Ziel: Ziel dieser Studie war es, anhand von dreidimensionalen sonografischen Messungen
Normkurven für das fetale Lungen-, Thorax- und Herzvolumen zu etablieren. Material und Methoden: Hierzu wurden 300 Feten zwischen 18 und 34 Schwangerschaftswochen mit den Ultraschallgeräten
Voluson 530 ME und Voluson 730 PRO (General Electric, USA) mit einer abdominalen annularen
5 MHz-Volumensonde untersucht. Um das fetale Lungenvolumen zu bestimmen, wurden transversale
Schnittebenen jeder Lunge im multiplanaren Modus gemessen. Die Messungen wurden mittels
Umfahrung der Lungengrenzen im Querschnitt vorgenommen. Der Abstand zwischen den jeweiligen
Querschnitten wurde computergestützt berechnet. Die berechneten Volumendaten wurden
in Abhängigkeit vom Gestationsalter geplottet, um somit Normkurven für das Lungen-,
Herz- und Thoraxvolumen zu erhalten. Ergebnisse: Unsere Normkurven zeigen ein zunehmendes Volumenwachstum zwischen 22 SSW und 34 SSW.
Weiterhin konnten wir herausfinden, dass ein statistisch signifikanter Unterschied
zwischen dem rechten und linken Lungenwachstum (rechts > links) besteht. Bei einer
Gruppe von 12 Feten mit einer Skelettdysplasie oder einem Hydrothorax wurde der sonografische
Verdacht auf eine Lungenhypoplasie geäußert. Der Vergleich von 2-D-Messungen des schrägen
Lungendurchmessers und 3-D-Messungen der Lungenvolumina konnte zeigen, dass beide
Methoden geeignet sind, eine Lungenhypoplasie vor 24 SSW zu erkennen. Schlussfolgerung: Mit der 3-D-Sonografie ist es einfach, das fetale Lungenvolumen vor 30 SSW zu bestimmen.
Die ermutigenden Resultate lassen vermuten, dass sich mit diesem Verfahren Lungenhypoplasien
selbst vor 24 SSW erkennen lassen.
Abstract
Purpose: The aim of the study was to establish fetal lung, thoracic and heart volume nomograms
using three-dimensional (3D) ultrasonographic measurements. Materials and Methods: For this purpose a total of 300 fetuses were examined between 18 and 34 weeks of
gestation using Voluson 530 ME and Voluson 730 PRO (General Electic, USA) ultrasound
devices with 5 MHz three-dimensional annular volume transducers. To determine fetal
lung volume, each lung was measured separately using a transversal sectional plane
in the multiplanar mode. Measurements were performed by area tracing around the fetal
lung in cross-sectional planes in different slices. The distance between two represented
slices was calculated by computer. Calculated volume data was plotted against gestational
age in order to obtain nomograms of fetal lung, heart and thorax volumes. Results: Our nomograms revealed increasing lung, heart and thoracic volume growth between
22 and 34 weeks of gestation. Furthermore, we could demonstrate that there is a statistically
significant difference between the growth of the right and left lung volume (right
> left). In a group of 12 fetuses with skeletal dysplasias or hydrothorax pulmonary
hypoplasia was suspected by ultrasound. Comparing two-dimensional (2D) sonographic
measurements of oblique lung diameter and 3D lung volumetry, it was found that these
two methods were complementary for the recognition of pulmonary hypoplasia before
the 24 weeks of gestation. Conclusion: Using 3D ultrasound it is easy to perform fetal lung volumetry especially before
30 weeks of gestation. The encouraging results suggest that this method could be useful
for the early detection of pulmonary hypoplasia even before 24 weeks of gestation.
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