Re: Nasal bones on line
From: art fougner, md (evsono@pipeline.com)
Thu Nov 28 08:55:37 2002
unfortunately - this shows the power of this marker in a population
already selected as high risk. this group has done this before, eg -
short femur, pyelectasis, echogenic intracardiac focus, etc. what the
papers do NOT tell us is the sensitivity of these markers in a
population NOT thought to be at risk for Down's Syndrome - something, i
might add that HAS been amply demonstrated with NT scanning using the
Fetal Medicine Foundation protocol. my humble suggestion is to offer
the nuchal scan with maternal serum screen from 11 - 14 weeks as a
screen for aneuploidy, followed by a subsequent scan at 21-22 wks for
structural abnormalities.
happy thanksgiving for all Americans and best wishes from this New
Yorker to the rest of the world.
art
At Thu, 28 Nov 2002, Philippe Coquel wrote:
>
>the paper is on line
>Ph Coquel,MD
>
>http://www.jultrasoundmed.org/current.shtml
>
>Fetal Nose Bone Length
>A Marker for Down Syndrome in the Second Trimester
>Bryann Bromley, MD, Ellice Lieberman, MD, DrPH, Thomas D. Shipp, MD and Beryl R. Benacerraf, MD
>Departments of Obstetrics and Gynecology and Radiology, Massachusetts General Hospital, and Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts. Revised July 10, 2002. Revised manuscript accepted for publication August 1, 2002. Revision requested July 10, 2002. Revised manuscript accepted for publi-cation August 1, 2002.
>
>Address correspondence and reprint requests to Bryann Bromley, MD, Diagnostic Ultrasound Associates, 333 Longwood Ave, Boston, Massachusetts, 02115.
>
>Objective. To evaluate the significance of nasal bone length in relation to the detection of Down syndrome in the second trimester. Methods. We evaluated consecutive fetuses referred to our facility between 15 and 20 weeks' gestation for sonography and amniocentesis because of an increased risk of aneuploidy. A detailed structural survey, biometric measurements, and measurement of the nasal bone were obtained at the time of amniocentesis and subsequently compared with karyotype. The characteristics of the fetuses with Down syndrome were compared with those of the euploid fetuses. Results. A total of 239 fetuses were evaluated. Sixteen fetuses (7%) had Down syndrome, and 223 were euploid. In fetuses with Down syndrome, 6 (37%) of 16 did not have detectable nose bones, compared with 1 (0.5%) of 223 control fetuses, yielding a likelihood ratio of 83. Detectable nasal bones were seen in 10 fetuses with Down syndrome and 222 euploid fetuses. A receiver operating characteristic curve for the biparietal diameter-nasal bone length ratio showed that a value of 9 or greater detected 100% of fetuses with Down syndrome and 22% of euploid fetuses. If the ratio were 10 or greater, then 81% fetuses with Down syndrome and 11% of euploid fetuses would have been identified. If the ratio were 11 or greater, 69% of fetuses with Down syndrome would be identified, compared with 5% of euploid fetuses. Conclusions. The absence of a nasal bone is a powerful marker for Down syndrome. A short nasal bone is associated with an increased likelihood for fetal Down syndrome in a high-risk population.
>
>Key Words: aneuploidy, second trimester . fetal nose bone length . marker, fetal Down syndrome . midsagittal profile . sonography
>
>Abbreviations: BPD, biparietal diameter . DS, Down syndrome . NBL, nasal bone length . ROC, receiver operating characteristic
--
art fougner, md
ich bin ein New Yorker
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