时间—空间相关成像技术（STIC）评价正常胎儿心脏形态结构和左室收缩功能的初步研究

发布时间：2018-04-23 00:36

本文选题：时间-空间相关成像技术(STIC) + 胎儿心脏　；参考：《浙江大学》2014年硕士论文

【摘要】：三维胎儿超声心动图(Fetal Echocardiography)是近几年发展起来的一门新的超声心动图技术,随着彩色多普勒技术和围产医学的发展,以及胎儿期先天性心血管畸形介入治疗技术的进步,这一影像技术在胎儿心脏形态结构和左室收缩功能的产前诊断中发挥着愈来愈加重要的作用。本研究采用一种新的三维胎儿超声心动图技术时间-空间相关成像技术(STIC, spatiotemporal image correlation),主要对胎儿心脏形态结构和左室收缩功能进行评估,并与二维常规胎儿超声心动图检查进行比较。资料与方法一、研究对象本研究中研究对象为26例孕妇,年龄23～35岁,平均(28±2.9)岁,孕龄16周～41周,平均(31±7.4)周。所有研究对象均符合以下条件：常规产科超声检查未见明显异常,二维胎儿超声心动图检查未见明显的心血管畸形。二、方法使用GE Voluson730Expert型彩色多普勒超声诊断仪,采用S3二维探头(频率2.5～3.5MHZ)和三维容积探头(频率3.5-5.0MHz)。应用Fetal Echo软件及四维处理软件(4D View)。对每一研究对象由同一操作者进行平均20～40min的胎儿心脏二维超声扫查和10～20min的胎儿心脏、胸部三维超声扫查,以获得数据并存储。胎儿心脏形态结构评估要求获得心尖四腔心切面、左室流出道长轴切面或心尖五腔心切面、右室流出道长轴、三血管切面、主动脉弓长轴切面,观察心腔大小、瓣膜形态结构、室壁厚度、四个瓣口血流、动脉导管血流、主动脉和肺动脉起源、关系、内径、走行、主动脉弓血流、卵圆瓣活动。胎儿心脏左室功能评估,二维胎儿超声心动图采用简化Simpson法测定左室射血分数(LVEF)值；STIC采用4D View工作站中的VOCAL II(容积计算)功能进行左室三维重建,获得左室舒张末期容积(LVEDV)和收缩末期容积(LVESV),并根据公式LVEF=(LVEDV-LVESV)/LVEDV计算LVEF值结果一、共对26例孕妇进行了二维和三维胎儿超声心动图检查各26次,皆一次性成功获得满意二维和三维四腔心切面的图像。胎儿心脏形态结构及心律均正常25例,胎儿心律不规则1例,均在正常范围(120～180次／min)。二、对26例胎儿通过STIC技术获得的体积数据应用4D View工作站进行进一步的三维处理,主要包括TUI(Tomographic Ultrasound Imaging,断层超声显像)、Niche、Render(表面三维重建)、VOCAL II(容积计算),获得比常规二维胎儿超声心动图检查更多的切面及信息。三、对22例胎儿进行了心脏左室收缩功能评估。简化Simpson法测定左室舒张末期容积(LVEDV)平均(1.99±2.38)ml,左室收缩末期容积(LVESV)平均(0.62±0.48)ml；每搏量(SV)平均(1.37±2.00)ml,左室射血分数(LVEF)平均(63.0±8.4)%; STIC的VOCAL II(容积计算)左室三维重建后,得LVEDV平均(1.90±1.21)ml,LVESV平均(0.71±0.41)ml；每搏量(SV)平均(1.20±0.87)ml,左室射血分数(LVEF)平均(61.4±7.0)%。两种测量方法EDV、ESV、SV、EF比较差异均无显著性意义。结论 STIC具有多种快速空间成像技术和三维重建功能,对胎儿心脏内部结构的观察和分析更准确仔细,使胎儿超声检查受检查者经验、胎儿胎位等因素影响较小,并显著减少了检查时间,更合理准确地评估心室收缩功能,明显优于常规二维胎儿超声心动图技术,其临床应用必然有助于胎儿产前诊断的确立和疗效评价。
[Abstract]:Three-dimensional fetal echocardiography (Fetal Echocardiography) is a new echocardiographic technique developed in recent years. With the development of color Doppler and perinatal medicine and the advances in fetal congenital cardiovascular malformation, this imaging technique is in the form of fetal heart structure and left ventricular systolic function. In this study, a new three-dimensional fetal echocardiography (STIC, spatiotemporal image correlation) was used in this study to evaluate the fetal cardiac structure and left ventricular systolic function and to check with two-dimensional conventional fetal echocardiography. Compare.
Information and methods
First, the research object
In this study, the subjects were 26 pregnant women, aged 23~35 years, average (28 + 2.9) years of age and 16 weeks to 41 weeks of pregnancy, with an average of (31 + 7.4) weeks. All the subjects were in accordance with the following conditions: conventional obstetric ultrasound showed no obvious abnormalities, and two dimensional fetal echocardiography did not see obvious cardiovascular malformations.
Two, method
The GE Voluson730Expert color Doppler ultrasonic diagnostic instrument was used, the S3 two-dimensional probe (frequency 2.5 ~ 3.5MHZ) and the three-dimensional volume probe (frequency 3.5-5.0MHz) were used. The Fetal Echo software and the four dimensional processing software (4D View) were applied.
The fetal heart of 20 to 40min of the same operator was examined by the same operator for two dimensional ultrasound scan and 10 to 20min of the fetal heart. The three-dimensional ultrasound scan of the chest was used to obtain data and store.
The fetal heart morphological structure evaluation required the apical four cavities, the long axis of the left ventricular outflow tract or the five cavities of the apex, the long axis of the right ventricular outflow tract, the three vessels, the long axis of the aortic arch, the size of the heart cavity, the valve shape, the thickness of the ventricular wall, the blood flow of the four valves, the artery and the origin of the aorta and pulmonary artery. System, internal diameter, walking, aortic arch blood flow, oval valve activity.
Left ventricular function assessment, two-dimensional fetal echocardiography using simplified Simpson method to determine left ventricular ejection fraction (LVEF) value; STIC using VOCAL II (volume calculation) function in 4D View workstation to reconstruct left ventricle (LVEDV) and end systolic volume (LVESV) by the function of 4D View workstation, and according to formula LVEF= (LVEDV-LVESV) ) /LVEDV calculates the LVEF value
Result
A total of 26 pregnant women were examined 26 times by two-dimensional and three-dimensional fetal echocardiography. The images of satisfactory two-dimensional and three-dimensional four cavities were successfully obtained. 25 cases of fetal heart structure and rhythm were normal, and 1 cases of fetal arrhythmia were in normal range (120~180 times / min).
Two, the volume data obtained by STIC technology in 26 fetuses was applied to the 4D View workstation for further three-dimensional processing, including TUI (Tomographic Ultrasound Imaging, fault ultrasonography), Niche, Render (surface 3D reconstruction), VOCAL II (volume calculation), to obtain more sections than conventional two-dimensional fetal echocardiography. Information.
Three, the left ventricular systolic function was evaluated in 22 fetuses. The mean left ventricular end diastolic volume (LVEDV) was measured by the simplified Simpson method (1.99 + 2.38) ml, the mean left ventricular end systolic volume (LVESV) was (0.62 + 0.48) ml; the mean (SV) average (1.37 + 2) ml, the mean left ventricular ejection fraction (63 + 8.4)%, and STIC's VOCAL II (volume calculation) left ventricle After three-dimensional reconstruction, the average LVEDV (1.90 + 1.21) ml, LVESV average (0.71 + 0.41) ml, SV (1.20 + 0.87) ml, and left ventricular ejection fraction (LVEF) averaged (61.4 + 7)%. There were no significant differences in the two measurement methods EDV, ESV, SV, EF.
conclusion
STIC has a variety of rapid spatial imaging techniques and three-dimensional reconstruction functions. The observation and analysis of the internal structure of the fetal heart is more accurate and careful. The factors such as fetal ultrasound examination experience, fetal fetal position and other factors are less affected, and the examination time is reduced significantly, and the ventricular systolic function is more reasonable and accurate than the conventional two-dimensional fetus. The clinical application of echocardiography is bound to contribute to the establishment and evaluation of fetal prenatal diagnosis.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5

【共引文献】