时间—空间相关成像技术定量评价胎儿左室容积的研究
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摘要
目的：
本研究旨在探讨时间-空间相关成像技术(spatiotemporal image correlation, STIC)在定量胎儿左心室容积中的价值。
资料与方法：
一、研究对象
自2009年10月至2010年2月在浙江大学医学院附属邵逸夫医院门诊接受胎儿超声心动图检查的孕妇,随机抽取162例,排除图像质量较差的26例及双胎2例,134例正常单胎作为研究对象。孕妇年龄21～38岁,平均(27.1±4.8)岁,孕龄22～38周,平均(30.1±4.2)周,胎儿心率124～162次/分,平均145±9.1次/分。
二、仪器与方法
仪器为GE E8型彩色多普勒超声诊断仪,采用三维容积探头,频率4～8MHz。
1.在进行STIC数据采集前,先行二维超声心动图检查以确认所需的平面。如果不能获得满意的四腔心切面,嘱孕妇走动以增强胎动,获得满意显示声窗。在清晰显示胎儿四腔心切面后,启动STIC模式,图像放大至1.7倍左右,调节取样框使之包络整个胎儿胸腔,以此时的四腔心为起始切面,调节合适的扫描角度,扫描时间为7.5～12.5s,要求孕妇在整个采集过程中屏气配合,以避免运动伪像。激活自动容积按钮,自动扫过预先选定的组织。为了获得更好的图像质量和包含有所有解剖细节的体积元,对孕龄及体积较大的胎儿,扫描角度应相应增加,一般孕20～30周的胎儿扫描角度为30°～45°,孕30周以上的胎儿扫描角度为45°～75°。如图像不满意时重新采集,直至获得满意的容积数据。所有图像存储于四维处理软件(4D View)工作站,脱机测量相关左室容积参数,包括舒张末期容积(LVEDV)、收缩末期容积(LVESV).
对胎儿心脏左心室容积的测量,均在4D View工作站中后处理获得,M型超声心动图采用Teichholz法、二维胎儿超声心动图采用简化Simpson法测定、4DSTIC采用VOCALⅡ容积计算)功能进行左室三维重建,获得LVEDV和LVESV。本研究4D STIC VOCAL II法选择旋转角度为15°,描绘内膜层数为12层。所有测量值均取连续3次测量的平均值。
2.重复性分析随机抽取20例,两个观察者分别用VOCAL II法与M型Teichholz法、2DE Simpson法双盲法测量LVEDV、LVESV以比较观察者间的一致性。同一观察者也随机抽取20例,相隔1个月后盲法再次测量LVEDV、LVESV以比较观察者内的一致性。
三、统计学分析
应用SPSS16.0软件。观察者间及观察者内的偏倚用测值差值的标准差表示。采用Bland-Altman法分析M型Teichholz法、2DE Simpson法与VOCAL II法的重复性和三种方法两两之间的一致性。直线相关Pearson法分析三种方法两两之间的相关性。三种方法各自的观察者间和观察内的重复性比较行配对t检验。三种方法之间比较行方差分析和LSD-t检验。P<0.05认为差异有统计学意义。
结果：
1.重复性分析结果：LVEDV、LVESV观察者内及观察者间三次测值间均无显著差异,P>0.05。观察者间VOCAL II法r分别为0.988、0.887,2DE Simpson法r分别为0.982、0.883,M型Teichholz法r分别为0.909、0.843,P均<0.01；偏倚VOCAL II法分别为0.190ml、0.028ml,2DE Simpson's法分别为0.222ml、0.110ml,M型Teichholz法分别为0.691ml、0.361ml。观察者内VOCAL II法r分别为0.998、0.977,2DE Simpson法r分别为0.996、0.962,M型Teichholz法r分别为0.937、0.928,P均<0.01；偏倚VOCAL II法分别为0.076ml、0.053ml,2DE Simpson's法分别为0.102ml、0.076ml,M型Teichholz法分别为0.430ml、0.263ml。
2.4D STIC VOCALⅡ法与2DE Simpson法所测左心室EDV.ESV具有很好的相关性,r分别为0.968、0.956,P=0.000；但与M型Teichholz法相关性差,r分别为0.742、.491, P=0.000,2DE Simpson法与M型Teichholz法相关性亦较差,EDV、ESVr分别为0.757、0.552,P=0.000。
3. Bland-Altman法分析显示VOCALⅡ法与2DE Simpson法所测左心室EDV、ESV一致性最好,存在较小偏倚,两者差值标准差分别为EDV为0.282ml, ESV为0.117ml; VOCALⅡ法与M型Teichholz法一致性较差,存在较大偏倚,两者差值标准差EDV为0.866ml, ESV为0.463ml; 2DE Simpson法与M型Teichholz法一致性亦较差,存在较大偏倚,两者差值标准差EDV为0.809ml, ESV为0.419ml。
4.M型Teichholz法与VOCALⅡ法、2DE Simpson法所测得左室容积比较均有显著性差异,VOCAL II法与2DE Simpson法所测得左室容积比较无统计学意义。
5.根据孕周将研究对象分成四个阶段：21～25周、26～30周、31～35周和36～40周。三种方法测量左室容积的四组均数±标准差见表2.5。
结论：
4D STIC VOCAL II法和二维胎儿超声心动图简化Simpson法测量左室容积有良好的一致性,且4D STIC VOCAL II法所测左室容积观察者间及观察者内重复性均较其他两种方法好。4D STIC能够更准确的定量正常胎儿的左室容积,脱机分析测量相关容积数据显著减少了检查时间,三维重建更合理准确地评估心室收缩功能,将来进一步研究及应用将有助有深入了解发育中的胎儿心脏结构和功能。
Objective:
The purpose of this study was to investigate the feasibility of using novel three-dimensional echocardiographic technique-spatiotemporal image correlation (STIC) to assess left ventricular volume in normal fetuses.
Methods:
Study Populations and Methods:
From October 2009 to February 2010, we randomly enrolled 162 consecutive pregnant women, of whom 134 were recruited into study group (age 27.1±4.8 years, range 21～38 years, gestation age 30.1±4.2 weeks, range 22～38 weeks, fetal heart rate 145±9.1bpm,rang 124～162bpm).Twenty-six fetuses with poor 4D STIC image and 2 twin pregnancies were excluded.
4D volumes of the fetal heart were acquired by sonography using a motorized convex transabdominal transducer (RAB 4-8MHz probe, Voluson GE E8,GE Medical Systems) and data were processed by a sonography system capable of performing the STIC technique. First, the 2D settings were adjusted in order to obtain clear visualization of the internal limits of the heart. We aimed to acquire the volume when the fetus was not moving and the apex of the heart was towards the transducer, which was held over the transverse plane of the fetal heart at the level of the standard four-chamber view. Acquisition time ranged from 7.5s to 12.5s and the angle of acquisition ranged between 30°～75°depending on fetal montion and gestational age.The volumes with clear internal limits and no artifacts were then selected for further evaluation.
Offline analysis was performed using Voluson 4D View software.The Virtual Organ Computer-aided Analysis (VOCALⅡ),M-mode Teichholz formula and 2D biplane Simpson's method were then used to evaluate end-systolic and end-diastolic volumes of left ventricle.In this study the VOCALⅡwas used to evaluate volumes of left ventricle by obtaining a sequence of 12 sections of the heart, each obtained after a 15°rotation from the previous one. In each plane the contour was traced manually,and at the end, the computer provided the reconstruction of the left ventricle and calculated its volume.
Every measurement was done offline after the scan by the same operator for three times.
2. In 20 randomly selected cases, LVEDV and LVESV were measured by two independentechocardigraphers in order to compare the measurements and calculate interobserver agreement.
In 20 randomly selected cases, LVEDV and LVESV were measured by the same echocardigrapher twice after one month in order to compare the measurements and calculate intraobserver agreement.
Statistical analysis
The data were analyzed using the statistical software package SPSS 16.0. A value of P<0.05 was considered statistically significant.
Results:
1.Result of the reproducibility:For the interobserver LVEDV and LVESV correlation coefficients were 0.988 and 0.887 in 4D STIC VOCAL II rule,0.982 and 0.883 in Simpson's method,0.909 and 0.843 in Teichholz formula. In the Bland-Altman test the bias were 0.190ml and 0.028ml in 4D STIC VOCALⅡrule for LVEDV and LVESV, 0.222ml and 0.110ml in Simpson's method,0.691ml and 0.361ml in Teichholz formula. For the intraobserver LVEDV and LVESV correlation coefficients were 0.998 and 0.977 in 4D STIC VOCALⅡrule,0.996 and 0.962 in Simpson's method,0.937 and 0.928 in Teichholz formula. In the Bland-Altman test the bias were 0.076ml and 0.053ml in 4D STIC VOCAL II rule for LVEDV and LVESV,0.102ml and 0.076ml in Simpson's method,0.430ml and 0.263ml in Teichholz formula.
2.The highest concordance correlation (r=0.968 for LVEDV,r=0.956 for LVESV; P=0.000) was noted between Simpson's and 4D STIC VOCAL II values with a small bias (0.282ml for LVEDV,0.117ml for LVESV). There were poor concordance correlation between Simpson's method and M-mode Teichholz formula,0.757 for LVEDV and 0.552 for LVESV with bias 0.809ml for LVEDV,0.419ml for LVESV,so did to 4D STIC VOCAL II and M-mode Teichholz formula,0.742 for LVEDV and 0.491 for LVESV with bias 0.866ml for LVEDV,0.463ml for LVESV.
3.The Bland-Altman analysis showed that 4D STIC VOCAL II had the best agreement than M-mode Teichholz formula and Simpson's method. The result showed that there were significant difference between M-mode Teichholz formula and Simpson's method in LVEDV and LVESV (P<0.05).There were significant difference between M-mode Teichholz formula and 4D STIC VOCALⅡ(P<0.05), too. There were no significant differences between 4D STIC VOCAL II and Simpson's method in LVEDV and LV ESV.
Conclusion:
There is a good agreement between left ventricular volumes measured either by 4D STIC VOCAL II or by 2D biplane Simpson's method.4D STIC is a novel technique that can be more accurate than conventional methods in quantification of fetal left ventricular volumes. All the volume data acquisition is achieved by postprocessing facilities.STIC sweep decreases the exposure upon fetal heart obviously.4D STIC promises to become a new method for left ventricular.
本研究旨在探讨时间-空间相关成像技术(spatiotemporal image correlation, STIC)在定量胎儿左心室容积中的价值。
资料与方法：
一、研究对象
自2009年10月至2010年2月在浙江大学医学院附属邵逸夫医院门诊接受胎儿超声心动图检查的孕妇,随机抽取162例,排除图像质量较差的26例及双胎2例,134例正常单胎作为研究对象。孕妇年龄21～38岁,平均(27.1±4.8)岁,孕龄22～38周,平均(30.1±4.2)周,胎儿心率124～162次/分,平均145±9.1次/分。
二、仪器与方法
仪器为GE E8型彩色多普勒超声诊断仪,采用三维容积探头,频率4～8MHz。
1.在进行STIC数据采集前,先行二维超声心动图检查以确认所需的平面。如果不能获得满意的四腔心切面,嘱孕妇走动以增强胎动,获得满意显示声窗。在清晰显示胎儿四腔心切面后,启动STIC模式,图像放大至1.7倍左右,调节取样框使之包络整个胎儿胸腔,以此时的四腔心为起始切面,调节合适的扫描角度,扫描时间为7.5～12.5s,要求孕妇在整个采集过程中屏气配合,以避免运动伪像。激活自动容积按钮,自动扫过预先选定的组织。为了获得更好的图像质量和包含有所有解剖细节的体积元,对孕龄及体积较大的胎儿,扫描角度应相应增加,一般孕20～30周的胎儿扫描角度为30°～45°,孕30周以上的胎儿扫描角度为45°～75°。如图像不满意时重新采集,直至获得满意的容积数据。所有图像存储于四维处理软件(4D View)工作站,脱机测量相关左室容积参数,包括舒张末期容积(LVEDV)、收缩末期容积(LVESV).
对胎儿心脏左心室容积的测量,均在4D View工作站中后处理获得,M型超声心动图采用Teichholz法、二维胎儿超声心动图采用简化Simpson法测定、4DSTIC采用VOCALⅡ容积计算)功能进行左室三维重建,获得LVEDV和LVESV。本研究4D STIC VOCAL II法选择旋转角度为15°,描绘内膜层数为12层。所有测量值均取连续3次测量的平均值。
2.重复性分析随机抽取20例,两个观察者分别用VOCAL II法与M型Teichholz法、2DE Simpson法双盲法测量LVEDV、LVESV以比较观察者间的一致性。同一观察者也随机抽取20例,相隔1个月后盲法再次测量LVEDV、LVESV以比较观察者内的一致性。
三、统计学分析
应用SPSS16.0软件。观察者间及观察者内的偏倚用测值差值的标准差表示。采用Bland-Altman法分析M型Teichholz法、2DE Simpson法与VOCAL II法的重复性和三种方法两两之间的一致性。直线相关Pearson法分析三种方法两两之间的相关性。三种方法各自的观察者间和观察内的重复性比较行配对t检验。三种方法之间比较行方差分析和LSD-t检验。P<0.05认为差异有统计学意义。
结果：
1.重复性分析结果：LVEDV、LVESV观察者内及观察者间三次测值间均无显著差异,P>0.05。观察者间VOCAL II法r分别为0.988、0.887,2DE Simpson法r分别为0.982、0.883,M型Teichholz法r分别为0.909、0.843,P均<0.01；偏倚VOCAL II法分别为0.190ml、0.028ml,2DE Simpson's法分别为0.222ml、0.110ml,M型Teichholz法分别为0.691ml、0.361ml。观察者内VOCAL II法r分别为0.998、0.977,2DE Simpson法r分别为0.996、0.962,M型Teichholz法r分别为0.937、0.928,P均<0.01；偏倚VOCAL II法分别为0.076ml、0.053ml,2DE Simpson's法分别为0.102ml、0.076ml,M型Teichholz法分别为0.430ml、0.263ml。
2.4D STIC VOCALⅡ法与2DE Simpson法所测左心室EDV.ESV具有很好的相关性,r分别为0.968、0.956,P=0.000；但与M型Teichholz法相关性差,r分别为0.742、.491, P=0.000,2DE Simpson法与M型Teichholz法相关性亦较差,EDV、ESVr分别为0.757、0.552,P=0.000。
3. Bland-Altman法分析显示VOCALⅡ法与2DE Simpson法所测左心室EDV、ESV一致性最好,存在较小偏倚,两者差值标准差分别为EDV为0.282ml, ESV为0.117ml; VOCALⅡ法与M型Teichholz法一致性较差,存在较大偏倚,两者差值标准差EDV为0.866ml, ESV为0.463ml; 2DE Simpson法与M型Teichholz法一致性亦较差,存在较大偏倚,两者差值标准差EDV为0.809ml, ESV为0.419ml。
4.M型Teichholz法与VOCALⅡ法、2DE Simpson法所测得左室容积比较均有显著性差异,VOCAL II法与2DE Simpson法所测得左室容积比较无统计学意义。
5.根据孕周将研究对象分成四个阶段：21～25周、26～30周、31～35周和36～40周。三种方法测量左室容积的四组均数±标准差见表2.5。
结论：
4D STIC VOCAL II法和二维胎儿超声心动图简化Simpson法测量左室容积有良好的一致性,且4D STIC VOCAL II法所测左室容积观察者间及观察者内重复性均较其他两种方法好。4D STIC能够更准确的定量正常胎儿的左室容积,脱机分析测量相关容积数据显著减少了检查时间,三维重建更合理准确地评估心室收缩功能,将来进一步研究及应用将有助有深入了解发育中的胎儿心脏结构和功能。
Objective:
The purpose of this study was to investigate the feasibility of using novel three-dimensional echocardiographic technique-spatiotemporal image correlation (STIC) to assess left ventricular volume in normal fetuses.
Methods:
Study Populations and Methods:
From October 2009 to February 2010, we randomly enrolled 162 consecutive pregnant women, of whom 134 were recruited into study group (age 27.1±4.8 years, range 21～38 years, gestation age 30.1±4.2 weeks, range 22～38 weeks, fetal heart rate 145±9.1bpm,rang 124～162bpm).Twenty-six fetuses with poor 4D STIC image and 2 twin pregnancies were excluded.
4D volumes of the fetal heart were acquired by sonography using a motorized convex transabdominal transducer (RAB 4-8MHz probe, Voluson GE E8,GE Medical Systems) and data were processed by a sonography system capable of performing the STIC technique. First, the 2D settings were adjusted in order to obtain clear visualization of the internal limits of the heart. We aimed to acquire the volume when the fetus was not moving and the apex of the heart was towards the transducer, which was held over the transverse plane of the fetal heart at the level of the standard four-chamber view. Acquisition time ranged from 7.5s to 12.5s and the angle of acquisition ranged between 30°～75°depending on fetal montion and gestational age.The volumes with clear internal limits and no artifacts were then selected for further evaluation.
Offline analysis was performed using Voluson 4D View software.The Virtual Organ Computer-aided Analysis (VOCALⅡ),M-mode Teichholz formula and 2D biplane Simpson's method were then used to evaluate end-systolic and end-diastolic volumes of left ventricle.In this study the VOCALⅡwas used to evaluate volumes of left ventricle by obtaining a sequence of 12 sections of the heart, each obtained after a 15°rotation from the previous one. In each plane the contour was traced manually,and at the end, the computer provided the reconstruction of the left ventricle and calculated its volume.
Every measurement was done offline after the scan by the same operator for three times.
2. In 20 randomly selected cases, LVEDV and LVESV were measured by two independentechocardigraphers in order to compare the measurements and calculate interobserver agreement.
In 20 randomly selected cases, LVEDV and LVESV were measured by the same echocardigrapher twice after one month in order to compare the measurements and calculate intraobserver agreement.
Statistical analysis
The data were analyzed using the statistical software package SPSS 16.0. A value of P<0.05 was considered statistically significant.
Results:
1.Result of the reproducibility:For the interobserver LVEDV and LVESV correlation coefficients were 0.988 and 0.887 in 4D STIC VOCAL II rule,0.982 and 0.883 in Simpson's method,0.909 and 0.843 in Teichholz formula. In the Bland-Altman test the bias were 0.190ml and 0.028ml in 4D STIC VOCALⅡrule for LVEDV and LVESV, 0.222ml and 0.110ml in Simpson's method,0.691ml and 0.361ml in Teichholz formula. For the intraobserver LVEDV and LVESV correlation coefficients were 0.998 and 0.977 in 4D STIC VOCALⅡrule,0.996 and 0.962 in Simpson's method,0.937 and 0.928 in Teichholz formula. In the Bland-Altman test the bias were 0.076ml and 0.053ml in 4D STIC VOCAL II rule for LVEDV and LVESV,0.102ml and 0.076ml in Simpson's method,0.430ml and 0.263ml in Teichholz formula.
2.The highest concordance correlation (r=0.968 for LVEDV,r=0.956 for LVESV; P=0.000) was noted between Simpson's and 4D STIC VOCAL II values with a small bias (0.282ml for LVEDV,0.117ml for LVESV). There were poor concordance correlation between Simpson's method and M-mode Teichholz formula,0.757 for LVEDV and 0.552 for LVESV with bias 0.809ml for LVEDV,0.419ml for LVESV,so did to 4D STIC VOCAL II and M-mode Teichholz formula,0.742 for LVEDV and 0.491 for LVESV with bias 0.866ml for LVEDV,0.463ml for LVESV.
3.The Bland-Altman analysis showed that 4D STIC VOCAL II had the best agreement than M-mode Teichholz formula and Simpson's method. The result showed that there were significant difference between M-mode Teichholz formula and Simpson's method in LVEDV and LVESV (P<0.05).There were significant difference between M-mode Teichholz formula and 4D STIC VOCALⅡ(P<0.05), too. There were no significant differences between 4D STIC VOCAL II and Simpson's method in LVEDV and LV ESV.
Conclusion:
There is a good agreement between left ventricular volumes measured either by 4D STIC VOCAL II or by 2D biplane Simpson's method.4D STIC is a novel technique that can be more accurate than conventional methods in quantification of fetal left ventricular volumes. All the volume data acquisition is achieved by postprocessing facilities.STIC sweep decreases the exposure upon fetal heart obviously.4D STIC promises to become a new method for left ventricular.
引文
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[7]Bhat AH,Corbett VN, Liu R,et al. Validation of volume and mass assessments for human fetal heart imaging by 4-dimensional spatio-temporal image correlation echocardiography:in vitro balloon model experiments.J Ultrasound Med.2004;23(9):1151-1159.
[8]Uittenbogaard LB, Haak MC, Spreeuwenberg MD, et al.Fetal cardiac function assessed with four-dimensional ultrasound imaging using spatiotemporal image correlation.Ultrasound Obstet Gynecol.2009; 33(3):272-281.
[9]Rizzo G, Capponi A, Cavicchioni O, et al.Fetal cardiac stroke volume determination by four-dimensional ultrasound with spatio-temporal imagecorrelation compared with two-dimensional and Doppler ultrasonography.Prenat Diagn.2007; 27(12):1147-1150.
[10]Molina FS, Faro C, Sotiriadis A, Dagklis T,et al.Heart stroke volume and cardiac output by four-dimensional ultrasound in normal fetuses.Ultrasound Obstet Gynecol.2008; 32(2): 181-187.
[11]Messing B,Cohen SM,Valsky DV.et al.Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode.Ultrasound Obstet Gynecol.2007;30(2):142-151.
[12]Atkins BZ,Kuo J,Shah AS,et al.Real-time three-dimensional echocardiography to construct clinically ready,load-independent indices of myocardial contractile performance.J Am Soc Echocardiogr.2003; 16(9):922-930.
[13]赵博文,姜卫香,杨园.等.时间-空间相关成像技术评价胎儿心脏形态结构的初步研究.中国超声医学杂志,2007(2)：145-147.
[14]刘涛,吴瑛,熊奕.等.动态正交三平面法在胎儿心脏节段分析中的应用.中国超声医学杂志,2007.23(8)：615-617.
[15]Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet.1986; 1 (8476):307-310.
[16]Bland JM,AltmanDG.Measurement error proportional to mean.BMJ.1996;313(7049):106.
[17]Shi JC,Chen CP.Spatio-temporal image correlation(STIC):innovative 3D/4D technique for ustrating unique and independent information and diagnosing complex congenital heart diseases. Croat Med J.2005;46(5):812-820.
[18]Goncalves LF,Espinoza J,Romero R,et al.Four dimensional fetalechOcardiOgraphy with spatiotemporal im age correlation(STIC):a systematic study of standard cardiac views assessed by different observers.Matern Fetal Neonatal Med.2005;17(5):323-331.
[19]Pooth RK,Korai A.B flow and B-flow Spatio-temporal image correlation in visualizing fetal cardiac blood flow.Croat Med J.2005,46(5):808-811.
[20]Gonealves LF,Lee W,Chaiworapongsa T,et al.Four-dimensional uhrasonography of the fetal heaa with spatio-temporal image correlation.Am J Obstet Gynecol.2003;189(6):1792-1802.
[21]DeVore GR,Falkensammer P,Sklansky MS,et al.Spatio-temporal image correlation(STIC):new technology for evaluation of the fetal heart.Ultrasound Obstet Gynecol.2003;22(4):380-387.
[22]Li X,Jones M,Irvine T,et al.Real-time 3-dimensional echocardiography for quantification of the difference in left ventricular versus right ventricular stroke volume in a chronic animal model study:Improved results using C-scans for quantifying aortic regurgitation.J Am Soc Echecardiogr.2004;17(8):870-875.
[1]Goncalves LF,Lee W,Chaiworapongsa T,et al.Four-dimensional ultrasonography of the fetal heart with spatio-temporal image correlation. Am J Obstet Gynecol.2003; 189(6):1792-1802.
[2]Yagel S,Cohen SM.3D and 4D ultrasound in fetal cardiac scanning:a new look at the fetal heart.Ultrasound Obstet Gynecol.2007;29(1):81-95.
[3]Paladini D,Vassallo M.The role of spatio-temporal image correlation(STIC) with tomographic ultrasound imaging(TUI) in the sequential analysis of fetal congenital heart disease.Ultrasound Obstet Gynecol.2006;27(5):555-561.
[4]Nelson TIL Pretorius DH,Sklansky M,et al.Three-dimensional echocardiographic evaluation of fetal heart anatomy and function:acquisition,analysis,and display.J Ultrasound Med.1996;15(1):1-9.
[5]Deane C.Extended field-of-view and B-flow ultrasound:fashion or future? Ultrasound Obstet Gynecol.2000;15(2):96-97.
[6]Pooh RK Korai A.B-flow and B-flow spatio-temporal image correlation in visualizing fetal cardiac blood flow.Croat Med J.2005;46(5):808-811.
[7]DeVore GR,Falkensammer P,Sklansky MS,et al.Spatio-temporal image correlation(STIC):new technology for evaluation of the fetal heart.Ultrasound Obstet Gynecol.2003;22(4):380-387.
[8]Yagel S,Benachi A,Bonnet D,et al.Rendering in fetal cardiac scanning:the intracardiac septa and the coronal atrioventricular valve planes. Ultrasound Obstet Gynecol.2006;28(3):266-274.
[9]Chaoui R,Hoffmann J,Heling KS.Three-dimensional(3D)and 4D color Doppler fetal echocardiography using spatio-temporal image correlation(STIC).Ultrasound Obstet Gynecol.2004; 23(6):535-545.
[10]Espinoza J,Goncalves LF,Lee W,et al.The use of the minimum projection mode in 4-dimensional examination of the fetal heart with spatiotemporal image correlation.J Ultrasound Med.2004;23(10):1337-1348.
[11]Sklansky M.Advances in fetal cardiac imaging.Pediatr Cardiol.2004;25(3):307-321.
[12]DeVore GR,Polanco B,Sklansky MS,et al.The'spin'technique:a new method for examination of the fetal outflow tracts using three-dimensional ultrasound.Ultrasound Obstet Gynecol.2004;24(1):72-82.
[13]Yagel S, Benachi A,et al.Rendering in fetal cardiac scanning:the intracardiac septa and the coronal atrioventricular valve planes.Ultrasound Obstet Gynecol. 2006;28(3):266-274.
[14]Van den Bosch AE,Ten Harkel DJ,McGhie JS,et al.Surgical validation of real-time transthoracic 3D echocardiographic assessment of atrioventricular septal defects.Int J Cardiol.2006; 112(2):213-218.
[15]Rizzo G Capponi A Vendola M et al.Role of tomographic ultrasound imaging with spatiotemporal image correlation for identifying fetal ventricular septal defects.J Ultrasound Med.2008;27(7):1071-1075.
[16]Devore GR,Polanko B.Tomographic ultrasound imaging of the fetal heart:a new technique for identifying normal and abnormal cardiac anatomy.J Ultrasound Med. 2005;24(12):1685-1696.
[17]Espinoza J,Goncalves LF,Lee W,et al.The use of the minimum projection mode in 4-dimensional examination of the fetal heart with spatiotemporal image correlation.J Ultrasound Med.2004;23(10):1337-1348.
[18]Chaoui R,Hoffmann J,Heling KS.Three-dimensional(3D)and 4D color Doppler fetal echocardiography using spatio-temporal image correlation(STIC).Ultrasound Obstet Gynecol.2004;23(6):535-545.
[19]Chaoui R,Schneider MB,Kalache KD. Right aortic arch with vascular ring and aberrant left subclavian artery.-prenatal diagnosis assisted by three-dimensional power Doppler ultrasound.Ultrasound Obstet Gynecol.2003;22(6):661-663.
[20]Espinoza J, Goncalves LF,Lee W,et al. A novel method to improve prenatal diagnosis of abnormal systemic venous connections using three and four-dimensional ultrasonography and inversion mode.Ultrasound Obstet Gynecol. 2005;25(5):428-434.
[21]Goncalves LF,Espinoza J,Lee W,et al.A new approach to fetalechocardiography:digital casts of the fetal cardiac chambers and great vessels for detection of congenital heart disease.J Ultrasound Med.2005;24(4):415-424.
[22]Paladini D,Volpe P,Sglavo G,et al.Transposition of the great arteries in the fetus:assessment of the spatial relationships of the arterial trunks by four-dimensional echocardiography.Ultrasound Obstet Gynecol.2008;31(3):27 1-276.
[23]Pooh RK, Korai A.B-flow and B-flow spatio-temporal image correlation in visualizing fetal cardiac blood flow. Croat Med J.2005;46(5):808-811.
[24]Hata T,Dai SY,Inubashiri E et al.Four-dimensional sonography with B-flow imaging and spatiotemporal image correlation for visualization of the fetal heart.J Clin Ultrasound.2008; 36(4):204-207.
[25]Yagel S, Valsky DV,Messing B.Detailed assessment of fetal ventricular septai defect with 4D color Doppler ultrasound using spatio—temporal image correlation technology.Ultrasound Obstet Gynecol.2005;25(1):97-98.
[26]Yagel S,Benachi A,Bonnet D,et al.Rendering in fetal cardiac scanning:the intracardiac septa and the coronal atrioventricular valve planes.Ultrasound Obstet Gynecol.2006;28(3):266-274.
[27]Sklansky MS, DeVore GR, Wong PC. Real-time 3-dimensional fetal echocardiography with an instantaneous volume-rendered display:early description and pictorial essay. J Ultrasound Med.2004; 23(2):283-289.
[28]Espinoza J, Goncalves LF, Lee W, et al. The use of the minimum projection mode in 4-dimensional examination of the fetal heart with spatiotemporal image correlation.J Ultrasound Med,2004; 23(10):1337-1348.
[29]Meyer-Wittkopf M, Cole A, Cooper SG, et al. Three-dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses and in fetuses with congenital heart disease. J Ultrasound Med.2001; 20(4):317-327.
[30]Uittenbogaard LB,Haak MC, Spreeuwenberg MD,et al.Fetal cardiac function assessed with four-dimensional ultrasound imaging usingspatiotemporal image correlation. Ultrasound Obstet Gynecol.2009;33(3):272-281.
[31]Rizzo G,Capponi A,Cavicchioni O,et al.Fetal cardiac stroke volume determination by four-dimensional ultrasound with spatio-temporal imagecorrelation compared with two-dimensional and Doppler ultrasonography.Prenat Diagn.2007; 27(12):1147-1150.
[32]Messing B,Cohen SM,Valsky DV,et al.Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode.Ultrasound Obstet Gynecol.2007;30:142-151.
[33]Vinals F, Poblete P, Giuliano A. Spatio-temporal image correlation (STIC):a new tool for the prenatal screening of congenital heart defects. Ultrasound Obstet Gynecol.2003;22(4):388-394.
[2]Schmidt KQ Silverman NH, Hoffman JIE. Determination of ventricular volumes in human fetal hearts by 2D echocardiography.Am J Cardiol.1995;76(17):1313-1316.
[3]Schmidt KG, Silverman NH,Van Hare GF, et al.Two-dimensional echocardiographic determination of ventricular volumes in the fetal heart.Validation studies in fetal lambs.Circulation.1990;81(1):325-333.
[4]Goncalves LF,Espinoza J,Romero R,et al.Four-dimensional ultrasonography of the fetal heart using a novel Tomogrphic Ultrasound imaging disply. J Periant Med.2006;34(1):39-55.
[5]Simpson JM,Cook A.Repeatability of echocardiographic measurements in the human fetus.Ultrasound Obstet Gynecol.2002;20(4):332-339.
[6]Meyer-Wittkopf M, Cole A, Cooper SG, et al. Three-dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses and in fetuses with congenital heart disease. J Ultrasound Med.2001;20(4):317-327.
[7]Bhat AH,Corbett VN, Liu R,et al. Validation of volume and mass assessments for human fetal heart imaging by 4-dimensional spatio-temporal image correlation echocardiography:in vitro balloon model experiments.J Ultrasound Med.2004;23(9):1151-1159.
[8]Uittenbogaard LB, Haak MC, Spreeuwenberg MD, et al.Fetal cardiac function assessed with four-dimensional ultrasound imaging using spatiotemporal image correlation.Ultrasound Obstet Gynecol.2009; 33(3):272-281.
[9]Rizzo G, Capponi A, Cavicchioni O, et al.Fetal cardiac stroke volume determination by four-dimensional ultrasound with spatio-temporal imagecorrelation compared with two-dimensional and Doppler ultrasonography.Prenat Diagn.2007; 27(12):1147-1150.
[10]Molina FS, Faro C, Sotiriadis A, Dagklis T,et al.Heart stroke volume and cardiac output by four-dimensional ultrasound in normal fetuses.Ultrasound Obstet Gynecol.2008; 32(2): 181-187.
[11]Messing B,Cohen SM,Valsky DV.et al.Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode.Ultrasound Obstet Gynecol.2007;30(2):142-151.
[12]Atkins BZ,Kuo J,Shah AS,et al.Real-time three-dimensional echocardiography to construct clinically ready,load-independent indices of myocardial contractile performance.J Am Soc Echocardiogr.2003; 16(9):922-930.
[13]赵博文,姜卫香,杨园.等.时间-空间相关成像技术评价胎儿心脏形态结构的初步研究.中国超声医学杂志,2007(2)：145-147.
[14]刘涛,吴瑛,熊奕.等.动态正交三平面法在胎儿心脏节段分析中的应用.中国超声医学杂志,2007.23(8)：615-617.
[15]Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet.1986; 1 (8476):307-310.
[16]Bland JM,AltmanDG.Measurement error proportional to mean.BMJ.1996;313(7049):106.
[17]Shi JC,Chen CP.Spatio-temporal image correlation(STIC):innovative 3D/4D technique for ustrating unique and independent information and diagnosing complex congenital heart diseases. Croat Med J.2005;46(5):812-820.
[18]Goncalves LF,Espinoza J,Romero R,et al.Four dimensional fetalechOcardiOgraphy with spatiotemporal im age correlation(STIC):a systematic study of standard cardiac views assessed by different observers.Matern Fetal Neonatal Med.2005;17(5):323-331.
[19]Pooth RK,Korai A.B flow and B-flow Spatio-temporal image correlation in visualizing fetal cardiac blood flow.Croat Med J.2005,46(5):808-811.
[20]Gonealves LF,Lee W,Chaiworapongsa T,et al.Four-dimensional uhrasonography of the fetal heaa with spatio-temporal image correlation.Am J Obstet Gynecol.2003;189(6):1792-1802.
[21]DeVore GR,Falkensammer P,Sklansky MS,et al.Spatio-temporal image correlation(STIC):new technology for evaluation of the fetal heart.Ultrasound Obstet Gynecol.2003;22(4):380-387.
[22]Li X,Jones M,Irvine T,et al.Real-time 3-dimensional echocardiography for quantification of the difference in left ventricular versus right ventricular stroke volume in a chronic animal model study:Improved results using C-scans for quantifying aortic regurgitation.J Am Soc Echecardiogr.2004;17(8):870-875.
[1]Goncalves LF,Lee W,Chaiworapongsa T,et al.Four-dimensional ultrasonography of the fetal heart with spatio-temporal image correlation. Am J Obstet Gynecol.2003; 189(6):1792-1802.
[2]Yagel S,Cohen SM.3D and 4D ultrasound in fetal cardiac scanning:a new look at the fetal heart.Ultrasound Obstet Gynecol.2007;29(1):81-95.
[3]Paladini D,Vassallo M.The role of spatio-temporal image correlation(STIC) with tomographic ultrasound imaging(TUI) in the sequential analysis of fetal congenital heart disease.Ultrasound Obstet Gynecol.2006;27(5):555-561.
[4]Nelson TIL Pretorius DH,Sklansky M,et al.Three-dimensional echocardiographic evaluation of fetal heart anatomy and function:acquisition,analysis,and display.J Ultrasound Med.1996;15(1):1-9.
[5]Deane C.Extended field-of-view and B-flow ultrasound:fashion or future? Ultrasound Obstet Gynecol.2000;15(2):96-97.
[6]Pooh RK Korai A.B-flow and B-flow spatio-temporal image correlation in visualizing fetal cardiac blood flow.Croat Med J.2005;46(5):808-811.
[7]DeVore GR,Falkensammer P,Sklansky MS,et al.Spatio-temporal image correlation(STIC):new technology for evaluation of the fetal heart.Ultrasound Obstet Gynecol.2003;22(4):380-387.
[8]Yagel S,Benachi A,Bonnet D,et al.Rendering in fetal cardiac scanning:the intracardiac septa and the coronal atrioventricular valve planes. Ultrasound Obstet Gynecol.2006;28(3):266-274.
[9]Chaoui R,Hoffmann J,Heling KS.Three-dimensional(3D)and 4D color Doppler fetal echocardiography using spatio-temporal image correlation(STIC).Ultrasound Obstet Gynecol.2004; 23(6):535-545.
[10]Espinoza J,Goncalves LF,Lee W,et al.The use of the minimum projection mode in 4-dimensional examination of the fetal heart with spatiotemporal image correlation.J Ultrasound Med.2004;23(10):1337-1348.
[11]Sklansky M.Advances in fetal cardiac imaging.Pediatr Cardiol.2004;25(3):307-321.
[12]DeVore GR,Polanco B,Sklansky MS,et al.The'spin'technique:a new method for examination of the fetal outflow tracts using three-dimensional ultrasound.Ultrasound Obstet Gynecol.2004;24(1):72-82.
[13]Yagel S, Benachi A,et al.Rendering in fetal cardiac scanning:the intracardiac septa and the coronal atrioventricular valve planes.Ultrasound Obstet Gynecol. 2006;28(3):266-274.
[14]Van den Bosch AE,Ten Harkel DJ,McGhie JS,et al.Surgical validation of real-time transthoracic 3D echocardiographic assessment of atrioventricular septal defects.Int J Cardiol.2006; 112(2):213-218.
[15]Rizzo G Capponi A Vendola M et al.Role of tomographic ultrasound imaging with spatiotemporal image correlation for identifying fetal ventricular septal defects.J Ultrasound Med.2008;27(7):1071-1075.
[16]Devore GR,Polanko B.Tomographic ultrasound imaging of the fetal heart:a new technique for identifying normal and abnormal cardiac anatomy.J Ultrasound Med. 2005;24(12):1685-1696.
[17]Espinoza J,Goncalves LF,Lee W,et al.The use of the minimum projection mode in 4-dimensional examination of the fetal heart with spatiotemporal image correlation.J Ultrasound Med.2004;23(10):1337-1348.
[18]Chaoui R,Hoffmann J,Heling KS.Three-dimensional(3D)and 4D color Doppler fetal echocardiography using spatio-temporal image correlation(STIC).Ultrasound Obstet Gynecol.2004;23(6):535-545.
[19]Chaoui R,Schneider MB,Kalache KD. Right aortic arch with vascular ring and aberrant left subclavian artery.-prenatal diagnosis assisted by three-dimensional power Doppler ultrasound.Ultrasound Obstet Gynecol.2003;22(6):661-663.
[20]Espinoza J, Goncalves LF,Lee W,et al. A novel method to improve prenatal diagnosis of abnormal systemic venous connections using three and four-dimensional ultrasonography and inversion mode.Ultrasound Obstet Gynecol. 2005;25(5):428-434.
[21]Goncalves LF,Espinoza J,Lee W,et al.A new approach to fetalechocardiography:digital casts of the fetal cardiac chambers and great vessels for detection of congenital heart disease.J Ultrasound Med.2005;24(4):415-424.
[22]Paladini D,Volpe P,Sglavo G,et al.Transposition of the great arteries in the fetus:assessment of the spatial relationships of the arterial trunks by four-dimensional echocardiography.Ultrasound Obstet Gynecol.2008;31(3):27 1-276.
[23]Pooh RK, Korai A.B-flow and B-flow spatio-temporal image correlation in visualizing fetal cardiac blood flow. Croat Med J.2005;46(5):808-811.
[24]Hata T,Dai SY,Inubashiri E et al.Four-dimensional sonography with B-flow imaging and spatiotemporal image correlation for visualization of the fetal heart.J Clin Ultrasound.2008; 36(4):204-207.
[25]Yagel S, Valsky DV,Messing B.Detailed assessment of fetal ventricular septai defect with 4D color Doppler ultrasound using spatio—temporal image correlation technology.Ultrasound Obstet Gynecol.2005;25(1):97-98.
[26]Yagel S,Benachi A,Bonnet D,et al.Rendering in fetal cardiac scanning:the intracardiac septa and the coronal atrioventricular valve planes.Ultrasound Obstet Gynecol.2006;28(3):266-274.
[27]Sklansky MS, DeVore GR, Wong PC. Real-time 3-dimensional fetal echocardiography with an instantaneous volume-rendered display:early description and pictorial essay. J Ultrasound Med.2004; 23(2):283-289.
[28]Espinoza J, Goncalves LF, Lee W, et al. The use of the minimum projection mode in 4-dimensional examination of the fetal heart with spatiotemporal image correlation.J Ultrasound Med,2004; 23(10):1337-1348.
[29]Meyer-Wittkopf M, Cole A, Cooper SG, et al. Three-dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses and in fetuses with congenital heart disease. J Ultrasound Med.2001; 20(4):317-327.
[30]Uittenbogaard LB,Haak MC, Spreeuwenberg MD,et al.Fetal cardiac function assessed with four-dimensional ultrasound imaging usingspatiotemporal image correlation. Ultrasound Obstet Gynecol.2009;33(3):272-281.
[31]Rizzo G,Capponi A,Cavicchioni O,et al.Fetal cardiac stroke volume determination by four-dimensional ultrasound with spatio-temporal imagecorrelation compared with two-dimensional and Doppler ultrasonography.Prenat Diagn.2007; 27(12):1147-1150.
[32]Messing B,Cohen SM,Valsky DV,et al.Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode.Ultrasound Obstet Gynecol.2007;30:142-151.
[33]Vinals F, Poblete P, Giuliano A. Spatio-temporal image correlation (STIC):a new tool for the prenatal screening of congenital heart defects. Ultrasound Obstet Gynecol.2003;22(4):388-394.