Comparison of best landmarks for calculating fetal jaw measurements by ultrasound and MRI in micrognathia.

IF 2.1 3区医学 Q2 PEDIATRICS

Pediatric Radiology Pub Date : 2024-10-01 Epub Date: 2024-08-24 DOI:10.1007/s00247-024-06032-1

Bailey D Lyttle, S Christopher Derderian, Ilana Neuberger, Nicholas J Behrendt, Kaci Pickett-Nairne, Christian R Francom, Kenneth W Liechty, Mariana L Meyers

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Abstract

Background: Micrognathia can be diagnosed in utero with ultrasound by measuring the jaw index and/or inferior facial angle, though it can be challenging due to fetal positioning. The jaw index can be measured with magnetic resonance imaging (MRI) using the masseter muscle, but indistinct margins can lead to inaccuracy; the easily visualized posterior teeth buds may be a better landmark.

Objective: We aimed to evaluate inter-reader variability, agreement with ultrasound, and association with postnatal outcomes using MRI to measure the inferior facial angle, jaw index by masseter muscle, and jaw index by posterior teeth buds.

Materials and methods: A single-institution retrospective review was performed of singleton pregnancies with prenatally diagnosed micrognathia by ultrasound or MRI from September 2013-June 2022. Ultrasound measurements were obtained by a maternal-fetal medicine specialist and MRI measurements by two radiologists to evaluate inter-reader variability. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to assess agreement between imaging methods and logistic regressions and ROC curves to assess associations with postnatal outcomes.

Results: Forty-three fetuses (median gestational age 26 weeks (IQR 22-31); 47% male (20/43)) were included. Ultrasound measurements could not be obtained for jaw index in 15/43 (35%) fetuses and inferior facial angle in 11/43 (26%); MRI measurements were obtained by at least one reader in all cases. Jaw index by teeth buds demonstrated lowest inter-reader variability (ICC = 0.82, P < 0.001) and highest agreement with ultrasound (bias -0.23, 95% CI -2.8-2.2). All MRI measurements, but not ultrasound, predicted need for mandibular distraction (inferior facial angle P = 0.02, jaw index by masseter muscle P = 0.04, jaw index by teeth buds P = 0.01).

Conclusion: Fetal MRI measurements, particularly jaw index measured by posterior teeth buds, demonstrate low inter-reader variability and high agreement with ultrasound, and may predict need for mandibular distraction postnatally.

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通过超声波和核磁共振成像计算小颌畸形胎儿下颌测量值的最佳地标比较。

背景：小颌畸形可在子宫内通过超声波测量下颌指数和/或下颌角来诊断，但由于胎位的原因，这可能具有挑战性。下颌指数可通过磁共振成像（MRI）使用颌间肌进行测量，但边缘不清晰会导致测量不准确；容易观察到的后牙蕾可能是更好的标志：我们的目的是评估使用核磁共振成像测量面下角、下颌角指数（通过颌间肌）和下颌角指数（通过后牙蕾）时，阅片员之间的差异性、与超声波的一致性以及与产后结果的关联：2013年9月至2022年6月期间，对通过超声波或核磁共振成像诊断为产前小颌畸形的单胎妊娠进行了单机构回顾性审查。超声波测量由一名母胎医学专家进行，核磁共振成像测量由两名放射科医生进行，以评估读片者之间的差异性。使用类内相关系数（ICC）和Bland-Altman分析评估成像方法之间的一致性，使用逻辑回归和ROC曲线评估与产后结果的关联：共纳入 43 个胎儿（中位胎龄 26 周（IQR 22-31）；47% 为男性（20/43））。15/43（35%）名胎儿的颌骨指数和11/43（26%）名胎儿的下颌角指数无法通过超声波测量；所有病例中至少有一名读者通过核磁共振成像进行了测量。通过牙蕾测量的颌骨指数显示出最小的读片者间变异性（ICC = 0.82，P 结论）：胎儿核磁共振成像测量结果，尤其是通过后牙蕾测量的颌骨指数，显示出较低的读片者间变异性和较高的超声波一致性，并可预测产后是否需要进行下颌骨牵引。

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来源期刊

Pediatric Radiology 医学-核医学

CiteScore

4.40

自引率

17.40%

发文量

300

审稿时长

3-6 weeks

期刊介绍： Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.