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Published on: January 27, 2023
Comparing three cardiothoracic ratio measurement techniques and creating multivariable scoring system to predict
Sanitra Anuwutnavin1, Patsawee Rangseechamrat2, Nalat Sompagdee2
1Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand. asanitra@hotmail.com.
Insights
Cardiothoracic (CT) diameter ratio and middle cerebral artery-peak systolic velocity (MCA-PSV) show promise for predicting hemoglobin Bart
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Diagnostic Imaging
Background:
- Hemoglobin Bart's disease is a severe inherited blood disorder.
- Prenatal diagnosis is crucial for managing affected pregnancies.
- Ultrasound markers are being explored for non-invasive prediction.
Purpose of the Study:
- To evaluate cardiothoracic (CT) ratio techniques (diameter, circumference, area) for predicting Hemoglobin Bart's disease.
- To develop a multivariable scoring system using ultrasound markers for improved diagnostic accuracy.
Main Methods:
- Prospective study of 151 singleton pregnancies at risk for Hemoglobin Bart's disease.
- Assessment of three CT ratio techniques and other ultrasound markers before invasive testing.
- Analysis of diagnostic performance and identification of significant predictors.
Main Results:
- CT diameter ratio showed higher sensitivity compared to circumference and area methods.
- Significant predictors included CT diameter ratio > 0.5, MCA-PSV > 1.5 MoM, and placental thickness > 3 cm.
- Middle cerebral artery-peak systolic velocity (MCA-PSV) demonstrated the highest sensitivity (97.8%) for affected fetuses.
Conclusions:
- CT diameter ratio is a valuable ultrasound marker for predicting Hemoglobin Bart's disease.
- A multivariable scoring system incorporating CT diameter ratio, MCA-PSV, and placental thickness achieved excellent diagnostic performance (100% sensitivity, 84.9% specificity).
- Multivariable analysis significantly enhances predictive capabilities over single-parameter assessments.
Abstract:
To assess the diagnostic performance of three cardiothoracic (CT) ratio techniques, including diameter, circumference, and area, for predicting hemoglobin (Hb) Bart's disease between 17 and 22 weeks' gestation, and to create a multivariable scoring system using multiple ultrasound markers. Before invasive testing, three CT ratio techniques and other ultrasound markers were obtained in 151 singleton pregnancies at risk of Hb Bart's disease. CT diameter ratio demonstrated the highest sensitivity among the other techniques. Significant predictors included CT diameter ratio > 0.5, middle cerebral artery-peak systolic velocity (MCA-PSV) > 1.5 multiples of the median, and placental thickness > 3 cm. MCA-PSV exhibited the highest sensitivity (97.8%) in predicting affected fetuses. A multivariable scoring achieved excellent sensitivity (100%) and specificity (84.9%) for disease prediction. CT diameter ratio exhibited slightly outperforming the other techniques. Increased MCA-PSV was the most valuable ultrasound marker. Multivariable scoring surpassed single-parameter analysis in predictive capabilities.
