CAJ | 학술논문

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.
목적 탐토실시삼유전용적성상정량정상태인좌심실용적적가행성화준학성.방법 대잉20～40주정상태인222례진행초성심동도검사,응용Philips iE33초성심동도의채집이유급실시삼유도상,채용QLAB연건탈궤정량좌실서장말기용적(end-diastolic volume,EDV)화수축말기용적(end-systolic volume,ESV),사용Cardiac 3DQ Advanced반자동변계검측법,여Cardiac 2DQ쌍평면Simpson법급M형Teichholz법측치비교.결과 척제도상질량교차적36례,배제쌍태5례,공유181례정상단태태인납입분석,삼충방법량량비교,실시삼유전용적성상SABD법여이유쌍평면Simpson법소측EDV、ESV상관성최호,r분별위0.987화0.988,Bland-Altman분석량자일치성최호,존재교소적편차,EDV위0.332 ml,ESV위0.135 ml.채용Bland-Altman분석삼충측량방법,실시삼유전용적성상SABD법적중복성최호(관찰자간EDV적편의위0.079 ml,ESV위0.042 ml;관찰자내EDV적편의위0.033 ml,ESV위0.016ml).EDV적관찰자내화관찰자간적변이계수:SABD법분별위2.85%화4.22%,이유쌍평면Simpson법분별위8.37%화8.98%,M형Teichholz법분별위30.63%화54.70%;ESV적관찰자내화관찰자간적변이계수:SABD법분별위2.34%화6.14%,이유쌍평면Simpson법분별위6.26%화11.7%,M형Teichholz법분별위43.06%화66.03%.결론 실시삼유전용적성상능구경준학지정량정상태인적좌실용적,유조우심입료해발육중적태인심장결구화공능.
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.