De Robertis Valentina, Bosco Mariachiara, Fantasia Ilaria, Olivieri Claudiana, Fanelli Tiziana, Volpe Paolo
Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy.
Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, AOUI Verona, 37129 Verona, Italy.
Diagnostics (Basel). 2025 Aug 20;15(16):2088. doi: 10.3390/diagnostics15162088.
: First-trimester referral scans in high-risk pregnancies are performed by expert fetal medicine operators using an extended protocol that includes direct fetal heart assessment. This study evaluated inter-operator agreement in characterizing the four-chamber view (4CV) and three vessels and trachea view (3VTV) using color Doppler during such scans in both normal and abnormal cases. : Two independent operators and a fetal cardiologist, all blinded to final diagnoses, retrospectively reviewed 2D images and video clips of the 4CV and 3VTV in 90 fetuses (45 with congenital heart disease [CHD] and 45 controls). The 4CV was classified into four patterns: (1) two atrioventricular (A-V) inflows of similar size, (2) one A-V inflow filling two ventricles, (3) one A-V inflow filling one ventricle, and (4) two A-V inflows with disproportion. The 3VTV was assessed for (1) normal V-sign, (2) abnormal vessel number, (3) abnormal vessel dimension, (4) abnormal spatial relationships, and (5) ductal dependence. Agreement was measured using Cohen's Kappa. : Perfect agreement (K = 1) was seen in normal cases. In CHD cases, inter-operator and operator-cardiologist agreement was almost perfect for 4CV (K = 0.83-0.96) and substantial for 3VTV (K = 0.77-0.80). The lowest agreement occurred with ventricular disproportion in 4CV and abnormalities in vessel number and size in 3VTV. : Expert operators show strong agreement in interpreting 4CV and 3VTV patterns in first-trimester scans using color Doppler. However, certain abnormalities-particularly ventricular disproportion and vessel anomalies-remain challenging to consistently interpret.
高危妊娠的孕早期转诊超声检查由专业的胎儿医学操作人员采用包括直接胎儿心脏评估的扩展方案进行。本研究评估了在正常和异常病例的此类扫描中，操作人员使用彩色多普勒对四腔心切面（4CV）和三血管气管切面（3VTV）特征描述的一致性。
两名独立的操作人员和一名胎儿心脏病专家，均对最终诊断不知情，回顾性地查看了90例胎儿（45例患有先天性心脏病[CHD]和45例对照）的4CV和3VTV的二维图像和视频片段。4CV被分为四种模式：（1）两个大小相似的房室（A-V）流入；（2）一个A-V流入填充两个心室；（3）一个A-V流入填充一个心室；（4）两个A-V流入不均衡。对3VTV评估了以下方面：（1）正常的V征；（2）血管数量异常；（3）血管尺寸异常；（4）空间关系异常；（5）导管依赖。使用Cohen's Kappa测量一致性。
在正常病例中观察到完全一致（K = 1）。在CHD病例中，操作人员之间以及操作人员与心脏病专家之间对4CV的一致性几乎是完美的（K = 0.83 - 0.96），对3VTV的一致性为实质性的（K = 0.77 - 0.80）。最低的一致性出现在4CV中的心室不均衡以及3VTV中的血管数量和尺寸异常方面。
专业操作人员在孕早期扫描中使用彩色多普勒解释4CV和3VTV模式时表现出很强的一致性。然而，某些异常情况——特别是心室不均衡和血管异常——在持续解释方面仍然具有挑战性。
