Goetzinger Katherine R, Cahill Alison G, Odibo Linda, Macones George A, Odibo Anthony O
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA.
Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri, USA.
J Ultrasound Med. 2018 Jan;37(1):139-147. doi: 10.1002/jum.14323. Epub 2017 Jul 14.
To determine whether fetuses with fetal growth restriction (FGR) are more likely to have abnormal cerebral vascular flow patterns compared to fetuses who are appropriate for gestational age (AGA) when quantified by using 3-dimensional (3D) power Doppler ultrasound.
We conducted a prospective cohort study of singleton gestations presenting for growth ultrasound examination between 24 and 36 weeks' gestation. Patients with FGR (estimated fetal weight < 10th percentile) were enrolled and matched 1:1 for gestational age (±7 days) with AGA fetuses. A standardized 3D power Doppler image of the middle cerebral artery territory was obtained from each patient. The vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated by the Virtual Organ computer-aided analysis technique (GE Healthcare, Milwaukee, WI). These indices were compared between FGR and AGA fetuses and correlated with 2-dimensional Doppler parameters. Neonatal outcomes were also compared with respect to the 3D parameters.
Of 306 patients, there were 151 cases of FGR. There was no difference in the VI (6.0 versus 5.7; P = .65) or VFI (2.0 versus 1.8; P = .31) between the groups; however, the FI was significantly higher in FGR fetuses compared to AGA controls (33.9 versus 32.3; P = .009). There was a weak, but significant, negative correlation between the FI and both the middle cerebral artery pulsatility index (r = -0.34; P < .001) and cerebroplacental ratio (r = -0.29; P < .001). Within the FGR group, there was no difference in any of the 3D vascular indices with regard to neonatal outcomes.
Three-dimensional power Doppler measurement of cerebral blood flow, but not the vascularization pattern, is significantly altered in FGR. This measurement may play a future role in distinguishing pathologic FGR from constitutionally small growth.
通过三维（3D）能量多普勒超声定量分析，确定与适于胎龄（AGA）胎儿相比，胎儿生长受限（FGR）胎儿是否更易出现异常脑血管血流模式。
我们对妊娠24至36周前来进行生长超声检查的单胎妊娠进行了一项前瞻性队列研究。纳入FGR（估计胎儿体重<第10百分位数）患者，并按胎龄（±7天）与AGA胎儿1:1匹配。从每位患者获取大脑中动脉区域的标准化3D能量多普勒图像。采用虚拟器官计算机辅助分析技术（通用电气医疗集团，威斯康星州密尔沃基）计算血管化指数（VI）、血流指数（FI）和血管化-血流指数（VFI）。比较FGR和AGA胎儿之间的这些指数，并与二维多普勒参数进行相关性分析。还比较了3D参数方面的新生儿结局。
306例患者中，有151例FGR。两组之间的VI（6.0对5.7；P = 0.65）或VFI（2.0对1.8；P = 0.31）无差异；然而，FGR胎儿的FI显著高于AGA对照组（33.9对32.3；P = 0.009）。FI与大脑中动脉搏动指数（r = -0.34；P < 0.001）和脑胎盘比率（r = -0.29；P < 0.001）均呈弱但显著的负相关。在FGR组内，3D血管指数在新生儿结局方面无差异。
FGR中脑血流的三维能量多普勒测量有显著改变，但血管化模式无改变。该测量可能在未来区分病理性FGR与体质性小生长方面发挥作用。
