背景 心臟是一立體且持續跳動之立體器官，因此以即時三度空間(四度空間)方式最能直接描述心臟的動態構造。但以M-mode及real-time 2D模式 檢查時檢查者須時檢查者須依據不同角度的切面變換在腦?組合後判斷出病灶類型，這對於複雜性的先天心臟決陷立體結構及與附近構造的相關性資料常顯不足；本研究利用新引進之即時三度空間超音波掃描儀探討即時三度空間超音波掃描對複雜性的先天心臟病診斷的臨床實用性。方法 於2003年2月至2003年4月間共選取4類共18位複雜性先天性心臟患者(包含4例右心室雙出口、5例法洛氏四合症、四例肺動脈閉鎖合併完整心室中隔、5例單一心室；年齡：10天至12歲；體重：2.5至50公斤)以新引進之Philips SONOS 7500超波掃描儀及陣列式探頭進行掃描，並包含兩種掃描模式：即時扇形三度空間超音波影像掃描(RT-3D)及全影像模式(full-volume)兩種。探討此影像系統對這類患者心臟內部病灶解析與診斷能力。並與傳統二維影像超音波作臨床應用之比較。結果 所有18位複雜性先天性心臟患者皆成的完成掃描；即時三度空間超音波(RT-3D)與二維超音波(2D)檢查花費時間為11.4±1.4與12.8±1.9分鐘(p<0.01)；而此兩種影像檢查模式能正確診斷內臟位置人數分別為17 (94.4%)與16(88.9%)人、正確診斷腔靜脈-心房、心房-心室、心室-大動脈連接關位置的人數分別為14(77.8%)與13(72.2%), 17(94.4%)與16(88.9)及18(100%)與18(100%)人；正確診斷三尖瓣的人數分別為13(72.2%)與10(55.6%)人(p = 0.17). 每位患者也成的取得清晰的全影像(full-volume)，並於每類病患取一例影像做切面展示並分析其病灶與心臟內部結構的立體位置關系。結論 以本研究所使用之超音波掃描儀已能達到真正即時之立體結構掃描同時做出診斷的功能;同時也使檢查者能直覺並很容易的了解心臟內複雜的立體結構關係，因此此二維影像能提供更多諸如手術計劃所需的資訊。足夠的解析度及操作的便利性已使掃描接近實際臨床應用的階段。

Background. As a beating organ in the human body, the structure and motion of the heart can be depicted best with real-time 3-dimensional (RT-3D) image modality. Traditional M-mode and real-time two-dimensional (2D) echocardiography can be used for diagnosis of complex congenital heart defects, but with these modalities, the type of lesion and its complexity can only be appreciated indirectly, after composition of plane sections of different angles in mind. This study utilized the newly invented echocardiography platform for RT-3D scanning in selected patients with congenital heart diseases and evaluated its clinical applications in those patients. Materials and Methods. Between February 2003 and April 2003, totally 18 patients of 4 different categories of diagnoses (4 cases with double-outlet right ventricle, 5 cases with tetralogy of Fallot, 4 cases with pulmonary atresia and intact ventricular sepum and 5 cases with single ventricle) were enrolled in this study. Scanning in these patients was performed with 2D scanner then the Philips SONOS 7500 system equipped with an Matrix probe. Their ages ranged from 10 days to 12 years, and the body weight ranged from 2.5 to 50 kilograms. Two modes of scanning were used in this study to evaluate the feasibility for diagnosis and analysis of the complex lesions in our patients. Comparison of clinical usefulness was also made with 2D echocardiography. Results. The time spent for RT-3D scanning (11.4±1.4 min.) was significantly less than that for 2D platform (12.8±1.9 min.) ( p ＜ 0.01). Visceral situs was confirmed in 17 (94.4%) patients with the RT-3D platform and 16 (88.9%) patients with the 2D platform. Cardiac connections were analyzed segmentally, and 14 (77.8%) vs 13 (72.2%), 17 (94.4%) vs 16 (88.9), and 18 (100%) vs 18 (100%) patients were confirmed in their venoatrial, atrioventricular, and ventriculoarterial connections, respectively. Difference was found in confirmation of tricuspid and mitral valves in 13 (72.2%) and 10 (55.6%) with RT-3D and 2D platforms, respectively. One full-volume data set in each of 4 patient groups was used to analyze the 3D relationship of the complex lesions and their surrounding structures, and was demonstrated in this study. Conclusion: The capability of the new RT-3D system for fast, accurate diagnosis of complex congenital heart lesions was demonstrated in this study. Meanwhile, with the RT-3D system, the examiner can delineate the complex intracardiac morphology and 3D relationships easily and intuitively. More clinical information can be derived from the new system, including that which is required for planning surgery. Improvement in image resolution and operation procedure has made this RT-3D scanning system ready for practically clinical application.