visualization by. 1st/2nd examiner. Detailed Fetal. Neurosonogram. Structures. Percent of satisfactory visualization by. 1st/2nd examiner. Biparietal diameter.
18th World Congress on Ultrasound in Obstetrics and Gynecology
Oral poster abstracts
OP03.04 Basic as well as detailed neurosonogram can be performed by an off-line analysis of 3D fetal brain volumes
OP03.05 Prenatal diagnosis and outcome of cavum veli interpositi cysts
E. Bornstein1 , A. Monteagudo1 , L. D. Platt2 , R. Santos1 , I. E. Timor-Tritsch1
V. D’Addario, A. Pintucci, A. C. Rossi, V. Pinto, L. Di Cagno Dept. Obstetrics & Gynecology, Fetal Medicine Unit, University of Bari, Bari, Italy
1
Obstetrics & Gynecology, New York University Medical Center, New York, United States, 2 Center for Womens Ultrasound, David Geffen School of Medicine at UCLA, Los Angeles, United States Objectives: To evaluate the feasibility and the processing time using off-line analysis of 3D brain volumes to perform basic as well as detailed, targeted, fetal neurosonogram. Study design: Three dimensional fetal brain volumes were obtained in 20 consecutive healthy fetuses that underwent routine anatomical survey at 20 to 23 post menstrual weeks. Grey scale and power Doppler volumes of the fetal brain were acquired in the axial, coronal and the sagittal planes using trans-abdominal and transvaginal approaches, respectively. Off-line analysis of each volume was performed by two of the authors in a blinded fashion. Initially, a list containing the basic structures, as defined by ISUOG and AIUM guidelines, complete with intra-cranial biometrical measurements was attempted. Subsequently, we attempted to identify a list of CNS structures recommended by ISUOG guidelines for fetal neurosonogram. Additional structures that were selected by the authors were also sought (see * in table). The feasibility of obtaining diagnostic quality images was evaluated. The processing times of volume acquisition as well as the off-line analysis were recorded. Results: Volume acquisition time was 3–6 sec/volume and a mean processing time of 9.5 and 11 minutes to complete both the ‘basic’ and the ‘detailed’ neurosonogram was recorded by the two examiners, respectively. The feasibility of obtaining diagnostic quality images of the different structures is displayed in the table. Conclusions: Off-line analysis of fetal 3D brain volumes at 20–23 weeks of gestation can identify all the structures necessary to complete a detailed fetal neurosonogram. This approach may provide several potential advantages such as a short processing time, increased safety due to shorter dwell time, increased patient through-put, and the ability to obtain off-site expert consultation if necessary.
Objectives: The velum interpositum is a cerebral area limited by the pineal body and the foramen of Monro and forms the roof of the third ventricle. Occasionally this space is fluid-filled and is sonographically visible as anechoic cyst with regular borders. Because of its rare detection, the incidence of cavum velum interpositum (CVI) cyst is actually undetermined. The aim of the study was to describe sonographic diagnosis and outcomes of fetuses presenting CVI cysts. Methods: 5 fetuses referred to our Unit for the detection of an inter-hemispheric cyst or a borderline ventriculomegaly were reviewed. Gestational age ranged from 20 to 36 weeks. All fetuses underwent targeted prenatal scans of intracranial structures and a detailed anatomical survey to rule out associated malformations. The CVI was assessed in the mid-sagittal view generally used for the assessment of the corpus callosum. Follow up consisted in neurologic examination, neurosonography and MR at birth. Results: The CVI cyst appeared as a well-defined anechoic lesion without adjacent mass effect. In all fetuses the cyst was single and in 2 cases it slightly enlarged within 2 months. The cyst was isolated in 2 fetuses, associated with hypoplasia of corpus callosum in 1 fetus and with borderline ventriculomegaly in 3 fetuses. A single umbilical artery was the only extracranial anomaly and was detected in only 1 fetus. Neonatal follow up ranged from 1 month to 4 years : neuroimaging confirmed the presence of CVI cyst in all the cases. The cyst regressed in one case within one month from delivery. Only 1 newborn was affected with psychomotor disorder. This infant presented hypoplasia of corpus callosum and borderline ventriculomegaly. Conclusions: Prenatal diagnosis of the CVI cysts by ultrasound is feasible. When the cyst is an isolated finding, it is consistent with favourable postnatal outcomes.
OP03.06 Prenatally diagnosed ventriculomegaly: Associations and outcome L. Dam1 , T. E. Cohen-Overbeek2 , B. T. Poll-The3 , R. M. van Zalen-Sprock1 , C. M. Bilardo1 , E. Pajkrt1 1
Basic CNS Examination Structures Biparietal diameter Occipito-frontal diameter Head circumference Cerebellum Cisterna magna Nuchal fold Choroid plexuses Lateral ventricles Cavum septi pellucidi Thalami Falx
318
Percent of satisfactory visualization by Detailed Fetal Neurosonogram 1st /2nd examiner Structures
Percent of satisfactory visualization by 1st /2nd examiner
100%/90% 100%/90%
Corpus callosum Cavum vergae*
95%/80% 90%/90%
100%/90% 95%/90% 95%/90% 50%/50% 100%/100% 95%/95% 95%/85% 100%/95% 100%/100%
Quadrigeminal plate Quadrigeminal cistern* Cisterna ambiens* Vermis (sagittal view)* Tela choroidea* Site of torcular* 4th ventricle Anterior horn Posterior horn Evaluate 3rd ventricle Vein of Galen* Pericallosal artery* Circle of Willis Orbits
100%/65% 100%/65% 90%/65% 85%/60% 95%/90% 40%/50% 60%/60% 100%/90% 100%/95% 95%/90% 58%/58% 92%/83% 50%/67% 50%/50%
Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands, 2 Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, Netherlands, 3 Pediatric Neurology, Academic Medical Centre, Amsterdam, Netherlands Objectives: The aim of this study was to determine the incidence of associated structural anomalies, prenatal course and survival in pregnancies complicated by prenatally diagnosed fetal ventriculomegaly. Methods: The fetal medicine unit databases in our centres were searched to identify all cases where a prenatal detection of fetal ventriculomegaly was made between January 2000 and May 2007. Search criteria included a cerebral ventricular diameter dilatation (Vp) ≥ 10 mm and an initial scan performed between 18 and 24 weeks. Fetal medicine, obstetric, cytogenetic, neonatal, genetic, radiologic and where appropriate histopathological reports were reviewed to obtain the outcome. The population was divided into three groups according to ventricular width: mild: Vp 10.0–12.0 mm, moderate: Vp 12.1 mm –14.9 mm and severe: Vp ≥ 15 mm. Results: We identified 122 cases of fetal ventriculomegaly (Table 1).
Ultrasound in Obstetrics & Gynecology 2008; 32: 308–397
