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目的研究不同初始切面胎儿心脏三维容积包图像质量,探讨三维成像技术联合断层超声显像技术在正常胎儿心脏超声检查中的价值。方法应用胎儿三维成像技术对158例胎儿(孕16～40周)心脏以心尖四腔心切面和胸骨旁四腔心切面作初始切面采集三维容积数据。应用软件进行离机分析,用断层超声显像模式对胎儿四腔心、五腔心、三血管气管、左心室流出道、右心室流出道、大动脉短轴、主动脉弓、动脉导管弓、上下腔静脉长轴9个标准切面进行显示。按不同孕龄将158例胎儿分为3组,A组(16～24周)、B组(25～32周)和C组(33～40周),对3组胎儿9个标准切面显示情况进行组间对比分析。结果应用心脏三维容积技术在158例胎儿中采集到满意的心脏容积数据包图像149个,其中心尖四腔心切面容积包72个,胸骨旁四腔心切面容积包77个。(1)上下腔静脉切面、大动脉短轴切面图像清晰显示率(2分切面率),心尖四腔心切面容积包图像及胸骨旁四腔心切面容积包图像的A组与B组间对比,差异均有统计学意义(心尖四腔心切面容积包χ2=4.927、22.938,胸骨旁四腔心切面容积包χ2=6.312、21.761,P均<0.05)。(2)主动脉弓切面、动脉导管弓切面图像清晰显示率(2分切面率),仅在心尖四腔心切面容积包图像的A组与B组间对比差异有统计学意义(χ2=8.053、4.967,P均<0.05)。(3)心尖四腔心切面容积包和胸骨旁四腔心切面容积包B组图像清晰显示率最高,C组其次,A组最低。结论心尖四腔心切面和胸骨旁四腔心切面均可作为胎儿心脏三维容积成像采集初始切面,三维容积成像中重建切面受外部条件影响明显。胎儿心脏三维超声检查最佳孕龄范围为25～32孕周,孕龄大小对以心尖四腔心作初始切面的心脏三维图像质量影响较大。这两个初始切面可为胎儿心脏三维容积图像规范化采集和远程会诊图像规范化采集提供参考。
OBJECTIVE: To study the image quality of three-dimensional volumetric images of fetal heart in different initial sections and explore the value of three-dimensional imaging combined with tomographic imaging in normal fetal cardiac ultrasonography. Methods Fetal three-dimensional imaging technique was used to collect three-dimensional volume data of 158 fetuses (from 16 to 40 weeks of gestation) in the initial section of apical four-chamber heart-cut and parasternal four-chamber heart-cut. Application of software for off-line analysis of fetal four-chamber heart, five chamber heart, three vascular trachea, left ventricular outflow tract, right ventricular outflow tract, aortic arch, aortic arch, patent ductus arteriosus, superior and inferior vena cava Long axis 9 standard section display. A total of 158 fetuses were divided into three groups according to different gestational ages: group A (16-24 weeks), group B (25-32 weeks) and group C (33-40 weeks) Compare between groups. Results A total of 149 images of cardiac volume were collected from 158 fetuses using cardiac 3D volumetric technique. The volume of apical four-chamber coronal plane was 72, and that of the parasternal four-chamber coronal plane was 77. (1) Comparison between Group A and Group B of the images of the superior and inferior vena cava, the images of the short aorta of the aorta (2-incision rate), the volume images of apical four-chamber and the volume images of the parasternal four- The difference was statistically significant (apical four-chamber coronal volume package χ2 = 4.927,22.938, paracentesis four-chamber coriolis volume package χ2 = 6.312,21.761, P all <0.05). (2) The images of the aortic arch and the arch of the patent ductus arteriosus showed a clear display rate (2-incision rate). There was significant difference between group A and group B only in the apical four-chamber coronal volume images (χ2 = 8.053,4.967 , P <0.05). (3) The volume of the apical four-chamber coronal section and the four-chamber coronal section of the parasternal volume of the paracentesis group B showed the highest percentage of clear images, followed by group C and lowest in group A. Conclusions The apical four-chamber coronal section and the parasternal four-chamber coronal section can both acquire the initial section as the fetal cardiac three-dimensional volume imaging. The reconstructed section in the three-dimensional volume imaging is obviously affected by the external conditions. Fetal heart three-dimensional ultrasound examination of the best gestational age range of 25 to 32 gestational weeks, gestational age size of the apical four-chamber heart as the initial section of the heart three-dimensional image quality greater impact. These two initial sections can provide reference for the standardized acquisition of 3D volume images of fetal heart and the standardization of remote consultation images.