Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Placenta. 2020 Jun;95:84-90. doi: 10.1016/j.placenta.2020.04.015. Epub 2020 May 4.
Three-dimensional (3D) sonography combined with tomographic ultrasound imaging (TUI) to observe placental vascular anastomoses in monochorionic diamniotic (MCDA) twin pregnancies was evaluated.
Women with MCDA twin pregnancies at a gestational age of 16-32 weeks were enrolled in this retrospective study. Placental anastomoses were detected using two-dimensional (2D) and 3D sonography. Two-dimensional data were obtained by color and spectral Doppler and 3D data with high-definition flow within the area between twins' umbilical cord insertions. Volume post-processing using TUI mode identified anastomoses. Anastomotic findings on ultrasound were compared with fetoscopic surgery or postnatally injected placentas for diagnostic value. Anastomoses detection was compared between the two imaging modalities.
Seventy-six twin pregnancies were analyzed: 11 selective intrauterine growth restrictions (sIUGR), 10 twin-to-twin transfusion syndrome (TTTS), and 55 without complications. Seventy-one twin pregnancies had arterio-arterial (AA) anastomoses and 75 had arterio-venous (AV) anastomoses. Three-dimensional sonography combined with TUI was more sensitive (87.3%) and accurate (88.2%) in detecting AA anastomoses than 2D sonography (74.6%, 76.3%, respectively; P < 0.05), but had comparable sensitivity for AV anastomoses. The specificity of both modalities for anastomoses was 100%. The detection rate of AA anastomoses by 3D modality was (40%) TTTS vs. (87.3%) normal (P < 0.05), but comparable (90.9%) for sIUGR. The detection rates of AV anastomoses (90%, 81.8%) in TTTS and sIUGR were comparable with (87.3%) normal (P > 0.05).
Three-dimensional sonography combined with TUI highlighted placental anastomoses and may be useful for the clinical diagnosis and therapy of MCDA twin complications.
本研究评估了三维（3D）超声联合层析超声成像（TUI）观察单绒毛膜双羊膜（MCDA）双胎妊娠胎盘血管吻合的效果。
本回顾性研究纳入了 16-32 孕周 MCDA 双胎妊娠孕妇。使用二维（2D）和 3D 超声检测胎盘吻合。2D 数据通过彩色和频谱多普勒获得，3D 数据通过双胞胎脐带插入处之间区域的高清血流获得。TUI 模式的容积后处理识别吻合。将超声吻合发现与胎儿镜手术或产后注射胎盘进行比较，以评估诊断价值。比较了两种成像方式的吻合检测效果。
共分析了 76 例双胎妊娠：11 例选择性宫内生长受限（sIUGR），10 例双胎输血综合征（TTTS），55 例无并发症。71 例双胎妊娠有动脉-动脉（AA）吻合，75 例有动脉-静脉（AV）吻合。3D 超声联合 TUI 检测 AA 吻合的敏感性（87.3%）和准确性（88.2%）均高于 2D 超声（分别为 74.6%和 76.3%；P<0.05），但检测 AV 吻合的敏感性无差异。两种方法检测吻合的特异性均为 100%。3D 模式检测 AA 吻合的检出率在 TTTS 中为（40%），在正常妊娠中为（87.3%）（P<0.05），但在 sIUGR 中相当（90.9%）。TTTS 和 sIUGR 中 AV 吻合的检出率（90%和 81.8%）与正常妊娠（87.3%）相当（P>0.05）。
3D 超声联合 TUI 可突出显示胎盘吻合，可能有助于 MCDA 双胎并发症的临床诊断和治疗。
