小于胎龄儿的左右心室 24 节段球形体指数异常。
Right and left ventricular 24-segment sphericity index is abnormal in small-for-gestational-age fetuses.
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Fetal Diagnostic Centers, Pasadena, Tarzana and Lancaster, CA, USA.
出版信息
Ultrasound Obstet Gynecol. 2018 Aug;52(2):243-249. doi: 10.1002/uog.18820.
OBJECTIVE
Fetuses with growth restriction have been reported to have an abnormal sphericity index (SI), which is indicative of the shape of the ventricular chambers of the heart. Our aim was to evaluate the SI for 24 transverse segments distributed from base to apex of the right (RV) and left (LV) ventricles to determine whether, in small-for-gestational-age (SGA) fetuses, the SI is abnormal at locations other than the basal segment.
METHODS
We evaluated 30 SGA fetuses between 25 and 37 weeks of gestation. SI was computed for both ventricles by dividing the end-diastolic mid-basal-apical length by each of 24 end-diastolic transverse segmental widths, from base (Segment 1) to apex (Segment 24). For each ventricle, the Z-score and centile for the SI from each of the 24 segments were computed using the mean and SD from published equations. The 24-segment method, defining abnormal SI as values < 10 centile or > 90 centile, was compared with that of using only the basal segment by chi-square analysis to determine the number of fetuses identified with an abnormal SI.
RESULTS
In 23 of the 30 (77%) SGA fetuses, at least one of the 24 transverse segments in one or both ventricles had an abnormal SI; in 17% of cases, both ventricles were affected, in 23% of cases only the RV was involved and in 37% of cases only the LV was involved. Compared with the 24-segment model, significantly fewer fetuses with an abnormal SI were identified using only basal Segment 1, from the RV base (58%, 7/12; P < 0.01) or only Segment 12, in the mid portion of the RV (50%, 6/12; P < 0.005). Combining measurements of Segment 1 and Segment 12 from the RV identified 83% of fetuses with at least one abnormal SI and was not significantly different from using the 24-segment model. Similarly, significantly fewer fetuses with an abnormal SI were identified using only LV basal Segment 1 (63%, 10/16; P < 0.006) or only Segment 12, in the mid portion of the LV (75%, 12/16; P < 0.03), when compared with the 24-segment model. Combining measurements of both LV Segment 1 and Segment 12 identified 81% (13/16) of fetuses with an abnormal SI and was not significantly different from using the 24-segment model.
CONCLUSION
The 24-segment SI of RV and LV provides a comprehensive method with which to examine the shape of the ventricular chambers and identifies more SGA fetuses with an abnormal SI than are identified using only the basal segment SI. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
目的
已有研究报道，生长受限胎儿的心室球形指数（sphericity index，SI）异常，这反映了心室腔的形状。我们的目的是评估右心室（RV）和左心室（LV）的 24 个横向节段的 SI，以确定在小于胎龄儿（small-for-gestational-age，SGA）中，基底段以外的节段是否存在 SI 异常。
方法
我们评估了 30 名 25 至 37 周妊娠的 SGA 胎儿。通过将舒张末期的中基底-顶长除以每个舒张末期的 24 个横向节段宽度来计算心室的 SI，节段宽度从基底（节段 1）到心尖（节段 24）。对于每个心室，使用已发表公式的平均值和标准差，计算每个节段的 SI 的 Z 评分和百分位数。使用 χ2 分析比较 24 节段法（定义为 <10 百分位数或 >90 百分位数的 SI 为异常）和仅使用基底段的方法，以确定有多少胎儿的 SI 异常。
结果
在 30 名 SGA 胎儿中的 23 名（77%）中，一个或两个心室的 24 个横向节段中的至少一个节段的 SI 异常；在 17%的情况下，两个心室都受到影响，在 23%的情况下，仅 RV 受到影响，在 37%的情况下，仅 LV 受到影响。与 24 节段模型相比，仅使用 RV 基底的节段 1（58%，7/12；P<0.01）或仅 RV 中部的节段 12（50%，6/12；P<0.005）确定的 SI 异常胎儿数量明显减少。组合使用 RV 的节段 1 和节段 12 的测量结果可识别出 83%的至少一个 SI 异常的胎儿，与使用 24 节段模型无显著差异。类似地，与 24 节段模型相比，仅使用 LV 基底的节段 1（63%，10/16；P<0.006）或 LV 中部的节段 12（75%，12/16；P<0.03）确定的 SI 异常胎儿数量明显减少。同时组合使用 LV 的节段 1 和节段 12 可识别出 81%（13/16）的 SI 异常胎儿，与使用 24 节段模型无显著差异。
结论
RV 和 LV 的 24 节段 SI 提供了一种全面的方法来检查心室腔的形状，与仅使用基底段 SI 相比，它能识别出更多的 SGA 胎儿存在 SI 异常。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
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