三维超声VOCAL旋转技术在胎儿肺容积测定中的应用
发布时间：2018-08-25 14:03
【摘要】：研究背景：随着现代医学的飞速发展和医疗新技术的不断涌现,越来越多的胎儿畸形在宫内逐渐被人们发现和认识,对胎儿肺发育不良的研究也已经成为了当今产前超声诊断的热点之一。因此,了解胎儿肺容积的正常超声测量值并评价分析其随孕周、胎儿质量的变化规律就显得尤为重要。 目的：通过使用三维超声旋转技术虚拟器官计算机辅助分析(virtual organ computer-aided analysis, VOCAL)对胎儿的肺容积进行测量,建立不同孕周胎儿肺容积正常参考值范围,对胎儿的肺发育进行评价,分析并探讨正常胎儿肺容积随孕周、胎儿质量的变化规律。用肺容积与胎儿质量之比对胎儿肺发育不良进行评估,分析并探讨肺容积与胎儿质量的比值对产前诊断胎儿肺发育不良的临床价值。 研究对象与方法：本研究以单胎妊娠的270例正常胎儿及20例肺发育不良(PH)高危胎儿为研究对象,孕周为17-36周,应用三维超声VOCAL旋转技术手动描绘测量胎儿左肺容积(LLV)及右肺容积(RLV),相加得出总肺容积(TLV)。应用经腹二维超声测量评价胎儿生长发育的相关生物学指标,包括双顶径(BPD)、头围(HC)、腹围(AC)、股骨长度(FL),经Hadlock方程系统自动计算生成胎儿质量,计算出肺容积与胎儿质量的比值,评价胎儿肺发育状况,追踪随访胎儿产后及尸检结果,并与产前诊断结果对照,评价三维超声VOCAL旋转技术的准确性及可靠性。 结果：正常组胎儿的左、右肺容积及总肺容积与孕周呈显著正相关(r值分别为0.973、0.975、0.978,p值均小于0.01),左肺容积的均值从20周的4.05ml、28周的17.39ml到34周的32.16ml,右肺容积的均值从20周的5.64ml、28周的22.25ml到34周的40.24ml,总肺容积的均值从20周的9.69ml、28周的39.64ml到34周的72.40ml,并且肺容积随着胎儿质量的增加亦呈现上升的趋势(r值为0.980,p0.01),以上可以看出正常胎儿肺容积与胎儿质量的相关性高于胎儿肺容积与孕周的相关性。 胎儿存在在肺发育不良时,肺的质量明显减轻,胎儿肺容积明显减小,肺容积与胎儿质量之比显著低于正常对照组。在20例肺发育不良的高危胎儿中、,2例因羊水过少未能获得满意的三维超声图像,肺发育不良高危胎儿应用三维超声VOCAL旋转技术获得肺容积的成功率为90%,应用肺容积与胎儿质量之比诊断胎儿肺发育不良的敏感度为91.66%,特异度为83.33%,阳性预测值为91.66%,阴性预测值为83.33%,诊断准确率为88.88%。另外将三维超声VOCAL旋转技术测量所得到的肺容积与尸体解剖后应用水容积置换法所得到的实际肺容积进行配对t检验,t=0.90,p=0.9290.05,说明这两种测量方法无明显差异,具有较高的一致性。将两种测量方法进行双变量相关分析,结果显示两种测量方法有较显著地正相关关系,r=0.993,p0.01。将肺容积/胎儿质量的比值与湿肺质量/胎儿质量的比值进行配对t检验,t=1.91,p=0.250.05,说明两种结果无明显差异,具有一致性；将两组测量结果进行双变量相关分析,结果显示肺容积/胎儿质量的比值与湿肺质量/胎儿质量的比值有较显著地正相关关系,r=0.979,p0.01。 结论：(1)正常胎儿左、右肺容积及总肺容积均随着孕周的增长而增长,胎儿肺容积与孕周呈曲线正相关；(2)胎儿肺容积随胎儿质量的增加而增加,二者存在显性线性关系；(3)应用肺容积与胎儿质量之比能较准确的诊断肺发育不良；(4)三维超声VOCAL旋转技术对测量胎儿肺容积有较好的可行性和可靠性。图10幅,表3个,参考文献66篇
[Abstract]:BACKGROUND: With the rapid development of modern medicine and the emergence of new medical technology, more and more fetal malformations are gradually discovered and recognized in utero. The study of fetal pulmonary dysplasia has become one of the hotspots of prenatal ultrasound diagnosis. It is very important to analyze the variation of fetal quality with the gestational weeks.
Objective: To measure fetal lung volume by virtual organ computer-aided analysis (VOCAL) using three-dimensional ultrasound rotating technique, establish the normal reference range of fetal lung volume at different gestational weeks, evaluate fetal lung development, analyze and explore the normal fetal lung volume with gestational weeks, fetal lung volume. The ratio of lung volume to fetal mass was used to evaluate fetal pulmonary dysplasia, and the clinical value of the ratio of lung volume to fetal mass in prenatal diagnosis of fetal pulmonary dysplasia was analyzed and discussed.
Objects and Methods: 270 normal fetuses and 20 high-risk fetuses with pulmonary hypoplasia (PH) of single pregnancy were studied. The gestational age was 17-36 weeks. Left lung volume (LLV) and right lung volume (RLV) were measured manually by three-dimensional ultrasonic VOCAL rotation technique. Total lung volume (TLV) was measured by two-dimensional transabdominal ultrasonography. Biological parameters of fetal growth and development, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femoral length (FL), were evaluated by Hadlock equation system. The ratio of lung volume to fetal quality was calculated automatically. The fetal lung development was evaluated. The fetal postpartum and autopsy results were followed up and compared with the prenatal diagnosis results. To compare the accuracy and reliability of three dimensional ultrasound VOCAL rotation technique.
Results: Left and right lung volume and total lung volume were positively correlated with gestational age (r values were 0.973, 0.975, 0.978, P values were less than 0.01), mean left lung volume was 4.05 ml at 20 weeks, 17.39 ml at 28 weeks to 32.16 ml at 34 weeks, mean right lung volume was 5.64 ml at 20 weeks, 22.25 ml at 28 weeks to 40.24 ml at 34 weeks, respectively. The mean value was 9.69ml at 20 weeks, 39.64 ml at 28 weeks to 72.40 ml at 34 weeks, and lung volume increased with the increase of fetal weight (r value was 0.980, p0.01). The correlation between normal fetal lung volume and fetal quality was higher than that between fetal lung volume and gestational age.
In 20 fetuses with high risk of pulmonary hypoplasia, 2 fetuses with low amniotic fluid failed to obtain satisfactory three-dimensional ultrasound images, and high risk fetuses with pulmonary hypoplasia received three-dimensional ultrasound VOCAL. The success rate of rotational technique was 90%. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the ratio of lung volume to fetal mass were 91.66%, 83.33%, 91.66%, 83.33% and 88.88% respectively. In addition, the lung volume measured by three-dimensional ultrasound and VOCAL rotational technique were compared with those of cadavers. After dissection, the actual lung volume obtained by water volume replacement method was tested by paired t test, t = 0.90, P = 0.9290.05, indicating that there was no significant difference between the two methods, with high consistency. The ratio of volume to fetal mass and the ratio of wet lung mass to fetal mass were tested by paired t test, t = 1.91, P = 0.250.05, indicating that there was no significant difference and consistency between the two results. Positive correlation, r=0.979, p0.01.
Conclusion: (1) Left and right lung volume and total lung volume of normal fetus increase with the increase of gestational age, and fetal lung volume is positively correlated with gestational age; (2) fetal lung volume increases with the increase of fetal weight, and there is a significant linear relationship between them; (3) The ratio of lung volume to fetal mass can be used to diagnose pulmonary dysplasia more accurately; (4) Fetal lung volume is positively correlated with gestational age. 3-D ultrasonic VOCAL rotation technique is feasible and reliable in measuring fetal lung volume. Fig. 10, 3 tables, 66 references
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5
本文编号：2203097
[Abstract]:BACKGROUND: With the rapid development of modern medicine and the emergence of new medical technology, more and more fetal malformations are gradually discovered and recognized in utero. The study of fetal pulmonary dysplasia has become one of the hotspots of prenatal ultrasound diagnosis. It is very important to analyze the variation of fetal quality with the gestational weeks.
Objective: To measure fetal lung volume by virtual organ computer-aided analysis (VOCAL) using three-dimensional ultrasound rotating technique, establish the normal reference range of fetal lung volume at different gestational weeks, evaluate fetal lung development, analyze and explore the normal fetal lung volume with gestational weeks, fetal lung volume. The ratio of lung volume to fetal mass was used to evaluate fetal pulmonary dysplasia, and the clinical value of the ratio of lung volume to fetal mass in prenatal diagnosis of fetal pulmonary dysplasia was analyzed and discussed.
Objects and Methods: 270 normal fetuses and 20 high-risk fetuses with pulmonary hypoplasia (PH) of single pregnancy were studied. The gestational age was 17-36 weeks. Left lung volume (LLV) and right lung volume (RLV) were measured manually by three-dimensional ultrasonic VOCAL rotation technique. Total lung volume (TLV) was measured by two-dimensional transabdominal ultrasonography. Biological parameters of fetal growth and development, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femoral length (FL), were evaluated by Hadlock equation system. The ratio of lung volume to fetal quality was calculated automatically. The fetal lung development was evaluated. The fetal postpartum and autopsy results were followed up and compared with the prenatal diagnosis results. To compare the accuracy and reliability of three dimensional ultrasound VOCAL rotation technique.
Results: Left and right lung volume and total lung volume were positively correlated with gestational age (r values were 0.973, 0.975, 0.978, P values were less than 0.01), mean left lung volume was 4.05 ml at 20 weeks, 17.39 ml at 28 weeks to 32.16 ml at 34 weeks, mean right lung volume was 5.64 ml at 20 weeks, 22.25 ml at 28 weeks to 40.24 ml at 34 weeks, respectively. The mean value was 9.69ml at 20 weeks, 39.64 ml at 28 weeks to 72.40 ml at 34 weeks, and lung volume increased with the increase of fetal weight (r value was 0.980, p0.01). The correlation between normal fetal lung volume and fetal quality was higher than that between fetal lung volume and gestational age.
In 20 fetuses with high risk of pulmonary hypoplasia, 2 fetuses with low amniotic fluid failed to obtain satisfactory three-dimensional ultrasound images, and high risk fetuses with pulmonary hypoplasia received three-dimensional ultrasound VOCAL. The success rate of rotational technique was 90%. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the ratio of lung volume to fetal mass were 91.66%, 83.33%, 91.66%, 83.33% and 88.88% respectively. In addition, the lung volume measured by three-dimensional ultrasound and VOCAL rotational technique were compared with those of cadavers. After dissection, the actual lung volume obtained by water volume replacement method was tested by paired t test, t = 0.90, P = 0.9290.05, indicating that there was no significant difference between the two methods, with high consistency. The ratio of volume to fetal mass and the ratio of wet lung mass to fetal mass were tested by paired t test, t = 1.91, P = 0.250.05, indicating that there was no significant difference and consistency between the two results. Positive correlation, r=0.979, p0.01.
Conclusion: (1) Left and right lung volume and total lung volume of normal fetus increase with the increase of gestational age, and fetal lung volume is positively correlated with gestational age; (2) fetal lung volume increases with the increase of fetal weight, and there is a significant linear relationship between them; (3) The ratio of lung volume to fetal mass can be used to diagnose pulmonary dysplasia more accurately; (4) Fetal lung volume is positively correlated with gestational age. 3-D ultrasonic VOCAL rotation technique is feasible and reliable in measuring fetal lung volume. Fig. 10, 3 tables, 66 references
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5
【共引文献】
相关期刊论文 前1条
1 张洁;姜凡;罗平;解翔;;中晚孕胎肺生长规律的超声评价[J];安徽医科大学学报;2013年12期
相关会议论文 前1条
1 王晶;杨太珠;;胎儿先天性膈疝的产前超声诊断及临床管理[A];2014’中国西部声学学术交流会论文集[C];2014年
相关硕士学位论文 前2条
1 魏新红;正常胎儿肺体积及发育的MRI评估[D];山东大学;2014年
2 张洁;中晚孕胎肺生长规律的超声评价[D];安徽医科大学;2014年
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