Jabak Salma, Vigneswaran Trisha V, Charakida Marietta, Kasapoglu Taner, de Jesus Cruz Jader, Simpson John M, Zidere Vita
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.
Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom.
Fetal Diagn Ther. 2020;47(4):268-276. doi: 10.1159/000502839. Epub 2019 Oct 9.
In the first trimester, ultrasound confirmation of normal or abnormal cardiac anatomy is difficult. B-mode and colour flow Doppler (CFD) are used to assess the foetal heart. Superb microvascular imaging (SMI) can visualise blood flow within the heart and vessels in early gestation.
We report an initial experience of SMI for visualisation of normal and abnormal cardiac anatomy in the first trimester.
Transabdominal foetal echocardiography was performed between 11 + 6 and 14 + 3 weeks (Aplio 500 US system, Toshiba Medical Systems, Tokyo, Japan) from January 2017 to December 2017. All scans were performed at a tertiary foetal cardiology unit. To assess the potential utility of the technique for early gestation screening, normal scans were reviewed by foetal medicine trainees with respect to the B-mode, CFD and SMI. Three key views were selected to compare modalities: the 4-chamber view, outflow tracts and the 3-vessel and trachea view (VTV). Visualisation rates of key echocardiographic features of significant cardiac abnormalities by SMI were reviewed.
Fifty-five normal echocardiograms and 34 cardiac abnormalities were included. In the normal heart, when B-mode, CFD and SMI were assessed separately, SMI had the highest rate of visualisation of 4-chamber, outflow tracts and 3-VTV (93, 85 and 83%, respectively). Intra-observer reliability was moderate for SMI of the 3 standard views (kappa 1, 0.64 and 0.64); inter-observer for 4-chamber and outflow tract views was moderate (kappa 0.64 and 0.77). In 29/34 abnormal cases, SMI showed key features, enhancing greyscale visualisation.
SMI has potential to become a useful, complementary modality for early foetal echocardiography. Further prospective studies are warranted to establish the place of the technique in assessment of the first trimester foetal heart.
在孕早期，超声确认心脏解剖结构正常或异常较为困难。B 型超声和彩色血流多普勒（CFD）用于评估胎儿心脏。超微血管成像（SMI）能够在妊娠早期显示心脏和血管内的血流情况。
我们报告了超微血管成像（SMI）在孕早期可视化正常和异常心脏解剖结构的初步经验。
2017 年 1 月至 2017 年 12 月期间，采用经腹胎儿超声心动图检查（使用日本东京东芝医疗系统公司的 Aplio 500 超声系统），孕周为 11⁺⁶至 14⁺³周。所有扫描均在三级胎儿心脏病科进行。为评估该技术在孕早期筛查中的潜在效用，胎儿医学实习生对正常扫描图像进行 B 型超声、CFD 和 SMI 方面的评估。选择三个关键切面比较不同模式：四腔心切面、流出道切面以及三血管和气管切面（VTV）。回顾了 SMI 对显著心脏异常关键超声心动图特征的显示率。
纳入了 55 份正常超声心动图和 34 例心脏异常病例。在正常心脏中，分别评估 B 型超声、CFD 和 SMI 时，SMI 对四腔心、流出道和三血管气管切面的显示率最高（分别为 93%、85%和 83%）。观察者内对三个标准切面 SMI 的可靠性为中等（kappa 值分别为 1、0.64 和 0.64）；四腔心和流出道切面的观察者间可靠性为中等（kappa 值分别为 0.64 和 0.77）。在 34 例异常病例中的 29 例中，SMI 显示了关键特征，增强了灰阶显示效果。
SMI 有潜力成为早期胎儿超声心动图的一种有用的补充模式。有必要进行进一步的前瞻性研究，以确定该技术在孕早期胎儿心脏评估中的地位。
