Child odd vein judgment method based on ultrasonic detection

Abstract

The invention discloses a children odd vein judgment method based on ultrasonic detection. The method comprises the following steps: collecting basic data; performing ultrasonic detection; measuring information; judging odd veins: judging whether the odd veins are expanded or not according to the normal reference range of the ratio of the inner diameter of the odd veins to the inner diameter of the aorta root under the condition that the body surface area of the child patient is unknown; under the condition that the body surface area of a child patient is known, a regression equation between the odd vein inner diameter and the body surface area is established, and a Z value judgment model and a judgment standard are established. According to the invention, a standard section and a normal sonogram feature are provided for exploration of children odd veins on an echocardiogram as a reference; the ratio of the odd vein to the aorta root is determined according to the measured value of the section of the odd vein echocardiogram, and whether the odd vein expands or not is judged; under the condition that the body surface area of a child is known, whether the child odd vein is expanded or not is quickly and accurately judged through application of the child odd vein predicted value regression equation and the Z value judgment model, and data support is provided for further searching for odd vein related malformation.

Description

Technical Field

[0001] The present invention relates to the field of ultrasound detection of the azygos vein, and specifically to a method for evaluating the azygos vein in children based on ultrasound detection. Background Art

[0002] The azygos vein is an important channel between the superior vena cava system and the inferior vena cava system, and the entire trunk venous network is composed of the azygos vein system. Under pathological conditions, the azygos vein system can function as a collateral pathway. Due to the imperfect development and function of the azygos valve, the azygos vein is prone to dilation. Whether the azygos vein is dilated or not can reflect the pressure and blood volume of the superior and inferior vena cava systems. Dilation of the azygos vein in childhood often indicates cardiovascular structural and / or functional abnormalities. Some cardiovascular malformations with occult clinical symptoms, such as partial anomalous pulmonary venous drainage into the azygos vein, may initially only manifest as dilation of the azygos vein in the early stage. As the primary examination method for screening cardiovascular abnormalities in childhood, if the dilation of the azygos vein can be detected early and accurately, the cause can be further analyzed, the diagnosis can be clarified, and effective information can be provided for clinical practice.

[0003] In the past, most studies on azygos vein-related diseases were based on CT images, and the statistical range of normal inner diameter values was only limited to adults. Reports on the azygos vein in ultrasound are mostly individual cases, and the reported normal values of the inner diameter are only limited to fetuses. There is no research on the method for evaluating the azygos vein in children based on ultrasound detection and the normal value range. Therefore, the research on the method for ultrasound detection of the azygos vein in children is extremely urgent. Summary of the Invention

[0004] The present invention aims at the technical problems mentioned in the background art and provides a method for evaluating the azygos vein in children based on ultrasound detection. By establishing a normal reference value range for the azygos vein in children in a single center, establishing a suitable regression equation and Z-value evaluation model, it can quickly and accurately judge whether the azygos vein in children is widened, providing data support for the ultrasound diagnosis of diseases related to the widening of the azygos vein in children.

[0005] To achieve the above technical objectives, the technical solution adopted by the present invention is: a method for evaluating the azygos vein in children based on ultrasound detection, which is operated according to the following steps: S1. Collection of basic data: Record the age, gender, height, and weight information of the child. S2. Ultrasound detection: Perform ultrasound detection on the azygos vein in children to obtain the long-axis azygos vein arch section of the superior vena cava beside the right sternum, the three-vessel-trachea section beside the sternum, and the biatrial section under the xiphoid process respectively. S3. Measurement information: Measure the inner diameter of the azygos vein at about 3-5 mm from the azygos vein inlet into the superior vena cava at the long-axis azygos vein arch section of the superior vena cava beside the right sternum, measure at least three times, and take the average value. Measure the aortic root diameter when the aortic valve is open in the parasternal long-axis view of the left ventricle, measure at least three times, and take the average value; S4. Azygos vein assessment S41 When the body surface area of the child is unknown: Based on the measurement data obtained in step S3, statistically obtain the normal reference range of the ratio of the azygos vein diameter to the aortic root diameter, and then judge whether the azygos vein is dilated; S42 When the body surface area of the child is known: S421 Establish a regression equation between the azygos vein diameter and the body surface area Use several regression models for comparison, and the model with the largest adjusted R2, the smallest RMSE, and the residuals conforming to the normal distribution is used to establish the reference regression equation; The regression equation is an exponential model, that is, Ln[y]=1.427 + 0.466*Ln[x]; According to the above equation, the predicted value of the azygos vein diameter based on the body surface area Where: y is the predicted value of the azygos vein; x is the body surface area; S422 Establish a Z-value judgment model According to the Z-value calculation formula, referring to the regression equation, the Z-value calculation formula is obtained as: Z=(ln(M)-1.427 - 0.466*Ln[x]) / 0.106 Where: M is the measured value of the azygos vein; x is the body surface area S423 Judgment criteria First, obtain the predicted value (theoretical value) according to the regression equation. If the measured value is wider than the theoretical value, then further judge whether there is azygos vein dilation according to the Z value; The Z value between -2 and +2 indicates that the azygos vein diameter is normal; the Z value greater than +2 indicates that azygos vein dilation is considered.

[0006] As a preferred technical solution: In the ultrasonic detection of step S2, the operation method for obtaining the optimal section is as follows: S21. Place the probe at the right parasternal high position or the suprasternal notch; cut out the long axis of the superior vena cava, adjust the probe so that the long axis of the superior vena cava is horizontal to display the azygos vein arch, and obtain the right parasternal long axis of the superior vena cava-azygos vein arch section; S22. On the basis of the conventional short axis view of the great arteries, push the probe up one intercostal space, point the marker to the left shoulder, and tilt the sound beam cephalad and to the right shoulder to obtain the parasternal three-vessel-trachea section; S23. Place the probe under the xiphoid process for transverse section, rotate clockwise, and tilt it backward to the right to display the double atria and obtain the sub-xiphoid double atria section.

[0007] As a preferred technical solution: The cross-section obtained by using the described operation method is applied as the standard cross-section for exploring the azygos vein in children by echocardiogram and the characteristics of the normal sonogram.

[0008] As a preferred technical solution: In step S21, on the long-axis cross-section of the superior vena cava and azygos vein arch beside the right sternum, the azygos vein is clearly shown above the right pulmonary artery and drains into the superior vena cava behind the superior vena cava. The two-dimensional lumen is clearly shown, and red blood flow signals can be seen inside by color Doppler ultrasound. This cross-section is the best cross-section for measuring the inner diameter of the azygos vein.

[0009] As a preferred technical solution: In step S22, in the cross-section of the three major vessels - trachea beside the sternum, the superior vena cava, aorta, and pulmonary artery are arranged from right to left. Under the guidance of color Doppler ultrasound, small red azygos vein blood flow can be seen flowing into behind the superior vena cava.

[0010] As a preferred technical solution: In step S23, in the sub-xiphoid biatrial cross-section, under the guidance of color Doppler ultrasound, small blue azygos vein blood flow with a direction opposite to that of the abdominal aortic blood flow can be seen behind the left atrium.

[0011] As a preferred technical solution: The body surface area calculation formula is: BSA [㎡]=0.024265×Wt (kg) 0.5378 ×H (cm) 0.3964 。

[0012] As a preferred technical solution: In step S41, the regression equations adopted include linear regression equation, logarithmic regression equation, power regression equation, exponential regression equation, and square root regression equation.

[0013] As a preferred technical solution: In step S41, the ratio of the inner diameter of the azygos vein to the root diameter of the aorta is 0.262±0.029; calculated according to the mean ± 1.96 * standard deviation, the 95% confidence interval of the ratio of the azygos vein to the root of the aorta in children is 0.206 - 0.318.

[0014] The beneficial effects of the present invention are as follows: 1. The correct ultrasonic operation method can display a clear ultrasonic image of the azygos vein, providing a standard cross-section and the characteristics of the normal sonogram as a reference for exploring the azygos vein in children by echocardiogram, and improving the accuracy of the exploration results; 2. By determining the ratio of the azygos vein to the root diameter of the aorta through the measured values of the cross-section of the azygos vein echocardiogram, it can be used as a simplified evaluation method to judge whether the azygos vein is dilated, especially when the body surface area is unknown; 3. When the body surface area of a child is known, the application of the regression equation for predicting the azygos vein value and the Z-value judgment model in children can quickly and accurately determine whether the azygos vein in children is dilated, providing data support for further searching for azygos vein-related malformations. Description of the Drawings

[0015] Figure 1 It is a longitudinal section view of the azygos vein arch of the superior vena cava at the right parasternal (or suprasternal fossa).

[0016] Figure 2 It is a cross-sectional view of the three-vessel-trachea at the parasternal.

[0017] Figure 3 It is a cross-sectional view of the two atria under the xiphoid process.

[0018] Figure 4 It is a curve graph between the Z value of ±3 of the relationship between the internal diameter of the azygos vein and the body surface area drawn according to the regression model.

[0019] Figure 5 It is a distribution graph of the ratio of the internal diameter of the azygos vein to the internal diameter of the aortic root.

[0020] Figure 6 It is a scatter plot of the relationship between the ratio of the internal diameter of the azygos vein to the internal diameter of the aortic root and age.

[0021] Figure 7 It is a scatter plot of the relationship between the ratio of the internal diameter of the azygos vein to the internal diameter of the aortic root and the body surface area.

[0022] Figure 8 It is a scatter plot of the internal diameter of the azygos vein with the body surface area as the X-axis for the normal azygos vein group and the dilated azygos vein group.

[0023] Figure 9 It is a scatter plot of the ratio of the internal diameter of the azygos vein to the internal diameter of the aortic root with the body surface area as the X-axis for the normal azygos vein group and the dilated azygos vein group. Detailed Embodiment

[0024] The following further describes the present invention in conjunction with the drawings and embodiments.

[0025] This method for judging the azygos vein in children based on ultrasonic detection disclosed by the present invention includes the following operation steps: S1. Collection of basic data: Record the age, gender, height, and weight information of the child.

[0026] S2. Ultrasonic detection: Perform ultrasonic detection on the azygos vein in children to obtain the longitudinal section view of the azygos vein arch of the superior vena cava at the right parasternal, the cross-sectional view of the three-vessel-trachea at the parasternal, and the cross-sectional view of the two atria under the xiphoid process, respectively.

[0027] S3. Measurement information: Measure the internal diameter of the azygos vein at about 3 - 5 mm from the orifice where the azygos vein drains into the superior vena cava on the long-axis section of the azygos vein arch at the right parasternal superior vena cava, measure at least three times, and take the average value; on the long-axis section of the left ventricle at the parasternal position, measure the internal diameter of the aortic root when the aortic valve is open, measure at least three times, and take the average value. The average value obtained after measurement is used to statistically obtain the subsequent regression equation of azygos vein prediction value and the reference range of the ratio of the azygos vein to the aortic root.

[0028] The formula for calculating the body surface area is: BSA [㎡] = 0.024265 × Wt (kg) 0.5378 × H (cm) 0.3964 .

[0029] S4. Azygos vein evaluation S41 When the body surface area of the child is unknown: Based on the data obtained in step S3. The normal reference range of the ratio of the internal diameter of the azygos vein to the internal diameter of the aortic root is statistically obtained from the measurement data, and then it is judged whether the azygos vein is dilated or not The ratio of the azygos vein to the aortic root is 0.262 ± 0.029, which is relatively constant and not related to age and body surface area; calculated according to the mean ± 1.96 * standard deviation, the 95% confidence interval of the ratio of the azygos vein to the aortic root in children is 0.206 - 0.318.

[0030] S42 When the body surface area of the child is known: S421 - Establish a regression equation between the internal diameter of the azygos vein and the body surface area Several regression models are used for comparison, and the model with the largest adjusted R2, the smallest RMSE and the residuals conforming to the normal distribution is used to establish the reference regression equation. The regression equations used include linear regression equation, logarithmic regression equation, power regression equation, exponential regression equation and square root regression equation.

[0031] The regression equation is an exponential model, that is, Ln[y] = 1.427 + 0.466 * Ln[x]; According to the above equation, the predicted value of the internal diameter of the azygos vein according to the body surface area Where: y is the predicted value of the azygos vein; x is the body surface area, which is obtained from the body surface area calculation formula.

[0032] The predicted value is to be able to calculate the theoretical width of the azygos vein according to the body surface area of children. If the measured value is wider than the theoretical value, it is further judged whether there is azygos vein dilation according to the subsequent Z value.

[0033] S422 - Establish a Z-value evaluation model: Referring to the exponential regression equation in step S41, the formula for calculating the Z value is: Z = (ln(M) - 1.427 - 0.466 * Ln[x]) / 0.106 Where: M is the measured value of the azygos vein; x is the body surface area, which is obtained from the body surface area calculation formula.

[0034] S423 - Judgment criteria First, obtain the predicted value (theoretical value) according to the regression equation. If the measured value is wider than the theoretical value, then further judge whether there is azygos vein dilation according to the Z value; When the Z value is between -2 and +2, the internal diameter of the azygos vein is normal; when the Z value is greater than +2, azygos vein dilation is considered to exist.

[0035] For example, the measured value of the azygos vein is 4.0 mm, and the body surface area of the child is 0.6 m 2 , and the Z value calculated according to the above formula is 0.59. This value is between -2 and +2, so the internal diameter of the azygos vein is considered normal. If the Z value is greater than +2, azygos vein dilation is considered to exist, and further examination is needed to find the cause of the widened azygos vein.

[0036] As a preferred embodiment, during the ultrasonic detection in step S2, the following operation method is used to obtain the optimal section: S21. Place the probe at the high position on the right parasternal or suprasternal notch; cut out the long axis of the superior vena cava, adjust the probe so that the long axis of the superior vena cava is in the horizontal position, then the azygos vein arch can be displayed. Obtain the section of the azygos vein arch with the long axis of the superior vena cava at the right parasternal (or suprasternal notch). At the section of the azygos vein arch with the long axis of the superior vena cava at the right parasternal (or suprasternal notch), it is clearly shown that the azygos vein is located above the right pulmonary artery and drains into the superior vena cava behind the superior vena cava, and the two-dimensional lumen is clearly shown. Color Doppler ultrasound shows red blood flow signals inside. This section is the best section for measuring the internal diameter of the azygos vein. Figure 1 It can be seen that the azygos vein drains into the superior vena cava above the right pulmonary artery, and color Doppler ultrasound shows the red blood flow in the azygos vein. Where: RA is the right atrium; LA is the left atrium; RPA is the right pulmonary artery; SVC is the superior vena cava; AZV is the azygos vein.

[0037] S22. On the basis of the conventional short axis section of the great arteries, push the probe up one intercostal space, point the marker to the left shoulder, and tilt the sound beam cephalad and to the right shoulder to obtain the parasternal three-vessel-trachea section. This section is similar to the three-vessel-trachea section in the fetal period, with the superior vena cava, aorta, and pulmonary artery arranged from right to left. Under the guidance of color Doppler ultrasound, it can be seen that the red and thin azygos vein blood flow drains behind the superior vena cava. Figure 2 It can be seen that the azygos vein drains behind the superior vena cava, and color Doppler ultrasound shows the red blood flow in the azygos vein. Where: PA is the pulmonary artery; AO is the aorta; SVC is the superior vena cava; AZV is the azygos vein.

[0038] S23. Place the probe under the xiphoid process for a transverse section, rotate it clockwise, and tilt it backward to the right to display the double atria and obtain a sub-xiphoid double-atria section. In the sub-xiphoid double-atria section, under the guidance of color Doppler ultrasound, a small blue blood flow of the azygos vein can be seen behind the left atrium, flowing in the opposite direction to the blood flow of the abdominal aorta. Figure 3 Color Doppler ultrasound guidance shows blue blood flow in the azygos vein behind the left atrium, where: RA right atrium; LA left atrium; SVC superior vena cava; DAO abdominal aorta; AZV azygos vein.

[0039] The section obtained by the above operation method is used as the standard section for exploring the azygos vein in children by echocardiography and the application of normal sonogram features, providing the standard section and normal sonogram features as a reference for exploring the azygos vein in children by echocardiography, and improving the accuracy of exploration results.

[0040] Since the sub-xiphoid double-atria section requires color Doppler blood flow guidance to show the azygos vein blood flow, but it is difficult to show the blood flow at the entrance of the azygos vein into the superior vena cava and where it passes through the diaphragm, and the two-dimensional lumen structure of the azygos vein cannot be clearly shown on this section. On the one hand, the azygos vein is located in the far field of the sound beam on this section, especially at the entrance of the superior vena cava, and the attenuation of the sound beam will affect the exploration; on the other hand, the inner diameter of the azygos vein in children is too small, and children generally have abdominal breathing, and abdominal exploration is easily affected by the respiratory movement of children. Abdominal gas, intestinal tubes, etc. will also interfere with the exploration of the azygos vein. Moreover, the sub-xiphoid section generally requires moderate pressure on the probe to clearly show the cardiovascular structure, but the venous lumen is extremely vulnerable to the influence of the probe pressure on the inner diameter, resulting in a situation where the probe pressure is too small and the section cannot be clearly shown, and when the probe pressure is increased, the azygos vein cannot be shown. Therefore, it is difficult to explore and measure the inner diameter of the normal azygos vein in children using the sub-xiphoid section.

[0041] The three-vessel-trachea section in children can show the confluence segment of the azygos vein behind the superior vena cava. The two-dimensional lumen structure of the azygos vein is well shown in children of low age groups. However, since the azygos vein is located in the far field of the sound beam, in older children, as the chest wall thickens and the thymus gradually degenerates, the two-dimensional clarity of this section decreases, and the azygos vein can only be shown in some children under the guidance of color Doppler blood flow.

[0042] The long-axis section of the azygos vein arch of the superior vena cava on the right parasternal (or suprasternal fossa) can clearly show the lumen structure at the entrance of the azygos vein into the superior vena cava. On this section, the azygos vein is located in the near field of the sound beam, with fewer interfering factors, and the two-dimensional lumen display rate of the azygos vein is relatively satisfactory at all age groups. The ultrasonic display rate of the azygos vein in children under 5 years old on this section can reach more than 90%. Therefore, this section is selected to measure the inner diameter of the azygos vein in children.

[0043] Therefore, the long-axis view of the azygos arch in the right parasternum (or suprasternal fossa) of the superior vena cava is used as the main measurement basis, while the three-vessel-trachea view in children and the subxiphoid biatrial view are used as auxiliary bases.

Claims

1. A method for evaluating the azygos vein in children based on ultrasound detection, characterized in that: Follow these steps: S1. Basic data collection: record the age, gender, height and weight of the child; S2. Ultrasound examination: Ultrasound examination of the azygos vein in children was performed to obtain the long-axis azygos arch section of the superior vena cava, the parasternal three-vessel-tracheal section, and the subxiphoid biatrial section of the right side; S3. Measurement information: The inner diameter of the azygos vein was measured at about 3-5 mm from the point where the azygos vein joins the superior vena cava at the long axis of the azygos arch section of the superior vena cava at the right parasternal side. The measurement was performed at least three times and the average value was taken. The inner diameter of the aortic root was measured at least three times in the parasternal left ventricular long axis section when the aortic valve was open, and the average value was taken. S4. Evaluation of the azygos vein S41 If the patient's body surface area is unknown: Obtaining a normal reference range of the ratio of the inner diameter of the azygos vein to the inner diameter of the aorta root according to the measurement data obtained in step S3, and then judging whether the azygos vein is dilated or not; S42 If the patient's body surface area is known: S421 Establishment of regression equation between inner diameter of azygos vein and body surface area Several regression models were used for comparison, and the model with the largest adjusted R2, the smallest RMSE, and the residual conforming to the normal distribution was used to establish the reference regression equation; The regression equation is an exponential model, that is, Ln[y]=1.427+0.466*Ln[x]; According to the above equation, the predicted value of the inner diameter of the azygos vein based on the body surface area is Where: y predicted value of azygos vein; x body surface area; S422 Establishing Z-value evaluation model According to the Z value calculation formula, the Z value calculation formula is obtained by referring to the regression equation: Z=(ln(M)-1.427-0.466*Ln[x]) / 0.106 Where: M is the measured value of the azygos vein; x is the body surface area S423 Evaluation Criteria First, the predicted value (theoretical value) is obtained based on the regression equation. If the measured value is wider than the theoretical value, the Z value is further used to determine whether it is azygos vein dilatation; A Z value between -2 and +2 indicates a normal inner diameter of the azygos vein; a Z value greater than +2 indicates dilatation of the azygos vein.

2. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 1, characterized in that: In the ultrasonic detection of step S2, the operation method of obtaining the optimal section is as follows: S21. Place the probe in the high position of the right parasternum or the suprasternal fossa; cut out the long axis of the superior vena cava, adjust the probe so that the long axis of the superior vena cava is horizontal to show the azygos arch, and obtain the normal long axis azygos arch section of the superior vena cava at the right parasternal position; S22. On the basis of the conventional short-axis section of the great arteries, the probe is moved upward by one intercostal space, the marker points to the left shoulder, and the sound beam is tilted toward the head and right shoulder to obtain a parasternal three-vessel-tracheal section. S23. Place the probe under the xiphoid process for transverse cutting, rotate it clockwise, and tilt it to the right and rear to display the two atria and obtain a subxiphoid bi-atrial section.

3. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 2, characterized in that: The section obtained by the operation method is used as the standard section for exploring the azygos vein in children on echocardiography and the application of normal sonographic features.

4. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 2, characterized in that: In step S21, the long-axis azygos arch section of the superior vena cava beside the right sternum clearly shows that the azygos vein is located above the right pulmonary artery and merges into the superior vena cava behind the superior vena cava. The two-dimensional lumen is clearly displayed, and red blood flow signals can be seen in it through color Doppler ultrasound. This section is the best section for measuring the inner diameter of the azygos vein.

5. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 2, characterized in that: In step S22, in the parasternal three-vessel-tracheal section, the superior vena cava, aorta, and pulmonary artery are arranged from right to left. Under the guidance of color Doppler ultrasound, the red thin azygos vein blood flow behind the superior vena cava can be seen to flow into it.

6. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 2, characterized in that: In step S23, in the bi-atrial section below the xiphoid process, under the guidance of color Doppler ultrasound, a thin blue azygos vein blood flow in the opposite direction to the abdominal aorta blood flow can be seen behind the left atrium.

7. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 1, characterized in that: The formula for calculating body surface area is: BSA[㎡]=0.024265×Wt (kg) 0.5378 ×H (cm) 0.3964 。 8. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 1, characterized in that: In step S41, the regression equation used includes a linear regression equation, a logarithmic regression equation, a power regression equation, an exponential regression equation and a square root regression equation.

9. The method for evaluating the azygos vein of children based on ultrasound detection according to claim 1, characterized in that: In step S41, the ratio of the inner diameter of the azygos vein to the aortic root is 0.262±0.029; calculated according to the mean±1.96*standard deviation, the 95% confidence interval of the ratio of the azygos vein to the aortic root in children is 0.206-0.318.

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