Barsoom M J, Feldman D M, Borgida A F, Esters D, Diana D, Egan J F
Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06030, USA.
J Ultrasound Med. 2001 Oct;20(10):1043-6. doi: 10.7863/jum.2001.20.10.1043.
To determine whether the presence of an isolated fetal cardiac echogenic focus should be an indication for fetal echocardiography.
We reviewed our fetal echocardiography and obstetrics databases from January 1992 through July 1999. The study groups were formulated from patients referred for fetal echocardiography. Patients referred for echocardiography because of a single isolated fetal cardiac echogenic focus were compared with patients referred for other indications. The sensitivity, specificity, and positive and negative predictive values were calculated for an isolated echogenic focus as a marker for structural cardiac abnormalities as detected by fetal echocardiography.
Of 10,406 fetuses seen for ultrasonography, 1908 had fetal echocardiography. Cardiac abnormalities were identified in 3.4% (65 of 1908) of the fetuses that had echocardiography. The prevalence of an isolated echogenic focus was 2.2% (230 of 10,406) and was the indication in 12.1% (230 of 1908) of our echocardiograms. Only 1 of the 230 fetuses with an isolated echogenic focus had a structural cardiac defect (membranous ventricular septal defect). An isolated echogenic focus as a marker for congenital cardiac defects resulted in sensitivity and specificity of 1.5% and 87.6%, respectively. The positive and negative predictive values were 0.4% and 96.2%, respectively The relative risk for an echogenic focus in predicting congenital cardiac defects was 0.11 (95% confidence interval, 0.02-0.82).
An isolated fetal cardiac echogenic focus is not an efficacious marker for congenital cardiac defects. It should not be the sole indication for fetal echocardiography.
确定孤立性胎儿心脏强回声灶的存在是否应作为胎儿超声心动图检查的指征。
我们回顾了1992年1月至1999年7月期间的胎儿超声心动图和产科数据库。研究组由因胎儿超声心动图检查而转诊的患者组成。将因单一孤立性胎儿心脏强回声灶而转诊进行超声心动图检查的患者与因其他指征转诊的患者进行比较。计算孤立性强回声灶作为胎儿超声心动图检测到的心脏结构异常标志物的敏感性、特异性、阳性预测值和阴性预测值。
在接受超声检查的10406例胎儿中，1908例进行了胎儿超声心动图检查。在接受超声心动图检查的胎儿中，3.4%（1908例中的65例）被发现有心脏异常。孤立性强回声灶的患病率为2.2%（10406例中的230例），并且是我们超声心动图检查指征的12.1%（1908例中的230例）。在230例有孤立性强回声灶的胎儿中，只有1例有心脏结构缺陷（膜周部室间隔缺损）。孤立性强回声灶作为先天性心脏缺陷的标志物，其敏感性和特异性分别为1.5%和87.6%。阳性预测值和阴性预测值分别为0.4%和96.2%。强回声灶预测先天性心脏缺陷的相对风险为0.11（95%置信区间，0.02 - 0.82）。
孤立性胎儿心脏强回声灶不是先天性心脏缺陷的有效标志物。它不应作为胎儿超声心动图检查的唯一指征。
