Fatih ŞANLIKAN, Resul ARISOY, Koray ÖZBAY, Altuğ SEMİZ

Tekiz gebeliklerde birinci trimester intrakranial translusensi nomogramı

Tekiz gebeliklerde birinci trimester intrakranial translusensi nomogramı Özet Amaç:11-14. gebelik haftaları için intrakranial translusensi (IT) nomogramı oluşturulması ve IT ölçümlerinin gebelik günleri, baş popo mesafesi ve bipariyatel çap ile olan ilişkisinin değerlendirilmesi. Gereçler ve Yöntem: Kliniğimize başvuran birinci trimester’deki 119 tekiz gebe çalışmaya dâhil edildi, bu gebelerde fetüslerin IT genişliği değerlendirilip gebelik günü, b aş popo mesafesi (CRL) ve bipariyatel çap (BPD)ile olan ilişkisi araştırıldı. Yapısal veya kromozomal anomali saptanan fetüsler ve çoğul gebelikler çalışma dışı bırakıldı. Bulgular: Çalışmamızda ortalama gebelik günü 86,6 ± 4,9, CRL 61,6 ± 7,2 mm, BPD 20,7 ± 2,3 mm, IT genişliği 1,7 ± 0,3 mm olarak tespit edildi. 11-14. gebelik haftaları için gebelik günlerine göre IT nomogramı oluşturuldu. Lineer regresyon analizinde IT ile gebelik günü, CRL ve BPD arasında zayıf pozitif korelasyon saptandı (sırasıyla r=0.30, r2=0,0899, r2 =0,0815). IT genişliğinin 50.persentil değeri 11 hafta 0-6 gün, 12 hafta 0-6 gün ve 13 hafta 0-6 gün için sırasıyla 1,5 mm, 1,7 mm ve 1,8 mm olarak saptandı. Sonuç: Birinci trimesterde nuchal tranlusensi ölçümleri yapılırken eş zamanlı olarak kolaylıkla ölçülebilen IT, santral sinir sistemi anomalilerinin saptanmasında faydalı olabilen bir ölçümdür. Çalışmamızın sonuçları literatürü destekleyecek şekilde, IT’nin ilerleyen gebelik haftalarıyla beraber lineer olarak arttığını ve gebelik günleri, CRL ve BPD ile korele olduğunu göstermiştir. Elde ettiğimiz IT nomogramı kendi popülasyonumuzun değerlendirilmesinde faydalı olabilir. Anahtar Kelimeler: İntrakranial translusensi, birinci trimester, nomogram First trimester intracranial translucency nomogram in singleton pregnancies Abstract Objective: Our aim was to create an intracranial translucency (IT) nomogram for the 11-14 weeks of gestation and to evaluate the relationships between IT measurements and gestational days, crown rump length and biparietal diameter. Material and Methods: 119 singleton pregnant women who applied to our clinic in the first trimester were included in the study. The IT of the fetuses were evaluated and the relationship between IT measurements and gestational day, crown rump length (CRL) and biparietal diameter (BPD) was investigated. Results: We determined the mean values for gestational day, CRL, BPD and IT as 86.6 ± 4.9 days, 61.6 ± 7.2 mm, 20.7 ± 2.3 mm1.7 ± 0.3 mm, respectively. After then an IT nomogram was formed according to pregnancy days for the11-14gestational weeks. Linear regression analysis revealed a weak positive correlation between IT and gestational day, CRL and BPD (r= 0.30, r2= 0.0899, r2= 0.0815, respectively).The 50th percentile value of IT was determined as 1.5 mm, 1.7 mm and 1.8 mm for 11 weeks 0-6 days, 12 weeks 0-6 days and 13 weeks 0-6 days, respectively. Conclusion: IT can be easily measured simultaneously while performing nuchal translucency measurements in the first trimester, which can be useful in detecting central nervous system anomalies. The results of our study showed that IT increased linearly with advancing gestational weeks and correlated with gestational days, CRL and BPD, in accordance with the literature. The IT nomogram we obtained can be useful in evaluating our own population. Keywords: Intracranial translucency, first trimester, nomogram

Anahtar Kelimeler:

İntrakranial translusensi, birinci trimester, nomogram

PDF

___

Referans1- Zaganjor I, Sekkarie A, Tsang BL, Williams J, Razzaghi H et al. Describing the Prevalence of Neural Tube Defects Worldwide: A Systematic Literature Review. PLoS One 2016;11(4):e0151586.
Referans2- Timbolschi D, Schaefer E, Monga B, Fattori D, Dott B et al. Neural tube defects: the experience of the registry of congenital malformations of Alsace, France, 1995-2009. Fetal Diagn Ther 2015;37(1):6-17.
Referans3- Chaoui R, Benoit B, Mitkowska-Wozniak H, Heling KS, Nicolaides KH. Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11-13-week scan. Ultrasound Obstet Gynecol 2009;34(3):249-52.
Referans4- Chaoui R, Nicolaides KH. From nuchal translucency to intracranial translucency: towards the early detection of spina bifida. Ultrasound Obstet Gynecol. 2010;35(2):133-8.
Referans5- Kavalakis I, Souka AP, Pilalis A, Papastefanou I, Kassanos D. Assessment of the posterior brain at 11-14 weeks for the prediction of open neural tube defects. Prenat Diagn 2012;32(12):1143-6.
Referans6- Mangione R, Dhombres F, Lelong N, Amat S, Atoub F, Friszer S, Khoshnood B, Jouannic JM. Screening for fetal spina bifida at the 11-13-week scan using three anatomical features of the posterior brain. Ultrasound Obstet Gynecol. 2013;42(4):416-20.
Referans7- Fong KW, Toi A, Okun N, Al-Shami E, Menezes RJ. Retrospective review of diagnostic performance of intracranial translucency in detection of open spina bifida at the 11-13-week scan. Ultrasound Obstet Gynecol 2011;38(6):630-4.
Referans8- Chen FC, Gerhardt J, Entezami M, Chaoui R, Henrich W. Detection of Spina Bifida by First Trimester Screening - Results of the Prospective Multicenter Berlin IT-Study. Ultraschall Med 2017;38(2):151-157.
Referans9- Suresh S, Sudarshan S, Rangaraj A, Indrani S, Cuckle H. Spina bifida screening in the first trimester using ultrasound biparietal diameter measurement adjusted for crown-rump length or abdominal circumference. Prenat Diagn 2019;39(4):314-318.
Referans10- Ferreira AF, Syngelaki A, Smolin A, Vayna AM, Nicolaides KH. Posterior brain in fetuses with trisomy 18, trisomy 13 and triploidy at 11 to 13 weeks' gestation. Prenat Diagn 2012;32(9):854-8.
Referans11- Garcia-Posada R, Eixarch E, Sanz M, Puerto B, Figueras F, Borrell A. Cisterna magna width at 11-13 weeks in the detection of posterior fossa anomalies. Ultrasound Obstet Gynecol 2013;41(5):515-20.
Referans12- Papastefanou I, Souka AP, Pilalis A, Panagopoulos P, Kassanos D. Fetal intracranial translucency and cisterna magna at 11 to 14 weeks : reference ranges and correlation with chromosomal abnormalities. Prenat Diagn 2011;31(12):1189-92.
Referans13- Egle D, Strobl I, Weiskopf-Schwendinger V, Grubinger E, Kraxner F, Mutz-Dehbalaie IS, Strasak A, Scheier M. Appearance of the fetal posterior fossa at 11 + 3 to 13 + 6 gestational weeks on transabdominal ultrasound examination. Ultrasound Obstet Gynecol 2011;38(6):620-4.
Referans14- Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A. One case of increased intracranial translucency during the first trimester associated with the Dandy-Walker variant. Prenat Diagn 2012 ;32(6):602-3.
Referans15- Sivri Aydın D, Yayla M. Evaluation of the fourth ventricle and nomogram of intracranial translucency at 11–13 weeks of gestation. Perinatal Journal 2018;26(2):102–105.
Referans16- Ergin RN, Yayla M. The nomogram of intracranial translucency in the first trimester in singletons. J Turk Ger Gynecol Assoc 20121;13(3):153-6.
Referans17- Molina-Giraldo S, Pérez-Olivo JL, Arias JL, Acuña E, Alfonso D, Arreaza M, Leal MB. Normal Intracranial Translucency Values During the First Trimester of Gestation in a Latin American Population. J Ultrasound Med 2016;35(10):2231-6.
Referans18- Adiego B, Illescas T, Martinez-Ten P, Bermejo C, Perez-Pedregosa J, Wong AE, Sepulveda W. Intracranial translucency at 11-13 weeks of gestation: prospective evaluation and reproducibility of measurements. Prenat Diagn 2012;32(3):259-63.
Referans19- Kose S, Altunyurt S, Keskinoglu P. A prospective study on fetal posterior cranial fossa assessment for early detection of open spina bifida at 11-13 weeks. Congenit Anom (Kyoto) 2018;58(1):4-9.
Referans20- Maruotti GM, Saccone G, D'Antonio F, Berghella V, Sarno L, Morlando M, Giudicepietro A, Martinelli P. Diagnostic accuracy of intracranial translucency in detecting spina bifida: a systematic review and meta-analysis. Prenat Diagn 2016;36(11):991-996.
Referans21- Sirico A, Raffone A, Lanzone A, Saccone G, Travaglino A, Sarno L, Rizzo G, Zullo F, Maruotti GM. First trimester detection of fetal open spina bifida using BS/BSOB ratio. Arch Gynecol Obstet 2019 Dec 24. doi: 10.1007/s00404-019-05422-3.
Referans22- Ushakov F, Sacco A, Andreeva E, Tudorache S, Everett T, David AL, Pandya PP. Crash sign: new first-trimester sonographic marker of spina bifida. Ultrasound Obstet Gynecol. 2019;54(6):740-745.
Referans23-Chaoui R, Benoit B, Entezami M, Frenzel W, Heling KS, Ladendorf B, Pietzsch V, Sarut Lopez A, Karl K. Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11-13 weeks' gestation. Ultrasound Obstet Gynecol. 2020;55(1):81-86.