Gestasyonel diyabetli hastalarda plasentanın shear wave elastografi ve superb microvascular imaging yöntemleri ile değerlendirilmesi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Gestasyonel diabetes mellitus, gebelik anında veya öncesinde başlayan bir hastalık olup dünyada prevalansı, ortalama gebelik yaşının artması ve obezitenin yaygınlaşması ile birlikte artmaktadır. Bu hastalarda plasentada çeşitli mikrovasküler değişiklikler mevcut olup çalışmamızda superb microvascular imaging ve shear wave elastografi gibi güncel yöntemlerle gestasyonel diabetes mellitus hastalarında plasental mikrosirkülasyon ve sertlik değerlendirilmesi amaçlanmıştır. Prospektif çalışmamızda 20 adet gestasyonel diabetes mellitus tanılı hasta ve 20 adet normal glikoz profiline sahip olan 21 ve üzerinde gestasyonel haftada olan toplam 40 gebe hasta çalışmaya dahil edilmiştir. Anterior yerleşimli plasentası bulunan bu olgularda plasentada superb microvascular imaging’le vaskülarite özellikleri ve shear wave elastografi’yle plasenta sertlik dereceleri bağımsız 2 radyolog tarafından incelendi. Vaskülarite ve sertlik değerlerinde iki grup arasında yapılan karşılaştırmada gestasyonel diabetes mellitus grubundaki değerler anlamlı olarak daha yüksek bulunmuştur (p=0.002). Gestasyonel diabetes mellitus tanısı olmasıyla plasenta vaskülarite ve sertlik değerleri arasında anlamlı ve pozitif ilişki olduğu bulunmuştur (p<0.01). Ayrıca VKİ’yle plasenta sertlik değerleri arasında anlamlı ve pozitif korelasyon saptanmıştır (p<0.01). Gestasyonel diabetes mellitus varlığını öngörmede superb microvascular imaging yöntemi için duyarlılık ve özgüllük değerleri % 75 ve % 70 olarak, shear wave elastografi yöntemi için % 80 ve % 85 olarak saptanmıştır. Çalışmamız, literatüre bakıldığında gestasyonel diabetes mellitus olgularında plasentanın superb microvascular imaging’le değerlendirildiği ilk çalışma olarak karşımıza çıkmaktadır. Radyasyon maruziyeti olmaması, tekrarlanabilirliği, hasta başı uygulama kolaylığıyla ultrasonografi, obstetride yadsınamaz bir yere sahip olmakla birlikte konvansiyonel ultrasonografi incelemelerinin yanısıra superb microvascular imaging ve shear wave elastografi gibi yöntemlerin günlük pratikte ve çalışmalarda daha fazla kullanılmasıyla ultrasonografinin tanısal etkinliğinin artacağına ve hasta yönetimine klinik faydalar sağlanacağına inanıyoruz.
Gestational diabetes mellitus is a disease that starts at the time of pregnancy or is diagnosed for the first time even if it exists before pregnancy, and its prevalence is increasing all over the world with the increase in the average gestational age and the prevalence of obesity. There are various microvascular changes in the placenta in this patient group, and in our study, it was aimed to evaluate placental microcirculation and stiffness in gestational diabetes mellitus patients with advanced current methods and measurement methods such as superb microvascular imaging and shear wave elastography. In our prospectively designed study, 20 patients with gestational diabetes mellitus and 20 patients with normal glucose profile and a total of 40 pregnant patients at 21 weeks of gestation and above were included in the statistical stage. In these cases with anteriorly located placenta, the vascularity features of the placenta with superb microvascular imaging and the degree of placental stiffness by shear wave elastography were examined by 2 independent radiologists. As a result of the statistical evaluation, in the comparison between the two groups in superb microvascular imaging values, the values in the group with gestational diabetes mellitus were found to be significantly higher than the control group (p=0.002). According to the results of the statistical analysis, there was a significant and positive correlation between the diagnosis of gestational diabetes mellitus and placenta superb microvascular imaging values (p<0.01). In the comparison between the two groups in shear wave elastography values, the values in the group with gestational diabetes mellitus were found to be significantly higher (p=0.001). According to the results of the statistical analysis, a significant and positive correlation was found between the diagnosis of gestational diabetes mellitus and placenta shear wave elastography stiffness values (p<0.01). In addition, a significant and positive correlation was found between body mass index and placenta shear wave elastography values (p<0.01). In predicting the presence of gestational diabetes mellitus, the sensitivity and specificity values for the superb microvascular imaging method were found to be 75% and 70%, respectively, and 80% and 85%, respectively, for the shear wave elastography method. Our study is the first study in the current literature in which placenta was evaluated with superb microvascular imaging in cases with gestational diabetes mellitus. Ultrasonography has an undeniable place in obstetrics with its lack of radiation exposure, reproducibility, and ease of application at the bedside. Besides the conventional ultrasonography, we believe there will be great benefits in diagnostic efficiency of ultrasonography in terms of clinic and patient management with the use of innovative methods such as superb microvascular imaging and shear wave elastography more in daily practice and studies.
Gestational diabetes mellitus is a disease that starts at the time of pregnancy or is diagnosed for the first time even if it exists before pregnancy, and its prevalence is increasing all over the world with the increase in the average gestational age and the prevalence of obesity. There are various microvascular changes in the placenta in this patient group, and in our study, it was aimed to evaluate placental microcirculation and stiffness in gestational diabetes mellitus patients with advanced current methods and measurement methods such as superb microvascular imaging and shear wave elastography. In our prospectively designed study, 20 patients with gestational diabetes mellitus and 20 patients with normal glucose profile and a total of 40 pregnant patients at 21 weeks of gestation and above were included in the statistical stage. In these cases with anteriorly located placenta, the vascularity features of the placenta with superb microvascular imaging and the degree of placental stiffness by shear wave elastography were examined by 2 independent radiologists. As a result of the statistical evaluation, in the comparison between the two groups in superb microvascular imaging values, the values in the group with gestational diabetes mellitus were found to be significantly higher than the control group (p=0.002). According to the results of the statistical analysis, there was a significant and positive correlation between the diagnosis of gestational diabetes mellitus and placenta superb microvascular imaging values (p<0.01). In the comparison between the two groups in shear wave elastography values, the values in the group with gestational diabetes mellitus were found to be significantly higher (p=0.001). According to the results of the statistical analysis, a significant and positive correlation was found between the diagnosis of gestational diabetes mellitus and placenta shear wave elastography stiffness values (p<0.01). In addition, a significant and positive correlation was found between body mass index and placenta shear wave elastography values (p<0.01). In predicting the presence of gestational diabetes mellitus, the sensitivity and specificity values for the superb microvascular imaging method were found to be 75% and 70%, respectively, and 80% and 85%, respectively, for the shear wave elastography method. Our study is the first study in the current literature in which placenta was evaluated with superb microvascular imaging in cases with gestational diabetes mellitus. Ultrasonography has an undeniable place in obstetrics with its lack of radiation exposure, reproducibility, and ease of application at the bedside. Besides the conventional ultrasonography, we believe there will be great benefits in diagnostic efficiency of ultrasonography in terms of clinic and patient management with the use of innovative methods such as superb microvascular imaging and shear wave elastography more in daily practice and studies.
Açıklama
Anahtar Kelimeler
Gestasyonel diabetes mellitus, Plasenta, Superb microvascular imaging, Shear wave elastografi, Gestational diabetes mellitus, Placenta, Superb microvascular imaging, Shear wave elastography
