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Anuwutnavin S, Unalome V, Rekhawasin T, Tongprasert F, Thongkloung P. Fetal left-atrial posterior-space-to-diagonal ratio at 17-37 weeks' gestation for prediction of total anomalous pulmonary venous connection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:488-496. [PMID: 36099492 DOI: 10.1002/uog.26072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To develop normative data for the left-atrial posterior-space-to-diagonal (LAPSD) ratio and post-left atrium space (PLAS) index in fetuses from 17 to 37 weeks' gestation, and determine the optimal cut-offs of the LAPSD ratio and PLAS index to discriminate between normal fetuses and those with total anomalous pulmonary venous connection (TAPVC). METHODS This was a prospective cross-sectional assessment of 428 structurally normal fetuses between 17 and 37 weeks' gestation and a retrospective study of 27 TAPVC fetuses. The fetal LAPSD ratio was calculated by dividing the left atrium-descending aorta distance (LDD) by the left atrial diagonal diameter (LA). The PLAS index was calculated as the ratio of the LDD to the descending aorta diameter (DA). Pearson's correlation analysis was used to examine the correlation of cardiac parameters with gestational age (GA) and fetal somatic growth. The PLAS index and LAPSD ratio were compared between the normal and TAPVC groups to assess their usefulness in the prenatal diagnosis of TAPVC. RESULTS LDD, LA and DA measures showed moderate to strong positive correlation, whereas both the LAPSD ratio and PLAS index showed a slight decrease with increasing GA and biometric variables. The fetal LAPSD ratio and PLAS index in TAPVC cases were significantly greater compared with those of fetuses with a normal heart (both P < 0.001). There were no significant differences in the PLAS index and LAPSD ratio between the isolated and complex TAPVC groups (both P = 1). No significant associations of the PLAS index and LAPSD ratio with fetal gender, four-chamber view type (apical, basal or lateral) or TAPVC type were found. Using values of ≥ 0.35 for the LAPSD ratio and of ≥ 1 for the PLAS index exhibited similar excellent diagnostic performance, with a sensitivity of 100% and specificity of 97.0% or 95.1% for detecting TAPVC. CONCLUSIONS Our study demonstrates that the LAPSD ratio is a practical and effective screening tool for diagnosing fetal TAPVC, similar to the PLAS index. Incorporating these parameters into routine cardiac scanning may enhance the prenatal detection of TAPVC. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Anuwutnavin
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V Unalome
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Rekhawasin
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - F Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Thongkloung
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Wang X, Yang TY, Zhang YY, Liu XW, Zhang Y, Sun L, Gu XY, Chen Z, Guo Y, Xue C, Han JC, Zhu HG, He YH. Diagnosis of fetal total anomalous pulmonary venous connection based on the post-left atrium space ratio using artificial intelligence. Prenat Diagn 2022; 42:1323-1331. [PMID: 35938586 DOI: 10.1002/pd.6220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore whether the post-left atrium space (PLAS) ratio would be useful for prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC) using echocardiography and artificial intelligence. METHODS We retrospectively included 642 frames of four-chamber view from 319 fetuses (32 with TAPVC and 287 without TAPVC) in end-systolic and end-diastolic periods with multiple apex directions. The average gestational age was 25.6±2.7 weeks. No other cardiac or extracardiac malformations were observed. The dataset was divided into a training set (n=540; 48 with TAPVC and 492 without TAPVC) and test set (n=102; 20 with TAPVC and 82 without TAPVC). The PLAS ratio was defined as the ratio of the epicardium-descending aortic distance to the center of the heart-descending aortic distance. Supervised learning was used in DeepLabv3+, FastFCN, PSPNet, and DenseASPP segmentation models. The area under the curve (AUC) was used on the test set. RESULTS Expert annotations showed that this ratio was not related to the period or apex direction. It was higher in the TAPVC group than in the control group detected by expert and the four models. The AUC of expert annotations, DeepLabv3+, FastFCN, PSPNet, and DenseASPP were 0.977, 0.941, 0.925, 0.856, and 0.887, respectively. CONCLUSION Segmentation models achieve good diagnostic accuracy for TAPVC based on the PLAS ratio. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xin Wang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Ting-Yang Yang
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Ying-Ying Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiao-Wei Liu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Ye Zhang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Lin Sun
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Xiao-Yan Gu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Zhuo Chen
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Yong Guo
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Chao Xue
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Jian-Cheng Han
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Hao-Gang Zhu
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Yi-Hua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
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Han J, Li T, Wu W, Zhang Y, Liu X, Gu X, Sun L, Gao S, He Y. Post-Left Atrium Space Index in Fetuses With Total Anomalous Pulmonary Venous Connection and Other Congenital Heart Diseases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2405-2412. [PMID: 32491276 DOI: 10.1002/jum.15362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We aimed to explore the value of the post-left atrium space (PLAS) index in the diagnosis of total anomalous pulmonary venous connection (TAPVC) and the effect of other congenital heart diseases on the PLAS index in the fetus. METHODS The PLAS index of 69 fetuses with TAPVC was analyzed retrospectively. Approximately 252 healthy fetuses were randomly selected as controls, and 110 cases of intracardiac malformations were randomly selected for comparison. The PLAS index was defined as the ratio of the left atrium-descending aorta distance divided by the descending aorta diameter from the 4-chamber view in the end-systolic phase. RESULTS There were no significant differences in the PLAS index among the 3 groups of isolated TAPVC subtypes (P > .05), or among the isolated TAPVC group and the simple and complex cardiac anomaly groups (P > .05). Compared with the control group, the PLAS index of the TAPVC group was significantly increased (P < .001). The PLAS index was significantly higher in the TAPVC group than in hypoplastic left heart syndrome, endocardial cushion defect, conotruncal defect, and ventricular septal defect groups (P < .05). The PLAS indices of the hypoplastic left heart syndrome, endocardial cushion defect, and conotruncal defect groups were all higher than that of the control group (P < .05). There was no significant difference in the PLAS index between the ventricular septal defect and control groups (P > .05). CONCLUSIONS The PLAS index is a sensitive parameter for the diagnosis of fetal TAPVC. There were no significant differences in the PLAS index among different TAPVC types. Complex intracardiac anomalies have an influence on the PLAS index.
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Affiliation(s)
- Jiancheng Han
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Tianjing Li
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Wenfang Wu
- School of Biology Medical Engineering, Capital Medical University, Beijing, China
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Xiaowei Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Lin Sun
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China
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