Gestasyonel Diabetes Mellitusta Plasentanın Shear Wave Elastografi ile Değerlendirilmesi

Year 2022, , 162 - 167, 30.08.2022

Emine Uysal , Mehmet Öztürk , Ayşegül Kebapçılar , Cetin Celik , Mustafa Koplay , Mustafa Yasir Özlü

https://doi.org/10.46332/aemj.929451

Abstract

Amaç: Bu çalışmada gestasyonel diabetes mellitus (GDM) tanısı almış gebelerde shear wave elastografi (SWE) kullanarak plasenta elastisite değerlerini belirlemek ve kontrol grubu plasenta elastisite değerleri ile karşılaştırmak amaçlanmıştır.

Araçlar ve Yöntem: Ağustos 2018 ile Aralık 2018 tarihleri arasında GDM tanısı almış 31 gebe ve 30 sağlıklı gebe çalışmaya dahil edildi. GDM tanısı için 75 g oral glukoz tolerans testi (OGTT) yapıldı. Hipertansiyon, sistemik hastalık ve sigara kullanım öyküsü olan, gebelik öncesi diabetes mellitus tanısı alan ve plasentası anteriorda olmayan gebeler çalışmaya dahil edilmedi. SWE değerlendirmeleri iki radyolog tarafından ayrı ayrı gerçekleştirildi. SWE incelemesi için plasentanın homojen ekotekstüre sahip, damar ve kalsifikasyon içermeyen bölgeleri tercih edildi. Elastisite değerlendirmesi için 10 mm çapında dairesel alanlar kullanılarak 3 farklı lokalizasyondan ölçümler yapıldı. Her plasenta için elde edilen üç değerin ortalaması hesaplanarak ortalama elastisite değerleri belirlendi.

Bulgular: GDM grubunda yaş ortalaması kontrol grubuna göre anlamlı derecede yüksekti (p=0.039). Her iki grup arasında gebelik haftaları anlamlı farklılık göstermemekteydi (p=0.55). Plasentanın ortanca (minimum-maksimum) sertlik değerleri GDM grubunda 14.1 (5-21.9) kPa, kontrol grubunda ise 12.6 (7.6-39.6) kPa olarak tespit edildi. Kontrol grubunda plasenta sertlik değerleri GDM grubuna göre hafif düşük olmakla birlikte iki grup arasında istatiksel olarak anlamlı farklılık yoktu (p=0.26). Her iki grupta maternal yaş ve gebelik haftası ile plasenta sertlik ve hız değerleri arasında anlamlı ilişki tespit edilmedi (p=0.306, p=0.23, p=0.19, p=0.27). Sınıf içi korelasyon katsayıları sertlik (kPa) için 0.88 ve hız (m/s) için 0.84 idi.

Sonuç: SWE pek çok organ da olduğu gibi plasentanın değerlendirilmesinde gri skala ultrasonografiyi tamamlayıcı yöntem olarak kullanılabilir. 

Keywords

gestasyonel diabetes mellitus, plasenta, shear wave elastografi, ultrason

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Evaluation of Placenta by Shear Wave Elastography in Gestational Diabetes Mellitus

Abstract

Purpose: This study aims to determine the placental elasticity by using shear wave elastography (SWE) in women with gestational diabetes mellitus (GDM), and to compare it with the placental elasticity of the control group. 

Materials and Methods: Thirty-one women with GDM and 30 healthy pregnant between August-December 2018 were included in the study. Pregnant women with a history of hypertension, systemic disease, and smoking, who were diagnosed with diabetes mellitus before pregnancy and did not have anterior placenta were excluded from the study. SWE evaluations were carried out separately by two blinded radiologists. For SWE examination, regions of the placenta with homogeneous echotexture and without vascular and calcification were preferred. For elasticity evaluation, measurements were taken from 3 different localizations using 10 mm diameter circular areas, and the average value was calculated.

Results: The mean age of the GDM group was significantly higher than that of the control group (p=0.039). Gestational weeks did not differ significantly between the two groups (p=0.55). The median (min-max) stiffness values of the placenta were 14.1 (5-21.9) kPa in the GDM group and 12.6 (7.6-39.6) kPa in the control group. There was no statistically significant difference between the two groups (p=0.26). There was no relationship between maternal age and gestational week with placental elasticity in both groups (p=0.306, p=0.23, p=0.19, p=0.27). Intraclass correlation coefficients were 0.88 for stiffness (kPa) and 0.84 for velocity (m/s).

Conclusion: SWE can be used as a complementary method to grayscale ultrasonography to evaluate the placenta, as in many organs.

Keywords

gestational diabetes mellitus, placenta, shear wave elastography, ultrasound

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