产前3D HD-Flow在脐带真结辅助评估模型中的构建与初步评价

doi:10.6040/j.issn.1671-7554.0.2026.0155

摘要/Abstract

摘要： 目的基于三维高分辨率血流容积成像(three-dimensional high-definition flow volume imaging, 3D HD-Flow)构建脐带真结的辅助评估模型,并初步评价其对二维超声可疑病例的补充鉴别价值。方法前瞻性纳入2022年1月至2025年8月在济南市妇幼保健院经二维超声拟诊为脐带打结的单胎孕妇44例。采用3D HD-Flow提取15项超声特征,包括闭合环完整性、血管穿行、脐带螺旋指数及血流动力学参数等。经单因素分析筛选变量,采用Firth惩罚似然逻辑回归构建诊断模型,以受试者工作特征曲线评估其诊断效能,并采用Bootstrap法校正曲线下面积(area under the curve, AUC)。同时绘制校准曲线评估模型拟合优度,并采用留一法交叉验证(leave-one-out cross-validation, LOOCV)进行内部验证。结果 44例研究对象中确诊真结18例(40.9%),假结26例(59.1%)。单因素分析筛选出闭合环完整性、血管穿行、脐带螺旋指数及打结处脐动脉搏动指数4项特征。打结处脐动脉搏动指数在单因素分析中组间差异有统计学意义(真结组1.12±0.45 vs. 假结组0.90±0.15,P=0.024)。多因素Firth逻辑回归分析显示,闭合环完整性(OR=3.49,95%CI:1.54~13.76,P=0.002)与血管穿行(OR=14.39,95%CI:1.75~456.33,P=0.011)为独立预测因子。模型AUC为0.988(Bootstrap校正后AUC=0.985,95%CI:0.961~0.999),LOOCV所得AUC为0.981(95%CI:0.950~1.000)。校准曲线显示模型预测概率高于实际观测概率,提示存在高估倾向。灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为94.4%、100.0%、97.6%、100.0%及95.8%。两项核心特征的观察者间一致性极佳(组内相关系数分别为0.92和0.88)。结论基于3D HD-Flow的影像学特征在二维超声拟诊为脐带打结的单胎孕妇中具有较好的辅助评估价值,可作为该人群的补充评估工具。

关键词: 脐带真结, 三维高分辨率血流成像, 辅助评估模型, 产前超声, Logistic

Abstract: Objective To develop an auxiliary assessment model for true umbilical cord knots based on three-dimensional high-definition flow volume imaging(3D HD-Flow)and to preliminarily evaluate its complementary discriminative value in singleton pregnancies with suspected umbilical cord knots on two-dimensional ultrasound. Methods This prospective study included 44 singleton pregnant women with suspected umbilical cord knots detected by two-dimensional ultrasound at Jinan Maternal and Child Care Hospital from January 2022 to August 2025. Using 3D HD-Flow, 15 sonographic features were extracted, including closed-loop integrity, vascular traversing, umbilical cord coiling index and hemodynamic parameters.Variables were screened through univariate analysis, and a diagnostic model was constructed using Firth penalized likelihood logistic regression. Model performance was evaluated using receiver operating characteristic curve analysis with bootstrap-corrected area under the curve(AUC). Calibration curve was plotted to assess model fit, and leave-one-out cross-validation(LOOCV)was performed for internal validation. Results Among the 44 cases, 18(40.9%)were confirmed as true knots and 26(59.1%)as false knots. Univariate analysis identified four significant features: closed-loop integrity score, vascular traversing score, umbilical cord coiling index, and umbilical artery pulsatility index at the knot. The umbilical artery pulsatility index at the knot showed significant intergroup difference in univariate analysis(true knot group: 1.12±0.45 vs. false knot group: 0.90±0.15, P=0.024). Multivariable Firth logistic regression revealed that closed-loop integrity(OR=3.49, 95%CI: 1.54-13.76, P=0.001 8)and vascular traversing(OR=14.39, 95%CI: 1.75-456.33, P=0.010 7)were independent predictors. The model achieved an AUC of 0.988(bootstrap-corrected AUC=0.985, 95%CI: 0.961-0.999), with LOOCV-derived AUC of 0.981(95%CI: 0.950-1.000). The calibration curve demonstrated that the predicted probabilities were higher than the observed probabilities, indicating an overestimation tendency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 94.4%, 100%, 97.6%, 100%, and 95.8%, respectively. Inter-observer agreement for both core features was excellent(intraclass correlation coefficient: 0.92 and 0.88, respectively). Conclusion The 3D HD-Flow-based imaging features demonstrate good auxiliary assessment value in singleton pregnant women with suspected umbilical cord knots on two-dimensional ultrasound, and can serve as a complementary assessment tool for this population.

Key words: True umbilical cord knot, Three-dimensional high-definition flow imaging, Auxiliary assessment model, Prenatal ultrasound, Logistic regression

中图分类号:

R445.1

王波,魏新红,贾文婷. 产前3D HD-Flow在脐带真结辅助评估模型中的构建与初步评价[J]. 山东大学学报 (医学版), 2026, 64(8): 89-95.

WANG Bo, WEI Xinhong, JIA Wenting. Construction and preliminary evaluation of a prenatal 3D HD-Flow based auxiliary assessment model for true umbilical cord Knots[J]. Journal of Shandong University (Health Sciences), 2026, 64(8): 89-95.

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