Prenatal diagnosis of pulmonary hypoplasia
Prenatal diagnosis of pulmonary hypoplasia
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DOI：
10.1097/gco.0b013e3283505a86
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发表时间：
2012-03
影响因子：
2.1
通讯作者：
P. Vergani
中科院分区：
文献类型：
--
作者：
P. Vergani
综述目的：综述肺发育不良的常用诊断方法及其在不同病理状态下的相关性。最近的发现二维生物特征参数不够准确，不能应用于临床实践，除了肺头比（LHR）：观察到的/预期的LHR仍然是先天性膈疝胎儿肺发育不良的最佳预测因子。三维超声技术的引入允许直接测量肺体积。三维推导的列线图似乎可靠的预测正常和病理肺体积。MRI越来越受到人们的关注。最近发表的关于这种方法的研究具有高度异质性;因此，尚无普遍接受的预测肺发育不全的标准化值。最后，一些作者提出了多普勒超声测速检测与肺发育不全相关的肺血管的变化。然而，到目前为止，还没有一个明确的测试来预测肺发育不全。总结致命类型肺发育不全的预测对于改善咨询和新生儿援助至关重要。至少目前还没有一项测试可以预测出生后的肺功能。对于不同的基础病理，临床、超声和MRI参数的不同组合似乎可以更好地评估肺发育不良的风险。
Purpose of review To review the most used tests for diagnosis of pulmonary hypoplasia, and their pertinence in different pathological conditions. Recent findings The two-dimensional biometric parameters are not accurate enough to be applied in clinical practice, except for the lung-to-head ratio (LHR): the observed/expected LHR remains the best predictor of pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia. The introduction of three-dimensional ultrasound tecniques has allowed to directly measure lung volume. Three-dimensional-derived nomograms seem reliable for the prediction of both normal and pathological pulmonary volumes. MRI is attracting increasing attention. The studies recently published on this method are highly heterogeneous; universally accepted standardized values for the prediction of pulmonary hypoplasia are, hence, not available. Finally, some authors proposed Doppler ultrasound velocimetry to detect changes in pulmonary vascularization that correlate to pulmonary hypoplasia. However, a well-defined test to predict pulmonary hypoplasia has not emerged so far. Summary The prediction of the lethal type of pulmonary hypoplasia is pivotal to improve counseling and neonatal assistance. There is not a single test that can, at least for now, predict postnatal lung function. For different underlying pathologies, different combinations of clinical, ultrasound, and MRI parameters seem to better assess the risk of pulmonary hypoplasia.