Zhu Yin-Di, Wang Ming-Yue, Pan Mei-Fang, Bian Jin-Yan, Chen You-Guo, Gu Xin-Xian
Department of Gynecology and Obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Ultrasound, Suzhou Xiangcheng People's Hospital, Suzhou, China.
Ann Transl Med. 2022 Jul;10(14):760. doi: 10.21037/atm-22-3089.
Seeking an optimal time point for ultrasound examination is important for the diagnosis of late selective intrauterine growth restriction (sIUGR) at birth in monochorionic diamniotic (MCDA) twin pregnancies. We aimed to assess the role of ultrasound characteristics at 19-24 weeks as predictive tools for late sIUGR at birth in MCDA twin pregnancies.
We retrospectively recruited 32 sIUGR and 56 normal patients with MCDA twin pregnancies. Ultrasound indexes of these included subjects at 19-24 weeks, including the middle cerebral artery peak systolic velocity (MCA-PSV), umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) were assessed. Receiver operating characteristic (ROC) curves were used to ascertain the predictive value of ultrasound characteristics discrepancy for such complications, and the relationship between the ultrasound characteristics and sIUGR was assessed by a logistic regression analysis.
Differences were found in the MCA-PI, UA-PI, and CPR discordances between the normal MCDA and sIUGR subjects. CPR discordance was the most effective characteristic for predicting sIUGR [area under the ROC curve (AUC) =0.883; 95% CI: 0.795-0.948], followed by UA-PI discordance (AUC =0.772; 95% CI: 0.685-0.829), and MCA-PI discordance (AUC =0.746; 95% CI: 0.681-0.823), respectively. Additionally, the optimal cutoff value of CPR discordance was 21.65, and the corresponding sensitivity and specificity were 0.750 and 0.929, respectively. The correlation analysis revealed that gestational age (GA) at ultrasound scan but not at delivery was significantly correlated with the MCA-PSV (r=0.55, P<0.01), UA-PI (r=0.55, P<0.01), MCA-PI (r=0.49, P<0.01), and CPR (r=0.55, P<0.01) in sIUGR, while GA at both ultrasound scan and birth was significantly correlated with MCA-PSV (r=0.65, P<0.01), UA-PI (r=0.49, P<0.01), MCA-PI (r=0.48, P<0.01), and CPR (r=0.63, P<0.01) in normal MCDA.
Increased MCA-PI, UA-PI, and CPR discordances were found in fetuses with sIUGR. CPR discordance could serve as a predictive index for sIUGR. An early ultrasound examination may be more accurate than biochemical modality for sIUGR prediction.
寻找超声检查的最佳时间点对于单绒毛膜双羊膜囊（MCDA）双胎妊娠中晚期选择性胎儿生长受限（sIUGR）的出生诊断至关重要。我们旨在评估孕19 - 24周时超声特征作为MCDA双胎妊娠晚期sIUGR出生预测工具的作用。
我们回顾性招募了32例sIUGR患者和56例正常MCDA双胎妊娠患者。评估了这些受试者孕19 - 24周时的超声指标，包括大脑中动脉收缩期峰值流速（MCA-PSV）、脐动脉搏动指数（UA-PI）、大脑中动脉搏动指数（MCA-PI）和脑胎盘比值（CPR）。采用受试者工作特征（ROC）曲线确定超声特征差异对此类并发症的预测价值，并通过逻辑回归分析评估超声特征与sIUGR之间的关系。
正常MCDA和sIUGR受试者之间在MCA-PI、UA-PI和CPR差异方面存在差异。CPR差异是预测sIUGR最有效的特征[ROC曲线下面积（AUC）=0.883；95%置信区间：0.795 - 0.948]，其次是UA-PI差异（AUC =0.772；95%置信区间：0.685 - 0.829）和MCA-PI差异（AUC =0.746；95%置信区间：0.681 - 0.823）。此外，CPR差异的最佳截断值为21.65，相应的敏感性和特异性分别为0.750和0.929。相关性分析显示，超声检查时而非分娩时的孕周与sIUGR中的MCA-PSV（r =0.55，P <0.01）、UA-PI（r =0.55，P <
