四维与三维能量多普勒超声在早孕期胎儿生长受限中的诊断价值比较

Comparison of the diagnostic value of four-dimensional and three-dimensional power Doppler ultrasound in fetal growth restriction in early pregnancy

目的探讨与对比分析四维能量多普勒超声与三维能量多普勒超声在早孕期胎儿生长受限(FGR)中的临床价值。方法选择2018年12月至2021年11月在该院妇产科进行完整建卡并分娩的早孕期高危产妇84例作为研究对象,经临床诊断为FGR的产妇24例(FGR组),非FGR产妇60例(非FGR组),采用四维能量多普勒超声、三维能量多普勒超声检查2组血流特征,并比较2种超声诊断的价值。结果FGR组脐动脉三维能量多普勒超声阻力指数(RI,0.70±0.09)、搏动指数(PI,1.08±0.24)高于非FGR组(0.54±0.09、0.78±0.12),差异有统计学意义(P<0.05),但FGR组收缩期峰值流速[PSV,(36.30±2.16)cm/s]与非FGR组[(36.42±1.11)cm/s]比较,差异无统计学意义(P>0.05)。FGR组胎盘四维能量多普勒超声血管化指数(VI,6.18±0.38)、血管化-血流指数(VFI,1.09±0.13)高于非FGR组(3.15±0.22、0.54±0.09),血流指数(FI,22.87±1.48)低于非FGR组(26.53±2.10),差异均有统计学意义(P<0.05)。FGR组的分娩方式、分娩孕周、胎儿出生时体重、脐动脉pH值、Apgar评分与非FGR组比较,差异均有统计学意义(P<0.05)。在84例产妇中,三维能量多普勒超声诊断为FGR 22例,四维能量多普勒超声诊断为FGR 24例,三维能量多普勒超声与四维能量多普勒超声在早孕期FGR中的诊断敏感度分别为91.7%(22/24)、100.0%(24/24),诊断特异度分别为96.7%(58/60)和100.0%(60/60)。结论四维能量多普勒超声与三维能量多普勒超声可有效反映胎儿脐动脉、胎盘的血流状况,但在早孕期FGR中四维能量多普勒超声的敏感度和特异度更高。

Objective To explore and compare the clinical value of four-dimensional and three-dimensional power Doppler ultrasound in fetal growth restriction(FGR)in early pregnancy.Methods From December 2018 to November 2021,a total of 84 cases of high-risk parturient women in early pregnancy who underwent complete card establishment and delivery in the obstetrics and gynecology department of this hospital were selected as the research subjects.And there were 24 cases were clinically diagnosed with FGR(the FGR group)and 60 cases of non-FGR(the non-FGR group).Four-dimensional and three-dimensional power Doppler ultrasound were used to examine the characteristics of blood flow of the two groups,and the diagnostic values of the two kinds of ultrasound was compared.Results The three-dimensional power Doppler ultrasound resistance index(RI)and pulsatility index(PI)of the umbilical artery in the FGR group(0.70±0.09,1.08±0.24)were higher than those in the non-FGR group(0.54±0.09,0.78±0.12),and the differences were statistically significant(P<0.05).But there were no differences in peak systolic velocity(PSV)compared between the FGR group[(36.30±2.16)cm/s]and the non-FGR group[(36.42±1.11)cm/s](P>0.05).The four-dimensional power Doppler ultrasound vascularization index(VI)and vascularization-flow index(VFI)of the placenta in the FGR group(6.18±0.38,1.09±0.13)were higher than those in the non-FGR group(3.15±0.22,0.54±0.09),and the blood flow index(FI)in the FGR group(22.87±1.48)were lower than that in the non-FGR group(26.53±2.10),all with statistically significant differences(P<0.05).There were significant differences in delivery mode,delivery gestational age,fetal weight at birth,pH value of umbilical artery and Apgar score between the FGR group and the non-FGR group(P<0.05).Among 84 cases,22 cases were diagnosed as FGR by three-dimensional energy Doppler ultrasound,and 24 cases were diagnosed as FGR by four-dimensional energy Doppler ultrasound.The diagnostic sensitivity of three-dimensional and fourdimensional energy Doppler ultrasound in FGR in early pregnancy was 91.7%(22/24)and 100.0%(24/24),and the diagnostic specificity was 96.7%(58/60)and 100.0%(60/60).Conclusion The four-dimensional and three-dimensional power Doppler ultrasound can effectively reflect the blood flow of fetal umbilical artery and placenta,while the sensitivity and specificity of four-dimensional power Doppler ultrasound are higher in FGR in early pregnancy.