Simcox Louise E, Higgins Lucy E, Myers Jenny E, Johnstone Edward D
Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, England.
St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, England.
J Ultrasound Med. 2017 Jul;36(7):1415-1429. doi: 10.7863/ultra.16.03045. Epub 2017 Mar 24.
To assess intraexaminer and interexaminer reliability of 3-dimensional fetal sonographic measurements.
Three-dimensional fetal organ volumes (head, kidney, total thigh volume, and fractional thigh volume) were acquired during the second and third trimesters, with the addition of placental volume in the second trimester, by 2 different experienced, blinded sonographers. Fifty-eight fetuses were examined from 21 to 39 weeks' gestation. Intraexaminer and Interexaminer reliability was assessed with Bland-Altman plots, and their 95% limits of agreement and intraclass correlation coefficients.
The most significant interexaminer error was observed in the second-trimester kidney volume (95% limits of agreement, ± 110%), and the best agreement was for the third-trimester fractional thigh volume (95% limits of agreement, ± 25%) and second-trimester head volume (95% limits of agreement, -7%-25%). Second- and third-trimester intraclass correlation coefficient results were all greater than 0.75, apart from second-trimester kidney volume intraexaminer (0.374) and interexaminer (0.061) measurements, second-trimester placenta interexaminer measurements (0.390), and third-trimester kidney interexaminer measurements (0.647).
Three-dimensional fetal sonographic volumes of the head, kidney, total thigh, and placenta have limited reproducibility, and improvements in measurement techniques are needed before they can be used routinely to assess fetal growth. The 3-dimensional fractional thigh volume can be reliably obtained in the late third trimester.
评估三维胎儿超声测量的检查者内和检查者间可靠性。
两名经验丰富的、不知情的超声检查医师在孕中期和孕晚期获取三维胎儿器官体积（头部、肾脏、大腿总体积和大腿部分体积），孕中期还增加了胎盘体积。对58例妊娠21至39周的胎儿进行检查。采用Bland-Altman图评估检查者内和检查者间的可靠性，以及它们的95%一致性界限和组内相关系数。
检查者间误差最显著的是孕中期肾脏体积（95%一致性界限，±110%），一致性最好的是孕晚期大腿部分体积（95%一致性界限，±25%）和孕中期头部体积（95%一致性界限，-7%至25%）。除孕中期肾脏体积检查者内（0.374）和检查者间（0.061）测量值、孕中期胎盘检查者间测量值（0.390）以及孕晚期肾脏检查者间测量值（0.647）外，孕中期和孕晚期组内相关系数结果均大于0.75。
头部、肾脏、大腿总体积和胎盘的三维胎儿超声体积再现性有限，在能够常规用于评估胎儿生长之前，需要改进测量技术。孕晚期可可靠地获得三维大腿部分体积。
