Nuchal translucency thickness measurements for fetal aneuploidy screening: Log NT-MoM or Delta-NT, performer-specific medians and ultrasound training

J Med Screen 2006;13:4-7
doi:10.1258/096914106776179755
© 2006 Medical Screening Society

 

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Original Articles


Wilfried J A Gyselaers,
Annie J Vereecken,
Erik J H Van Herck,
Dany P L Straetmans,
Willem U A M Ombelet and
Jan G Nijhuis
,


Ziekenhuis Oost Limburg, Genk, Belgium;
Algemeen Medisch Laboratorium (AML), Desguinlei 88/1, Antwerp, Belgium;
AML, Antwerp, Belgium;
AML, Antwerp, Belgium;
Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium;
Fetomaternal Medicine, Academic Hospital Maastricht, The Netherlands

Objectives: To evaluate in fetal aneuploidy screening the desirabilityof using Fetal Medicine Foundation (FMF) normal medians of nuchaltranslucency thickness (NT) measurements or performer-specificmedians, and whether the NT measurements should be expressedas Delta-NT or Log NT-MoM values.

Settings: First trimester-combined screening programme in alow risk population in Flanders, Belgium (Algemeen Medisch Laboratorium,Antwerp).

Methods: Pregnancies unaffected by trisomy 21 (T21) were screenedby FMF-trained or other ultrasonographers. Performer-specificNT medians were established for FMF-trained and other ultrasonographers.NCSS Statistical Software was used to establish probabilityplots for Log NT-MoM and Delta-NT values, relative to performer-specificreferences or to the FMF-reference.

Results: A total of 16,096 pregnancies were evaluated. Six FMF-traineesand five other ultrasonographers each performed between 83 and658 NT measurements. For the FMF-trainees, FMF-specific NT-MoMmedians were close to one at a crown-rump length (CRL) between50 and 80 mm, whereas the population-specific NT-MoM mediansof the other ultrasonographers were close to one at a CRL between40 and 80 mm. Performer-specific Delta-NT values fitted a Gaussiandistribution between the 5th and 90th percentiles, while forthe Log NT-MoM values this was between the 10th and 95th percentiles.

Conclusion: We conclude that (i) the use of screening wouldbenefit from performer-specific NT-medians based on Log NT-MoMvalues; (ii) the use of Log NT-MoM values is marginally betterthan the use of delta-NT MoMs; and (iii) NT measurements arevalid at about 10 weeks (crown-rump length 40–45 mm) aswell as at 11–13 weeks.


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