Matsui Hikoro, Mellander Mats, Roughton Michael, Jicinska Hana, Gardiner Helena M
Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, Du Cane Rd, London, W12 0HS, UK.
Circulation. 2008 Oct 28;118(18):1793-801. doi: 10.1161/CIRCULATIONAHA.108.787598. Epub 2008 Oct 13.
Prenatal diagnosis of aortic coarctation suffers from high false-negative rates at screening and poor specificity.
This retrospective study tested the applicability of published aortic arch and ductal Z scores (measured just before the descending aorta in the 3-vessel and tracheal view) and their ratio on 200 consecutive normal controls at a median of 22+/-0 gestational weeks (range, 15+/-4 to 38+/-4 weeks). Second, this study tested the ability of serial Z scores to distinguish fetuses with coarctation within a cohort with ventricular and/or great arterial disproportion detected at screening or fetal echocardiography. Third, it evaluated the diagnostic significance of associated cardiac lesions, coarctation shelf, and isthmal flow disturbance. We studied 44 fetuses with suspected coarctation at 24+/-0 weeks (range, 17+/-3 to 37+/-4 weeks). Receiver-operating characteristic curves were created. Logistic regression tested the association between z scores, additional cardiac diagnoses, and coarctation. Good separation was found of isthmal Z scores for cases requiring surgery from controls and false-positive cases, and receiver-operating characteristic curves showed an excellent area under the curve for isthmal Z score (0.963) and isthmal-to-ductal ratio (0.969). Serial isthmal Z scores improved to >-2 in suspected cases with normal outcomes; those requiring surveillance or surgery remained <-2. Minor lesions did not increase the diagnostic specificity of coarctation, but isthmal flow disturbance increased the odds ratio of true coarctation versus arch hypoplasia 16-fold.
Isthmal Z scores and isthmal-to-ductal ratio are sensitive indicators of fetal coarctation. Serial measurements and abnormal isthmal flow patterns improve diagnostic specificity and may reduce false positives.
主动脉缩窄的产前诊断在筛查时假阴性率高且特异性差。
这项回顾性研究测试了已发表的主动脉弓和导管Z值（在三血管和气管视图中降主动脉之前测量）及其比值在200例连续正常对照中的适用性，这些对照的孕周中位数为22±0周（范围为15±4至38±4周）。其次，本研究测试了连续Z值区分在筛查或胎儿超声心动图中检测到心室和/或大动脉不对称的队列中患有缩窄的胎儿的能力。第三，评估了相关心脏病变、缩窄嵴和峡部血流紊乱的诊断意义。我们研究了44例在24±0周（范围为17±3至37±4周）疑似缩窄的胎儿。绘制了受试者操作特征曲线。逻辑回归测试了Z值、额外的心脏诊断和缩窄之间的关联。发现对于需要手术的病例与对照和假阳性病例，峡部Z值有良好的区分，受试者操作特征曲线显示峡部Z值（0.963）和峡部与导管比值（0.969）的曲线下面积极佳。在结局正常的疑似病例中，连续峡部Z值改善至>-2；那些需要监测或手术的病例仍<-2。轻微病变并未增加缩窄的诊断特异性，但峡部血流紊乱使真正缩窄与主动脉弓发育不全的比值比增加了16倍。
峡部Z值和峡部与导管比值是胎儿缩窄的敏感指标。连续测量和异常峡部血流模式可提高诊断特异性并可能减少假阳性。
