Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Paediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam, the Netherlands.
Prenat Diagn. 2017 Oct;37(10):1008-1016. doi: 10.1002/pd.5135. Epub 2017 Sep 4.
The objective of the study is to investigate the prenatal influence of congenital heart defects (CHD) on trajectories of fetal cortical folding using three-dimensional ultrasound (3D US).
We included 20 CHD fetuses and 193 controls for studying the fetal brain at 22, 26 and 32 weeks' gestational age (GA). The Sylvian, insula and parieto-occipital fissure (POF) depths were measured using 3D US, and reliability was evaluated. Doppler indices of the umbilical artery and middle cerebral artery were measured to calculate the cerebro-placental ratio. Associations between CHD and cortical folding were estimated using linear mixed models.
Brain fissure measurements were successful in over 80% of 3D US scans, except for the POF at 32 weeks' GA (65%). All measurements showed a good reliability (intraclass correlation coefficients > 0.84). Growth trajectories of the left insula depth (ß = -2.753, 95% CI = -5.375; -0.130, p = 0.040) and right POF (ß = -3.762, 95% CI = -7.178; -0.346, p = 0.031) were decreased in CHD compared with controls, whereas growth rates were increased (ß = 0.014, 95% CI = 0.001; 0.027, p = 0.036 and ß = 0.024, 95% CI = 0.007; 0.041, p = 0.006). In contrast to controls, we found no associations between cerebro-placental ratio and cortical folding in CHD.
Fetal cortical folding can be evaluated reliably by measuring brain fissure depths. Trajectories of cortical folding between 22 and 32 weeks' GA seem to be influenced by CHD. © 2017 John Wiley & Sons, Ltd.
本研究旨在通过三维超声（3D US）研究先天性心脏病（CHD）对胎儿皮质折叠轨迹的产前影响。
我们纳入了 20 例 CHD 胎儿和 193 例对照，以研究 22、26 和 32 孕周胎儿的大脑。使用 3D US 测量了大脑外侧裂、脑岛和顶枕裂（POF）的深度，并评估了其可靠性。测量脐动脉和大脑中动脉的多普勒指数，以计算脑胎盘比。使用线性混合模型估计 CHD 与皮质折叠之间的关联。
除了 32 孕周的 POF（65%）外，3D US 扫描中超过 80%的脑裂测量都成功完成。所有测量均具有良好的可靠性（组内相关系数>0.84）。与对照组相比，CHD 组左侧脑岛深度（ß=-2.753，95%CI=-5.375；-0.130，p=0.040）和右侧 POF（ß=-3.762，95%CI=-7.178；-0.346，p=0.031）的生长轨迹降低，而生长速度增加（ß=0.014，95%CI=0.001；0.027，p=0.036 和 ß=0.024，95%CI=0.007；0.041，p=0.006）。与对照组相比，我们在 CHD 中没有发现脑胎盘比与皮质折叠之间的关联。
通过测量脑裂深度可以可靠地评估胎儿皮质折叠。22 至 32 孕周之间的皮质折叠轨迹似乎受到 CHD 的影响。© 2017 约翰威立父子公司。
