22 feb. FIRST TRIMESTER DIAGNOSTIC ACCURACY OF TWO-DIMENSIONAL AND FOUR-DIMENSIONAL ULTRASOUND IN MAJOR CONGENITAL HEART DISEASES
Ştefania Tudorache*, Monica Laura Cara*, Florin Burada**, Cristiana Simionescu***, Alice Nicoleta Dragoescu****, D. G. Iliescu*
* Department of Obstetrics and Gynaecology, Prenatal Diagnostic Unit, University of Medicine
and Pharmacy, University Emergency County Hospital, Craiova, Romania.
** Department of Genetics, Human Genomics Laboratory, University of Medicine and Pharmacy,
Craiova, Romania
***Department of Pathology, University of Medicine and Pharmacy, Craiova, Romania
**** Anaesthesiology and Intensive Care Department, University of Medicine and Pharmacy,
University Emergency County Hospital, Craiova, Romania.
Rezumat: Acurateţea examinării ecografice 2D şi 4D în diagnosticul anomaliilor cardiace congenitale în primul trimestru de sarcină
Obiective Determinarea sensibilităţii şi specificităţii examinării ecografice 2D şi 4D în screening-ul pentru anomalii cardiace congenitale, la 11 – 13+4 săptămâni de sarcină. Ca metode standard de referinţă am folosit: reexaminarea în echipă multidisciplinară, examinarea anatomopatologică şi reevaluarea ecografică ulterioară.
Material şi metodă Au fost analizate datele a 1456 cazuri (videoclipuri şi imagini STIC – spatial temporal image correlation), obţinute şi postprocesate după un protocol standard. Au fost calculate sensibilitatea, specificitatea şi ratele de probabilitate (likelihood ratios – LRs), prin compararea diagnosticului prenatal cu diagnosticul final. S-a folosit testul McNemar pentru proporii dependente.
Rezultate În seria de cazuri au fost prezente 13 cazuri de anomalii cardiace congenitale majore. 11 cazuri (84.62%) au fost diagnosticate în primul trimestru de sarcină. Toate cazurile au fost diagnosticate în perioada prenatală. Sensibilitatea, specificitatea şi valorile predictive pozitive şi negative au fost 84.62%, 99.85%, 84.62%, 99.85% (pentru metoda 2D) şi respectiv 84.62%, 99.70%, 73.33%, 99.84% pentru metoda 4D). Diagnostic odds ratio (DOR) a fost 3619 pentru metoda 2D şi respectiv 1806.75 pentru 4D.
Concluzii Dacă se folosesc sisteme de performanţă şi protocoale standard, ambele metode (2D şi 4D) ating rate mari de acurateţe în diagnosticul precoce a anomaliilor cardiace majore.
Abstract:
Objectives To determine the sensitivity and specificity of two-dimensional ultrasound (2DUS) and four-dimensional US (4DUS) in major congenital heart diseases (MCHDs) screening at 11 to 13 +4 weeks. We used: specialists’ team 2DUS reexamination, pathological examination, and subsequently assessment as the reference standard methods.
Methods Videoclips and spatial temporal image correlation (STIC) datasets from 1456 pregnant women were analyzed, using a standard protocol for storing and postprocessing data. Estimates of sensitivity, specificity and likelihood ratios were calculated by comparing antenatal findings with subsequent verification of diagnosis. Likelihood ratios and diagnostic odds ratio are reported. McNemar’s test for dependent proportion and sign test was used in order to compare the sensitivity of the techniques.
Results There were 13 MCHDs cases. 11 cases (84.62%) were first trimester diagnosed. The prenatal detection rate was 100%. Sensitivity, specificity and positive and negative predictive values of 2DUS in determining the presence or absence of MCHD were 84.62%, 99.85%, 84.62%, 99.85% and 84.62%, 99.70%, 73.33%, 99.84% for 4DUS. 2DUS method had a diagnostic odds ratio of 3619 and the 4DUS method 1806.75.
Conclusion 2DUS and 4DUS performed with good quality systems and using standard protocols are highly accurate tools for the early MCHDs diagnosis
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