Li Xuelei, Zhou Meng, Wang Shanshan, Zhang Chaoxue
Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China.
Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Anhui, China.
Heliyon. 2024 Mar 3;10(5):e27455. doi: 10.1016/j.heliyon.2024.e27455. eCollection 2024 Mar 15.
To investigate the diagnostic utility of multimodal ultrasound for fetal bowel dilatation (FBD) in different parts of the bowel and to examine its prognostic potential in FBD.
This retrospective study analyzed 86 fetuses with a dilated bowel identified via ultrasound in a 10-month postnatal follow-up. Both two- and three dimensional (2D and 3D, respectively) ultrasound volume imaging were used to characterize dilation across different bowel sections. The optimal intestinal diameter cut-off values for pathological bowel dilatation were determined and a predictive model for neonatal surgery was developed.
The 86 cases of dilatation were distributed as follows: duodenal (n = 36); jejunum/ileum (n = 35); and colonic (n = 15). Duodenal dilatations presented the earliest during pregnancy compared to the other 2 groups (24.4 versus [vs.] 29 vs. 33.7 weeks respectively; p < 0.05). Cases with small intestinal dilatation were delivered earlier than those with colonic dilatation (p < 0.05). Infants with duodenal dilatation had the lowest birth weight and the highest rate of multi-system abnormalities (30.6% vs. 5.7% vs. 20%; p < 0.001). More than one-half of the multi-system abnormalities had chromosomal abnormalities (multiple, 54% vs. single, 12.5%; p = 0.015). There were 2 stillbirths, 24 induced labors, 44 postnatal surgeries, and 18 normal cases after birth. In predicting adverse neonatal outcomes of jejunum/ileum dilatation using a cut-off value of 15.5 mm small intestine diameter, sensitivity was 81.5%, specificity was 62.5%, and the area under the receiver operating characteristic curve (AUC) was 0.762 (p < 0.05). For colonic dilatation, using a cut-off value of 21.5 mm colon diameter: sensitivity was 83.3%, specificity was 77.8%, and AUC was 0.861 (p < 0.05). In detecting jejunum/ileum and colonic obstruction, 3D ultrasound demonstrated significantly better diagnostic efficiency than 2D ultrasound (p < 0.05). Using the backward stepwise selection method, a predictive model for neonatal surgery in patients with jejunum/ileum and colonic dilatation was established: logit (P) = -1.58 + (2.32 × polyhydramnios) +(2.0 × ascites) +(1.14 × hyperechogenic bowel). The AUC for the prediction model was 0.874 (p < 0.05), with 76% sensitivity and 94.1% specificity.
Duodenal dilatation occurred earlier, with a higher incidence of chromosomal abnormalities and multi-system abnormalities than dilatation of other parts of the bowel. 3D ultrasound played an important role in the detection of jejunum/ileum and colon obstructions. Clinical signs, including polyhydramnios, ascites, and strong echoes in the intestine, can be used to predict neonatal surgery.
探讨多模态超声对胎儿不同肠段肠扩张（FBD）的诊断价值，并评估其对FBD的预后预测潜力。
本回顾性研究分析了86例经超声诊断为肠扩张的胎儿，对其进行了为期10个月的产后随访。二维和三维（分别为2D和3D）超声容积成像用于描述不同肠段的扩张情况。确定病理性肠扩张的最佳肠径临界值，并建立新生儿手术预测模型。
86例扩张病例分布如下：十二指肠（n = 36）；空肠/回肠（n = 35）；结肠（n = 15）。与其他两组相比，十二指肠扩张在孕期出现最早（分别为24.4周对比[vs.]29周和33.7周；p < 0.05）。小肠扩张的病例比结肠扩张的病例分娩更早（p < 0.05）。十二指肠扩张的婴儿出生体重最低，多系统异常发生率最高（30.6%对比5.7%对比20%；p < 0.001）。超过一半的多系统异常伴有染色体异常（多发，54%对比单发，12.5%；p = 0.015）。有2例死产，24例引产，44例产后手术，18例出生后情况正常。以小肠直径15.5 mm为临界值预测空肠/回肠扩张新生儿不良结局时，敏感性为81.5%，特异性为62.5%，受试者操作特征曲线（AUC）下面积为0.762（p < 0.05）。对于结肠扩张，以结肠直径21.5 mm为临界值：敏感性为83.3%，特异性为77.8%，AUC为0.861（p < 0.05）。在检测空肠/回肠和结肠梗阻方面，3D超声显示出比2D超声显著更高的诊断效率（p < 0.05）。采用向后逐步选择法，建立了空肠/回肠和结肠扩张患者新生儿手术预测模型：logit（P）= -1.58 +（2.32×羊水过多）+（2.0×腹水）+（1.14×肠壁高回声）。预测模型的AUC为0.874（p < 0.05），敏感性为76%，特异性为94.1%。
十二指肠扩张出现更早，与肠道其他部位扩张相比，染色体异常和多系统异常发生率更高。3D超声在检测空肠/回肠和结肠梗阻中起重要作用。包括羊水过多、腹水和肠道强回声在内的临床体征可用于预测新生儿手术。
