孕12至32周正常胎儿的肺和心脏容积的三维超声测量

Lung and heart volumes by three-dimensional ultrasound in normal fetuses at 12-32 weeks' gestation.

作者信息

Peralta C F A, Cavoretto P, Csapo B, Falcon O, Nicolaides K H

机构信息

Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK.

出版信息

Ultrasound Obstet Gynecol. 2006 Feb;27(2):128-33. doi: 10.1002/uog.2670.

DOI:10.1002/uog.2670

PMID:16388511

Abstract

OBJECTIVE

To establish reference intervals for the fetal right, left and total lung volumes and heart volume between 12 and 32 weeks of gestation.

METHODS

Fetal lung and heart volumes were measured using three-dimensional (3D) ultrasound in 650 normal singleton pregnancies at 12-32 weeks. The VOCAL (Virtual Organ Computer-aided AnaLysis) technique was used to obtain a sequence of six sections of each lung and the heart around a fixed axis, each after a 30 degrees rotation from the previous one. The rotation axis for the lungs extended from the apex to the upper limit of the diaphragm dome, and the rotation axis for the heart extended from its apex to its connection to the great vessels. The contour of each of these organs was drawn manually in the six different rotation planes to obtain the 3D volume measurement. In 60 cases the fetal lungs and heart volumes were measured by the same sonographer twice and also by a second sonographer once in order to compare the measurements and calculate intra- and interobserver agreement.

RESULTS

The total lung volume and heart volume increased with gestation, from respective mean values of 1.6 and 0.6 mL at 12 weeks to 10.9 and 4.3 mL at 20 weeks and 49.3 and 26.6 mL at 32 weeks. The right to left lung volume ratio did not change significantly with gestation (median, 0.7), whereas the heart to total lung volume ratio increased with gestation from about 0.3 at 12 weeks to 0.5 at 32 weeks. In the Bland-Altman plot, the difference between paired measurements by two sonographers was, in 95% of the cases, less than 0.05, 0.5 and 1.9 mL for each lung at 12-13, 19-22 and 29-32 weeks, respectively, and the corresponding values for the heart volumes were 0.04, 0.4 and 2.3 mL.

CONCLUSIONS

In normal fetuses the lung and heart volumes increase between 12 and 32 weeks of gestation. The extent to which in pathological pregnancies possible deviations in these measurements from normal prove to be useful in the prediction of outcome remains to be determined.

摘要

目的

建立妊娠12至32周胎儿右肺、左肺及全肺体积和心脏体积的参考区间。

方法

采用三维（3D）超声对650例妊娠12 - 32周的正常单胎妊娠胎儿的肺和心脏体积进行测量。使用VOCAL（虚拟器官计算机辅助分析）技术，围绕固定轴获取每个肺和心脏的六个截面序列，每个截面相对于前一个截面旋转30度。肺的旋转轴从肺尖延伸至膈肌穹窿的上限，心脏的旋转轴从心尖延伸至其与大血管的连接处。在六个不同的旋转平面上手动绘制这些器官的轮廓，以获得三维体积测量值。在60例病例中，由同一位超声检查医师对胎儿肺和心脏体积进行两次测量，并由另一位超声检查医师进行一次测量，以比较测量结果并计算观察者内和观察者间的一致性。

结果

全肺体积和心脏体积随孕周增加而增大，12周时平均值分别为1.6 mL和0.6 mL，20周时为10.9 mL和4.3 mL，32周时为49.3 mL和26.6 mL。右肺与左肺体积比随孕周无显著变化（中位数为0.7），而心脏与全肺体积比随孕周从12周时约0.3增加至32周时0.5。在Bland - Altman图中，两位超声检查医师的配对测量差异在12 - 13周、19 - 22周和29 - 32周时，95%的病例中每个肺的差异分别小于0.05 mL、0.5 mL和1.9 mL，心脏体积的相应值分别为0.04 mL、0.4 mL和2.3 mL。