BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain.
Instituto de Investigación Sanitaria Aragón (IISAragon), Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER), Zaragoza, Spain.
Ultrasound Obstet Gynecol. 2021 Jul;58(1):42-47. doi: 10.1002/uog.23592.
To explore whether neurosonography can detect differences in cortical development and corpus callosal length in late-onset small fetuses subclassified into small-for-gestational age (SGA) or growth restricted (FGR).
This was a prospective cohort study in singleton pregnancies, including normally grown fetuses (birth weight between the 10 and 90 centiles) and late-onset small fetuses (estimated fetal weight < 10 centile, diagnosed after 32 weeks of gestation and confirmed by birth weight < 10 centile). Small fetuses were subclassified into SGA (birth weight between the 3 and 9 centiles and normal fetoplacental Doppler) and FGR (birth weight < 3 centile and/or abnormal cerebroplacental ratio and/or abnormal uterine artery Doppler). Neurosonography was performed at 33 ± 1 weeks of gestation to assess the depth of the insula, Sylvian fissure and parieto-occipital sulcus in the axial views and corpus callosal length in the midsagittal plane. Measurements were performed offline using Alma Workstation software and were adjusted by biparietal diameter or cephalic index. Linear regression analysis was used to assess the association between the neurosonographic variables and study group, adjusting for confounding factors such as gender, gestational age at neurosonography, nulliparity and pre-eclampsia.
In total, 318 fetuses were included, of which 97 were normally grown and 221 were late-onset small fetuses that were further subdivided into late-onset SGA (n = 67) or late-onset FGR (n = 154). Compared to controls, both SGA and FGR cases showed significantly increased insular depth adjusted for biparietal diameter (median (interquartile range), controls 0.329 (0.312-0.342) vs SGA 0.339 (0.321-0.347) vs FGR 0.336 (0.325-0.349); P = 0.006). A linear tendency to reduced Sylvian fissure depth adjusted for biparietal diameter was also observed across the study groups (mean ± SD, controls 0.148 ± 0.021 vs SGA 0.142 ± 0.025 vs FGR 0.139 ± 0.022; P = 0.003). However, differences were significant only between the FGR and control groups. Corpus callosal length adjusted for cephalic index was significantly reduced in FGR cases compared with both controls and SGA cases, while there was no difference between SGA cases and controls (median (interquartile range), controls 0.500 (0.478-0.531) vs SGA 0.502 (0.487-0.526) vs FGR 0.475 (0.447-0.508); P = 0.005). No differences were found in parieto-occipital sulcus depth between the three study groups.
Neurosonography seems to be a sensitive tool to detect subtle structural differences in brain development in late-onset small fetuses. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
探讨神经超声能否检测出晚发型小胎龄儿（SGA）或生长受限（FGR）亚类皮质发育和胼胝体长度的差异。
这是一项单胎妊娠的前瞻性队列研究，包括正常生长胎儿（出生体重位于第 10 和 90 百分位之间）和晚发型小胎儿（估计胎儿体重<第 10 百分位，在 32 孕周后诊断，并通过出生体重<第 10 百分位确认）。小胎儿进一步分为 SGA（出生体重位于第 3 和 9 百分位之间，且胎儿胎盘多普勒正常）和 FGR（出生体重<第 3 百分位和/或脑胎盘比异常和/或子宫动脉多普勒异常）。在 33±1 孕周时进行神经超声检查，以评估轴向切面的脑岛、大脑外侧裂和顶枕沟的深度以及正中矢状面的胼胝体长度。使用 Alma 工作站软件离线进行测量，并通过双项径或头围指数进行调整。线性回归分析用于评估神经超声变量与研究组之间的相关性，同时调整性别、神经超声检查时的孕龄、初产和子痫前期等混杂因素。
共纳入 318 例胎儿，其中 97 例为正常生长，221 例为晚发型小胎儿，进一步分为晚发型 SGA（n=67）或晚发型 FGR（n=154）。与对照组相比，SGA 和 FGR 病例的脑岛深度均显著增加（经双项径调整后，中位数（四分位间距），对照组 0.329（0.312-0.342）比 SGA 0.339（0.321-0.347）比 FGR 0.336（0.325-0.349）；P=0.006）。通过双项径调整后，Sylvian 裂深度也呈现出逐渐降低的趋势（平均值±标准差，对照组 0.148±0.021比 SGA 0.142±0.025比 FGR 0.139±0.022；P=0.003）。然而，仅在 FGR 组和对照组之间存在显著差异。与对照组和 SGA 组相比，FGR 组的胼胝体长度经头围指数调整后显著缩短，而 SGA 组与对照组之间无差异（中位数（四分位间距），对照组 0.500（0.478-0.531）比 SGA 0.502（0.487-0.526）比 FGR 0.475（0.447-0.508）；P=0.005）。三组间顶枕沟深度无差异。
神经超声似乎是一种敏感的工具，可以检测晚发型小胎龄儿脑发育的细微结构差异。© 2021 年国际妇产科超声学会。
