Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium.
Ultrasound Obstet Gynecol. 2013 Dec;42(6):669-78. doi: 10.1002/uog.12548.
To assess prospectively the use of four-dimensional (4D) spatiotemporal image correlation (STIC) in the evaluation of the fetal heart at 11-14 weeks' gestation.
The study involved offline analysis of 4D-STIC volumes of the fetal heart acquired at 11-14 weeks' gestation in a population at high risk for congenital heart disease (CHD). Regression analysis was used to investigate the effect of gestational age, maternal body mass index, quality of the 4D-STIC volume, use of a transvaginal vs transabdominal probe and use of color Doppler ultrasonography on the ability to visualize separately different heart structures. The accuracy in diagnosing CHD based on early fetal echocardiography (EFE) using 4D-STIC vs conventional two-dimensional (2D) ultrasound was also evaluated.
One hundred and thirty-nine fetuses with a total of 243 STIC volumes were included in this study. Regression analysis showed that the ability to visualize different heart structures was correlated with the quality of the acquired 4D-STIC volumes. Independently, the use of a transvaginal approach improved visualization of the four-chamber view, and the use of Doppler improved visualization of the outflow tracts, aortic arch and interventricular septum. Follow-up was available in 121 of the 139 fetuses, of which 27 had a confirmed CHD. A diagnosis based on EFE using 4D-STIC was possible in 130 (93.5%) of the 139 fetuses. Accuracy in diagnosing CHD using 4D-STIC was 88.7%, and the results of 45% of the cases were fully concordant with those of 2D ultrasound or the final follow-up diagnosis. EFE using 2D ultrasound was possible in all fetuses, and accuracy in diagnosing CHD was 94.2%. Five of the seven false-positive or false-negative cases were minor CHD.
In fetuses at 11-14 weeks' gestation, the heart can be evaluated offline using 4D-STIC in a large number of cases, and this evaluation is more successful the higher the quality of the acquired volume. 2D ultrasound remains superior to 4D-STIC at 11-14 weeks, unless volumes of good to high quality can be obtained.
前瞻性评估四维（4D）时空关联（STIC）技术在 11-14 孕周胎儿心脏评估中的应用。
本研究对高先天性心脏病（CHD）风险人群在 11-14 孕周采集的胎儿心脏 4D-STIC 容积进行离线分析。采用回归分析方法，研究了胎龄、孕妇体重指数、4D-STIC 容积质量、经阴道与经腹探头应用、彩色多普勒超声对不同心脏结构可视化的影响。还评估了基于胎儿早期超声心动图（EFE）的 4D-STIC 对 CHD 的诊断准确性与二维（2D）超声的比较。
本研究共纳入 139 例胎儿，共 243 个 STIC 容积。回归分析显示，不同心脏结构的可视化能力与所采集的 4D-STIC 容积质量有关。独立地，经阴道方法的应用改善了四腔心切面的可视化，而多普勒的应用改善了流出道、主动脉弓和室间隔的可视化。139 例胎儿中 121 例有随访资料，其中 27 例确诊为 CHD。139 例胎儿中 130 例（93.5%）可基于 4D-STIC 的 EFE 做出诊断。使用 4D-STIC 诊断 CHD 的准确率为 88.7%，45%的病例结果与 2D 超声或最终随访诊断完全一致。所有胎儿均可进行 2D 超声 EFE，诊断 CHD 的准确率为 94.2%。5 例假阳性或假阴性病例为轻度 CHD。
在 11-14 孕周的胎儿中，可离线使用 4D-STIC 对心脏进行大量评估，获得的容积质量越高，评估成功率越高。在 11-14 孕周时，2D 超声优于 4D-STIC，除非能获得高质量的容积。
