Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology.
Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology.
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DOI：
10.1016/j.ebiom.2021.103326
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发表时间：
2021-05
期刊：
影响因子：
11.1
通讯作者：
Sled JG
中科院分区：
文献类型：
--
作者：
Cahill LS;Stortz G;Ravi Chandran A;Milligan N;Shinar S;Whitehead CL;Hobson SR;Ayyathurai V;Rahman A;Saghian R;Jobst KJ;McShane C;Block-Abraham D;Seravalli V;Laurie M;Millard S;Delp C;Wolfson D;Baschat AA;Murphy KE;Serghides L;Morgen E;Macgowan CK;Parks WT;Kingdom JC;Sled JG
脐动脉（UA）多普勒搏动指数在临床上用于检测胎儿-胎盘血管阻力升高。然而，该指标被胎儿心脏功能的变化所混淆，并且仅适度预测胎盘病理。我们的研究小组开发了一种新的超声方法，可以测量UA中的波反射，从而分离出胎盘特有的多普勒信号成分。本研究探讨是否波反射在UA是预测胎盘血管病变。对241名孕妇进行了标准临床多普勒超声检查。其中，40名妇女符合严格定义的对照组预设标准，36名母亲血管灌注不良（MVM）和16名胎儿血管灌注不良（FVM）。使用计算程序，多普勒波形被分解成一对向前和向后传播的波。与对照组相比，MVM（p<0.0001）或FVM病理（p = 0.02）女性的波反射显著升高。相反，脐动脉和子宫动脉搏动指数仅在MVM组升高（p<0.0001），FVM组与对照组之间无差异。结合标准临床超声参数，测量UA中的波反射，有可能提高UA多普勒检测胎盘血管病变的诊断性能。识别患有FVM病理的女性在产前特别具有挑战性，未来的研究将确定处于这种特定胎盘疾病风险中的女性是否可以从这种新型诊断技术中受益。
The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ultrasound methodology that measures wave reflections in the UA, thereby isolating a component of the Doppler signal that is specific to the placenta. The present study examined whether wave reflections in the UA are predictive of placental vascular pathology. Standard clinical Doppler ultrasound of the UAs was performed in 241 pregnant women. Of these, 40 women met narrowly defined preset criteria for the control group, 36 had maternal vascular malperfusion (MVM) and 16 had fetal vascular malperfusion (FVM). Using a computational procedure, the Doppler waveforms were decomposed into a pair of forward and backward propagating waves. Compared to controls, wave reflections were significantly elevated in women with either MVM (p<0.0001) or FVM pathology (p = 0.02). In contrast, the umbilical and uterine artery pulsatility indices were only elevated in the MVM group (p<0.0001) and there were no differences between women with FVM and the controls. The measurement of wave reflections in the UA, combined with standard clinical ultrasound parameters, has the potential to improve the diagnostic performance of UA Doppler to detect placental vascular pathology. Identifying women with FVM pathology is particularly challenging prenatally and future investigations will determine if women at risk of this specific placental disease could benefit from this novel diagnostic technique.
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影响因子：
10.6
作者：
Stortz G;Cahill LS;Chandran AR;Baschat A;Sled JG;Macgowan CK
通讯作者：
Macgowan CK
DOI：
10.1152/ajpheart.00733.2018
发表时间：
2019-03-01
影响因子：
4.8
作者：
Cahill, Lindsay S.;Zhou, Yu-Qing;Sled, John G.
通讯作者：
Sled, John G.
影响因子：
9.8
作者：
Khalil, Asma;Morales-Rosello, Jose;Thilaganathan, Basky
通讯作者：
Thilaganathan, Basky
影响因子：
7.1
作者：
Man, J.;Hutchinson, J. C.;Sebire, N. J.
通讯作者：
Sebire, N. J.
影响因子：
3.3
作者：
Redline, RW
通讯作者：
Redline, RW