Iliac crest angle: a novel sonographic parameter for the prediction of Down syndrome risk during the second trimester of pregnancy.
OBJECTIVE
To validate a new sonographic technique for the display and measurement of fetal iliac crest angle (ICA), and to determine the relative contribution of standardized fetal pelvic measurements for estimating risk of Down syndrome during the second trimester of pregnancy.


METHODS
Three-dimensional ultrasonography of the fetal pelvis was performed during a second-trimester scan for genetic amniocentesis. A coronal view of the 'virtual pelvis' was obtained by applying a maximum intensity projection algorithm to visualize both iliac wings. Two different ICAs were measured from a coronal projection of the fetal pelvis (ICA-coronal 1 and ICA-coronal 2); the latter approach relied on using ischial tuberosities as reference landmarks. Next, a coronal projection of the fetal pelvis was rotated to demonstrate a rendered view of the axial fetal pelvis. Axial inner (ICA-inner), middle (ICA-middle) and outer (ICA-outer) ICAs were measured. The maximum anterior iliac distance measurement was defined as the widest separation between the most anterior points of the rendered iliac crests. The reproducibility of each ICA method was analyzed using Bland-Altman statistics. Simple and multiple logistic regression analysis determined the relative contribution of each parameter as a prenatal predictor of Down syndrome.


RESULTS
Ninety-four normal fetuses and 19 fetuses with Down syndrome were examined. The ICA-middle and ICA-coronal 2 parameters were the most reproducible angle measurements. The mean +/- SD ICA-middle measurement for fetuses with Down syndrome was significantly greater than that for normal subjects (94.5 +/- 9.8 degrees vs. 83.1 +/- 6.5 degrees ; P < 0.001). The mean +/- SD ICA-coronal 2 angle measurement for fetuses with Down syndrome was slightly greater than that for normal subjects (57.9 +/- 5.5 degrees vs. 51.9 +/- 7.1 degrees ; P = 0.0014). A multiple logistic regression model including ICA-middle and ICA-coronal 2 provided a predictive ability of 88.1% based on the area under the receiver-operating characteristics curve. This combination had a sensitivity of 94.4% for a false-positive rate of 5% in the detection of Down syndrome.


CONCLUSIONS
Standardized iliac crest measurements of the fetal pelvis can be used to identify some fetuses at risk for trisomy 21 during the second trimester of pregnancy.
Lee
W
W
Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA. wlee@beaumont.edu
Balasubramaniam
M
M
Yeo
L
L
Hassan
S S
SS
Gotsch
F
F
Kusanovic
J P
JP
Gonçalves
L F
LF
Romero
R
R
D000328:Adult; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000000981:diagnostic imaging* / Q000196:embryology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging* / Q000196:embryology; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000196:embryology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012016:Reference Values; D016216:Ultrasonography, Prenatal