Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy.
Scientific Directorate, IRCCS Istituto G. Gaslini, Genoa, Italy.
Ultrasound Obstet Gynecol. 2022 Dec;60(6):766-773. doi: 10.1002/uog.26033.
To assess, in a population comprising normal fetuses and fetuses with primary or post-hemorrhagic ventriculomegaly, the reproducibility of measurement of neonatal ultrasound indices in the fetus and to compare the performance of various cut-offs of these parameters to diagnose ventriculomegaly and classify its severity.
This was a retrospective cross-sectional study including 182 singleton fetuses assessed by transvaginal neurosonography. The sample populations included 116 normal fetuses and 66 fetuses with primary (n = 56) or post-hemorrhagic (n = 10) ventriculomegaly. In all cases, the atrial width (AW) was measured according to standard protocols and the findings were compared with four sonographic indices developed in the neonate: the anterior horn width (AHW), the ventricular index (VI), the thalamo-occipital distance (TOD) and the fronto-occipital horn ratio (FOHR). Reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC) and diagnostic accuracy of the neonatal indices was assessed against AW using areas under the receiver-operating-characteristics curves (AUC).
The intra- and interoperator reproducibility of measurement of AW and the neonatal measurements was excellent, with ICCs > 0.99 for all measures. The association in the fetus of all four variables developed in the neonate with the degree of ventriculomegaly as defined by the AW was strong for severe ventriculomegaly (AW > 15.0 mm; all AUC > 0.95), whereas the separation of cases with mild ventriculomegaly (AW, 10.0-15.0 mm) from those with normal AW (< 10.0 mm) was less effective.
When applied in the fetus, all four indices of ventriculomegaly developed in neonates (AHW, VI, TOD, FOHR) were associated strongly with fetal AW when the AW measurement indicated severe fetal ventriculomegaly. However, for mild ventriculomegaly, the association was weaker, probably due to the fact that, in the fetus, mild ventriculomegaly is not caused by obstruction of the ventricular system. Considering the similar performance of the four neonatal variables and the technical issues involved in determination of TOD and FOHR in the fetus, use of VI and AHW is preferred. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
在包括正常胎儿和原发性或出血后脑室扩张胎儿的人群中，评估新生儿超声指数在胎儿中的测量重复性，并比较这些参数的各种截断值诊断脑室扩张和分类严重程度的性能。
这是一项回顾性的横断面研究，包括 182 例经阴道神经超声评估的单胎胎儿。样本人群包括 116 例正常胎儿和 66 例原发性（n=56）或出血后（n=10）脑室扩张胎儿。在所有情况下，均根据标准方案测量房宽（AW），并将结果与在新生儿中开发的四个超声指标进行比较：前角宽（AHW）、脑室指数（VI）、丘脑枕距（TOD）和额枕角比（FOHR）。使用组内相关系数（ICC）评估测量的可重复性，使用接受者操作特征曲线下的面积（AUC）评估新生儿指数对 AW 的诊断准确性。
AW 和新生儿测量的内-间操作员测量的可重复性极好，所有测量的 ICC 均>0.99。当 AW 定义为严重脑室扩张（AW>15.0mm；所有 AUC>0.95）时，新生儿中所有四个变量与脑室扩张程度的关联在胎儿中均很强，而轻度脑室扩张（AW，10.0-15.0mm）与正常 AW（<10.0mm）之间的分离效果较差。
当应用于胎儿时，在 AW 测量提示严重胎儿脑室扩张时，新生儿脑室扩张的四个指数（AHW、VI、TOD、FOHR）均与胎儿 AW 强烈相关。然而，对于轻度脑室扩张，相关性较弱，可能是因为在胎儿中，轻度脑室扩张不是由脑室系统阻塞引起的。考虑到这四个新生儿变量的性能相似，以及在胎儿中确定 TOD 和 FOHR 所涉及的技术问题，使用 VI 和 AHW 更为可取。
