Three-dimensional power Doppler and color Doppler ultrasound for evaluation of cerebral blood perfusion in fetuses with congenital heart disease

doi:10.3877/cma.j.issn.1672-6448.2020.09.010

Abstract

Abstract:

Objective

To evaluate cerebral blood perfusion in fetuses with congenital heart disease by three-dimensional power Doppler and color Doppler ultrasound.

Methods

The umbilical artery pulsation index (UA-PI) and the middle cerebral artery pulsation index (MCA-PI) were calculated by two-dimensional color Doppler ultrasound in 156 fetuses at Suzhou Hospital Affiliated to Nanjing Medical University from January 2017 to August 2018, including 105 normal fetuses (control group) and 51 fetuses with congenital heart disease. The ratio of MCA-PI to UA-PI was also calculated (CPR=MCA-PI/UA-PI). Three-dimensional power Doppler ultrasound combined with virtual organ computer-assisted analysis (VOCAL) technology was utilized to assess blood perfusion parameters of the proximal part of the middle cerebral artery, including vascularization index (VI), blood flow index (FI), and vascularization blood flow index (VFI), to evaluate the fetal cerebral perfusion during pregnancy. Z value was corrected for the measured data. ANOVA was then used to compare the above parameters among normal fetuses and fetuses with different congenital heart diseases including transposition of the great arteries (TGA), hypoplastic left heart syndrome (HLHS), left sided obstructive lesions (LSOL), and right sided obstructive lesions (RSOL), followed by Bonferronni's method for pairwise comparisons.

Results

Compared with the normal control group, there was a significant reduction in MCA-PI (1.27±0.30 vs 1.30±0.30 and 2.15±0.48) and CPR (1.26±0.29 vs 1.32±0.18 and 1.92±0.58), and a significant increase in VI (71.71±19.57 vs 68.11±14.35 and 42.19±16.29), FI (88.71±12.53 vs 81.80±14.21 and 50.15±17.76), and VFI (34.70±7.17 vs 35.98±6.52 and 20.90±11.06) in HLHS fetuses and LSOL fetuses (P<0.001 for all). However, there was no significant difference in MCA VI, F, or VFI among the RSOL fetuses, TGA fetuses, and the normal fetuses (P>0.05).

Conclusion

Fetal cerebral perfusion with congenital heart disease significantly increases, especially in fetuses with HLHS and LSOL. Prenatal application of three-dimensional power Doppler and color Doppler ultrasound can effectively evaluate cerebral perfusion in fetuses with these congenital heart diseases.

Key words: Ultrasound, Congenital heart disease, Brain blood flow

Zhong Yang, Xuedong Deng, Wei Jiang, Linliang Yin, Qi Pan, Hong Liang, Jianfang Ma, Zhongshan Gou, Zhenqi Wang. Three-dimensional power Doppler and color Doppler ultrasound for evaluation of cerebral blood perfusion in fetuses with congenital heart disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 874-879.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2020.09.010

https://chaosheng.cma-cmc.com.cn/EN/Y2020/V17/I09/874

Figures/Tables 3

References 16

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组别	例数	脐动脉PI	大脑中动脉PI	CPR	大脑中动脉VI	大脑中动脉FI	大脑中动脉VFI
正常组	105	1.15±0.15	2.15±0.48	1.92±0.58	42.19±16.29	50.15±17.76	20.90±11.06
TGA	6	1.28±0.12	2.36±0.36	1.86±0.36	50.27±15.08	55.24±14.36	22.59±6.56
HLHS	12	1.03±0.26	1.27±0.30	1.26±0.29	71.71±19.57	88.71±12.53	34.70±7.17
LSOL	16	1.00±0.20	1.30±0.30	1.32±0.18	68.11±14.35	81.80±14.21	35.98±6.52
RSOL	17	1.22±0.32	1.65±0.59	1.36±0.39	37.34±11.27	43.54±13.06	20.61±9.40
F值	?	6.063	20.368	9.545	17.519	27.014	12.008
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	脐动脉PI	大脑中动脉PI	CPR	大脑中动脉VI	大脑中动脉FI	大脑中动脉VFI
正常组	105	1.15±0.15	2.15±0.48	1.92±0.58	42.19±16.29	50.15±17.76	20.90±11.06
TGA	6	1.28±0.12	2.36±0.36	1.86±0.36	50.27±15.08	55.24±14.36	22.59±6.56
HLHS	12	1.03±0.26	1.27±0.30	1.26±0.29	71.71±19.57	88.71±12.53	34.70±7.17
LSOL	16	1.00±0.20	1.30±0.30	1.32±0.18	68.11±14.35	81.80±14.21	35.98±6.52
RSOL	17	1.22±0.32	1.65±0.59	1.36±0.39	37.34±11.27	43.54±13.06	20.61±9.40
F值	?	6.063	20.368	9.545	17.519	27.014	12.008
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

因变量	与正常组比较组	平均值差值	标准误差	P值	95%可信区间
脐动脉PI	TGA	-0.1282	0.08474	0.133	-0.2963~-0.0399
	HLHS	0.1212	0.06240	0.055	0.0026~0.2450
	LSOL	0.1436	0.05542	0.011	0.0337~0.2536
	RSOL	-0.0750	0.05511	0.176	-0.1842~0.0342
大脑中动脉PI	TGA	-0.2088	0.19357	0.283	-0.5924~0.1747
	HLHS	0.8795	0.14254	<0.001	0.5970~1.1619
	LSOL	0.8468	0.12661	<0.001	0.5959~1.0977
	RSOL	0.4967	0.12359	<0.001	0.2518~0.7416
CPR	TGA	0.0505	0.21389	0.814	-0.3738~0.4748
	HLHS	0.6542	0.15751	<0.001	0.3418~0.9667
	LSOL	0.5977	0.13990	<0.001	0.3202~0.8753
	RSOL	0.5511	0.13106	<0.001	0.2914~0.8108
大脑中动脉VI	TGA	-8.0751	6.71190	0.231	-21.3752~5.2250
	HLHS	-29.5193	4.94250	<0.001	-39.3132~-19.7254
	LSOL	-25.9185	4.39010	<0.001	-34.6177~-17.2192
	RSOL	4.8510	4.28523	0.260	-3.6405~13.3424
大脑中动脉FI	TGA	-5.0751	6.86360	0.461	-18.6758~8.5256
	HLHS	-38.5459	5.05421	<0.001	-48.5612~-28.5307
	LSOL	-31.6274	4.48932	<0.001	-40.5233~-22.7315
	RSOL	6.6250	4.38209	0.133	-2.0584~15.3084
大脑中动脉VFI	TGA	-1.9804	4.18243	0.637	-10.2681~6.3074
	HLHS	-14.0929	3.07985	<0.001	-20.1958~-7.9899
	LSOL	-15.3687	2.73563	<0.001	-20.7895~-9.9479
	RSOL	0.0010	2.67029	1.000	-5.2903~5.2924

因变量	与正常组比较组	平均值差值	标准误差	P值	95%可信区间
脐动脉PI	TGA	-0.1282	0.08474	0.133	-0.2963~-0.0399
	HLHS	0.1212	0.06240	0.055	0.0026~0.2450
	LSOL	0.1436	0.05542	0.011	0.0337~0.2536
	RSOL	-0.0750	0.05511	0.176	-0.1842~0.0342
大脑中动脉PI	TGA	-0.2088	0.19357	0.283	-0.5924~0.1747
	HLHS	0.8795	0.14254	<0.001	0.5970~1.1619
	LSOL	0.8468	0.12661	<0.001	0.5959~1.0977
	RSOL	0.4967	0.12359	<0.001	0.2518~0.7416
CPR	TGA	0.0505	0.21389	0.814	-0.3738~0.4748
	HLHS	0.6542	0.15751	<0.001	0.3418~0.9667
	LSOL	0.5977	0.13990	<0.001	0.3202~0.8753
	RSOL	0.5511	0.13106	<0.001	0.2914~0.8108
大脑中动脉VI	TGA	-8.0751	6.71190	0.231	-21.3752~5.2250
	HLHS	-29.5193	4.94250	<0.001	-39.3132~-19.7254
	LSOL	-25.9185	4.39010	<0.001	-34.6177~-17.2192
	RSOL	4.8510	4.28523	0.260	-3.6405~13.3424
大脑中动脉FI	TGA	-5.0751	6.86360	0.461	-18.6758~8.5256
	HLHS	-38.5459	5.05421	<0.001	-48.5612~-28.5307
	LSOL	-31.6274	4.48932	<0.001	-40.5233~-22.7315
	RSOL	6.6250	4.38209	0.133	-2.0584~15.3084
大脑中动脉VFI	TGA	-1.9804	4.18243	0.637	-10.2681~6.3074
	HLHS	-14.0929	3.07985	<0.001	-20.1958~-7.9899
	LSOL	-15.3687	2.73563	<0.001	-20.7895~-9.9479
	RSOL	0.0010	2.67029	1.000	-5.2903~5.2924

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