应用时空关联模式的四维超声技术测量人胎儿左心室容量和射血分数的可重复性。

Reproducibility of echocardiographic measurements of human fetal left ventricular volumes and ejection fractions using four-dimensional ultrasound with the spatio-temporal image correlation modality.

机构信息

Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2012 Jan;160(1):22-9. doi: 10.1016/j.ejogrb.2011.09.036. Epub 2011 Oct 21.

DOI:10.1016/j.ejogrb.2011.09.036

PMID:22018832

Abstract

OBJECTIVES

To determine the reproducibility, both reliability and agreement, of measurements of fetal left ventricular parameters from volumes obtained by spatio-temporal image correlation (STIC) acquisition applying virtual organ computer-aided analysis (VOCAL) and Simpson's rule (method of discs). Furthermore the success rate of STIC acquisition was determined.

STUDY DESIGN

In 84 pregnancies between 20 and 34 weeks of gestation the fetal heart was scanned using the STIC modality. An optimal four-chamber view in end-diastole and end-systole was obtained. Left ventricular end-diastolic volume, left ventricular end-systolic volume, stroke volume and ejection fraction were determined. For calculations based on Simpson's rule only one plane was traced, whereas for VOCAL six planes were traced. To quantify the reliability intraclass correlation coefficients were calculated for both intra- and inter-observer measurements. Agreement of measurements was evaluated by Bland-Altman plots.

RESULTS

The STIC volumes of 54 women (64%) were excluded from the study because of poor quality, leaving 30 volumes for further analysis. Intraclass correlation coefficients for intra-observer reliability for VOCAL and Simpson were 0.99 and 0.99 for left ventricular end-diastolic volume, 0.95 and 0.92 for left ventricular end-systolic volume, 0.98 and 0.97 for stroke volume, 0.76 and 0.77 for ejection fraction, respectively. Intraclass correlation coefficients for inter-observer reliability for VOCAL and Simpson were 0.97 and 0.86 for left ventricular end-diastolic volume, 0.97 and 0.86 for left ventricular end-systolic volume, 0.95 and 0.81 for stroke volume, 0.68 and 0.63 for ejection fraction, respectively. According to Bland-Altman plots, the mean percentage difference and 95% limits of intra- and inter-observer agreement for left ventricular stroke volume measurements using VOCAL were -0.2 (-25.1, 24.7)% and 2.8 (-34.2, 39.8)%, respectively. For left ventricular stroke volume measured with Simpson versus VOCAL the mean percentage difference and 95% limits of agreement were -1.8 (-22.1, 18.5)%.

CONCLUSIONS

4D STIC enables reproducible measurements of left ventricular volumes. Reliability of the VOCAL mode is not essentially different from the single-plane method used in Simpson's rule. The large percentage of poor quality STIC volumes and the wide limits of inter-observer agreement would create obstacles for the clinical applicability of this technique.

摘要

目的

确定通过时空关联（STIC）采集应用虚拟器官计算机辅助分析（VOCAL）和辛普森规则（圆盘法）获得的胎儿左心室参数测量的可重复性，即可靠性和一致性。此外，还确定了 STIC 采集的成功率。

研究设计

在 20 至 34 孕周的 84 例妊娠中，使用 STIC 模式对胎儿心脏进行扫描。获得舒张末期和收缩末期的最佳四腔心视图。确定左心室舒张末期容积、左心室收缩末期容积、每搏输出量和射血分数。基于辛普森规则的计算仅追踪一个平面，而对于 VOCAL 则追踪六个平面。为了量化可靠性，对内和观察者间测量值均计算了组内相关系数。通过 Bland-Altman 图评估测量值的一致性。

结果

由于质量差，54 名女性（64%）的 STIC 容积被排除在研究之外，留下 30 个容积进行进一步分析。对于 VOCAL 和辛普森的观察者内可靠性，左心室舒张末期容积的组内相关系数分别为 0.99 和 0.99，左心室收缩末期容积为 0.95 和 0.92，每搏输出量为 0.98 和 0.97，射血分数为 0.76 和 0.77。对于 VOCAL 和辛普森的观察者间可靠性，左心室舒张末期容积的组内相关系数分别为 0.97 和 0.86，左心室收缩末期容积为 0.97 和 0.86，每搏输出量为 0.95 和 0.81，射血分数为 0.68 和 0.63。根据 Bland-Altman 图，使用 VOCAL 测量左心室每搏输出量的观察者内和观察者间平均百分比差异和 95% 一致性限分别为-0.2（-25.1，24.7）%和 2.8（-34.2，39.8）%。对于辛普森与 VOCAL 测量的左心室每搏输出量的平均百分比差异和 95% 一致性限分别为-1.8（-22.1，18.5）%。