Hernandez-Andrade E, Jansson T, Figueroa-Diesel H, Rangel-Nava H, Acosta-Rojas R, Gratacós E
Department of Obstetrics, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clínic and Fetal and Perinatal Medicine Group, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Spain.
Ultrasound Obstet Gynecol. 2007 May;29(5):556-61. doi: 10.1002/uog.4005.
To standardize the evaluation of regional fetal brain blood perfusion, using power Doppler ultrasound (PDU) to estimate the fractional moving blood volume (FMBV) and to evaluate the reproducibility of this estimation.
Brain blood perfusion was evaluated in 35 normally grown fetuses at 28-30 weeks of gestation, using PDU. The following cerebral regions were included in the PDU color box: anterior sagittal, complete sagittal, basal ganglia, and cerebellar. Ten consecutive good-quality images of each anatomical plane were recorded and the delimitation of the region of interest (ROI) was performed off-line. FMBV was quantified in the ROI of all images and the mean considered as the final value. Differences between regions, variability, reproducibility and agreement between observers were assessed.
Power Doppler images of the described anatomical planes were obtained in all cases, regardless of fetal position. The median time for the acquisition of the images was 7 (range 4-12) min. Mean (range) FMBV values were: anterior sagittal, 16.5 (10.7-22.8)%, inter-patient coefficient of variation (CV) 0.22; complete sagittal, 13.5 (8.8-16.1)%, CV 0.27; basal ganglia, 18.3 (10.7-27.6)%, CV 0.27; and cerebellar, 6.6 (3.0-11.0)%, CV 0.38. There were statistically significant differences in FMBV between cerebellar and complete sagittal ROIs with the frontal and basal ganglia regions. Reproducibility analyses showed an intraclass correlation coefficient of 0.91 (95% CI 0.67-0.97) and an interclass correlation coefficient of 0.87 (95% CI 0.70-0.94). Interobserver agreement showed a mean difference between observers of -0.2 (SD 2.7) with 95% limits of agreement -5.6 to 5.2.
When the regions of interest are well defined, the FMBV estimate offers a method to quantify blood flow perfusion in different fetal cerebral areas. There appear to be regional differences in FMBV within the fetal brain.
规范区域胎儿脑血流灌注的评估，使用能量多普勒超声（PDU）估计移动血容量分数（FMBV）并评估该估计值的可重复性。
在35例孕28 - 30周正常生长的胎儿中，使用PDU评估脑血流灌注。PDU彩色框包括以下脑区：矢状面前部、完整矢状面、基底神经节和小脑。记录每个解剖平面连续10张高质量图像，并离线进行感兴趣区域（ROI）的划定。对所有图像的ROI进行FMBV定量，取平均值作为最终值。评估各区域之间的差异、变异性、可重复性以及观察者之间的一致性。
无论胎儿体位如何，所有病例均获得了上述解剖平面的能量多普勒图像。图像采集的中位时间为7（范围4 - 12）分钟。平均（范围）FMBV值为：矢状面前部，16.5（10.7 - 22.8）%，患者间变异系数（CV）0.22；完整矢状面，13.5（8.8 - 16.1）%，CV 0.27；基底神经节，18.3（10.7 - 27.6）%，CV 0.27；小脑，6.6（3.0 - 11.0）%，CV 0.38。小脑与完整矢状面ROI与额叶和基底神经节区域之间的FMBV存在统计学显著差异。可重复性分析显示组内相关系数为0.91（95%CI 0.67 - 0.97），组间相关系数为0.87（95%CI 0.70 - 0.94）。观察者间一致性显示观察者之间的平均差异为 - 0.2（标准差2.7），95%一致性界限为 - 5.6至5.2。
当感兴趣区域定义明确时，FMBV估计提供了一种量化不同胎儿脑区血流灌注的方法。胎儿脑内FMBV似乎存在区域差异。
