文献詳細
今月の臨床 これを読めばすべてわかる―最新の産婦人科超音波診断
VI 新しい超音波技術の展望
文献概要
近年の超音波診断装置における技術革新は目覚しく,リアルタイムにvolume dataを取得し高速に3D画像を構築可能な4Dプローブが開発されている.この4Dプローブを使用することにより,従来では得られなかったリアルタイムでの直交3断面画像表示,rendering画像表示,プローブ面と平行の断面表示,直交3断面それぞれに厚みを持たせた画像の表示,胎児心臓の4D動画表示,平行面の多断面表示などの構築が可能となった.この3D超音波検査法の技術では2D画像よりも多くの情報を表示できるため,より正確な診断が可能となった.特に体積の診断には有用であるために,これまで妊娠初期の胎嚢や卵黄嚢,胎児,さらには胎盤の体積や胎盤内の血管分布などの測定がこの3D超音波検査法を用いて行われ,周産期予後との比較が検討されている.このように,3D超音波検査診断法は,今や産科における胎児胎盤診断に有用なツールとして注目されており,本稿では,これらの報告について概説し,今後の産婦人科領域における3D超音波検査法の臨床的有用性について考察したい.
参考文献
1)Bagratee JS, Regan L, Khullar V, et al : Reference intervals of gestational sac, yolk sac and embryo volumes using three-dimensional ultrasound. Ultrasound Obstet Gynecol 34 : 503-509, 2009
2)Hafner E, Metzenbauer M, Hofinger D, et al : Placental growth from the first to the second trimester of pregnancy in SGA-foetuses and pre-eclamptic pregnancies compared to normal foetuses. Placenta 24 : 336-342, 2003
3)Guiot C, Gaglioti P, Oberto M, et al : Is three-dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth-restricted pregnancies? Ultrasound Obstet Gynecol 31 : 171-176, 2008
4)Noguchi J, Hata K, Tanaka H, et al : Placental vascular sonobiopsy using three-dimensional power Doppler ultrasound in normal and growth restricted fetuses. Placenta 30 : 391-397, 2009
5)Metzenbauer M, Hafner E, Hoefinger D, et al : Three-dimensional ultrasound measurement of the placental volume in early pregnancy : method and correlation with biochemical placental parameters. Placenta 22 : 602-605, 2001
6)Metzenbauer M, Hafner E, Schuchter K, et al : First-trimester placental volume as a marker for chromosomal anomalies : preliminary results from an unselected population. Ultrasound Obstet Gynecol 19 : 240-242, 2002
7)Falcon O, Wegrzyn P, Faro C, et al : Gestational sac volume measured by three-dimensional ultrasound at 11 to 13+6 weeks of gestation : relation to chromosomal defects. Ultrasound Obstet Gynecol 25 : 546-550, 2005
8)Dugoff L, Hobbins JC, Malone FD, et al : First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications : a population-based screening study(the FASTER Trial). Am J Obstet Gynecol 191 : 1446-1451, 2004
9)Smith GC, Stenhouse EJ, Crossley JA, et al : Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab 87 : 1762-1767, 2002
10)Krantz D, Goetzl L, Simpson JL, et al : Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-assocated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol 191 : 1452-1458, 2004
11)Smith GC, Shah I, Crossley JA, et al : Pregnancy-associated plasma protein A and alpha-fetoprotein and prediction of adverse perinatal outcome. Obstet Gynecol 107 : 161-166, 2006
12)Proctor LK, Toal M, Keating S, et al : Placental size and the prediction of severe early-onset intrauterine growth restriction inwomen with low pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 34 : 274-282, 2009
13)Law LW, Leung TY, Sohota DS, et al : Which ultrasound of biochemical markers are independent predictors of small-for-gestational age? Ultrasound Obstet Gynecol 34 : 283-287, 2009
掲載誌情報