三维超声测量妊娠中晚期分隔膜厚度判断双胎绒毛膜性  

Determining chorionicity in twin pregnancies during the second and third trimesters: Three-dimensional ultrasonic measurement of inter-twin membrane thickness

作　　者：谭喜平 王慧芳[2] 甘晗靖 刘涛 熊奕 林琪 焦阳 张辉[1] 

机构地区：[1]深圳市人民医院超声科,广东深圳518020 [2]深圳市第二人民医院超声科,广东深圳518035

出　　处：《中国医学影像技术》2011年第11期2283-2286,共4页Chinese Journal of Medical Imaging Technology

基　　金：深圳市科技计划项目基金(重点)项目(200901004)

摘　　要：目的探讨妊娠中晚期运用三维超声测量分隔膜厚度判断双胎绒毛膜性的可行性及准确性、可重复性。方法对妊娠中晚期(孕17～36周)的113对双胎,分别运用二维和三维超声测量分隔膜厚度,并追踪其产后绒毛膜性,通过绘制ROC曲线确定预测绒毛膜性的分隔膜厚度最佳截断值,通过计算组内相关系数和Kappa值评估观察者内及观察者间的变异情况,并比较二维、三维超声测量分隔膜厚度判断绒毛膜性的准确性。结果①区分单绒毛膜双胎与双绒毛膜双胎分隔膜厚度的最佳截断值为1.8mm。②运用三维超声测量双胎间分隔膜厚度判断绒毛膜性的准确性较高,ROC曲线下面积、敏感度、特异度分别为0.906、95.35%、94.29%。③运用三维超声测量分隔膜厚度判断绒毛膜性时,观察者内和观察者间的组内相关系数为0.98、0.98;观察者间Kappa值为0.96。结论运用三维超声测量妊娠中晚期双胎间分隔膜厚度判断绒毛膜性具有可行性,且准确性高、重复性好,是一项有效的补充指标。Objective To explore whether the chorionicity can be diagnosed during middle and late trimesters by measuring the thickness of the inter-twin membrane with three-dimensional （3D） ultrasound, and to evaluate the accuracy and the reproducibility of this technique. Methods Totally 113 twin pregnancies＇s chorionicities were assessed between 17 and 36 weeks of gestation prenatally and confirmed postnatally. The dividing membranes between the fetuses were visualized and measured with 2D and 3D ultrasound, respectively. The receiver operator characteristic （ROC） curve was drawn to deter mine the optimal cut-off point of the thickness of the membranes for predicting chorionicity. Intraclass correlation coefficients and Kappa index were calculated to evaluate the inter- and intraoperator variability. The accuracy of prenatal assessment of chorionicity by 2D and 3D ultrasound measurement of membrane thickness was also compared. Results ①The best cut-off of membrane thickness for discriminating monochorionic from diehorionic twinning was 1.8 mm. ②When measuring the thickness of the membranes in twins using 3D ultrasound, there was a high degree accuracy in the determination of cho rionicity. The area under the ROC curve, sensitivity and specificity was 0. 906, 95. 35% and 94.29%, respectively. ③With 3D ultrasound, the intraclass correlation coefficients for variability intra- and interoperator was 0.98 and 0.98, respectively. Kappa indices for variability interoperator was 0. 96. Conclusion It is feasible, accurate and reproducible to assess chorionicity by measuring the intra-mniotic membrane thickness with 3D ultrasound in twin pregnancies during the second and third trimesters. The intra-amniotic membrane thickness is an effective supplementary indicator.

关 键 词：超声检查 双生 绒毛膜性 分隔膜厚度 

分 类 号：R714.23[医药卫生—妇产科学] R445.1[医药卫生—临床医学]