intelligent navigation echocardiography (FINE,5D Heart)based on STIC volumes can successfully generate 9 standard fetal echocardiography views in 86.7%-100% of fetuses in the 2nd and 3rd trimesters.This method can simplify examination of the fetal heart and reduce operator dependency.