Lip-Sosa D L, Pérez-Cruz M, Ahumada-Droguett P, Ribas-Prats T, Puertollano M, García-Gómez M A, Mazarico E, Eixarch E, Escera C, Gómez-Roig M D
BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
Ultrasound Obstet Gynecol. 2023 Aug;62(2):226-233. doi: 10.1002/uog.26169.
To investigate measurements on neurosonography of midbrain morphology, including corpus callosum-fastigium length and tectal length, in late-onset small fetuses subclassified as small-for-gestational-age (SGA) or growth-restricted (FGR).
This was a case-control study of consecutive singleton pregnancies delivered at term at a single center between January 2019 and July 2021, including those with late-onset smallness (estimated fetal weight (EFW) < 10 centile) and appropriate-for-gestational-age controls matched by age at neurosonography. Small fetuses were further subdivided into SGA (EFW between 3 and 9 centile and normal fetoplacental Doppler) and FGR (EFW < 3 centile or EFW < 10 centile with abnormal cerebroplacental ratio and/or uterine artery Doppler). Transvaginal neurosonography was performed at a mean ± SD gestational age of 33 ± 1 weeks in all fetuses to evaluate corpus callosum-fastigium length and tectal length in the midsagittal plane. Intra- and interobserver agreement was evaluated using the intraclass correlation coefficient and Bland-Altman plots.
A total of 70 fetuses with late-onset smallness (29 with SGA and 41 with FGR) and 70 controls were included. Compared with controls, small fetuses showed significantly shorter corpus callosum-fastigium length (median (interquartile range), 44.7 (43.3-46.8) mm vs 43.7 (42.4-45.5) mm, P < 0.001) and tectal length (mean ± SD, 10.5 ± 0.9 vs 9.6 ± 1.0 mm, P < 0.001). These changes were more prominent in FGR fetuses, with a linear trend across groups according to severity of smallness. Corpus callosum-fastigium length and tectal length measurements showed excellent intra- and interobserver reliability.
Small fetuses exhibited shorter corpus callosum-fastigium length and tectal length compared with controls, and these differences were more pronounced in fetuses with more severe smallness. These findings illustrate the potential value of midbrain measurements assessed on neurosonography as biomarkers for brain development in a high-risk population. However, further studies correlating these parameters with postnatal functional tests and follow-up are needed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
研究在晚发性小胎儿（分为小于胎龄儿（SGA）或生长受限儿（FGR））中，经颅超声对中脑形态的测量，包括胼胝体-顶核长度和顶盖长度。
这是一项病例对照研究，纳入了2019年1月至2021年7月在单一中心足月分娩的连续单胎妊娠，包括晚发性小胎儿（估计胎儿体重（EFW）<第10百分位数）以及经颅超声检查时年龄匹配的适于胎龄对照。小胎儿进一步细分为SGA（EFW在第3至第9百分位数之间且胎儿胎盘多普勒正常）和FGR（EFW<第3百分位数或EFW<第10百分位数且脑胎盘比值异常和/或子宫动脉多普勒异常）。所有胎儿均在平均±标准差孕周33±1周时行经阴道经颅超声检查，以评估矢状面中的胼胝体-顶核长度和顶盖长度。采用组内相关系数和Bland-Altman图评估观察者内和观察者间的一致性。
共纳入70例晚发性小胎儿（29例SGA和41例FGR）以及70例对照。与对照相比，小胎儿的胼胝体-顶核长度显著缩短（中位数（四分位间距），44.7（43.3 - 46.8）mm对43.7（42.4 - 45.5）mm，P<0.001），顶盖长度也显著缩短（平均±标准差，10.5±0.9对9.6±1.0mm，P<0.001）。这些变化在FGR胎儿中更为明显，根据小的严重程度在各组间呈线性趋势。胼胝体-顶核长度和顶盖长度测量显示出良好的观察者内和观察者间可靠性。
与对照相比，小胎儿的胼胝体-顶核长度和顶盖长度较短，且这些差异在更严重的小胎儿中更为明显。这些发现说明了经颅超声评估的中脑测量作为高危人群脑发育生物标志物的潜在价值。然而，需要进一步研究将这些参数与出生后功能测试及随访相关联。©2023国际妇产科超声学会。
