二维与四维超声对产前疑似胎儿先天性心脏病的诊断价值比较OA
Comparison of the Diagnostic Value of Two-Dimensional and Four-Dimensional Ultrasonography for Prenatally Suspected Fetal Congenital Heart Disease
目的 比较二维超声与四维超声对产前疑似胎儿先天性心脏病(CHD)的诊断效能,并评价四维超声的补充诊断价值.方法 回顾性选取 2022 年 5 月至 2024 年 8 月于淅川县人民医院行产前检查,且常规产前超声提示胎儿心脏结构或血流异常、需进一步行胎儿超声心动图评估的孕妇 86 例.所有孕妇均完成二维及四维超声检查,二维和四维图像分别由具有胎儿超声心动图经验的医师独立判读.以产后超声心动图或终止妊娠后胎儿病理结果为参考标准,分别评价二维超声和四维超声的诊断效能及与参考标准的一致性.结果 86 例受检孕妇中,经参考标准确诊胎儿 CHD 19例(22.09%).二维超声检出 16 例,四维超声检出 18 例.二维超声诊断 CHD 的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为 63.16%、94.03%、87.21%、75.00%和 90.00%,四维超声分别为 89.47%、98.51%、96.51%、94.44%和 97.06%.二维和四维超声与参考标准的 κ 值分别为 0.606 和 0.897.配对比较显示,四维超声诊断准确率高于二维超声(P=0.008),但两者敏感度和特异度比较差异均无统计学意义(P＞0.05).结论 在产前超声提示疑似胎儿CHD 的人群中,四维超声与参考标准具有较高一致性,其诊断准确率高于二维超声,可为胎儿心脏结构及大血管关系的进一步评估提供补充信息.但敏感度和特异度与二维超声相比差异未达到统计学意义.
Objective To compare the diagnostic performance of two-dimensional ultrasonography and four-dimensional ultrasonography for prenatally suspected fetal congenital heart disease(CHD),and to evaluate the additional diagnostic value of four-dimensional ultrasonography.Methods A retrospective study was conducted involving 86 pregnant women who underwent prenatal examinations at Xichuan County People's Hospital from May 2022 to August 2024 and whose routine prenatal ultrasonography suggested fetal cardiac structural or blood flow abnormalities requiring further fetal echocardiographic evaluation.All participants underwent both two-dimensional and four-dimensional ultrasonography.Two-dimensional and four-dimensional images were independently interpreted by physicians experienced in fetal echocardiography.Postnatal echocardiography or fetal pathological findings after termination of pregnancy were used as the reference standard.The diagnostic performance of two-dimensional and four-dimensional ultrasonography and their agreement with the reference standard were evaluated separately.Results Among the 86 pregnant women,fetal CHD was confirmed in 19 cases(22.09%)according to the reference standard.Sixteen cases were detected by two-dimensional ultrasonography and 18 cases by four-dimensional ultrasonography.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of two-dimensional ultrasonography for diagnosing fetal CHD were 63.16%,94.03%,87.21%,75.00%,and 90.00%,respectively,compared with 89.47%,98.51%,96.51%,94.44%,and 97.06%,respectively,for four-dimensional ultrasonography.The κ values for agreement with the reference standard were 0.606 for two-dimensional ultrasonography and 0.897 for four-dimensional ultrasonography.Paired comparison showed that the diagnostic accuracy of four-dimensional ultrasonography was higher than that of two-dimensional ultrasonography(P=0.008),whereas no statistically significant differences were observed in sensitivity or specificity between the two methods(P＞0.05).Conclusion Among fetuses with suspected CHD on prenatal ultrasonography,four-dimensional ultrasonography shows high agreement with the reference standard and higher diagnostic accuracy than two-dimensional ultrasonography,and may provide additional information for evaluating fetal cardiac structures and the relationships of the great vessels.However,the differences in sensitivity and specificity between four-dimensional and two-dimensional ultrasonography did not reach statistical significance.
武安玲
淅川县人民医院 超声科,河南 南阳 474450
先天性心脏病胎儿二维超声四维超声产前诊断
congenital heart diseasefetustwo-dimensional ultrasonographyfour-dimensional ultrasonographyprenatal diagnosis
《临床研究》 2026 (10)
117-120,4
评论