Tanigaki Shinji, Miyakoshi Kei, Tanaka Mamoru, Hattori Yoshihisa, Matsumoto Tadashi, Ueno Kazunori, Uehara Katsuhiko, Nishimura Osamu, Minegishi Kazuhiro, Ishimoto Hitoshi, Shinmoto Hiroshi, Ikeda Kazushige, Yoshimura Yasunori
Dept of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan.
Radiology. 2004 Sep;232(3):767-72. doi: 10.1148/radiol.2323030359.
To determine the ratio of fetal lung volume (FLV) to fetal body weight (FBW) by using ultrasonography (US) and magnetic resonance (MR) imaging and to evaluate the usefulness of this ratio in predicting pulmonary hypoplasia (PH) in fetuses at high risk.
MR imaging lung volumetry and US biometry were performed in 90 fetuses at 25-39 weeks gestation. In the control group of 73 fetuses, normal lung development was confirmed at neonatal follow-up and the normative ratio of MR imaging-measured FLV to US-estimated FBW (FLV/FBW) was determined. The high-risk group included 17 fetuses at risk for PH. The FLV/FBW was compared between the control and high-risk groups and with US parameters for predicting the development of PH in the high-risk group. Measurements 2 or more standard deviations below the mean control group measurement were considered abnormal. Comparisons of the FLV/FBW between groups were made by using the Student t test. The association between development of PH and measurement of each parameter was analyzed by using the Fisher exact probability test.
In the control group, the FLV/FBW decreased with gestational age during the third trimester and had a normal distribution (mean ratio, 0.028 mL/g; range, 0.015-0.444 mL/g). The mean FLV/FBW for the nine fetuses with PH (0.012 mL/g +/- 0.008) was significantly lower (P <.001) than that for the control group (0.028 mL/g +/- 0.007). Fetuses with abnormal FLV/FBW values were at significantly greater risk (P <.05) for PH development. Abnormal FLV/FBW values had higher diagnostic accuracy than abnormal US parameters. Sensitivity of the FLV/FBW was 89% (eight of nine fetuses); specificity, 88% (seven of eight fetuses); positive predictive value, 89% (eight of nine fetuses); negative predictive value, 88% (seven of eight fetuses); and accuracy, 88% (15 of 17 fetuses).
The FLV/FBW reflects the adequacy of intrauterine lung growth and can help predict PH.
通过超声检查（US）和磁共振成像（MR）测定胎儿肺体积（FLV）与胎儿体重（FBW）的比值，并评估该比值在预测高危胎儿肺发育不全（PH）中的作用。
对90例孕25 - 39周的胎儿进行MR成像肺容积测量和US生物测量。在73例胎儿的对照组中，新生儿随访证实肺发育正常，并确定MR成像测量的FLV与US估计的FBW（FLV/FBW）的正常比值。高危组包括17例有PH风险的胎儿。比较对照组和高危组的FLV/FBW，并与预测高危组PH发展的US参数进行比较。低于对照组平均测量值2个或更多标准差的测量值被视为异常。采用Student t检验比较组间FLV/FBW。使用Fisher精确概率检验分析PH发展与各参数测量之间的关联。
在对照组中，FLV/FBW在孕晚期随孕周增加而降低，呈正态分布（平均比值为0.028 mL/g；范围为0.015 - 0.444 mL/g）。9例PH胎儿的平均FLV/FBW（0.012 mL/g ± 0.008）显著低于对照组（0.028 mL/g ± 0.007）（P <.001）。FLV/FBW值异常的胎儿发生PH的风险显著更高（P <.05）。异常的FLV/FBW值比异常的US参数具有更高的诊断准确性。FLV/FBW的敏感性为89%（9例胎儿中的8例）；特异性为88%（8例胎儿中的7例）；阳性预测值为89%（9例胎儿中的8例）；阴性预测值为88%（8例胎儿中的7例）；准确性为88%（17例胎儿中的15例）。
FLV/FBW反映了宫内肺生长的充足程度，有助于预测PH。
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