Ductus venosus pulsatility index measurement reduces the false-positive rate in first-trimester screening

作者：Timmerman E^*; Rengerink K Oude; Pajkrt E; Opmeer B C; van der Post J A M; Bilardo C M

来源：Ultrasound in Obstetrics and Gynecology, 2010, 36(6): 661-667.

DOI：10.1002/uog.7706

• Down syndrome screening
• ductus venosus
• nuchal translucency
• prediction model

Objective To investigate if ductus venosus (DV) pulsatility index for veins (PIV) and a-wave measurements can increase the accuracy of first-trimester Down syndrome screening in a high-risk population.
Methods The database of our fetal medicine unit was searched for all cases at increased first-trimester Down syndrome risk. Multivariable logistic regression was used to construct a prediction rule for chromosomal anomalies at any given maternal age, nuchal translucency multiples of the median (NT-MoM) and DV-Ply MoM. The discriminative ability of the model was assessed by using receiver operating characteristics (ROC) analysis.
Results The study population included 445 fetuses. DV-PlV was increased (>= 95(th) percentile) in 239 (54%) and DV a-wave was abnormal in 187 fetuses (42%). In this cohort, 80% of all chromosomal anomalies were identified by an increased DV-PIV and 68% by an abnormal a-wave. The odds of chromosomal anomalies increased by a factor of 4.2 per MoM increase in DV-Ply, adjusted for NT and maternal age. The area under the ROC curve for the prediction of chromosomal anomalies was 0.79. After correction for DV-PIV, DV a-wave did not significantly add to the prediction of chromosomal anomalies.
Conclusion In a population of fetuses at increased first-trimester risk for Down syndrome, the combination in a logistic regression model of NT, DV-Ply and maternal age can improve the accuracy of screening for trisomy 21 and other chromosomal anomalies. This is the first study that models the additional value of DV-Ply as a continuous variable to NT measurement alone in a high-risk first-trimester population.

• 出版日期2010-12