Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy.
Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy.
Ultrasound Obstet Gynecol. 2018 Feb;51(2):214-218. doi: 10.1002/uog.17406. Epub 2017 Dec 27.
To introduce a new sonographic marker of intrathoracic liver herniation in fetuses with left-sided congenital diaphragmatic hernia (CDH).
In a consecutive series of fetuses with isolated CDH, an ultrasound volume of the fetal abdomen was acquired. On this volume, offline calculation of the angle formed by the midline of the abdomen (joining the center of the vertebral body to the abdominal insertion of the umbilical cord) and a second line joining the center of the vertebral body to the intra-abdominal convexity of the umbilical vein was carried out to give the umbilical vein deviation angle (UVDA). The UVDA was measured in a group of normal fetuses selected as controls. At follow-up, the presence of liver herniation was investigated in all cases of CDH. UVDA values were compared between the CDH group and controls, and between CDH 'liver-up' vs 'liver-down' cases. A receiver-operating characteristics (ROC) curve was constructed to identify a cut-off value of the UVDA with the highest accuracy in predicting liver herniation in the CDH group.
Between 2009 and 2015, 22 cases of left-sided CDH were included in the study group, of which nine cases had liver herniation. Eighty-eight normal fetuses were recruited as controls. The UVDA was significantly higher in the cases vs controls (15.25 ± 7.91° vs 7.68 ± 1.55°; P < 0.0001). Moreover, the UVDA was significantly increased in CDH fetuses with liver-up vs liver-down (21.77 ± 8.79° vs 10.75 ± 2.10°; P < 0.0001). On ROC curve analysis the UVDA showed good prediction of liver herniation (area under the ROC curve, 0.94; P < 0.0001) with the best cut-off of 15.2°, yielding a sensitivity of 89% and a specificity of 100% (P < 0.0001).
In fetuses with CDH, umbilical vein bowing may be quantified by measuring the UVDA using three-dimensional ultrasound. This sonographic marker seems to be an accurate predictor of liver herniation in left-sided CDH. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
介绍一种新的胎儿左侧先天性膈疝（CDH）伴胸腔内肝脏疝入的超声标记物。
在一系列连续的孤立性 CDH 胎儿中，采集胎儿腹部的超声容积。在此容积上，离线计算腹部中线（连接椎体中心和脐带腹侧附着处）与第二条连接椎体中心和脐静脉腹内凸度的线之间的夹角，得到脐静脉偏离角（UVDA）。选择一组正常胎儿作为对照组进行 UVDA 测量。在随访中，所有 CDH 病例均检查肝脏疝入情况。比较 CDH 组与对照组、CDH“肝上”与“肝下”病例的 UVDA 值。绘制受试者工作特征（ROC）曲线，以确定在 CDH 组中预测肝脏疝入的最佳 UVDA 截断值。
2009 年至 2015 年，研究组纳入 22 例左侧 CDH 病例，其中 9 例有肝脏疝入。招募 88 例正常胎儿作为对照组。病例组的 UVDA 明显高于对照组（15.25±7.91° vs 7.68±1.55°；P<0.0001）。此外，CDH 胎儿肝上与肝下的 UVDA 明显增加（21.77±8.79° vs 10.75±2.10°；P<0.0001）。ROC 曲线分析显示，UVDA 对肝脏疝入具有良好的预测能力（ROC 曲线下面积为 0.94；P<0.0001），最佳截断值为 15.2°，灵敏度为 89%，特异性为 100%（P<0.0001）。
在 CDH 胎儿中，可通过使用三维超声测量 UVDA 来定量测量脐静脉弯曲。这种超声标志物似乎是左侧 CDH 肝脏疝入的准确预测指标。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
