传统超声与三维超声在胎儿肾盂测量中的比较及其对新生儿泌尿系统疾病的潜在预测

Comparison of conventional versus three-dimensional ultrasound in fetal renal pelvis measurement and their potential prediction of neonatal uropathies.

作者信息

Duin L K, Nijhuis J G, Scherjon S A, Vossen M, Willekes C

机构信息

a Department of Obstetrics and Gynecology , University Medical Center , Groningen , the Netherlands and.

b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands.

出版信息

J Matern Fetal Neonatal Med. 2016;29(15):2494-9. doi: 10.3109/14767058.2015.1090970. Epub 2015 Oct 2.

DOI:10.3109/14767058.2015.1090970

PMID:26430907

Abstract

OBJECTIVE

To establish a threshold value for fetal renal pelvis dilatation measured by automatic volume calculation (SonoAVC) in the third trimester of pregnancy to predict neonatal uropathies, and to compare these results with conventional antero-posterior (AP) measurement, fetal kidney 3D volume and renal parenchymal thickness.

METHODS

In a prospective cohort study, 125 fetuses with renal pelvis AP diameter of ≥5 mm both at 20 weeks of gestation and in the third trimester, underwent an additional 3D volume measurement of the fetal kidney in the third trimester. Receiver operating characteristic (ROC) curves for establishing threshold values for fetal renal pelvis volume, AP measurement, fetal kidney volume and renal parenchymal thickness to predict neonatal uropathies were analyzed. Also, sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated.

RESULTS

A cut-off point of 1.58 cm³ was identified in the third trimester of pregnancy (AUC 0.865 (95% CI 0.789-0.940), sensitivity 76.3%, specificity 87.4%, LR+ 6.06, LR- 0.27) for measurements with SonoAVC. A cut-off value of 11.5 mm was established in the third trimester of pregnancy (AUC 0.828 (95% CI 0.737-0.918), sensitivity 71.1%, specificity 85.1%, LR+ 4.77, LR- 0.34) for the conventional AP measurement. A cut-off point for fetal kidney volume was calculated at 13.29 cm³ (AUC 0.769 (95% CI 0.657-0.881), sensitivity 71%, specificity 66%, LR+ 2.09, LR- 0.44). For renal parenchymal thickness, a cut-off point of 8.4 mm was established (AUC 0.216 (95% CI 0.117-0.315), sensitivity 31.6%, specificity 32.6%, LR+ 0.47, LR- 2.10).

CONCLUSION

This study demonstrates that 3D fetal renal pelvis volume measurements and AP measurements both have a good and comparable diagnostic performance, fetal renal volume a fair accuracy and renal parenchymal thickness a poor accuracy in predicting postnatal renal outcome.

摘要

目的

确定妊娠晚期通过自动容积计算（SonoAVC）测量胎儿肾盂扩张的阈值，以预测新生儿泌尿系统疾病，并将这些结果与传统前后径（AP）测量、胎儿肾脏三维容积及肾实质厚度进行比较。

方法

在一项前瞻性队列研究中，125例在妊娠20周和妊娠晚期肾盂AP直径均≥5 mm的胎儿，于妊娠晚期接受了额外的胎儿肾脏三维容积测量。分析用于确定胎儿肾盂容积、AP测量、胎儿肾脏容积和肾实质厚度预测新生儿泌尿系统疾病阈值的受试者操作特征（ROC）曲线。同时，计算敏感性、特异性、曲线下面积（AUC）和似然比。

结果

妊娠晚期SonoAVC测量的截断点为1.58 cm³（AUC 0.865（95%CI 0.789 - 0.940），敏感性76.3%，特异性87.4%，LR+ 6.06，LR- 0.27）。妊娠晚期传统AP测量的截断值为11.5 mm（AUC 0.828（95%CI 0.737 - 0.918），敏感性71.1%，特异性85.1%，LR+ 4.77，LR- 0.34）。胎儿肾脏容积的截断点计算为13.29 cm³（AUC 0.769（95%CI 0.657 - 0.881），敏感性71%，特异性66%，LR+ 2.09，LR- 0.44）。肾实质厚度的截断点为8.4 mm（AUC 0.216（95%CI 0.117 - 0.315），敏感性31.6%，特异性32.6%，LR+ 0.47，LR- 2.10）。