应用剪切波弹性成像技术评估宫内生长受限胎盘的弹性。

In vivo assessment of placental elasticity in intrauterine growth restriction by shear-wave elastography.

机构信息

Istanbul University, Cerrahpasa Medical Faculty Department of Radiology, Turkey.

Istanbul University, Cerrahpasa Medical Faculty Department of Obstetrics and Gynecology, Turkey.

出版信息

Eur J Radiol. 2017 Dec;97:16-20. doi: 10.1016/j.ejrad.2017.10.007. Epub 2017 Oct 8.

DOI:10.1016/j.ejrad.2017.10.007

PMID:29153362

Abstract

PURPOSE

In this study, we evaluated the placental elasticity in vivo by shear-wave elastography in pregnant women under follow-up for intrauterine growth restriction (IUGR) and compared the elasticity values to normal pregnancies.

MATERIAL AND METHODS

This prospective study included 42 pregnant women with a possible diagnosis of intrauterine growth restriction based on obstetrical grayscale and Doppler ultrasonography and 42 women with a normal pregnancy during the 2nd and 3rd trimester. During follow-up examinations, seven fetuses showed an increased growth and were delivered with a birth-weight above the 10 percentile. However, for statistical purposes we included these seven patients in the IUGR group due to prospective nature of the study. All patients initially underwent obstetrical grayscale and Doppler ultrasonography with measurement of resistivity and pulsatility indices from uterine arteries. Subsequently, elasticity values of the peripheral and central part of the placentas from fetal and maternal surfaces were measured by shear-wave elastography. Following delivery, Apgar scores at 1st and 5th minute, birth weight were collected. For statistical analysis, Mann-Whitney U test was used. ROC curves were plotted and cut-off values for elasticity values were analyzed.

RESULTS

Median elasticity values of the central part of the placentas from maternal (28kPa vs 6kPa) and fetal sides (21.5kPa vs 5kPa) were significantly higher in IUGR pregnancies compared to the control group (p<0.001). Similarly, median elasticity values of peripheral part of placentas from maternal (22kPa vs 5.35kPa) and fetal sides (22.5kPa vs 5.3kPa) were significantly higher in IUGR pregnancies compared to the control group (p<0.001).

CONCLUSION

Placental stiffness values are significantly higher in patients with IUGR. Shear-wave elastography can be used as a non-invasive, complementary method to gray-scale and Doppler ultrasound for diagnosing IUGR.

摘要

目的

本研究通过剪切波弹性成像评估了在宫内生长受限（IUGR）随访中的孕妇的胎盘弹性，并将弹性值与正常妊娠进行了比较。

材料和方法

本前瞻性研究纳入了 42 名基于产科灰阶和多普勒超声检查可能诊断为 IUGR 的孕妇，以及 42 名正常妊娠的孕妇，这些孕妇均处于妊娠 2 至 3 期。在随访检查中，有 7 名胎儿的生长速度增加，并以高于第 10 百分位数的出生体重分娩。然而，由于研究的前瞻性性质，出于统计目的，我们将这 7 名患者纳入 IUGR 组。所有患者最初均接受产科灰阶和多普勒超声检查，测量子宫动脉的阻力指数和搏动指数。随后，通过剪切波弹性成像测量胎儿面和母体面胎盘的外周和中央部分的弹性值。分娩后，收集第 1 分钟和第 5 分钟的 Apgar 评分和出生体重。统计学分析采用 Mann-Whitney U 检验。绘制 ROC 曲线并分析弹性值的截断值。

结果

与对照组相比，IUGR 妊娠的胎盘中央部分从母体面（28kPa 比 6kPa）和胎儿面（21.5kPa 比 5kPa）的中位数弹性值显著更高（p<0.001）。同样，与对照组相比，IUGR 妊娠的胎盘外周部分从母体面（22kPa 比 5.35kPa）和胎儿面（22.5kPa 比 5.3kPa）的中位数弹性值显著更高（p<0.001）。