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Pan L, Liang H, Meng Z, Wang J, Zhang R, Wu Y. Assessing the value of second-trimester nasal bone hypoplasia in predicting chromosomal abnormalities: a retrospective chromosomal microarray analysis of 351 fetuses. Arch Gynecol Obstet 2023; 308:1263-1270. [PMID: 36269386 DOI: 10.1007/s00404-022-06808-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/27/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the value of fetal nasal bone hypoplasia and other prenatal risk factors in predicting chromosomal abnormalities. METHODS In this retrospective cohort study, we collected data on singleton pregnancies diagnosed with fetal nasal bone hypoplasia during second-trimester ultrasound. Fetal karyotyping and chromosomal microarray analysis (CMA) were performed, and pregnancy outcomes were assessed. The association between fetal nasal bone hypoplasia and chromosomal abnormalities was evaluated according to whether other prenatal risk factors were observed. RESULTS Our final analysis included 351 pregnancies, of which 62 (17.7%) fetuses had chromosomal abnormalities, including 36 cases of trisomy-21, six cases of trisomy-18, one case each of trisomy-13, and 47, XYY syndrome, and 18 cases of copy number variations (CNVs). Among the 243 cases of isolated nasal bone hypoplasia, 28 (11.5%) cases of chromosomal aberrations were identified. The incidence was significantly higher if other soft markers or structural abnormalities were simultaneously detected. Pregnancy was terminated in 43 aneuploid fetuses and nine fetuses detected with CNVs. The parents of the fetuses diagnosed with 47, XYY syndrome and the other nine CNVs chose to continue the pregnancy, and no abnormalities were detected in the newborns. Furthermore, we found that other prenatal risk factors should be considered in evaluating the likelihood of chromosomal abnormalities in fetuses with nasal bone hypoplasia. CONCLUSIONS Nasal bone hypoplasia is a highly specific soft marker that is associated with multiple chromosomal abnormalities. The risk of chromosomal abnormalities increases when combined with structural abnormalities or increased nuchal translucency (NT). Chromosomal microarray analysis is a powerful prenatal test for chromosomal abnormalities, which may be warranted in fetuses with nasal bone hypoplasia.
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Affiliation(s)
- Lei Pan
- Department of Medical Genetics and Prenatal Diagnosis, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China
| | - Hui Liang
- Central Laboratory, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China
| | - Zhuo Meng
- Department of Medical Image Center, Medical Research Institute, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China
| | - Jun Wang
- Medical Research Institute, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China
| | - Rui Zhang
- Department of Medical Genetics and Prenatal Diagnosis, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China.
| | - Yong Wu
- Medical Research Institute, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China.
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Ji C, Jiang X, Yin L, Deng X, Yang Z, Pan Q, Zhang J, Liang Q. Ultrasonographic study of fetal facial profile markers during the first trimester. BMC Pregnancy Childbirth 2021; 21:324. [PMID: 33894762 PMCID: PMC8070329 DOI: 10.1186/s12884-021-03813-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/20/2021] [Indexed: 01/20/2023] Open
Abstract
Background To establish reference ranges of fetal facial profile markers and study their correlations with crown-rump length (CRL) during the first trimester (11 ~ 13+ 6 weeks’ gestation) in a Chinese population. Methods Ultrasonographic images of measuring fetal nuchal translucency (NT) were retrospectively selected randomly in normal fetuses whose parents were both Chinese. The facial markers included inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA) and profile line (PL) distance. These markers were measured through ViewPoint 6 software by two experienced sonographers. Results Three hundred and eighty fetuses were selected. The ICCs (95 % CI) of intra-operator 1 reproducibility of IFA, MNM angle, FMA, PL distance were 0.944 (0.886 ~ 0.973), 0.804 (0.629 ~ 0.902), 0.834 (0.68 ~ 0.918) and 0.935 (0.868 ~ 0.969), respectively. The ICCs (95 % CI) of intra-operator 2 reproducibility of IFA, MNM angle, FMA, PL distance were 0.931 (0.857 ~ 0.967), 0.809 (0.637 ~ 0.904), 0.786 (0.600 ~ 0.892) and 0.906 (0.813 ~ 0.954), respectively. The ICCs (95 % CI) of inter-operator reproducibility of IFA, MNM angle, FMA, PL distance were 0.885 (0.663 ~ 0.953), 0.829 (0.672 ~ 0.915), 0.77 (0.511 ~ 0.891) and 0.844 (0.68 ~ 0.925), respectively. The average ± SD of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively. IFA and PL distance significantly decreased with CRL, while MNM angle and FMA significantly increased with CRL. Conclusions It was feasible to measure fetal facial markers during the first trimester. In Chinese population, the reference ranges of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively, and the measurements were found to correlate with CRL.
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Affiliation(s)
- Chunya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Xiaoli Jiang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China.
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Jun Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Qing Liang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
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Tekesin I, Graupner O. Assessment of the maxilla-mandible-nasion angle in normal and aneuploid foetuses in the first trimester of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:110-116. [PMID: 33289128 DOI: 10.1002/jcu.22955] [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: 07/20/2020] [Revised: 10/28/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE This retrospective study aims to determine whether the maxilla-mandible-nasion (MMN) angle can be reliably measured in the first trimester, to describe normal ranges, and to determine if significant changes occur in foetuses with aneuploidies. METHODS The MMN angle was measured in stored 2D-ultrasound images of 200 normal fetal profiles between 11+0 and 13+6 weeks of gestation. Each image was analyzed by two observers at two independent time points. Bland-Altmann analysis was performed to evaluate the reliability of the measurements. Additionally, the MMN angle was measured on sonograms from 140 aneuploid foetuses. RESULTS The mean MMN angle in normal foetuses from 11 to 14 weeks of gestation was 15.4°. Reliability of the measurement was high when repeatedly measured by the same observer (ICC = 0.92 and 0.82) and between two observers (ICC = 0.77 and 0.63). Average MMN values in foetuses with trisomy 21, 13, and Turner syndrome were significantly higher than those measured in normal foetuses. The highest differences were observed in foetuses with trisomy 13. Among those, 62% had an MMN angle above the 95th percentile and 92% above the normal mean. CONCLUSION The MMN angle can be reliably measured in early pregnancy and is abnormal in about 60% of foetuses with trisomy 13.
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Affiliation(s)
| | - Oliver Graupner
- Department of Gynecology and Obstetrics, University Medical Center Aachen, Aachen, Germany
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Affiliation(s)
| | | | | | - Angie C Jelin
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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Liu W, Qu S, Wang M, Xu W, Zhang G, Zhang C. Maxilla-nasion-mandible (MNM) angle: an indicator to assess fetal facial profile in first-trimester of pregnancy. SPRINGERPLUS 2016; 5:1335. [PMID: 27563530 PMCID: PMC4980851 DOI: 10.1186/s40064-016-2944-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022]
Abstract
Objective The aim of this study was to observe whether there existed significant differences in the maxilla–nasion–mandible angle (MNM) between the first- and second-trimester of pregnancy, and to observe its predictive values for trisomy 18. Methods Two experienced ultrasonologists used 2D and 3D ultrasound imaging techniques to obtain the facial sagittal sections of fetuses in the first-trimester of pregnancy (crown-rump length 45–84 mm), respectively, so as to measure MNM. Results MNM could be measured in 91 % of normal fetuses, and the measurement differences by different operators in different groups were <1.1°; average MNM was 11.0°, and no significant change was observed in different gestational ages (P = 0.15). The average of MNMs in fetuses with trisomy 18 was 16.6°, which were all higher than the 95th percentile of normal measurement data. The sensitivity and specificity of increased MNM on the abnormal detection of trisomy 18 were 54.7 and 97.4 %, respectively. Conclusions The feasibility and reproducibility of measuring MNM in early pregnancy were good. MNM had certain suggestive roles for aneusomic chromosomal abnormalities, especially for fetuses with trisomy 18.
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Affiliation(s)
- Wei Liu
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong China
| | - Suhui Qu
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong China
| | - Mujun Wang
- Department of Surgery, The First People's Hospital of Jinan City, Jinan, 250011 Shandong China
| | - Wanju Xu
- Department of Clinical Laboratory, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong China
| | - Guangying Zhang
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong China
| | - Chengqi Zhang
- Department of Medicine Imaging, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250014 Shandong China
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Vos FI, de Jong-Pleij EAP, Bakker M, Tromp E, Kagan KO, Bilardo CM. Fetal facial profile markers of Down syndrome in the second and third trimesters of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:168-173. [PMID: 25366900 DOI: 10.1002/uog.14720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate the use of the maxilla-nasion-mandible (MNM) angle and fetal profile (FP) line to assess the degree of midfacial hypoplasia in Down-syndrome fetuses in the second and third trimesters of pregnancy. METHODS The MNM angle and FP line were measured retrospectively in stored two-dimensional images or three-dimensional volumes of fetuses with Down syndrome. Data collected from January 2006 to July 2013 were retrieved from the digital databases of participating units. The MNM angle was expressed as a continuous variable (degrees) and the FP line as positive, negative or zero. Measurements were obtained from stored images in the midsagittal plane by two experienced examiners and compared with our previously reported normal ranges for euploid fetuses. A MNM angle below the 5(th) centile of the reference range and a positive or negative FP line were considered as abnormal. RESULTS A total of 133 fetuses with Down syndrome were available for analysis, eight of which were subsequently excluded because of inadequate images. The MNM angle was not influenced by gestational age (P = 0.48) and was significantly smaller in Down-syndrome fetuses than in euploid fetuses (mean, 12.90° vs 13.53°, respectively; P = 0.015). The MNM angle was below the 5th centile for euploid fetuses in 16.8% of fetuses with Down syndrome (P < 0.01). In the cohort of Down-syndrome fetuses, a positive FP line was present in 41.6% of cases (with a false-positive rate (FPR) of 6.3%) and was positively correlated with Down syndrome and gestational age (P < 0.01). There was no case with a negative FP line. In cases of Down syndrome, a positive FP line was correlated with a small MNM angle (P < 0.01). CONCLUSIONS A small MNM angle and a positive FP line can be regarded as novel markers for Down syndrome. The FP line is an easy marker to measure, has a low FPR, does not require knowledge of normal reference values and has the potential to differentiate between Down syndrome and trisomy 18, as, in the latter, the FP line is often negative.
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Affiliation(s)
- F I Vos
- Fetal Medicine Unit, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E A P de Jong-Pleij
- Department of Obstetrics and Gynecology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M Bakker
- Fetal Medicine Unit, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E Tromp
- Department of Statistics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - K O Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - C M Bilardo
- Fetal Medicine Unit, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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