三維超聲VOCAL旋轉(zhuǎn)技術(shù)在胎兒肺容積測(cè)定中的應(yīng)用
發(fā)布時(shí)間：2018-08-25 14:03
【摘要】：研究背景：隨著現(xiàn)代醫(yī)學(xué)的飛速發(fā)展和醫(yī)療新技術(shù)的不斷涌現(xiàn),越來越多的胎兒畸形在宮內(nèi)逐漸被人們發(fā)現(xiàn)和認(rèn)識(shí),對(duì)胎兒肺發(fā)育不良的研究也已經(jīng)成為了當(dāng)今產(chǎn)前超聲診斷的熱點(diǎn)之一。因此,了解胎兒肺容積的正常超聲測(cè)量值并評(píng)價(jià)分析其隨孕周、胎兒質(zhì)量的變化規(guī)律就顯得尤為重要。 目的：通過使用三維超聲旋轉(zhuǎn)技術(shù)虛擬器官計(jì)算機(jī)輔助分析(virtual organ computer-aided analysis, VOCAL)對(duì)胎兒的肺容積進(jìn)行測(cè)量,建立不同孕周胎兒肺容積正常參考值范圍,對(duì)胎兒的肺發(fā)育進(jìn)行評(píng)價(jià),分析并探討正常胎兒肺容積隨孕周、胎兒質(zhì)量的變化規(guī)律。用肺容積與胎兒質(zhì)量之比對(duì)胎兒肺發(fā)育不良進(jìn)行評(píng)估,分析并探討肺容積與胎兒質(zhì)量的比值對(duì)產(chǎn)前診斷胎兒肺發(fā)育不良的臨床價(jià)值。 研究對(duì)象與方法：本研究以單胎妊娠的270例正常胎兒及20例肺發(fā)育不良(PH)高危胎兒為研究對(duì)象,孕周為17-36周,應(yīng)用三維超聲VOCAL旋轉(zhuǎn)技術(shù)手動(dòng)描繪測(cè)量胎兒左肺容積(LLV)及右肺容積(RLV),相加得出總肺容積(TLV)。應(yīng)用經(jīng)腹二維超聲測(cè)量評(píng)價(jià)胎兒生長發(fā)育的相關(guān)生物學(xué)指標(biāo),包括雙頂徑(BPD)、頭圍(HC)、腹圍(AC)、股骨長度(FL),經(jīng)Hadlock方程系統(tǒng)自動(dòng)計(jì)算生成胎兒質(zhì)量,計(jì)算出肺容積與胎兒質(zhì)量的比值,評(píng)價(jià)胎兒肺發(fā)育狀況,追蹤隨訪胎兒產(chǎn)后及尸檢結(jié)果,并與產(chǎn)前診斷結(jié)果對(duì)照,評(píng)價(jià)三維超聲VOCAL旋轉(zhuǎn)技術(shù)的準(zhǔn)確性及可靠性。 結(jié)果：正常組胎兒的左、右肺容積及總肺容積與孕周呈顯著正相關(guān)(r值分別為0.973、0.975、0.978,p值均小于0.01),左肺容積的均值從20周的4.05ml、28周的17.39ml到34周的32.16ml,右肺容積的均值從20周的5.64ml、28周的22.25ml到34周的40.24ml,總肺容積的均值從20周的9.69ml、28周的39.64ml到34周的72.40ml,并且肺容積隨著胎兒質(zhì)量的增加亦呈現(xiàn)上升的趨勢(shì)(r值為0.980,p0.01),以上可以看出正常胎兒肺容積與胎兒質(zhì)量的相關(guān)性高于胎兒肺容積與孕周的相關(guān)性。 胎兒存在在肺發(fā)育不良時(shí),肺的質(zhì)量明顯減輕,胎兒肺容積明顯減小,肺容積與胎兒質(zhì)量之比顯著低于正常對(duì)照組。在20例肺發(fā)育不良的高危胎兒中、,2例因羊水過少未能獲得滿意的三維超聲圖像,肺發(fā)育不良高危胎兒應(yīng)用三維超聲VOCAL旋轉(zhuǎn)技術(shù)獲得肺容積的成功率為90%,應(yīng)用肺容積與胎兒質(zhì)量之比診斷胎兒肺發(fā)育不良的敏感度為91.66%,特異度為83.33%,陽性預(yù)測(cè)值為91.66%,陰性預(yù)測(cè)值為83.33%,診斷準(zhǔn)確率為88.88%。另外將三維超聲VOCAL旋轉(zhuǎn)技術(shù)測(cè)量所得到的肺容積與尸體解剖后應(yīng)用水容積置換法所得到的實(shí)際肺容積進(jìn)行配對(duì)t檢驗(yàn),t=0.90,p=0.9290.05,說明這兩種測(cè)量方法無明顯差異,具有較高的一致性。將兩種測(cè)量方法進(jìn)行雙變量相關(guān)分析,結(jié)果顯示兩種測(cè)量方法有較顯著地正相關(guān)關(guān)系,r=0.993,p0.01。將肺容積/胎兒質(zhì)量的比值與濕肺質(zhì)量/胎兒質(zhì)量的比值進(jìn)行配對(duì)t檢驗(yàn),t=1.91,p=0.250.05,說明兩種結(jié)果無明顯差異,具有一致性；將兩組測(cè)量結(jié)果進(jìn)行雙變量相關(guān)分析,結(jié)果顯示肺容積/胎兒質(zhì)量的比值與濕肺質(zhì)量/胎兒質(zhì)量的比值有較顯著地正相關(guān)關(guān)系,r=0.979,p0.01。 結(jié)論：(1)正常胎兒左、右肺容積及總肺容積均隨著孕周的增長而增長,胎兒肺容積與孕周呈曲線正相關(guān)；(2)胎兒肺容積隨胎兒質(zhì)量的增加而增加,二者存在顯性線性關(guān)系；(3)應(yīng)用肺容積與胎兒質(zhì)量之比能較準(zhǔn)確的診斷肺發(fā)育不良；(4)三維超聲VOCAL旋轉(zhuǎn)技術(shù)對(duì)測(cè)量胎兒肺容積有較好的可行性和可靠性。圖10幅,表3個(gè),參考文獻(xiàn)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
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R714.5
本文編號(hào)：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
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R714.5
【共引文獻(xiàn)】
相關(guān)期刊論文 前1條
1 張潔;姜凡;羅平;解翔;;中晚孕胎肺生長規(guī)律的超聲評(píng)價(jià)[J];安徽醫(yī)科大學(xué)學(xué)報(bào);2013年12期
相關(guān)會(huì)議論文 前1條
1 王晶;楊太珠;;胎兒先天性膈疝的產(chǎn)前超聲診斷及臨床管理[A];2014’中國西部聲學(xué)學(xué)術(shù)交流會(huì)論文集[C];2014年
相關(guān)碩士學(xué)位論文 前2條
1 魏新紅;正常胎兒肺體積及發(fā)育的MRI評(píng)估[D];山東大學(xué);2014年
2 張潔;中晚孕胎肺生長規(guī)律的超聲評(píng)價(jià)[D];安徽醫(yī)科大學(xué);2014年
，本文編號(hào)：2203097
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