日本新生児成育医学会雑誌　第32巻　第1号　149 ～ 160頁（2020年）

日本新生児成育医学会雑誌　32(1)：149-160；2020　

受付日：2019．03．19

受理日：2019．09．11

早産児の3 次元心臓超音波検査―検者間誤差改善への取り組み

Interobserver Agreement and Quality Improvement of the Measurements of Three-Dimensional Echocardiography in Preterm Infant

＊1 神奈川県立こども医療センター　新生児科，＊2 独立行政法人国立病院機構三重中央医療センター　新生児科，＊3 安城更生病院　新生児科，＊4 静岡県立こども病院　循環器科，＊5 埼玉医科大学総合医療センター総合周産期母子医療センター　小児循環器部門

＊1 Department of Neonatology, Kanagawa Children’s Medical Center，＊2 Department of Neonatology, National Hospital Organization Mie Chuo Medical Center，＊3 Department of Neonatology, Anjo Kosei Hospital，＊4 Department of Cardiology, Shizuoka Children’s Hospital，＊5 Pediatric Cardiology, Saitama Medical Center, Saitama Medical University

神谷雄作＊1＊2・五十里　東＊1＊3・植田由依＊1＊4・増谷　聡＊5・豊島勝昭＊1

Yusaku KAMIYA＊1＊2，Azuma IKARI＊1＊3，Yui UEDA＊1＊4，Satoshi MASUTANI＊5，Katsuaki TOYOSHIMA＊1

Key Words：newborn infant，premature infant，3-dimensional echocardiography，ventricular volume，interobserver agreement

3 次元心臓超音波検査は短時間に心全体の挙動を把握でき，早産児の循環管理へ応用が期待される。早産児における3 次元心臓超音波検査のInterobserver agreement を検討した。同一検者が記録した極低出生体重児の3 次元心臓超音波検査を対象に，小児科医2 名が同一解析ソフトを用い心室容積の複数のパラメータを独立して測定した。初回測定で検者間の相関係数は弱い相関関係を示した。解析方法を統一し再解析を行うと，相関係数は左室拡張末期容積：0.46 → 0.74，左室一回拍出量：0.65 → 0.90，右室拡張末期容積：0.47 → 0.68，右室一回拍出量：0.53 → 0.72 と前回より強い相関関係を認めた。解析方法を統一すれば，3 次元心臓超音波検査により早産児の心室容積を再現性よく測定できる可能性がある。

Background：Three-dimensional echocardiography（ 3DE） provides total heart motion and function in a short period and thus can become a useful evaluation tool in early preterm management. However, interobserver agreement analysis of 3DE in preterm infants has not been reported.
Methods：We conducted this study to perform interobserver agreement analysis of 3DE in preterm infants and to assess the feasibility of 3DE analysis by neonatologists. Two independent pediatricians, each having only 1 month experience in 3DE analysis, analyzed 21 3DE datasets of a preterm infant that had been obtained by a single, experienced echocardiographer. Ventricular and stroke volume of those datasets were quantified.
Results：Correlation coefficients among analysts were as low as 0.46 for left ventricular end-diastolic volume（ LVEDV）, 0.65 for LV stroke volume（ LVSV）, 0.47 for right ventricular EDV（ RVEDV）, and 0.53 for RV stroke volume（ RVSV）. After we further unified the means of identifying the ventricular cavity border and position of the valves, correlation coefficients improved to 0.74 for LVEDV, 0.90 for LVSV, 0.68 for RVEDV, and 0.72 for RVSV. Improvement of interobserver agreement was also confirmed by reduced 95％ limits of the agreement obtained by Bland-Altman analysis.
Conclusion：Even pediatricians with little experience in 3DE analysis are able to quantify ventricular and stroke volume with acceptable interobserver agreement by unifying the analysis methodology.