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Kasera B, Shinar S, Edke P, Pruthi V, Goldenberg A, Erdman L, Van Mieghem T. Deep-learning computer vision can identify increased nuchal translucency in the first trimester of pregnancy. Prenat Diagn 2024; 44:535-543. [PMID: 38558081 DOI: 10.1002/pd.6559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Many fetal anomalies can already be diagnosed by ultrasound in the first trimester of pregnancy. Unfortunately, in clinical practice, detection rates for anomalies in early pregnancy remain low. Our aim was to use an automated image segmentation algorithm to detect one of the most common fetal anomalies: a thickened nuchal translucency (NT), which is a marker for genetic and structural anomalies. METHODS Standardized mid-sagittal ultrasound images of the fetal head and chest were collected for 560 fetuses between 11 and 13 weeks and 6 days of gestation, 88 (15.7%) of whom had an NT thicker than 3.5 mm. Image quality was graded as high or low by two fetal medicine experts. Images were divided into a training-set (n = 451, 55 thick NT) and a test-set (n = 109, 33 thick NT). We then trained a U-Net convolutional neural network to segment the fetus and the NT region and computed the NT:fetus ratio of these regions. The ability of this ratio to separate thick (anomalous) NT regions from healthy, typical NT regions was first evaluated in ground-truth segmentation to validate the metric and then with predicted segmentation to validate our algorithm, both using the area under the receiver operator curve (AUROC). RESULTS The ground-truth NT:fetus ratio detected thick NTs with 0.97 AUROC in both the training and test sets. The fetus and NT regions were detected with a Dice score of 0.94 in the test set. The NT:fetus ratio based on model segmentation detected thick NTs with an AUROC of 0.96 relative to clinician labels. At a 91% specificity, 94% of thick NT cases were detected (sensitivity) in the test set. The detection rate was statistically higher (p = 0.003) in high versus low-quality images (AUROC 0.98 vs. 0.90, respectively). CONCLUSION Our model provides an explainable deep-learning method for detecting increased NT. This technique can be used to screen for other fetal anomalies in the first trimester of pregnancy.
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Affiliation(s)
- Bhavya Kasera
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Division of Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Parinita Edke
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Division of Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vagisha Pruthi
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Anna Goldenberg
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Division of Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- CIFAR, Toronto, Ontario, Canada
| | - Lauren Erdman
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Division of Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Computational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
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Geerts L, Meyer R, Nolan H, Nel L, Nel DG, Brink L, Odendaal H. Reference standards for facial measurements in early third trimester South African fetuses, and the effect of maternal and fetal characteristics. J Matern Fetal Neonatal Med 2022; 35:8434-8442. [PMID: 35042446 DOI: 10.1080/14767058.2021.1977794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Fetal alcohol spectrum disorder (FASD) is a major problem worldwide and dysmorphic facial features may be a prenatal biomarker for FASD. Deviations from normal facial development cannot be explored before establishing the normal variation in a specific population, since ethnic differences may exist.Objectives: Main objective: to establish reference standards for 23 facial measurements on 3D ultrasound volumes obtained between days 196 and 224 of gestation in healthy unexposed South African fetuses from an area with historically high alcohol consumption prevalence and a population group with no existing normative values. Secondary objective: to assess the confounding effect of maternal and fetal characteristics.Design: This study involves 97 women (including 43 smokers) who had been enrolled in the Safe Passage Study (SPS), a large prospective multinational cohort study assessing the effects of prenatal alcohol exposure. They had adequate 3 D ultrasound volumes of the fetal face acquired at 28+0-31+6 weeks in singleton pregnancies without comorbidities, congenital abnormalities or exposure to alcohol, marijuana, or methamphetamines from 4 weeks before conception.Participants, materials, setting, methods: The participants were recruited from two residential areas of low socioeconomic status in Cape Town. Meticulous information was collected on maternal and pregnancy characteristics, including alcohol use at different time points. Gestational age (GA) was based on ultrasound biometry before 24 weeks, and 3D ultrasound volumes were acquired trans-abdominally from a sagittal and axial plane of the fetal face. Volumes were independently assessed offline by two observers and the image with the best landmark definition was used for 23 facial measurements, representing features previously described in children with FASD. The relation to the exact GA was assessed by regression analysis, the expected mean value and standard error of the estimate (SEE) was determined to transform all raw measurements into z-scores, and the effect of possible confounders on z-scores was assessed by ANOVA.Results: Ten variables changed significantly with advancing GA (extraocular diameter, anteroposterior, medio-lateral and supero-inferior ocular diameter, ocular volume, interlens distance, prenasal thickness, nasal bone length, nose length and nose protrusion) and thirteen did not (interocular distance; interocular: extraocular diameter ratio, prenasal thickness: nasal bone length ratio, pronasal-subnasal distance, subnasal-mouth distance, philtrum length, upper vermillion thickness, nose-philtrum angle, maxillary angle, facial height, facial protrusion, frontomaxillary facial angle and maxilla-nasion-mandible angle). Reference values (expected mean and SEE) for the 23 measurements were established for each day.The z-scores of all facial measurements were not independently affected by maternal age, parity, gravidity, smoking or body mass index, but infant sex and birthweight z-score significantly influenced several z-scores (infant sex for extraocular, medio-lateral, and supero-inferior ocular diameter, ocular volume, prenasal thickness and nose protrusion; birthweight z-score for extraocular diameter, interocular and interlens distance, nose protrusion and maxillary angle).Limitations: GA was not always confirmed by first trimester ultrasound and some measurements could not be obtained in all cases due to suboptimal image quality. The cohort included few heavy smokers so an effect of heavy or continued smoking cannot be ruled out, and the effect of ethnicity was not assessed.Conclusions: These are the first local reference standards for fetal facial measurements and, to our knowledge, the first reference standards for the supero-inferior ocular diameter, face protrusion, upper vermillion thickness, maxillary angle, and nose-philtrum angle. They were broadly in keeping with published references, with small discrepancies explained by minor differences in technique. Even in this narrow GA window, the distribution of many variables changed over time and normal variation was significantly influenced by fetal sex and birthweight z-score. The possible confounding effect of these factors needs to be considered when assessing the impact of harmful exposures like alcohol on facial development.
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Affiliation(s)
- Lut Geerts
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Rosemary Meyer
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Heidi Nolan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Lynel Nel
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Daniel Gerhardus Nel
- Department of Statistics and Actuarial Science, Centre for Statistical Consultation, University of Stellenbosch, Parow, South Africa
| | - Lucy Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
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Pranpanus S, Keatkongkaew K, Suksai M. Utility of fetal facial markers on a second trimester genetic sonogram in screening for Down syndrome in a high-risk Thai population. BMC Pregnancy Childbirth 2022; 22:27. [PMID: 35016623 PMCID: PMC8751369 DOI: 10.1186/s12884-021-04332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background To establish the reference ranges and evaluate the efficacy of the fetal facial sonomarkers prenasal thickness (PT), nasal bone length (NBL), PT/NBL ratio and NBL/PT ratio for Down syndrome screening in the second trimester of high-risk pregnancies using two-dimensional (2D) ultrasound. Methods A prospective study was done in Thai pregnant women at high risk for structural and chromosomal abnormalities between May 2018 and May 2019. The main exclusion criteria were any fetal anatomical anomaly detected on ultrasonography or postpartum examination, abnormal chromosome or syndrome other than Down syndrome. Ultrasounds were performed in 375 pregnant women at 14 to 22 weeks’ gestation and the fetal facial parameters were analyzed. Down syndrome results were confirmed by karyotyping. The reference ranges of these facial ultrasound markers were constructed based on the data of our population. The Down syndrome screening performance using these facial ultrasound markers was evaluated. Results In total, 340 euploid fetuses and 11 fetuses with Down syndrome met the inclusion criteria. The PT, NBL, and PT/NBL ratios in the euploid fetuses gradually increased with gestation progression while the NBL/PT ratio gradually decreased between 14–22 weeks’ gestation. The NBL, PT/NBL ratio, and NBL/PT ratio all had 100% sensitivity and PT had 91% sensitivity. These facial markers had 100% negative predictive value for Down syndrome screening in the second trimester. The Bland–Altman analysis showed the intra- and inter-observer variations of PT and NBL had high intraclass correlation coefficients (ICC) in both operators, with ICCs of 0.98 and 0.99 and inter-observer ICCs of 0.99 for both operators. Conclusion The facial ultrasound markers are very useful for second trimester Down syndrome screening in our population. These facial ultrasound markers were easily identifiable and highly consistent either intra- or inter-operator by using widely-available 2D ultrasound. However, the reference ranges for these markers need to be constructed based on individual populations. Trial registration Registration number: REC 61–029-12–3. Date of registration: 18 May 2018.
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Kavak SB, Kavak EC. Assessment of the Nasal Bone by 2-Dimensional Ultrasound in 2 Different Planes: Do They Give the Same Results? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:659-664. [PMID: 31617238 DOI: 10.1002/jum.15140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Measurement of the nasal bone is an important part of the genetic sonogram. This study aimed to compare nasal bone length measurements taken in 2 different planes and to determine whether there is consistency between the measurements. METHODS The nasal bone was measured in 103 fetuses whose mothers were admitted to our clinic for second-trimester ultrasound examinations and who did not have any accompanying diseases. In this prospective study, the gestational ages of fetuses ranged from 19 to 23 weeks. Nasal bones were measured in both coronal and midsagittal planes, and the similarity between the measurements was evaluated. Pearson correlation, Wilcoxon signed rank, and Kruskal-Wallis tests were used to evaluate the results. RESULTS The median nasal bone length increased with increasing gestational age in both planes, as expected. There were no statistically significant differences between the fetal nasal bone lengths taken in the midsagittal and coronal planes at 19 to 23 weeks' gestation (P > .05). CONCLUSIONS The coronal plane may be used as an alternative to evaluate the nasal bone in the second trimester of pregnancy.
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Affiliation(s)
- Salih Burcin Kavak
- Department of Obstetrics and Gynecology, Firat University, School of Medicine, Elazig, Turkey
| | - Ebru Celik Kavak
- Department of Obstetrics and Gynecology, Firat University, School of Medicine, Elazig, Turkey
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Manegold-Brauer G, Maymon R, Shor S, Cuckle H, Gembruch U, Geipel A. Down's syndrome screening at 11-14 weeks' gestation using prenasal thickness and nasal bone length. Arch Gynecol Obstet 2019; 299:939-945. [PMID: 30739175 DOI: 10.1007/s00404-019-05083-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/02/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform a multicenter prospective study of ultrasound prenasal thickness (PT), and nasal bone length (NBL) measurement at 11-14 weeks' gestation. METHODS Ultrasound PT and NBL determination was performed in 504 normal fetuses and 17 fetuses with Down's syndrome (DS). Measurements were made from mid-sagittal 2D images acquired using a standardized technique during nuchal translucency (NT) examination. PT and NBL values were expressed in multiples of the gestation-specific normal median (MoM) and as the PT/NBL ratio. Information on PT and NBL MoMs was also combined using logistic regression. Results were classified as positive according to whether they were greater than the normal 95th centile for PT, PT/NBL and the DS risk from logistic regression equation or below the 5th centile for NBL. RESULTS The median value in DS cases and unaffected controls were: PT 1.26 and 0.996 MoM; and NBL 0.596 and 0.993 MoM. The proportion of DS fetuses with positive results was 41% for PT, 65% for NBL, and 82% for both the PT/NBL ratio and DS risk from the logistic regression equation. PT/NBL levels did not vary according to gestational age. CONCLUSION The PT/NBL ratio is a valuable first trimester DS screening marker that can be easily determined concomitant with the NT measurement.
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Affiliation(s)
- Gwendolin Manegold-Brauer
- Department of Prenatal Medicine and Gynecologic Ultrasound, University of Basel, Women's Hospital, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Institute of Ultrasound, Sackler School of Medicine, Assaf Harofeh Medical Centre, Beer Yakov 70300, Tzrifin, Israel
| | - Shimrit Shor
- Department of Obstetrics and Gynecology, Institute of Ultrasound, Sackler School of Medicine, Assaf Harofeh Medical Centre, Beer Yakov 70300, Tzrifin, Israel
| | - Howard Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, 622 West 168th Street, New York, NY, 10032, USA
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
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Altunkeser A, Körez MK. Reference ranges for foetal nasal bone length, prenasal thickness, and interocular distance at 18 to 24 weeks' gestation in low-risk pregnancies. BMC Pregnancy Childbirth 2017; 17:416. [PMID: 29233116 PMCID: PMC5727986 DOI: 10.1186/s12884-017-1602-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the present study was to establish the normal ranges for foetal nasal bone length (NBL), prenasal skin thickness (PNT), interocular distance (IOD), and ratio of prenasal thickness to- nasal bone length (PNT/ NBL) at 18–24 weeks using two-dimensional (2D) ultrasound. Methods This study was a retrospective study of prenatal ultrasonographic records from 407 foetuses between 18 and 24 weeks gestational age (GA). The NBL, PNT, IOD, PNT/ NBL ratio, biparietal diameter (BPD), and femur length (FL) were investigated. The relationships among NBL, PNT, IOD, PNT/ NBL, and GA were evaluated. Additionally, descriptive statistics for NBL, PNT, and IOD values for each gestational week were obtained. Results There was a significant association between GA and NBL, PNT, and IOD between 18 and 24 weeks. NBL increased from a mean of 5.5 mm to 8.3 mm, PNT increased from a mean of 3.5 mm to 5.1 mm, and IOD increased from a mean of 11.1 mm to 14.5 mm. PNT/NBL ratio did not change with gestational age. Conclusions This study showed normal ranges for NBL, PNT, IOD, and PNT/ NBL ratios for foetuses between 18 and 24 weeks in low-risk pregnancies. There was a positive linear relationship between GA and NBL, PNT, and IOD. The PNT/NBL ratio might be a more useful measurement than NBL or PNT alone. Electronic supplementary material The online version of this article (10.1186/s12884-017-1602-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayşegül Altunkeser
- Department of Radiology, Konya Education and Research Hospital, Health Sciences University, Konya, Turkey. .,Radyoloji Bölümü Hacı Şaban Mah, Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Meram Yeni Yol Caddesi, No: 97, PK, Meram, Konya, 42090, Turkey.
| | - M Kazım Körez
- Department of Statistics, Faculty of Science, Selcuk University, Konya, Turkey
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Altman RM. Comment on "Nasal bone length: prenasal thickness ratio: a strong 2D ultrasound marker for Down syndrome". Prenat Diagn 2015; 35:512. [PMID: 25600949 DOI: 10.1002/pd.4557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/13/2015] [Indexed: 11/08/2022]
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Manegold-Brauer G, Bourdil L, Berg C, Schoetzau A, Gembruch U, Geipel A. Prenasal thickness to nasal bone length ratio in normal and trisomy 21 fetuses at 11-14 weeks of gestation. Prenat Diagn 2015; 35:1079-84. [PMID: 26147634 DOI: 10.1002/pd.4649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To show the feasibility and to create a reference range for prenasal thickness (PT) and for the PT to nasal bone length (NBL) ratio in normal fetuses at 11-14 gestational weeks and to compare the findings to fetuses with trisomy 21. METHOD PT, NBL and PT/NBL ratio were measured retrospectively in stored two-dimensional images of 1155 normal fetuses and 44 fetuses with trisomy 21. Mid-sagittal images were acquired at first trimester ultrasound examinations and were selected from our digital database. RESULTS The PT increased with CRL from 1.0 mm at 45-mm CRL to 1.6 mm at 84-mm CRL. The mean PT/NBL ratio was 0.6 and was not altered by CRL. The mean PT/NBL ratio in fetuses with trisomy 21 was significantly higher than in normal fetuses (p < 0.0001). For a cut-off value of 0.8 the PT/NBL yielded a sensitivity of 86.4% and a specificity of 98.4% for trisomy 21. CONCLUSION The assessment of PT between 11 and 14 gestational weeks is feasible with high intraclass correlation. The PT to NBL ratio seems to be a promising marker for trisomy 21 in the first trimester and was superior to the isolated contribution of NBL and PT measurements.
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Affiliation(s)
- Gwendolin Manegold-Brauer
- University of Bonn, Department of Obstetrics and Prenatal Medicine, Germany.,University of Basel, Department of Prenatal Medicine and Gynecologic Ultrasound, Switzerland
| | - Lucas Bourdil
- University of Bonn, Department of Obstetrics and Prenatal Medicine, Germany
| | - Christoph Berg
- University of Bonn, Department of Obstetrics and Prenatal Medicine, Germany.,University of Cologne, Division of Prenatal Medicine and Gynecologic Ultrasound, Germany
| | | | - Ulrich Gembruch
- University of Bonn, Department of Obstetrics and Prenatal Medicine, Germany
| | - Annegret Geipel
- University of Bonn, Department of Obstetrics and Prenatal Medicine, Germany
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Szili K, Szabó A, Vanya M, Bártfai G, Szabó J. [News methods for second trimester screening of Down syndrome: statistical analysis of the use of nasal bone length and prenasal thickness]. Orv Hetil 2015; 155:1876-81. [PMID: 25403282 DOI: 10.1556/oh.2014.29991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sonographic measurements of nasal bone length and prenasal soft tissue thickness are ultrasonographic methods for prenatal screening of Down syndrome. AIM The aim of the authors was to create a local normogram for nasal bone length and prenasal soft tissue thickness measurements and to test the performance of different statistical methods. METHOD Euploid (N = 1500) and trisomy 21 foetuses (N = 10) studied between April 2008 and December 2013 were included. Nasal bone length and prenasal thickness measurements were performed at the Medisono Fetal and Maternal Health Research Centre, Szeged, and cytogenetic tests were performed at the Department of Medical Genetics, University of Szeged, Hungary. Normograms were created with different number of patients (N = 100, 300, 500, 750. 1000 and 1500) and using 3 different statistical methods (linear regression, square-based regression, and box-plot analysis). RESULTS The results indicated that at least 1000 measurements are strongly recommended for the normograms. The increase of patient number improved the efficacy of the normograms in each of the 3 statistical methods used for analysis. In general practice box-plots provides a better performance over the other screening methods. However, advanced level screening requires local linear normograms for the best screening results. CONCLUSION The use of box-plots is recommended for the use in the daily practice but regression-based normograms are necessary for advanced prenatal screening.
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Affiliation(s)
- Károly Szili
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Orvosi Genetikai Intézet Szeged Medisono Magzati és Anyai Egészségkutató Központ Szeged Somogyi u. 4. 6720
| | - Andrea Szabó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Orvosi Genetikai Intézet Szeged Medisono Magzati és Anyai Egészségkutató Központ Szeged Somogyi u. 4. 6720
| | - Melinda Vanya
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Szülészeti és Nőgyógyászati Klinika Szeged Semmelweis u. 1. 6725
| | - György Bártfai
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Szülészeti és Nőgyógyászati Klinika Szeged Semmelweis u. 1. 6725
| | - János Szabó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Orvosi Genetikai Intézet Szeged Medisono Magzati és Anyai Egészségkutató Központ Szeged Somogyi u. 4. 6720
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