Can Prenatal Diagnosis of Total Anomalous Pulmonary Venous Return (TAPVR) Using Routine Fetal Ultrasound be Improved? A Case-Control Study. (31st December 2022)

• Record Type: Journal Article
• Authors: Heard, Jack; Soni, Reeni; Nikel, Katarina; Day, Chelsea; Pylypjuk, Christy
• Other Names: Faggioni Lorenzo Academic Editor.
• Is Part Of: Radiology research and practice. Volume 2022(2022)
• Publication Date: 2022-12-31
• Subjects: Radiography -- Periodicals; Radiology -- Periodicals; Medical radiology -- Periodicals; Radiology; Radiography; Radiology; Medical radiology; Electronic journals; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 616.0757
• DOI: 10.1155/2022/7141866
• Languages: English
• ISSNs: 2090-1941

Abstract

Abstract : Objectives . To determine the most common fetal ultrasound markers of total anomalous pulmonary venous return (TAPVR) during mid-trimester ultrasound using standardly obtained images and evaluate the performance of diagnostic algorithms for improving prenatal diagnosis. Methods . This was a matched case-control study at a regional referral centre (2005 to 2019). Cases of TAPVR were matched to controls 1 : 4 by date of birth and biologic sex. Postprocessing review of stored fetal ultrasound images was performed by two blinded and independent observers in a standardized fashion using nine sonographic markers: (i) left/right heart disproportion; (ii) abnormal distribution of great vessels; (iii) pulmonary vein entry into the left atrium (LA); (iv) confluence behind the LA; (v) abnormal coronary sinus; (vi) absence of the Coumadin ridge; (vii) aortic diameter; (viii) distance between LA and aorta; and (ix) post-LA space index >1.27. Descriptive and inferential statistics were used to present results and compare cases and controls. Diagnostic algorithms were compared by sensitivity/specificity. Results . 21 cases of isolated TAPVR were matched to 84 controls ( n = 105). The most common ultrasound marker of TAPVR was absence of pulmonary vein entry into the LA (42.9%), followed by abnormal Coumadin ridge (38.1%). Cases of TAPVR had significantly larger post-LA spaces than controls (p < 0.0001 ) and wider aortic diameters (p = 0.006 ). A diagnostic algorithm stratifying on absence of pulmonary veins followed by an abnormal Coumadin ridge, can correctly identify cases of TAPVR with high specificity (90.5%) and moderate sensitivity (61.9%). Conversely, a diagnostic algorithm using the presence of any 3 abnormal markers had improved specificity (94.1%) but poorer sensitivity (23.8%). Conclusions . Using standardly obtained images from routine fetal ultrasound, improved prenatal detection of isolated TAPVR is possible. A standardized diagnostic approach can be highly specific for fetal TAPVR, however, algorithms that are sufficiently sensitive for screening in the general population are still needed.