Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China.
Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China.
BMC Pregnancy Childbirth. 2022 Oct 2;22(1):738. doi: 10.1186/s12884-022-05028-9.
To study the correlations between facial profile markers and crown-lump length (CRL) in a Chinese population, and to evaluate the clinical value of these markers for abnormal fetuses during the first trimester (11 to 13 gestational weeks). METHODS: The facial profile markers were as followings: inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA), frontal space (FS) distance and profile line (PL) distance. These markers were measured in facial mid-sagittal section through ViewPoint 6 software. The diagnostic value of these markers for abnormal fetuses was assessed by receiver operating characteristic (ROC) curves.
According to the first-trimester scanning (FTS) and follow-up, 31 fetuses were enrolled in the abnormal group, including 14 cases of trisomy 21, 7 cases of trisomy 18, 10 cases with cleft lip and palate (CLP), and 1000 normal fetuses were selected. Among the normal fetuses, the IFA, FS distance and PL distance had negative correlations with CRL. The MNM angle and FMA had positive correlations with CRL. The mean IFA values for fetuses with trisomy 21 and trisomy 18 were 74.11° (standard deviation (SD) 7.48) and 69.88° (SD 7.08), respectively, which were significantly smaller than the normal fetuses (p = 0.013; p = 0.003). The mean MNM angle of fetuses with trisomy 18 and CLP were 6.98° (SD 2.61) and 9.41° (SD 2.57), respectively, which were significantly greater than the normal fetuses (p = 0.005; p < 0.001). The mean FMA values of trisomy 18 fetuses were 63.95° (SD 4.77), which was significantly smaller than the normal fetuses (p < 0.001). The mean FS distance of CLP fetuses was -0.22 mm (SD 1.38), which was significantly smaller than the normal fetuses (p < 0.001). The mean PL distance of trisomy 21, trisomy 18 and CLP fetuses were 2.89 mm (SD 0.41), 2.91 mm (SD 0.56) and 2.71 mm (SD 0.37), respectively. The difference with the normal fetuses had no statistical significance (p = 0.56; p = 0.607; p = 0.54).
Fetal facial profile markers had excellent correlations with CRL during the first trimester. IFA had certain clinical significance in detecting trisomy 21. FMA, IFA and MNM angle were reliable indicators for screening trisomy 18. The abnormal MNM angle and FS distance could be used as sensitive indicators for CLP. However, PL distance was not the best markers for trisomy 21, trisomy 18 and CLP.
研究中国人面部轮廓标志与冠臀长（CRL）之间的相关性，并评估这些标志在孕早期（11-13 孕周）用于异常胎儿的临床价值。
面部轮廓标志如下：下面部角（IFA）、上颌-鼻根-下颌（MNM）角、面上部角（FMA）、额面间距（FS）和轮廓线（PL）距离。通过 ViewPoint 6 软件在面部正中矢状面测量这些标志。通过受试者工作特征（ROC）曲线评估这些标志对异常胎儿的诊断价值。
根据孕早期扫描（FTS）和随访，31 例胎儿被纳入异常组，包括 14 例 21 三体，7 例 18 三体，10 例唇腭裂（CLP），1000 例正常胎儿。在正常胎儿中，IFA、FS 距离和 PL 距离与 CRL 呈负相关。MNM 角和 FMA 与 CRL 呈正相关。21 三体和 18 三体胎儿的 IFA 平均值分别为 74.11°（标准差（SD）7.48）和 69.88°（SD 7.08），显著小于正常胎儿（p=0.013；p=0.003）。18 三体和 CLP 胎儿的 MNM 角平均值分别为 6.98°（SD 2.61）和 9.41°（SD 2.57），显著大于正常胎儿（p=0.005；p<0.001）。18 三体胎儿的 FMA 平均值为 63.95°（SD 4.77），显著小于正常胎儿（p<0.001）。CLP 胎儿的 FS 距离平均值为-0.22mm（SD 1.38），显著小于正常胎儿（p<0.001）。21 三体、18 三体和 CLP 胎儿的 PL 距离平均值分别为 2.89mm（SD 0.41）、2.91mm（SD 0.56）和 2.71mm（SD 0.37），与正常胎儿相比差异无统计学意义（p=0.56；p=0.607；p=0.54）。
孕早期胎儿面部轮廓标志与 CRL 相关性良好。IFA 在检测 21 三体方面具有一定的临床意义。FMA、IFA 和 MNM 角是筛查 18 三体的可靠指标。异常的 MNM 角和 FS 距离可作为 CLP 的敏感指标。然而，PL 距离并不是 21 三体、18 三体和 CLP 的最佳标志物。
