3D Umbilical Venous Blood Flow - A New Paradigm for Improving the Assessment of Fetal Growth Restriction.

3D 脐静脉血流 - 改进胎儿生长受限评估的新范例。

• 批准号: 10386856
• 负责人: JEFFREY B FOWLKES
• 金额: $ 60.83万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10386856
• 关键词: 3-Dimensional; 3D ultrasound; Address; Adult; Biometry; Blood Circulation; Blood Flow Velocity; Blood Vessels; Blood flow; Caliber; Cardiovascular Diseases; Childhood; Circulatory Process; Clinical assessments; Color; Constitutional; Data; Dependence; Detection; Deterioration; Diabetes Mellitus; Doppler Ultrasound; Doppler velocimetry; Early Diagnosis; Evaluation; Family health status; Fetal Growth; Fetal Growth Retardation; Fetus; First Pregnancy Trimester; Geometry; Growth; Healthcare Systems; Human; Image; Imaging technology; In Vitro; Infant; Knowledge; Lead; Length; Longitudinal Studies; Manuals; Measurement; Measures; Metabolic; Methods; Monitor; Morbidity - disease rate; Nutrient; Obesity; Outcome; Oxygen; Pattern; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy Trimesters; Pregnant Women; Pregnant sheep; Prospective cohort; Reference Standards; Reproducibility; Research Personnel; Risk; Site; Small for Gestational Age Infant; Source; Structure of umbilical artery; Techniques; Technology; Transducers; Ultrasonic Transducer; Ultrasonography; Umbilical cord structure; Umbilical vein; Vascular resistance; Velocimetries; Venous; adverse outcome; adverse pregnancy outcome; antenatal; base; blood flow measurement; clinical application; clinical practice; cohort; detection method; experimental study; fetal; fetus at risk; improved; mortality; neonatal morbidity; novel strategies; perinatal outcomes; prospective; real-time images; ultrasound; wasting

Significance: Fetal growth restriction (FGR) is an independent predictor of infant and lifelong morbidity and mortality of non-anomalous fetuses. However, fetal biometry alone does not reliably distinguish between small fetuses at risk for poor outcomes from those that are constitutionally small. Considerable efforts have been directed toward developing more robust methods for the detection and monitoring of small fetuses at risk for adverse outcomes. Conventional efforts for measuring umbilical venous blood flow (UVBF), using conventional 2D vessel diameter measurements with Doppler velocimetry, have been challenging due to technical factors that make it impractical for routine clinical practice. We will address this problem by using 3D sonography to measure umbilical venous blood flow (3D UVBF). This approach combines color flow Doppler ultrasound with a 2D array transducer to quantify volume flow in a manner that does not require a priori knowledge of small vessel diameter, Doppler insonation angle, flow velocity profile, or vessel geometry. Hypotheses: 1) 3D UVBF is an accurate and reproducible sonographic parameter for measuring umbilical venous flow throughout gestation; 2) Reference standards for 3D UVBF will be readily generated that provide a necessary framework for prospective analyses; and 3) A predictable and progressive circulatory deterioration pattern, based on 3D UVBF, occurs significantly more frequently among small fetuses (EFW < 10th%) with adverse outcomes when compared to other small fetuses without complications. Preliminary Data: We have shown that the 3D UVBF % error, relative to average measured arterial and venous flow, was ≤ 10% for 8 of 9 measurements in exteriorized fetuses of pregnant ewes. Lower than expected 3D UVBF values were found in 2 of 7 fetuses from human pregnancies that later developed FGR or preeclampsia (Pinter S, et al. J Ultrasound Med 37:1633-1640, 2018). In further reproducibility studies, the 3D UVBF intra-subject and intra-measurement relative standard errors (RSE) were 12.1 ± 5.9 and 5.6 ± 1.9 % (mean ± SD), respectively (n=35). Specific Aims: We propose to validate 3D UVBF, develop 3D UVBF reference standards, and provide detailed observations of circulatory changes in small fetuses with EFW < 10th%. In Specific Aim 1, in-vitro flow phantom experiments and reproducibility studies in pregnant women will examine the accuracy and reproducibility of 3D UVBF. In Specific Aim 2, serial ultrasound scans will develop prescriptive 3D UVBF reference standards in 400 non-anomalous fetuses with normal growth outcomes. In Specific Aim 3, circulatory patterns of multi-vessel Doppler velocimetry and 3D UVBF changes will be determined in a prospective cohort of 1100 small fetuses. The added value of 3D UVBF and related Doppler circulatory patterns in identifying small fetuses with adverse perinatal outcomes or neonatal morbidities will be examined. Successful execution of our Aims should establish 3D UVBF as a reproducible circulatory parameter that is accurate and clinically applicable as early as the first trimester. Our approach may improve detection and monitoring of small fetuses before conventional imaging predictors of adverse pregnancy outcomes become apparent.

意义：胎儿生长限制（FGR）是婴儿和终生发病率的独立预测指标 非反对胎儿的死亡率。但是，仅胎儿生物特征并不能可靠地区分小 胎儿遇到持续很小的胎儿会出现不良预后的风险。大量的努力是 致力于开发更强大的方法，以检测和监测有风险的小胎儿 不利的结果。使用常规 用多普勒速度测定法测量2D容器直径，由于技术因素而受到挑战 使其对常规临床实践不切实际。我们将通过使用3D超声检查来解决这个问题 脐带静脉血流（3D UVBF）。这种方法将颜色流多普勒超声和2D阵列结合在一起 传感器以不需要先验知识的小容器直径的方式来量化体积流量 多普勒插音角，流速度轮廓或容器几何形状。假设：1）3D UVBF是准确的， 可再现的声音学参数，用于测量妊娠期间的脐静脉流； 2）参考 将很容易生成3D UVBF的标准，为前瞻性分析提供必要的框架； 3）基于3D UVBF的可预测和渐进的电路定义模式显着发生 与其他小的小胎儿（EFW <10％）中的频率更高（EFW <10％） 胎儿没有并发症。初步数据：我们已经证明了3D UVBF％误差，相对于平均 测量的动脉和静脉流量为孕妇母羊外部胎儿中9个测量中的8个测量中的8个。 在人类怀孕的7个胎儿中有2个中发现了3D UVBF值，后来发展 FGR或先兆子痫（Pinter S等人J超声医学37：1633-1640，2018）。在进一步的可重复性研究中 3D UVBF内部受试者和测量内相对标准误差（RSE）为12.1±5.9和5.6±1.9 ％（平均值±SD）分别（n = 35）。具体目的：我们建议验证3D UVBF，开发3D UVBF 参考标准标准，并提供了EFW <10％的小胎儿的电路变化的详细观察。 在特定的目标1中，孕妇的体外流量幻像实验和可重复性研究将检查 3D UVBF的准确性和可重复性。在特定的目标2中，串行超声扫描将产生规定性 3D UVBF参考标准标准在400个非反对胎儿中，其生长结果正常。在特定的目标3中 将在A中确定多种船尾多普勒速度法和3D UVBF变化的循环模式 1100个小胎儿的前瞻性队列。 3D UVBF和相关多普勒电路模式的附加值 在确定具有不良围产期结局或新生儿病毒的小胎儿时。成功的 我们的目标的执行应建立3D UVBF作为准确的可再现电路参数，并且 临床上适用于早孕期。我们的方法可以改善对小的检测和监测 不良怀孕结局的常规成像预测指标之前的胎儿变得显而易见。