多切面多角度二维显像结合CDFI血流参数动态调节在胎儿单纯性室间隔缺损中的诊断价值及漏诊原因分析OACSTPCD

Objective:To explore the diagnostic value of multi-slice and multi-angle two-dimensional imaging combined with dynamic adjustment of color Doppler flow imaging(CDFI)blood flow parameters in isolated ventricular septal defect(i-VSD)in fetuses,and to analyze the reasons for missed diagnosis.Methods:A total of 5000 pregnant women admitted to our hospital from May 2019 to June 2023 were selected for examination.143 pregnant women suspected of i-VSD were selected as the study subjects,all of whom underwent multi-section and multi-angle two-dimensional imaging and CDFI examination.They were divided into a non-matching group(31 cases)and a matching group(112 cases)based on postpartum results.The clinical data of two groups were compared.A multiple Logistic regression model was employed to analyze the influencing factors of missed diagnosis of fetal i-VSD using multi-slice,multi-angle,real-time two-dimensional imaging combined with CDFI blood flow parameters,and the diagnostic effectiveness of the model was evaluated using ROC curves and calibration curves.Results:143 fetuses were suspected of i-VSD.The accuracy of postpartum diagnosis was 85.31％,sensitivity was 88.79％,specificity was 70.37％,positive predictive value was 92.79％,and negative predictive value was 59.38％.The consistency test of prenatal and postpartum examination results showed that the combination of multi-slice real-time two-dimensional imaging and CDFI blood flow parameters showed good consistency with postpartum examination results.There were statistically significant differences between the eligible and non eligible groups in terms of age,body mass,medication history in early pregnancy,family history of heart disease,number of prenatal examinations,amniotic fluid status,abdominal wall scars,medical examination experience,clinical classification,and defect diameter(P＜0.05).The results of multiple Logistic stratified regression analysis showed that age,body mass,amniotic fluid status,abdominal wall scar,clinical classification,and defect diameter were independent risk factors for missed diagnosis of fetal i-VSD using multi-slice and multi-angle two-dimensional imaging combined with CDFI blood flow parameters(P＜0.05),and a predictive model was constructed,ROC curves showed that the AUC of the model was 0.885(95％CI:0.810-0.903),sensitivity was 87.2％,and specificity was 79.8％,indicating that the model had high discrimination,and the calibration curve indicated that the prediction model had good accuracy.Conclusion:Multi-section and multi-angle two-dimensional imaging combined with CDFI blood flow parameters can improve the diagnostic accuracy of i-VSD,while age,body mass,amniotic fluid condition,abdominal wall scar,clinical classification,and defect diameter can all affect the examination results.Therefore,it is necessary to strengthen the examination frequency for pregnant women with the above characteristics to reduce the risk of missed diagnosis of fetal i-VSD.