Uloga obojenoga doplera u dijagnostici fetalnih nakaznosti [The role of color Doppler in diagnosis of fetal malfomation]

Veček, Nenad (2015) Uloga obojenoga doplera u dijagnostici fetalnih nakaznosti [The role of color Doppler in diagnosis of fetal malfomation]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Aim: To investigate the contribution of additional examination by color Doppler (CD) in the diagnosis of fetal malformations and comprehensive overview of malformed fetuses. Introduction: Limitations in the creation and implementation of imaging examination reduce diagnostic performance gray scale ultrasound (BW-US). Malformations condition remodeling associated core network of the affected organs and certain regions determined by pathoanatomic change. This remodeling core networks can be recognized with CD, and their interpretation refers to a form of pathological changes. Determining pathoanatomical character disorders leads to the diagnosis of abnormalities. Patients and methods: 117 malformed fetuses examined with BW-US and CD before birth, and after birth by autopsy, or one or more methods for diagnosing malformations in children living like the imagery, intraoperative and clinical examination. For each fetus are determined the number and kind of malfomation and comprehensive consideration with the BW-US and with additional review from by CD. Results: Of 376 malformations properly diagnosed, 229 of them (60.09%) with BW-US and 251 of them (66.7%) with CD (Wilcoxon, p <0.01). Out of 117 malformed fetuses 76 (64.9%) was identified by using BW-US and 89 of them (76.1%) with CD; (McNemar, p < 0.001). Conclusions: Addition in diagnostics of disorders with pathoanathomical character significantly increases the efficiency of diagnosing fetal noncardiac malformations and comprehensive review of the fetus before birth. Therefore, additional review with CD should be considered as an option for the unclear findings in the management of fetal body structure observed with BW-US.

Abstract in Croatian

Svrha: Istražiti doprinos dopunskog pregleda obojenim doplerom (OD) u dijagnostici fetalnih nakaznosti i sveobuhvatno sagledavanje nakaznih plodova. Uvod: Ograničenja u stvaranju slikovnog prikaza smanjuju dijagnostičku uspješnost crno-bijelog ultrazvuka (CB-UZV). Nakaznosti uvjetuju preuređenje pripadajuće žilne mreže zahvaćenog organa i regije određenu njihovom patoanatomskom promjenom. Ta preuređenja žilne mreže predočavaju se s OD-om, a njihovim tumačenjem upućuje se na oblik patoanatomske promjene. Određivanje patoanatomskog karaktera poremećaja dovodi do dijagnoze nakaznosti. Ispitanici i metode: 117 nakaznih fetusa pregledano sa CB-UZV i OD prije rođenja, a potom obdukcijom, odnosno jednom ili više metoda za dijagnosticiranje nakaznosti u žive djece poput slikovnog prikaza, intraoperativnog i kliničkog pregleda. Za svaki plod odredio se broj i vrsta nakaznosti te cjelovitost sagledavanja sa CB-UZV i uz dopunski pregled OD-om. Rezultati: Od 376 nakaznosti ispravno je dijagnosticirano njih 229 (60,09%) sa CB-UZV-om i njih 251(66,7%) uz OD (Wilcoxon p<0,01). Od 117 nakaznih fetusa sveobuhvatno je sagledano njih, 76 (64,9%) sa CB-UZV-om i njih 89 (76,1%) uz OD, (McNemar; p=0,001). Zaključci: Dopuna dijagnostike poremećaja s patoanatomskom karakterizacijom značajno povećava uspješnost dijagnosticiranja nesrčanih fetalnih nakaznosti i sveobuhvatnog sagledavanja nakaznog fetusa prije rođenja. Stoga, dopunski pregled ODom je kvalitetna opcija za razrješavanje nejasnih nalaza u građi fetalnog tijela uočenih sa CB-UZV-om.

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