Медицинская литература. Новинки

 

 

 

 

 

 

Системное последовательное исследование сердца плода в режимах трехмерной ультразвуковой визуализации. Часть 1. Многосрезовый режим

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Сердце плода является наиболее труднодоступным органом для ультразвукового исследования. Стандартное двумерное ультразвуковое исследование позволяет визуализировать только те сечения, которые получены в результате реального сканирования. Появившиеся относительно недавно трехмерные технологии дают возможность получать множество эхографических сечений – от стандартных поперечных, сагиттальных и коронарных до специфических косых, “выкроенных” для оценки определенных структур сердца. Однако менее опытные в трехмерной эхографической визуализации специалисты находят анализ взаимоотношения анатомически сложных сердечно''сосудистых структур в трехмерном пространстве несколько затрудненным. В данной статье мы представляем протокол исследования сердца плода в многосрезовом режиме, являющийся базовым в трехмерном ультразвуковом исследовании. Пошаговый анализ кардиального объема позволяет реконструировать такие диагностически информативные сечения сердца, как поперечные срезы (на уровне верхнего живота, 4-камерный срез, срез через три главных сосуда с бифуркацией легочного ствола, “V”''соединение аортальной дуги и артериального протока), косые срезы (левый и правый желудочковые выходные тракты) и продольные срезы (через дугу аорты, артериальный проток и верхнюю и нижнюю поые вены), из одного кардиального объема, полученного на уровне базового 4''камерного среза.

Ключевые слова:
трехмерное ультразвуковое исследование, многосрезовый режим, сердце плода, эхокардиография плода.

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A Systematic Approach to Fetal Echocardiography Using Three-dimensional Sonography. Part 1. Multi-planar mode

Fetal heart is one of the most difficult organs to scan. Conventional two''dimensional cardiac examination has a limited post processing potential and can display only those images that visualized during the actual acquisition. Three-dimensional ultrasound acquires an image data set from a volume and allows multi''planar reformat, it gives us a freedom to recreate an infinite number of images in various planes ranging from the standard axial, sagittal, and coronal planes to the special oblique planes tailored for visualization of the specific regions of the heart. However, spatial and anatomical orientation during volume analysis appears difficult to less experienced operator. In this paper we introduce the standard post''processing protocol for evaluation of fetal cardiac anatomy using 3D multi''planar imaging. This step''by''step approach facilitates visualization of the basic and extended fetal cardiac planes that include the transverse view of the upper abdomen, 4-chamber view, 3 vessel view at the level of bifurcation of pulmonary trunk and “V”-sign confluence of cardiac arches, oblique planes of left and right ventricular outflow tracts and sagittal views of aortic and ductal arches and systemic venous return, reconstructed from the only one fetal cardiac volume acquired from the standard 4''chamber view.

Keywords:
three-dimensional ultrasound, multi-planar imaging, fetal heart, and fetal echocardiography.