| ObjectiveTo evaluate the lung development in common fetal thoracic lesions and the follow-up of the children,and to explore whether ultrasound fetal lung to body weight ratio(UFLB)can be used as an index for evaluating pulmonary hypoplasia(PH)and the value of lung ultrasound in the follow-up of children with thoracic lesions.MethodsA total of 81 patients who were undergoing persistent examinations in our hospital from November 2017 to July 2018 were included.There were 54 cases of congenital cystic adenomatoid malformation,18 cases of bronchopulmonary sequestration,and 9 cases of congenital diaphragmatic hernia,in another,100 normal fetuses were selected as the control group.The VOCAL technique was used to perform three-dimensional imaging of the normal lung tissue of the fetus,and a clear image was selected and stored in the machine.The image was processed then to obtain the normal lung volume.The total lung volume to the estimated fetal weight ratio is obtained as an ultrasound fetal lung to body weight ratio(UFLB).That is,the normal fetal lung volume to lung weight ratio(UFLB),the lung volume to lung weight ratio(UFLB)of the thoracic lesions were identified,and the high-risk fetus with pulmonary hypoplasia was identified,which was compared with the clinical diagnosis or pathological diagnosis of postpartum newborns.Follow-up of fetal pregnancy outcomes,and sign informed consent with the family members of the children,then provide three times free lung ultrasound examination to such children in 1 month,2 months,3 months after birth.The cut-off value of FLB was used as the gold standard for diagnosing pulmonary hypoplasia and the sensitivity,specificity,positive predictive value,negative predictive value,diagnostic coincidence rate and the area under the ROC curve of UFLB were calculated.Results(1)Correlation analysis was performed on 100 normal fetuses.The left lung volume,right lung volume,and total lung volume were highly positively correlated with gestational age respectively(r=0.967,0.965,0.973,P<0.05);fetal weight also had highly positive relationship with gestational age(r=0.971,P<0.05).Fetal lung volume had a significant positive correlation with body weight(r=0.970,P<0.05).The normal fetal UFLB is relatively constant,with a small change with gestational age(r=-0.371,P=0.000).The average of UFLB is about 0.028 and a range of about 0.022 to 0.035.(2)Observation group: Before 28 weeks of gestation,the UFLB of the PH fetus was 0.012±0.002,and the UFLB of the fetus without PH occurred was 0.026±0.004.28 weeks and 28 weeks later,the UFLB of the fetus with PH was 0.011±0.002 and the UFLB of the fetus without PH occurred was 0.027±0.005.(3)The diagnostic efficiency of UFLB:the sensitivity was 88.2%,the specificity was 93.7%,the positive predictive value was 78.9%,the negative predictive value was 96.8%,the diagnostic accuracy rate was 92.6%;Before 28 weeks of gestation,the area under the ROC curve was 0.894(95% confidence interval: 0.767-1.000,P<0.05),the sensitivity was about 80.0%,and the specificity was about 83.3%.After 28 weeks and 28 weeks later,the area under the ROC curve was 0.877(95% confidence interval: 0.777-0.977,P<0.05),the sensitivity was about 75.0%,and the specificity was about 90.9%.(4)The value of lung ultrasound in the follow-up study of prognosis: Lung ultrasound were used in 26 children with thoracic lesions.Four cases were found to be persistent,all of which showed a subpleural,larger intrapulmonary cystic mass,then confirmed by CT or X-ray examination.The remaining 22 cases of lung ultrasound examination did not have obvious mass echoes.The prenatal lesions were located in the subpleural or deep lung tissue.The volume of the mass was generally small.Among of these,12 cases underwent CT or X-ray examinations.The results showed that 8 cases were present,and 4 cases showed lung texture weight gain,increased local permeability in the lung field.One case was detected by lung ultrasound at 3 months during the follow-up,and the lesion was located near the pleura and X-ray tablet was confirmed to be pneumonia.So there was a limit on the detection rate of thoracic lesions mass.Lung ultrasound is sensitive to pneumonia.Conclusions(1)The normal left fetal lung volume,right lung volume,total lung volume and body weight were positively correlated with gestational age,and total lung volume were positively correlated with body weight.(2)UFLB can be used as a diagnostic index for pulmonary hypoplasia and especially suitable for the assessment of pulmonary hypoplasia result from different causes.(3)Though there are some limitations in mass detection,it has a good application prospect in the follow-up of neonatal with mass,and can observe the prognosis and outcome of the disease. |
