Three-dimensional ultrasonography for evaluation of development of fetal anal sphincter

doi:10.3877/cma.j.issn.1672-6448.2019.05.016

Abstract

Abstract:

Objective

To investigate the capability of tomography ultrasound (TUI) in evaluating the development of the normal anorectal structure to provide a reference for prenatal diagnosis of imperforate anus.

Methods

From June 2017 to July 2018, 315 singleton pregnant women at 19-40 weeks of gestational age were selected from Beijing Tiantan Hospital, and they ranged in age from 23 to 40 years, with an average age of 29±3 years. The TUI technique was applied to measure the fetal anal sphincter diameter (ASD), anal canal diameter (ACD), and anal canal length (ACL). The correlation between ASD, ACD, or ACL and gestational age was analyzed by Pearson correlation analysis, and the regression equation and curve were established. The intraclass correlation coefficient (ICC) and 95% confidence interval (CI) were used to evaluate the repeatability of the measurement of ASD, ACD, and ACL.

Results

The display rate of fetal anorectum in all fetuses by the TUI technique was 97.8% (308/315). Pearson correlation analysis showed that the normal fetal ASD, ACD, and ACL were positively correlated with the gestational age of the fetus, and the regression equations are: ASD, Y=-0.001X²+ 0.421X-1.726 (r=0.83, P<0.01); ACD, Y=0.418X-4.207 (r=0.89, P<0.01); and ACL, Y=0.526X-1.062 (r=0.87, P<0.01).

Conclusion

TUI for assessment of fetal anorectum is feasible. This method can be applied to improve the display rate of fetal anorectum.

Key words: Tomography ultrasound imaging, Anorectal malformation, Anal atresia, Anal sphincter, Rectum, Anal canal

Yang Guang, Wen He, Hongxia Zhang, Yukang Zhang, Bin Ning, Tengfei Yu. Three-dimensional ultrasonography for evaluation of development of fetal anal sphincter[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(05): 380-385.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2019.05.016

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References 17

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孕周	样本量	肛门括约肌直径（mm）		肛管直径（mm）		肛管长径（mm）
孕周	样本量	平均值	95% CI	平均值	95% CI	平均值	95% CI
19	13	5.2	4.7~5.8	3.9	3.5~4.3	8.7	8.1~9.3
20	12	5.8	5.3~6.2	4.2	3.7~4.7	9.3	8.6~10.1
21	11	6.7	6.1~7.2	4.4	4.0~4.9	10.0	9.4~10.6
22	13	6.9	6.4~7.4	4.6	4.0~5.2	10.5	9.8~11.2
23	15	7.2	6.7~7.7	5.4	4.9~5.9	11.0	10.4~11.5
24	18	7.7	7.2~8.2	5.5	5.1~5.9	11.8	11.1~12.4
25	18	8.2	7.7~8.7	6.3	5.9~6.6	12.2	11.7~12.7
26	14	8.6	8.1~9.0	6.7	6.0~7.3	12.7	11.9~13.4
27	11	8.7	8.4~9.1	7.3	6.5~8.2	13.1	12.2~13.8
28	16	8.9	8.5~9.3	7.8	7.3~8.3	13.6	12.9~14.5
29	18	9.0	8.5~9.4	8.0	7.5~8.5	14.0	13.4~14.6
30	11	9.3	8.8~9.8	8.3	7.7~9.0	15.0	14.1~15.9
31	12	9.7	9.0~10.4	8.9	8.3~9.5	15.4	14.2~16.6
32	14	10.0	9.4~10.6	9.2	8.5~9.9	15.9	15.1~16.8
33	13	10.6	10.1~11.1	9.5	9.0~10.1	16.3	15.4~17.1
34	16	10.9	10.4~11.4	10.1	9.7~10.6	16.8	16.1~17.5
35	13	11.1	10.6~11.5	10.4	9.9~11.0	17.5	16.9~18.2
36	16	11.2	10.8~11.7	10.8	10.3~11.3	17.9	17.3~18.6
37	13	11.6	11.1~12.1	11.3	10.7~12.0	18.7	18.0~19.3
38	14	12.0	11.4~12.6	11.7	11.1~12.3	18.9	18.3~19.5
39	14	12.5	11.8~13.1	11.9	11.4~12.5	19.3	18.5~20.0
40	13	13.2	12.3~14.1	12.2	11.6~12.9	19.6	18.6~20.6

孕周	样本量	肛门括约肌直径（mm）		肛管直径（mm）		肛管长径（mm）
孕周	样本量	平均值	95% CI	平均值	95% CI	平均值	95% CI
19	13	5.2	4.7~5.8	3.9	3.5~4.3	8.7	8.1~9.3
20	12	5.8	5.3~6.2	4.2	3.7~4.7	9.3	8.6~10.1
21	11	6.7	6.1~7.2	4.4	4.0~4.9	10.0	9.4~10.6
22	13	6.9	6.4~7.4	4.6	4.0~5.2	10.5	9.8~11.2
23	15	7.2	6.7~7.7	5.4	4.9~5.9	11.0	10.4~11.5
24	18	7.7	7.2~8.2	5.5	5.1~5.9	11.8	11.1~12.4
25	18	8.2	7.7~8.7	6.3	5.9~6.6	12.2	11.7~12.7
26	14	8.6	8.1~9.0	6.7	6.0~7.3	12.7	11.9~13.4
27	11	8.7	8.4~9.1	7.3	6.5~8.2	13.1	12.2~13.8
28	16	8.9	8.5~9.3	7.8	7.3~8.3	13.6	12.9~14.5
29	18	9.0	8.5~9.4	8.0	7.5~8.5	14.0	13.4~14.6
30	11	9.3	8.8~9.8	8.3	7.7~9.0	15.0	14.1~15.9
31	12	9.7	9.0~10.4	8.9	8.3~9.5	15.4	14.2~16.6
32	14	10.0	9.4~10.6	9.2	8.5~9.9	15.9	15.1~16.8
33	13	10.6	10.1~11.1	9.5	9.0~10.1	16.3	15.4~17.1
34	16	10.9	10.4~11.4	10.1	9.7~10.6	16.8	16.1~17.5
35	13	11.1	10.6~11.5	10.4	9.9~11.0	17.5	16.9~18.2
36	16	11.2	10.8~11.7	10.8	10.3~11.3	17.9	17.3~18.6
37	13	11.6	11.1~12.1	11.3	10.7~12.0	18.7	18.0~19.3
38	14	12.0	11.4~12.6	11.7	11.1~12.3	18.9	18.3~19.5
39	14	12.5	11.8~13.1	11.9	11.4~12.5	19.3	18.5~20.0
40	13	13.2	12.3~14.1	12.2	11.6~12.9	19.6	18.6~20.6

统计项	ICC（95%CI）
统计项	肛门括约肌直径	肛管直径	肛管长径
观察者1	0.903（0.854~0.972）	0.915（0.783~0.931）	0.895（0.789~0.916）
观察者2	0.902（0.787~0.952）	0.896（0.865~0.916）	0.917（0.835~0.953）
观察者间	0.925（0.835~0.964）	0.918（0.826~0.953）	0.901（0.813~0.921）

统计项	ICC（95%CI）
统计项	肛门括约肌直径	肛管直径	肛管长径
观察者1	0.903（0.854~0.972）	0.915（0.783~0.931）	0.895（0.789~0.916）
观察者2	0.902（0.787~0.952）	0.896（0.865~0.916）	0.917（0.835~0.953）
观察者间	0.925（0.835~0.964）	0.918（0.826~0.953）	0.901（0.813~0.921）

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