Zeng S, Zhou J, Peng Q, Tian L, Xu G, Zhao Y, Wang T, Zhou Q
Department of Ultrasonography, The Second Xiangya Hospital, Central South University, Hunan, PR China.
Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
Ultrasound Obstet Gynecol. 2015 Jun;45(6):649-56. doi: 10.1002/uog.14798.
To use three-dimensional (3D) power Doppler ultrasound to investigate cerebral blood flow perfusion in fetuses with congenital heart disease (CHD).
The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) in the total intracranial volume and the main arterial territories (middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA)) were evaluated prospectively and compared in 112 fetuses with CHD and 112 normal fetuses using 3D power Doppler. Correlations between the 3D power Doppler indices and neurodevelopment scores at 12 months of age were assessed in a subset of the CHD group, and values were compared with those of controls.
Compared with the controls, the VI, FI and VFI of the total intracranial volume and the three main arteries were significantly higher in fetuses with hypoplastic left heart syndrome and left-sided obstructive lesions (P < 0.001), and the 3D power Doppler values in the ACA territory were significantly higher in fetuses with transposition of the great arteries (P < 0.01). The largest proportional increase in the blood flow perfusion indices in the fetuses with CHD relative to controls was observed in the ACA territory (P < 0.05). Among 41 cases with CHD that underwent testing, the mean Psychomotor Development Index (PDI) and Mental Development Index (MDI) scores were significantly lower than in 94 of the controls that were tested (P < 0.001). Among these CHD cases, total intracranial FI was positively correlated with PDI (r = 0.342, P = 0.029) and MDI (r = 0.339, P = 0.030), and ACA-VI and ACA-VFI were positively correlated with PDI (r = 0.377 and 0.389, P = 0.015 and 0.012, respectively) but were not correlated with MDI (r = 0.243 and 0.203, P = 0.126 and 0.204, respectively).
Cerebral blood flow perfusion was increased relative to controls in most fetuses with CHD and was associated with neurodevelopment scores at 12 months. Prenatal 3D power Doppler ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.
运用三维（3D）能量多普勒超声研究先天性心脏病（CHD）胎儿的脑血流灌注情况。
采用3D能量多普勒前瞻性评估并比较112例CHD胎儿和112例正常胎儿全颅内体积及主要动脉区域（大脑中动脉（MCA）、大脑前动脉（ACA）和大脑后动脉（PCA））的血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI）。在CHD组的一个亚组中评估3D能量多普勒指标与12月龄时神经发育评分的相关性，并将这些值与对照组进行比较。
与对照组相比，左心发育不全综合征和左侧梗阻性病变胎儿的全颅内体积及三条主要动脉的VI、FI和VFI显著更高（P<0.001），大动脉转位胎儿ACA区域的3D能量多普勒值显著更高（P<0.01）。CHD胎儿相对于对照组，血流灌注指数增加比例最大的是在ACA区域（P<0.05）。在接受测试的41例CHD病例中，平均精神运动发育指数（PDI）和智力发育指数（MDI）评分显著低于接受测试的94例对照组（P<0.001）。在这些CHD病例中，全颅内FI与PDI呈正相关（r=0.342，P=0.029）和MDI呈正相关（r=0.339，P=0.030），ACA-VI和ACA-VFI与PDI呈正相关（分别为r=0.377和0.389，P=0.015和0.012），但与MDI无相关性（分别为r=0.243和0.203，P=0.126和0.204）。
大多数CHD胎儿的脑血流灌注相对于对照组增加，且与12月龄时的神经发育评分相关。产前3D能量多普勒超声可能有助于更早识别脑血管扩张病例，并为家长咨询提供信息。
