Schmiedl U P, Komarniski K, Winter T C, Luna J A, Cyr D R, Ruppenthal G, Schlief R
Department of Radiology, University of Washington, School of Medicine, Seattle 98195-7115, USA.
J Ultrasound Med. 1998 Feb;17(2):75-80; discussion 81-2. doi: 10.7863/jum.1998.17.2.75.
Ultrasonographic contrast agents that stay within the vascular space and do not cross the placenta may permit differentiation between the maternal and fetal portions of the placenta and may be clinically useful for diagnosis of placental abnormalities. This study was performed to assess the effects of Levovist (Schering AG, Berlin) on the placental circulation and to determine whether hemodynamic effects on the fetus occur. Ten studies were performed in five pregnant macaques (median weight, 9.15 kg; range, 6.15 to 11 kg; median gestational age, 121 days; range, 34 days to term) under anesthesia. Gray scale, color, and duplex Doppler sonographic scans of the fetus and placenta were acquired using a 5 MHz curved array transducer. Fetal heart rate, resistive index, and systolic-diastolic ratios were measured in the fetal middle cerebral artery, aorta, umbilical artery, and uterine artery before and after administration of contrast agent. The following dose regimen was tested: 5 ml of physiologic saline solution followed by 0.1 ml/kg of 300 mg/ml Levovist (diagnostic dose), 0.5 ml/kg of 400 mg/ml Levovist (maximum dose), and 5 ml physiologic saline solution. The order of diagnostic dose and maximal dose was randomized among animals. Color enhancement of the basal portions of the placenta was documented after administration of contrast agent. Heart rate and middle cerebral artery systolic-diastolic ratio did not change between baseline and injections. A 7% decrease of the resistive index from baseline to maximum dose was measured in the uterine artery (not significant). A 7.7% decrease in the systolic-diastolic ratio from baseline to maximum dose was recorded in the umbilical artery. However, an identical change was measured after saline solution was injected. The resistive index in the aorta increased by 2.6% from baseline to maximum dose, a change that was not significant (P > 0.5). Ultrasonographic contrast enhancement of the maternal circulation in placenta is demonstrated to be without significant effects on the fetal circulation as measured in this limited population.
停留在血管腔内且不穿过胎盘的超声造影剂，可能有助于区分胎盘的母体部分和胎儿部分，在临床上可能对胎盘异常的诊断有用。本研究旨在评估声诺维（先灵公司，柏林）对胎盘循环的影响，并确定是否对胎儿产生血流动力学效应。在麻醉下，对五只怀孕的猕猴（体重中位数为9.15千克；范围为6.15至11千克；妊娠年龄中位数为121天；范围为34天至足月）进行了十项研究。使用5兆赫的弯阵探头对胎儿和胎盘进行灰阶、彩色和双功多普勒超声扫描。在注射造影剂前后，测量胎儿大脑中动脉、主动脉、脐动脉和子宫动脉的胎儿心率、阻力指数和收缩期与舒张期比值。测试了以下剂量方案：5毫升生理盐水，随后是0.1毫升/千克的300毫克/毫升声诺维（诊断剂量）、0.5毫升/千克的400毫克/毫升声诺维（最大剂量），以及5毫升生理盐水。诊断剂量和最大剂量的顺序在动物之间随机安排。注射造影剂后记录了胎盘基部的彩色增强情况。心率和大脑中动脉收缩期与舒张期比值在基线和注射之间没有变化。子宫动脉从基线到最大剂量时阻力指数下降了7%（无统计学意义）。脐动脉从基线到最大剂量时收缩期与舒张期比值下降了7.7%。然而，注射生理盐水后也测量到了相同的变化。主动脉的阻力指数从基线到最大剂量时增加了2.6%，这一变化无统计学意义（P>0.5）。在这一有限的研究群体中，超声造影增强母体胎盘循环对胎儿循环无显著影响。
