1
|
Selcuk K, Sezik M, Yalcin SE, Yavuz A. Reference ranges of fetal cisterna magna volume measurements by three-dimensional ultrasonography in the late second trimester considering sonographic experience. Acta Radiol 2023; 64:1205-1211. [PMID: 35521820 DOI: 10.1177/02841851221098846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Volume measurements of fetal cisterna magna (CM) by three-dimensional (3D) ultrasonography may have a role in the diagnosis of various posterior fossa abnormalities. PURPOSE To evaluate reference intervals and reliability of fetal CM volume values by virtual organ computer-aided analysis (VOCAL) in structurally normal fetuses, considering experience of evaluators. MATERIAL AND METHODS Three operators with different 3D sonography experience levels measured CM volumes of 100 structurally normal fetuses at 18-27 weeks of gestation. Reference intervals for CM volumes were generated. Intraclass correlation coefficients (ICC) were calculated. RESULTS Mean fetal CM volume measurements by the three operators did not significantly (P = 0.49, P = 0.22, and P = 0.17, respectively) change through 20-23 weeks of gestation. Moderate degrees of inter-observer reliability were found with an ICC of 0.69 between novice and intermediate-level, ICC of 0.74 between experienced and intermediate-level, and ICC of 0.78 between experienced and novice observer, respectively. The novice sonographer generally overestimated CM measurements. Intra-observer reliability was good (ICC=0.85). CONCLUSION A reference chart for fetal CM volume by VOCAL was formed, revealing uniform mean values of 20-23 weeks of gestation. The inter-observer reliability is moderate, and biases seem relatively common for all experience categories.
Collapse
Affiliation(s)
- Koray Selcuk
- Kastamonu Tosya State Hospital, Kastamonu, Turkey
| | - Mekin Sezik
- Department of Obstetrics and Gynecology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Serenat Eris Yalcin
- Department of Obstetrics and Gynecology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - And Yavuz
- Department of Obstetrics and Gynecology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| |
Collapse
|
2
|
Prieto LJ, Ruiz Y, Pérez L, Bravo C, Aguado A, Alvarez-Mon M, Ortega MA, Marín C, De León-Luis J. The Brainstem-Vermis and Brainstem-Tentorium Angles in the Fetus: A Study of Their Reproducibility by Fetal Magnetic Resonance Imaging and Their Evolution Along the Gestation. Front Med (Lausanne) 2022; 9:878906. [PMID: 35692548 PMCID: PMC9178106 DOI: 10.3389/fmed.2022.878906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
AimTo assess the reproducibility of brainstem-vermis (BV) and brainstem-tentorium (BT) angles measured by fetal Magnetic Resonance Imaging (MRI) during second half of pregnancy in normal and abnormal fetuses. Secondly, to assess reproducibility of two alternative methodologies to measure the brainstem-tentorium angle (BT1 and BT2) proposed by our group that could be more reliable in fetuses with posterior fossa fluid collection (PFFC) anomalies. Finally, to describe the evolution of BV and BT angles along gestation in normal fetuses.MethodsWe conducted a cross-sectional study of BV and BT angles obtained by MRI performed at our center, in 22 fetuses with PFFC and 8 fetuses without PFFC to calculate both angles’ reproducibility and the correlation between them and the gestational age.ResultsWe found good interobserver reproducibility for the BV, BT1 and BT2 angles (Intraclass correlation coefficient: 0.98; 0.89 and 0.88 for each of these angles, with p < 0.001). In patients with PFFC the BT angle could not always be measured. BT angle presented a positive relationship with gestational age (p = 0.002) but BV angle stayed stable. The measurements of BV, BT1, and BT2 angles can be reliably performed by MRI with good interobserver reproducibility.ConclusionBV angle stays stable during pregnancy, whereas BT angle tends to augment with gestational age.
Collapse
Affiliation(s)
- Laura Joigneau Prieto
- Department of Radiology, University Hospital Gregorio Marañón, Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Yolanda Ruiz
- Department of Radiology, University Hospital Gregorio Marañón, Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laura Pérez
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Alejandra Aguado
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Melchor Alvarez-Mon
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), Madrid, Spain
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine (CIBEREHD), University Hospital Príncipe de Asturias, Alcala de Henares, Spain
| | - Miguel A. Ortega
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), Madrid, Spain
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Cancer Registry and Pathology, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
- *Correspondence: Miguel A. Ortega,
| | - Carlos Marín
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Juan De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| |
Collapse
|
3
|
Nagaraj UD, Kline-Fath BM, Horn PS, Venkatesan C. Evaluation of Posterior Fossa Biometric Measurements on Fetal MRI in the Evaluation of Dandy-Walker Continuum. AJNR Am J Neuroradiol 2021; 42:1716-1721. [PMID: 34266871 DOI: 10.3174/ajnr.a7215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dandy-Walker malformation, vermian hypoplasia, and Blake pouch remnant represent a continuum of anomalies and are common reasons for referral for fetal MR imaging. This study aimed to determine biometric measurements that quantitatively delineate these 3 posterior fossa phenotypes. MATERIALS AND METHODS Our single-center institutional review board approved a retrospective analysis of all fetal MRIs for posterior fossa malformations, including Dandy-Walker malformation, vermian hypoplasia, and Blake pouch remnant. Measurements included the anterior-to-posterior pons, craniocaudal and anterior-to-posterior vermis, lateral ventricle size, and tegmentovermian and posterior fossa angles. Measurements were compared with normal biometry and also between each subgroup. RESULTS Thirty-three fetuses met the criteria and were included in the study. Seven were designated as having Dandy-Walker malformation; 16, vermian hypoplasia; and 10, Blake pouch remnant. No significant group interactions with adjusted mean gestational age for tegmentovermian and posterior fossa angles were observed. The tegmentovermian angle was significantly higher in Dandy-Walker malformation (109.5° [SD, 20.2°]) compared with vermian hypoplasia (52.13° [SD, 18.8°]) and Blake pouch remnant (32.1° [SD, 17.9°]), regardless of gestational age. Lateral ventricle sizes were significantly higher in Dandy-Walker malformation at a mean of ≥23.1 weeks' gestational age compared with vermian hypoplasia and Blake pouch remnant. The anterior-to-posterior and craniocaudal vermes were significantly smaller in Dandy-Walker malformation compared with vermian hypoplasia and Blake pouch remnant at mean of ≥23.1 weeks' gestational age. CONCLUSIONS Dandy-Walker malformation can be described in relation to vermian hypoplasia and Blake pouch remnant by an increased tegmentovermian angle; however, other potential qualifying biometric measurements are more helpful at ≥23.1 weeks' gestational age. Because they fall along the same spectrum of abnormalities, the difficulty in distinguishing these entities from one another makes precise morphologic and biometric descriptions important.
Collapse
Affiliation(s)
- U D Nagaraj
- From the Department of Radiology and Medical Imaging (U.D.N., B.M.K.-F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio .,University of Cincinnati College of Medicine (U.D.N., B.M.K.-F., P.S.H., C.V.), Cincinnati, Ohio
| | - B M Kline-Fath
- From the Department of Radiology and Medical Imaging (U.D.N., B.M.K.-F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine (U.D.N., B.M.K.-F., P.S.H., C.V.), Cincinnati, Ohio
| | - P S Horn
- University of Cincinnati College of Medicine (U.D.N., B.M.K.-F., P.S.H., C.V.), Cincinnati, Ohio.,Department of Neurology (P.S.H., C.V.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - C Venkatesan
- University of Cincinnati College of Medicine (U.D.N., B.M.K.-F., P.S.H., C.V.), Cincinnati, Ohio.,Department of Neurology (P.S.H., C.V.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
4
|
Youssef A, Pilu G. Brain views that benefit from three-dimensional ultrasound. Curr Opin Obstet Gynecol 2021; 33:135-142. [PMID: 33399387 DOI: 10.1097/gco.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Fetal central nervous system malformations are among the most common congenital anomalies. Whereas simple axial views are sufficient for basic fetal brain examination, other important views are essential for a more detailed examination, which are sometimes challenging to obtain. Three-dimensional ultrasound can be helpful in obtaining standardized and reproducible images of many difficult fetal brain views. The aim of the present review is to explore the most recent evidence on the utility and technique of three-dimensional ultrasound in the examination of the fetal brain, with particular emphasis on the brain views that benefit from three-dimensional ultrasound. RECENT FINDINGS The article describes the various techniques of acquisition and analyses of three-dimensional ultrasound volumes of the fetal brain and their usefulness in the assessment of normal and abnormal fetal brain anatomy. Three-dimensional ultrasound has also permitted the application of many new technologies, such as artificial intelligence and deep machine learning. Recently, thanks to high-quality three-dimensional ultrasound, fetal cortical development can be assessed quantitatively and reliably. SUMMARY Three dimensional ultrasound can help as a complementary tool to two-dimensional ultrasound in the assessment of the fetal brain development and malformations. In addition, it paves the way for the application of promising technologies in the evaluation of fetal brain. VIDEO ABSTRACT A video summarizing the findings of the article. The video illustrates the various approaches and techniques applied for the examination of the fetal brain using three-dimensional ultrasound. Furthermore, the advantages and future perspectives of the application of three-dimensional ultrasound in the examination of the fetal brain are discussed, http://links.lww.com/COOG/A74.
Collapse
Affiliation(s)
- Aly Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | |
Collapse
|
5
|
Dall'Asta A, Grisolia G, Volpe N, Schera G, Sorrentino F, Frusca T, Ghi T. Prenatal visualisation of the torcular herophili by means of a Doppler technology highly sensitive for low-velocity flow in the expert assessment of the posterior fossa: a prospective study. BJOG 2020; 128:347-352. [PMID: 32619035 DOI: 10.1111/1471-0528.16392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the usefulness of a Doppler technology highly sensitive for low-velocity flow in the antenatal imaging of the torcular herophili (TH) in the second trimester of pregnancy. DESIGN Prospective study. SETTING Referral Fetal Medicine Unit. POPULATION Non-consecutive series of singleton pregnancies submitted to antenatal neurosonogram between 20 and 28 weeks of gestation. METHODS A midsagittal section of the fetal brain was obtained by insonating through the anterior fontanelle, then the MV-Flow™ and LumiFlow™ presets were selected to visualise the TH as the posterior confluence of the superior sagittal sinus and the straight sinus. MAIN OUTCOME MEASURES Evaluation of the anatomic relationship of the TH with the 'transpalatal line' joining the upper bony palate to the fetal skull. RESULTS A total of 99 pregnant women were recruited, including one fetus with open spina bifida, one with Dandy-Walker malformation (DWM) and two with Blake's pouch cysts. In normal fetuses, the TH appeared to lie on or just below the 'transpalatal line'. In the cases of Blake's pouch cyst, the position of the TH appeared normal if compared with controls, whereas in DWM a supra-elevated position of the TH in respect of the transpalatal line was demonstrated. Finally, in the fetus with Chiari II malformation the TH was identified below the 'transpalatal plane'. CONCLUSIONS Prenatal ultrasound visualisation of the TH by means of newly developed Doppler technologies characterised by high sensitivity for low-velocity flow is feasible and allows the indirect evaluation of the insertion of cerebellar tentorium in the second trimester. TWEETABLE ABSTRACT Prenatal imaging of the torcular herophili using a Doppler technology highly sensitive for low-velocity flow.
Collapse
Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - G Grisolia
- Obstetrics and Gynaecology Unit, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - N Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Gbl Schera
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - F Sorrentino
- Ultrasound Application Health & Medical Equipment, Samsung Electronics Italy, Milan, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynaecology, University of Parma, Parma, Italy
| |
Collapse
|
6
|
Spinelli M, Wiest R, Di Meglio L, Baumann M, Raio L, Surbek D. The "vermian-crest angle": does it allow accurate categorisation of fetal upward rotation of cerebellar vermis on intrauterine MRI? A pilot study. Clin Radiol 2019; 74:489.e1-489.e7. [PMID: 30954236 DOI: 10.1016/j.crad.2019.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
AIM To test a new parameter to assess the position of the fetal cerebellar vermis in the posterior fossa (PF) using intrauterine magnetic resonance imaging (MRI). MATERIALS AND METHODS The angle between the cerebellar vermis and the internal occipital crest (vermian-crest angle, VCA) was assessed retrospectively using MRI in fetuses with and without PF anomalies. Spearman's rank test was used to investigate correlation of the VCA with gestational age (GA). Groups were compared using Student's t-test and the one-way analysis of variance (ANOVA) with the Bonferroni adjustment. Box-and-whisker plots were also used. RESULTS One hundred and two normal cases were identified. Mean±SD GA at MRI was 26.5±2.8 weeks (range: 22-32 weeks). The VCA was 64.49±11.5° independently of GA (r=0.19; p=0.12). In addition, 30 fetuses at 19-28 weeks were identified with Blake's pouch cyst (BPC; n=5), Dandy-Walker malformation (DWM; n=12), mega cisterna magna (MCM; n=10), and vermian hypoplasia (VH; n=3). The VCA was significantly different in the DWM (p<0.001) and BPC (p<0.001) subgroups, but was not significantly different in cases of VH (p=0.84) and MCM (p=0.95) in comparison with controls. CONCLUSIONS A new method to assess vermian position within the PF using intrauterine MRI was assessed. In combination with the other existing parameters, it may be helpful for addressing the categorisation of upward rotation of the fetal cerebellar vermis; however, further studies are necessary to strengthen the present findings.
Collapse
Affiliation(s)
- M Spinelli
- Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - R Wiest
- Department of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - L Di Meglio
- Private Centre "Diagnostica ecografica Aniello Di Meglio srl", Naples, Italy
| | - M Baumann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - L Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - D Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| |
Collapse
|
7
|
Dall'Asta A, Paramasivam G, Basheer SN, Whitby E, Tahir Z, Lees C. How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology. Am J Obstet Gynecol 2019; 220:215-229. [PMID: 30447211 DOI: 10.1016/j.ajog.2018.11.1088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022]
Abstract
The antenatal evaluation of the fetal central nervous system (CNS) is among the most difficult tasks of prenatal ultrasound (US), requiring technical skills in relation to ultrasound and image acquisition as well as knowledge of CNS anatomy and how this changes with gestation. According to the International Guidelines for fetal neurosonology, the basic assessment of fetal CNS is most frequently performed on the axial planes, whereas the coronal and sagittal planes are required for the multiplanar evaluation of the CNS within the context of fetal neurosonology. It can be even more technically challenging to obtain "nonaxial" views with 2-dimensional (2D) US. The modality of 3-dimensional (3D) US has been suggested as a panacea to overcome the technical difficulties of achieving nonaxial views. The lack of familiarity of most sonologists with the use of 3D US and its related processing techniques may preclude its use even where it could play an important role in complementing antenatal 2D US assessment. Furthermore, once a 3D volume has been acquired, proprietary software allows it to be processed in different ways, leading to multiple ways of displaying and analyzing the same anatomical imaging or plane. These are difficult to learn and time consuming in the absence of specific training. In this article, we describe the key steps for volume acquisition of a 3D US volume, manipulation, and processing with reference to images of the fetal CNS, using a newly developed context-preserving rendering technique.
Collapse
Affiliation(s)
- Andrea Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Gowrishankar Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sheikh Nigel Basheer
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Sheffield, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Development and Regeneration, KU Leuven, Belgium.
| |
Collapse
|
8
|
Spinelli M, Di Meglio L, Mosimann B, Di Naro E, Surbek D, Raio L. The Vermian-Crest Angle: A New Method to Assess Fetal Vermis Position within the Posterior Fossa Using 3-Dimensional Multiplanar Sonography. Fetal Diagn Ther 2018; 46:223-230. [PMID: 30517923 DOI: 10.1159/000494721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal morphometry of the vermis and its relation to the posterior fossa (PF) rule out most major anomalies of the cerebellum. However, accurate categorization of the position and size of the fetal vermis remains a challenge. OBJECTIVE Our aim was to test a new method to assess the position and size of fetal vermis on 3-dimensional ultrasound (3D-US). METHODS We measured the vermian-crest angle (VCA) in normal fetuses using multiplanar 3D-US. We also assessed the diameters (superoinferior, anteroposterior, and horizontal) and volume of the vermis. The Spearman rank test and linear and polynomial regression analyses were used for statistical purposes. RESULTS We included 126 fetuses. Mean ± SD gestational age (GA) was 26.3 ± 4.6 (range 17-35.5) weeks. Mean ± SD superoinferior, anteroposterior, and horizontal diameters were 16.2 ± 4.9, 11.2 ± 3.6, and 5.6 ± 1.6 mm, respectively. Median (range) vermian volume was 0.50 (0.05-2.9) cm3. The VCA was 64.49° ± 11.45. We found no correlation between GA and VCA (r = 0.15; p = 0.13), a linear correlation between GA and vermian diameters, and a quadratic correlation between GA and vermian volume. CONCLUSIONS We provide a new method to assess vermian position and size within the PF using 3D-US. The combined information may be of value for screening purposes, particularly to differentiate between the various pathological situations encountered within the PF.
Collapse
Affiliation(s)
- Marialuigia Spinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy, .,Department of Clinical Research, University of Bern, Bern, Switzerland,
| | - Lavinia Di Meglio
- Private Centre "Diagnostica Ecografica Prenatale Aniello Di Meglio srl", Naples, Italy
| | - Beatrice Mosimann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Edoardo Di Naro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.,Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Chapman T, Menashe SJ, Zare M, Alessio AM, Ishak GE. Establishment of normative values for the fetal posterior fossa by magnetic resonance imaging. Prenat Diagn 2018; 38:1035-1041. [PMID: 30280395 DOI: 10.1002/pd.5367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Suspected Dandy-Walker continuum anomalies constitute a significant percentage of prenatal cases evaluated by magnetic resonance imaging (MRI). To unify the description of posterior fossa malformations, we sought to establish objective measurements for the posterior fossa in normal fetuses between 18 and 37 weeks gestation. METHODS T2-weighted images of normal fetal brains in sagittal projection were obtained from fetal magnetic resonance (MR) studies of normal brains performed from 2009 to 2017.121 fetal brains were included in the analysis. Three radiologists reviewed images and recorded the following for each case: superior posterior fossa angle (SPFA), posterior fossa perimeter, and tegmento-vermian angle (TVA). RESULTS For each feature, the mean of the measurements, the percentage of absolute difference of the reader measurement compared with mean measurement, and the interclass correlation (ICC) were calculated. Values are reported as mean ± standard deviation. Perimeter increases linearly with age, whereas the SPFA and the TVA are independent of gestational age. For all included cases, the SPFA averaged 100.9° ± 8° and the TVA averaged 2.5° ± 2.3°. CONCLUSION The superior posterior fossa angle, a novel measurement, and the posterior fossa perimeter can be used for establishing the expected size of the posterior fossa in second- and third-trimester fetuses by MRI.
Collapse
Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Megan Zare
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Adam M Alessio
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
10
|
Illescas T, Martínez-Ten P, Bermejo C, Estévez M, Adiego B. Brainstem–vermis and brainstem–tentorium angles: 3D ultrasound study of the intra- and inter-observer agreement. J Matern Fetal Neonatal Med 2017; 31:1073-1077. [DOI: 10.1080/14767058.2017.1306852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tamara Illescas
- Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology, Madrid, Spain
| | - Pilar Martínez-Ten
- Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology, Madrid, Spain
| | - Carmina Bermejo
- Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology, Madrid, Spain
| | - María Estévez
- Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology, Madrid, Spain
| | - Begoña Adiego
- Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology, Madrid, Spain
| |
Collapse
|
11
|
Pinto J, Paladini D, Severino M, Morana G, Pais R, Martinetti C, Rossi A. Delayed rotation of the cerebellar vermis: a pitfall in early second-trimester fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:121-124. [PMID: 26482947 DOI: 10.1002/uog.15782] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
We describe two cases in which delayed rotation of the cerebellar vermis simulated a Dandy-Walker malformation (DWM) on early second-trimester magnetic resonance imaging (MRI). Two pregnant women with suspected fetal posterior fossa anomaly on ultrasound examination underwent fetal MRI at 21 (Case 1) and 19 (Case 2) weeks' gestation. In both cases, upward rotation of the cerebellar vermis was noted; on midsagittal imaging, the brainstem-vermis angle was 28° and 43°, respectively, while cerebellar morphometry showed a reduced vermian anteroposterior diameter compared to reference data. The posterior fossa appeared to be mildly enlarged, while all other findings were normal. Follow-up MRI at 28 + 3 weeks' gestation (Case 1) and at 1 postnatal year (Case 2) showed completely normal findings. Both children had normal psychomotor development and neurological examinations at 1 year of age. Incomplete rotation of the cerebellar vermis can be a physiological finding on early second-trimester fetal MRI examination and can simulate DWM or other forms of cerebellar hypoplasia. Embryologically, delayed permeabilization of Blake's pouch could account for the delayed vermian rotation. Follow-up imaging at a later gestational age is crucial to ensure that this condition is not over-reported and to avoid the potential risk of unnecessary pregnancy interruption. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- J Pinto
- Neuroradiology Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - D Paladini
- Fetal Medicine Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - M Severino
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - G Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - R Pais
- Neuroradiology Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - C Martinetti
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
12
|
Xi Y, Brown E, Bailey A, Twickler DM. MR imaging of the fetal cerebellar vermis: Biometric predictors of adverse neurologic outcome. J Magn Reson Imaging 2016; 44:1284-1292. [DOI: 10.1002/jmri.25270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yin Xi
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Emily Brown
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | - April Bailey
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | | |
Collapse
|
13
|
Bernardo S, Vinci V, Saldari M, Servadei F, Silvestri E, Giancotti A, Aliberti C, Porpora MG, Triulzi F, Rizzo G, Catalano C, Manganaro L. Dandy-Walker Malformation: is the 'tail sign' the key sign? Prenat Diagn 2015; 35:1358-64. [PMID: 26448595 DOI: 10.1002/pd.4705] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/22/2015] [Accepted: 10/02/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aims to demonstrate the value of the 'tail sign' in the assessment of Dandy-Walker malformation. METHODS A total of 31 fetal magnetic resonance imaging (MRI), performed before 24 weeks of gestation after second-line ultrasound examination between May 2013 and September 2014, were examined retrospectively. All MRI examinations were performed using a 1.5 Tesla magnet without maternal sedation. RESULTS Magnetic resonance imaging diagnosed 15/31 cases of Dandy-Walker malformation, 6/31 of vermian partial caudal agenesis, 2/31 of vermian hypoplasia, 4/31 of vermian malrotation, 2/31 of Walker-Warburg syndrome, 1/31 of Blake pouch cyst and 1/31 of rhombencephalosynapsis. All data were compared with fetopsy results, fetal MRI after the 30th week or postnatal MRI; the follow-up depended on the maternal decision to terminate or continue pregnancy. In our review study, we found the presence of the 'tail sign'; this sign was visible only in Dandy-Walker malformation and Walker-Warburg syndrome. CONCLUSION The 'tail sign' could be helpful in the difficult differential diagnosis between Dandy-Walker, vermian malrotation, vermian hypoplasia and vermian partial agenesis.
Collapse
Affiliation(s)
- Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Valeria Vinci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Saldari
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Evelina Silvestri
- Surgical Pathology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Aliberti
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabio Triulzi
- UOC Neuroradiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università Tor Vergata, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
14
|
Chadha AS, Madhugiri VS, Tejus MN, Kumar VRR. The posterior cranial fossa: a comparative MRI-based anatomic study of linear dimensions and volumetry in a homogeneous South Indian population. Surg Radiol Anat 2015; 37:901-12. [PMID: 25626883 DOI: 10.1007/s00276-015-1434-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 01/19/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The posterior fossa contains structures that are vital to life. In this study, we aimed at establishing normal linear dimensions and volume data of the posterior fossa in a homogeneous south Indian population. We also evaluated the influence of large tumors on these parameters. We evaluated the accuracy of different techniques of measuring these dimensions and compared them with literature. MATERIALS AND METHODS Control and tumor MRIs were selected from an imaging database. Linear posterior fossa dimensions as well as volumes were measured using Image J and Fiji. The volume data were compared with similar data from literature. The effect of the presence of a tumor on posterior fossa volume was measured. RESULTS The posterior fossa volume was higher in men than in women, irrespective of whether the volume was estimated on axial, sagittal or coronal MR images. Despite the wide variation in the techniques used, there was no significant difference between the volumes reported in literature and the volumes calculated in the current series. The presence of large tumors did not affect linear dimensions or posterior fossa volumes. Among the techniques based on linear measurements that were assessed for concordance with manual segmentation, the technique using the formula for volume of an ellipsoid had the best agreement. CONCLUSIONS Posterior fossa volume is higher in men than in women, Posterior fossa dimensions were not affected by the presence of large tumors. Manual segmentation remains the most accurate method to measure posterior fossa volume.
Collapse
Affiliation(s)
- Awalpreet Singh Chadha
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Venkatesh S Madhugiri
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - M N Tejus
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - V R Roopesh Kumar
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| |
Collapse
|
15
|
Ichizuka K, Mishina M, Hasegawa J, Matsuoka R, Sekizawa A, Pooh RK. Diagnosis of a case of Dandy-Walker malformation aided by measurement of the brainstem-vermis angle at 14 weeks gestation. J Obstet Gynaecol Res 2014; 41:790-3. [DOI: 10.1111/jog.12623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kiyotake Ichizuka
- Department of Obstetrics and Gynecology; Showa University Northern Yokohama Hospital; Yokohama Japan
| | - Miyuki Mishina
- Department of Obstetrics and Gynecology; Showa University Northern Yokohama Hospital; Yokohama Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology; Showa University; Tokyo Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology; Showa University; Tokyo Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology; Showa University; Tokyo Japan
| | | |
Collapse
|
16
|
Meng X, Xie L. Quantitative evaluation of fetal brainstem-vermis and brainstem-tentorium angles by three-dimensional ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2076-2081. [PMID: 24996575 DOI: 10.1016/j.ultrasmedbio.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine reference values and ranges for brainstem-vermis (BV) angle and brainstem-tentorium (BT) angle and to assess the correlation among these angles, fetal gender and gestational age (GA) in 221 fetuses between 20 and 37 wk. The angles of the BV and BT were measured on the mid-sagittal view of the fetal head in normally developed Chinese fetuses. The ultrasound measurements, the fetal gender and the GA were collected for statistical analysis. Rank sum test revealed no significant differences in the measurements of the BV and the BT angles with respect to gender (all p > 0.05). Spearman rank correlation analysis showed no GA effect on the BV and the BT angles with correlation coefficients (r) of 0.05 (p > 0.05) and 0.09 (p > 0.05). The 95% reference ranges of the BV and the BT angles were 8.7° (4.5°-18.0°) and 28.0° (21.3°-43.8°), respectively. The newly established reference ranges may facilitate differential diagnosis of fetuses with suspected posterior fossa anomalies in the second and third trimesters.
Collapse
Affiliation(s)
- Xinyue Meng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Limei Xie
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
17
|
Contro E, Volpe P, De Musso F, Muto B, Ghi T, De Robertis V, Pilu G. Open fourth ventricle prior to 20 weeks' gestation: a benign finding? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:154-158. [PMID: 24151160 DOI: 10.1002/uog.13227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/12/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the role of the brainstem-vermis (BV) angle in the diagnosis of fetal posterior fossa abnormalities at 15-18 weeks' gestation. METHODS We examined retrospectively three-dimensional (3D) ultrasound volumes acquired at 15-18 gestational weeks in fetuses with normal posterior fossa (controls) and in those with cystic posterior fossa. Whether the fourth ventricle appeared open posteriorly in axial views was noted and the BV angle was measured. A detailed follow-up was obtained in all cases. RESULTS Of the 139 controls, 46 cases were excluded because of inadequate quality of the 3D volumes. Of the 93 remaining normal fetuses, 84 (90.3%) had a closed fourth ventricle and a BV angle < 20°, whereas 9/93 (9.7%) had an open fourth ventricle and a BV angle between 20° and 37°. The study group of 11 fetuses included seven with Dandy-Walker malformation and four with Blake's pouch cyst. In abnormal cases as a whole, the BV angle was significantly increased compared with that in controls (P < 0.0001). However, fetuses with Blake's pouch cyst and normal fetuses with an open fourth ventricle had strikingly similar sonograms: the BV angle was between 20° and 37° and the fourth ventricle appeared open only when viewed using a more steeply angulated scanning plane than that of the standard transcerebellar plane; in fetuses with Dandy-Walker malformation the fourth ventricle was widely open posteriorly, even in the standard transcerebellar view, and the BV angle was > 45°, significantly increased compared both with that in normal fetuses (P < 0.0001) and with that in fetuses with Blake's pouch cyst (P = 0.004). CONCLUSION An open fourth ventricle is found in about 10% of normal fetuses at 15-18 weeks' gestation. Measurement of the BV angle is useful in such cases, as a value ≥ 45° is associated with a very high risk of severe posterior fossa malformation.
Collapse
Affiliation(s)
- E Contro
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | |
Collapse
|
18
|
A Case of Enlarged Intracranial Translucency in a Fetus with Blake's Pouch Cyst. Case Rep Obstet Gynecol 2014; 2014:968089. [PMID: 24523974 PMCID: PMC3912764 DOI: 10.1155/2014/968089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022] Open
Abstract
The intracranial translucency (IT) is a recently introduced marker of open spina bifida (OSB). In this study, we describe a case of a fetus affected by Blake's pouch cyst which showed alterations of BS/BSOB ratio at the first trimester screening.
Collapse
|
19
|
Volpe P, Contro E, De Musso F, Ghi T, Farina A, Tempesta A, Volpe G, Rizzo N, Pilu G. Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:632-635. [PMID: 22253138 DOI: 10.1002/uog.11101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the role of the brainstem-vermis (BV) and brainstem-tentorium (BT) angles in the differential diagnosis of upward rotation of the fetal cerebellar vermis. METHODS The BV and BT angles were measured retrospectively on median sonographic views of the brain in 31 fetuses at 19-28 weeks' gestation with upward rotation of the cerebellar vermis due to Blake's pouch cyst (n = 12), Dandy-Walker malformation (n = 12) and cerebellar vermian hypoplasia (n = 7). Eighty normal fetuses at 20-24 weeks were included as controls. RESULTS In the control group, BV and BT angles were 9.1 ± 3.5° (range, 4-17°) and 29.3 ± 5.8° (range, 21-44°), respectively. The BV angle was significantly increased in each of the three subgroups of anomalies: Blake's pouch cyst (23 ± 2.8°; range, 19-26°), vermian hypoplasia (34.9 ± 5.4°; range, 24-40°) and Dandy-Walker malformation (63.5 ± 17.6°; range, 45-112°), the angle increasing with increasing severity of the condition. The BT angle had a similar pattern but there was overlap among the different groups. CONCLUSION The BV angle and, to a lesser degree, the BT angle are simple and reproducible measurements that provide valuable additional information for the categorization of upward rotation of the fetal cerebellar vermis. From mid gestation, a BV angle > 45° is strongly suggestive of a Dandy-Walker malformation, while a measurement < 30° favors the diagnosis of a Blake's pouch cyst.
Collapse
Affiliation(s)
- P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL Bari, Bari, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|