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Kaewnin J, Dulyaphat W, Tongsong T, Lertrat W, Tangshewinsirikul C. Neurosonographic Measurements of the Fetal Anterior Complex in Singleton Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2725-2737. [PMID: 37490581 DOI: 10.1002/jum.16307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To construct reference ranges of the fetal cerebral anterior complex, including ventricular index (VI), anterior horn of lateral ventricle width (AW), and cavum septi pellucidi (CSP) width, as a function of gestational age (GA), in Thai fetuses. METHODS Low-risk pregnancies were recruited to measure fetal anterior complex on axial transventricular and coronal transcaudate planes using transabdominal ultrasound. The downside and upside hemisphere were defined as cerebral hemisphere located distal and proximal to the transducer, respectively. The five variables, downside/upside VI, downside/upside AW and CSP width, were measured from each fetus. Best-fit models in predicting mean and standard deviation for each value as a function of GA were constructed, using regression analysis. Distributions of Z-scores of all values based on GA were created to evaluate the fitness of models. Intraclass correlation coefficients were used to assess inter-/intraobserver variability. RESULTS A total of 395 fetuses were measured for anterior complex. All parameters changed with GA with quadratic function. The models for predicting means and standard deviation of the five parameters as well as percentile charts were created. All models were proven well-fitted. The intra-/interobserver reliability coefficients of all values showed excellent agreement. CONCLUSION The reference ranges of the fetal anterior complex, including VI, AW, and CSP, in axial transventricular and coronal transcaudate planes have been established and available for clinical use.
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Affiliation(s)
- Jetsadaporn Kaewnin
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wirada Dulyaphat
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Waranyu Lertrat
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chayada Tangshewinsirikul
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Fantasia I, Faletra F, Bussani R, Murru FM, Ottaviani Giammarco C, Travan L, Sirchia F, Feresin A, Stampalija T. Obliterated cavum septi pellucidi: is it always a benign finding? A case report and narrative review of the literature. J Matern Fetal Neonatal Med 2023; 36:2232075. [PMID: 37414745 DOI: 10.1080/14767058.2023.2232075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The septum pellucidum is a virtual cavity located at the anterior part of the brain midline, which only in fetal life has a certain amount of fluid inside. The presence of an obliterated cavum septi pellucidi (oCSP) in the prenatal period is poorly described in the literature but, nevertheless, it constitutes an important clinical dilemma for the fetal medicine specialist in terms of significance and prognosis. Moreover, its occurrence is increasing maybe because of the widespread of high-resolution ultrasound machine. The aim of this work is to review the available literature regarding the oCSP along with the description of a case-report of oCSP with an unexpected outcome. METHODS A search of the literature through Pubmed was performed up to December 2022 with the aim to identify all cases of oCSP previously described, using as keywords "cavum septi pellucidi," "abnormal cavum septi pellucidi," "fetus," and "septum pellucidum." Along with the narrative review, we describe a case-report of oCSP. RESULTS A 39 years old woman was diagnosed with a nuchal translucency between the 95° and 99° centile in the first trimester and an oCSP and "hookshaped" gallbladder at 20 weeks. Left polymicrogyria was found at fetal magnetic resonance imaging (MRI). Standard karyotype and chromosomal microarray analysis (CMA) were normal. After birth, the newborn presented signs of severe acidosis, untreatable seizures and multiorgan failure leading to death. A targeted gene analysis of the epilepsy panel revealed the presence of a de novo pathogenic variant involving the PTEN gene. The literature review identified four articles reporting on the oCSP of which three were case report and one was a case-series. The reported rate of associated cerebral findings is around 20% and the rate of adverse neurological outcome is around 6%, which is higher than the background risk of the general population. CONCLUSIONS This case-report and review of the literature shows that oCSP is a clinical entity poorly described so far and that, despite the generally good prognosis, it requires caution in counseling. The diagnostic work-up should include neurosonography while fetal MRI may be always indicated for non-isolated cases only, depending on local facilities. Targeted gene analysis or whole exome sequencing may be indicated for non-isolated cases.
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Affiliation(s)
- Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Flavio Faletra
- Department of Medical Genetics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Rossana Bussani
- Institute of Pathologic Anatomy, Trieste University Hospital, Trieste, Italy
| | - Flora Maria Murru
- Department of Pediatric Radiology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | | | - Laura Travan
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Fabio Sirchia
- Medical Genetics Unit, IRCCS San Matteo Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Agnese Feresin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Agaoglu MO, Agaoglu Z, Ozturk FH, Celen S, Caglar T. Comparison of Cavum Septum Pellucidum Size in Euploid and Aneuploid Fetuses. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e511-e516. [PMID: 37846183 PMCID: PMC10579907 DOI: 10.1055/s-0043-1775847] [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] [Received: 06/03/2023] [Accepted: 07/24/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE The aim of the present study is to compare the cavum septum pellucidi (CSP) z-score in euploid and aneuploid fetuses and to investigate the performance of the CSP width/length and CSP width/biparietal diameter (BPD) ratios as a diagnostic marker in aneuploidy. METHODS A total of 54 patients, 20 aneuploid and 35 euploid fetuses, between 18 and 37 weeks of gestation, were included in this retrospective study. The CSP width z-score was compared between the two groups. Receiver operating characteristic (ROC) curves were calculated for the CSP width/length and CSP width/BPD ratios to predict aneuploidy. RESULTS The median CSP width was 4.8 mm (range, 1.8 to 8.5 mm) in the euploid group, and 5.4 mm (range 3.1 to 8.4 mm) in the aneuploid group. Cavum septum pellucidi width z-score, CSP width/length ratio, and CSP width/BPD ratio were significantly higher in fetuses with aneuploidy than in fetuses with normal karyotype (p = 0.001; p = 0.013; p = 0.028). In the ROC analysis, the CSP width/length ratio had the optimal cutoff value of 0.59, with 72.0% sensitivity and 58.0% specificity, and for the CSP width/BPD ratio, the cutoff value was 0.081 with 83.0% sensitivity and 61.0% specificity for detection of aneuploidy. CONCLUSION CSP width z-score was found to be increased in aneuploid fetuses. The CSP width /BPD ratio can be used as a new marker for predicting aneuploidy.
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Affiliation(s)
- Merve Ozturk Agaoglu
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Zahid Agaoglu
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Filiz Halici Ozturk
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Sevki Celen
- Department of Perinatology, Etlik City Hospital, Ankara, Turkey.
| | - Turhan Caglar
- Department of Perinatology, Etlik City Hospital, Ankara, Turkey.
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Fantasia I, Ciardo C, Bracalente G, Filippi E, Murru FM, Spezzacatene A, Bin M, Mendez Quintero O, Montaguti E, Lees C, Papanikolaou K, Pilu G, Prefumo F, Thilaganathan B, Stampalija T. Obliterated cavum septi pellucidi: Clinical significance and role of fetal magnetic resonance. Acta Obstet Gynecol Scand 2023; 102:744-750. [PMID: 37059118 DOI: 10.1111/aogs.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION The objective of this study was to describe a cohort of fetuses with an ultrasound prenatal diagnosis of obliterated cavum septi pellucidi (oCSP) with the aim to explore the rate of associated malformations, the progression during pregnancy and the role of fetal magnetic resonance imaging (MRI). MATERIAL AND METHODS This was a retrospective multicenter international study of fetuses diagnosed with oCSP in the second trimester with available fetal MRI and subsequent ultrasound and/or fetal MRI follow-up in the third trimester. Where available, postnatal data were collected to obtain information on neurodevelopment. RESULTS We identified 45 fetuses with oCSP at 20.5 weeks (interquartile range 20.1-21.1). oCSP was apparently isolated at ultrasound in 89% (40/45) and fetal MRI found additional findings in 5% (2/40) of cases, including polymicrogyria and microencephaly. In the remaining 38 fetuses, fetal MRI found a variable amount of fluid in CSP in 74% (28/38) and no fluid in 26% (10/38). Ultrasound follow-up at or after 30 weeks confirmed the diagnosis of oCSP in 32% (12/38) while fluid was visible in 68% (26/38). At follow-up MRI, performed in eight pregnancies, there were periventricular cysts and delayed sulcation with persistent oCSP in one case. Among the remaining cases with normal follow-up ultrasound and fetal MRI findings, the postnatal outcome was normal in 89% of cases (33/37) and abnormal in 11% (4/37): two with isolated speech delay, and two with neurodevelopmental delay secondary to postnatal diagnosis of Noonan syndrome at 5 years in one case and microcephaly with delayed cortical maturation at 5 months in the other. CONCLUSIONS Apparently isolated oCSP at mid-pregnancy is a transient finding with the visualization of the fluid later in pregnancy in up to 70% of cases. At referral, associated defects can be found in around 11% of cases at ultrasound and 8% at fetal MRI indicating the need for a detailed evaluation by expert physicians when oCSP is suspected.
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Affiliation(s)
- Ilaria Fantasia
- Unit of Fetal Medicine, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Claudia Ciardo
- Department of Gynecology and Obstetrics, Ospedale Fracastoro, San Bonifacio, Italy
| | | | - Elisa Filippi
- UOC Gynecology and Obstetrics, Ospedale Cà Foncello Treviso, Treviso, Italy
| | - Flora Maria Murru
- Radiology Service, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Anita Spezzacatene
- Radiology Service, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maura Bin
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Elisa Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Katherine Papanikolaou
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gianluigi Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Federico Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Tamara Stampalija
- Unit of Fetal Medicine, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Sepulveda W, Sepulveda F, Ranzini AC. Role of Fetal Magnetic Resonance Imaging in Differentiating Isolated Septal Agenesis from Septo-Optic Dysplasia: Case Study and Review. Fetal Diagn Ther 2023; 50:165-174. [PMID: 37015213 DOI: 10.1159/000530468] [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] [Received: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION The detection of absent septi pellucidi (ASP) during obstetric ultrasound is a rare event. However, the clinical implications of this finding are significant. ASP can be associated with severe central nervous system anomalies such as holoprosencephaly, agenesis/dysgenesis of the corpus callosum, schizencephaly, severe ventriculomegaly, and open neural tube defects. In such cases, the prognosis is poor. When no such anomalies are identified, isolated ASP usually carries a good prognosis. However, some fetuses thought to have isolated ASP actually have septo-optic dysplasia (SOD), which is associated with optic nerve hypoplasia, hypothalamic-pituitary dysfunction, and developmental delay. CASE PRESENTATION A case in which fetal 3.0 Tesla magnetic resonance imaging (MRI) was considered crucial to definitively diagnose isolated ASP is presented. A review of the literature was conducted and analyzed to determine the role of MRI in the evaluation of fetuses with ASP, with special consideration on the differential diagnosis between isolated ASP and SOD. CONCLUSION Differentiating isolated ASP from SOD is imperative for adequate prenatal counseling. Unfortunately, making a prenatal diagnosis of SOD requires visualization and evaluation of the fetal optic nerves, chiasm, and pituitary gland, which is very demanding and not always possible using ultrasound. Fetal MRI has the potential of obtaining high-quality images of the fetal brain, and therefore this technique can be used for establishing the differential diagnosis in utero.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Francisco Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
- Department of Neuroradiology, Institute of Neurosurgery "Dr. Alfonso Asenjo", National Health Service, Santiago, Chile
- Department of Radiology, Clinica Alemana, Santiago, Chile
| | - Angela C Ranzini
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, Ohio, USA
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Pomar L, Ochoa J, Cabet S, Huisman TAGM, Paladini D, Klaritsch P, Galmiche A, Prayer F, Gacio S, Haratz K, Malinger G, Van Mieghem T, Baud D, Bromley B, Lebon S, Dubruc E, Vial Y, Guibaud L. Prenatal diagnosis of Aicardi syndrome based on a suggestive imaging pattern: A multicenter case-series. Prenat Diagn 2022; 42:484-494. [PMID: 34984691 PMCID: PMC9302986 DOI: 10.1002/pd.6085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022]
Abstract
Objectives To characterize a suggestive prenatal imaging pattern of Aicardi syndrome using ultrasound and MR imaging. Methods Based on a retrospective international series of Aicardi syndrome cases from tertiary centers encountered over a 20‐year period (2000–2020), we investigated the frequencies of the imaging features in order to characterize an imaging pattern highly suggestive of the diagnosis. Results Among 20 cases included, arachnoid cysts associated with a distortion of the interhemispheric fissure were constantly encountered associated with complete or partial agenesis of the corpus callosum (19/20, 95%). This triad in the presence of other CNS disorganization, such as polymicrogyria (16/17, 94%), heterotopias (15/17, 88%), ventriculomegaly (14/20, 70%), cerebral asymmetry [14/20, 70%]) and less frequently extra‐CNS anomaly (ocular anomalies [7/11, 64%], costal/vertebral segmentation defect [4/20, 20%]) represent a highly suggestive pattern of Aicardi syndrome in a female patient. Conclusion Despite absence of genetic test to confirm prenatal diagnosis of AS, this combination of CNS and extra‐CNS fetal findings allows delineation of a characteristic imaging pattern of AS, especially when facing dysgenesis of the corpus callosum.
What is already known about this topic?
Aicardi syndrome (AS) is a rare developmental encephalopathy, characterized by the classic triad of infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae As the genetic etiology of AS is unknown and its classic triad cannot be extrapolated to prenatal diagnosis, to establish a prenatal imaging pattern is of major interest
What does this study add?
We confirmed and completed a prenatal imaging pattern highly suggestive of AS, based on the most frequent features encountered in a large series: arachnoid cysts associated with a distortion of the interhemispheric fissure, agenesis of the corpus callosum, cortical malformations and heterotopias, and less frequently extra‐CNS anomaly (ocular anomalies, costal/vertebral segmentation defect)
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Affiliation(s)
- Léo Pomar
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - José Ochoa
- Diagnus SA, Prenatal Diagnosis and Fetal Medicine Centre, Córdoba, Argentina
| | - Sara Cabet
- Pediatric and Fœtal Imaging, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Gaslini Children's Hospital, Genoa, Italy
| | - Philipp Klaritsch
- Research Unit for Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Aurore Galmiche
- Ultrasound and Fetal Medicine, Department of Obstetrics, Hospital of Niort, Niort, France
| | - Florian Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastián Gacio
- Division of Pediatric Neurology, Hospital of Children Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Karina Haratz
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gustavo Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - David Baud
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Bryann Bromley
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sébastien Lebon
- Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Estelle Dubruc
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Laurent Guibaud
- Pediatric and Fœtal Imaging, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Ghassemi N, Rupe E, Perez M, Lamale-Smith L, Fratto VM, Farid N, Hahn M, Ramos GA, Ho Y, Rakow-Penner R, Horton K, Khan S, Jones M, Pretorius DH. Ultrasound and Magnetic Resonance Imaging of Agenesis of the Corpus Callosum in Fetuses: Frontal Horns and Cavum Septi Pellucidi Are Clues to Earlier Diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2389-2403. [PMID: 32597533 DOI: 10.1002/jum.15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We hypothesized that: (1) fetal frontal horn (FH) morphology and their proximity to the cavum septi pellucidi (CSP) can assist in suspecting complete agenesis of the corpus callosum (cACC) and partial agenesis of the corpus callosum (pACC) earlier than known indirect ultrasound (US) findings; (2) FHs assist in differentiating a true CSP from a pseudocavum; and (3) magnetic resonance imaging (MRI) is useful in learning FH morphology and pseudocavum etiology. METHODS Thirty-two patients with cACC and 9 with pACC were identified on an Institutional Review Board-approved retrospective review. Of the 41 cases, 40 had prenatal US, and 21 had prenatal MRI; 17 had follow-up neonatal US, and 14 had follow-up neonatal MRI. Variables evaluated retrospectively were the presence of a CSP or a pseudocavum, ventricle size and shape, and FH shape (comma, trident, parallel, golf club, enlarged, or fused). Displacement between the inferior edge of the FH and the midline or cavum/pseudocavum was measured. RESULTS Fetal FHs had an abnormal shape in 77% ≤20 weeks' gestation, 86% ≤24 weeks, and 90% >24 weeks. Frontal horns were laterally displaced greater than 2 mm in 85% ≤20 weeks, 91% ≤24 weeks, and 95% >24 weeks. The CSP was absent in 100% of cACC cases and 78% of pACC cases, and a pseudocavum was present in 88% of cACC cases and 78% of pACC cases across gestation. Magnetic resonance imaging confirmed US pseudocavums to be focal interhemispheric fluid or an elevated/dilated third ventricle. CONCLUSIONS Frontal horns assist in assessing ACC ≤24 weeks and throughout gestation. Pseudocavums, often simulating CSPs, are common in ACC. Frontal horn lateral displacement and abnormal morphology, recognized by MRI correlations, are helpful in differentiating a pseudocavum from a true CSP. A normal CSP should not be cleared on screening US unless normally shaped FHs are seen directly adjacent to it.
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Affiliation(s)
- Neda Ghassemi
- University of California, San Diego, School of Medicine (N.G.)
| | - Eric Rupe
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Mishella Perez
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Leah Lamale-Smith
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Victoria M Fratto
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Nikdokht Farid
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Michael Hahn
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
| | - Gladys A Ramos
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Yoona Ho
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Rebecca Rakow-Penner
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Katelyn Horton
- University of California, Berkeley, California, USA (K.H.), USA
| | - Sohini Khan
- University of California, Berkeley, California, USA (K.H.), USA
| | - Marilyn Jones
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- General Surgery (S.K.) and Pediatrics (M.J.), University of California, USA
| | - Dolores H Pretorius
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
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Hormazabal L, Correa F, Escribano D, Quiroz G, Saint-Jean C, Espinel A, Diaz L, Zambrano B, Galindo A, Viñals F. Feasibility and agreement of including anterior-posterior complexes and landmarks of the proximal hemisphere into basic examination of the fetal brain: A prospective study. Prenat Diagn 2020; 40:596-604. [PMID: 31994747 DOI: 10.1002/pd.5652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the feasibility of identifying structures included in anterior complex (AC) and posterior complex (PC), as well as a series of anatomic landmarks that could help to demonstrate the integrity of the cerebral proximal hemisphere (PH). METHODS This was a prospective observational multicenter study of healthy pregnant women attending routine ultrasound screening at 20 + 0 to 33 + 6 weeks' gestation. Six physicians performed transabdominal (TA) ultrasound, in order to obtain the planes required to visualize the AC, PC, and PH. Blind analysis by a nonexpert and two experts in fetal neurosonography was used to assess the structures included in each plane view. RESULTS In the population studied (n = 747), detection of the structure rates for AC, PC, and proximal hemisphere was of 94%, 93%, and 96%, respectively, with an agreement of 97%, 94%, and 98% when comparing an expert and a nonexpert in fetal brain examiner. Detection of structures in the proximal hemisphere was significantly higher when observed through the proximal hemisphere plane rather than the transventricular plane. CONCLUSION Our results suggest that inclusion of AC and PC complexes visualization, as well as real-time access to the proximal hemisphere, is feasible and could improve the prenatal detection of fetal cerebral anomalies.
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Affiliation(s)
- Lorena Hormazabal
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Flavia Correa
- Fetal and Neonatal Ultrasonography, Department, Hospital Lusíadas, Lisbon, Portugal
| | - David Escribano
- Fetal Medicine Unit-Maternal and Child Health and Development Network, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Gabriel Quiroz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Constanza Saint-Jean
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Andrea Espinel
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Linder Diaz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Belkys Zambrano
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Alberto Galindo
- Fetal Medicine Unit-Maternal and Child Health and Development Network, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Fernando Viñals
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
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9
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Ben M'Barek I, Tassin M, Guët A, Simon I, Mairovitz V, Mandelbrot L, Picone O. Antenatal diagnosis of absence of septum pellucidum. Clin Case Rep 2020; 8:498-503. [PMID: 32185044 PMCID: PMC7069873 DOI: 10.1002/ccr3.2666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 09/18/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
The absence of septum pellucidum (ASP) is a rare disease, which affects the structure of the brain. It is either isolated or associated with various congenital brain malformations. The diagnosis of ASP can be performed by second-trimester ultrasound. When the ASP is isolated, prenatal counseling is optimistic regarding neurological outcome, but there is a 20% risk of septo-optic dysplasia in the neonate.
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Affiliation(s)
- Imane Ben M'Barek
- Service de Gynécologie‐ObstétriqueAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
| | - Mikael Tassin
- Service de Gynécologie‐ObstétriqueAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
| | - Agnes Guët
- Université de ParisParisFrance
- Service de Néonatalogie and Service de PédiatrieAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
| | - Isabelle Simon
- Service d’ImagerieAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
| | - Valerie Mairovitz
- Service de Gynécologie‐ObstétriqueAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
| | - Laurent Mandelbrot
- Service de Gynécologie‐ObstétriqueAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
| | - Olivier Picone
- Service de Gynécologie‐ObstétriqueAssistance Publique‐Hôpitaux de ParisHôpital Louis MourierColombesFrance
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10
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Viñals F, Correa F, Tubau A, Alonso I, Serra V, Herraiz I, Hormazabal L, Quiroz G, Saint-Jean C, Diaz L, Zambrano B, Galindo A. New Insights into the Anterior Complex. Fetal Diagn Ther 2020; 47:514-518. [PMID: 31931505 DOI: 10.1159/000504980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To introduce visualization of the germinal matrix (GM), external angle of the frontal horn, and periventricular white matter while evaluating the anterior complex (AC) during basic ultrasound assessment of the fetal brain. CASE PRESENTATIONS This is a retrospective observational study of healthy women with singleton pregnancies, with no increased risk of fetal central nervous system anomalies, attending routine ultrasound screening at 20-32 weeks' gestation. Seventeen cases are presented in which an abnormal aspect of the GM or external angle of the frontal horn or periventricular white matter on AC evaluation has allowed a prenatal diagnosis of peri-intraventricular hemorrhage, subependymal cysts, connatal cysts, periventricular venous hemorrhagic infarction, and white matter injury. CONCLUSION An extended AC evaluation could significantly improve the -diagnosis of hemorrhagic/cystic/hypoxic-ischemic lesions during the performance of a basic ultrasound study of the fetal brain.
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Affiliation(s)
- Fernando Viñals
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile,
| | - Flavia Correa
- Fetal and Neonatal Ultrasonography Department, Hospital Lusíadas, Lisbon, Portugal
| | - Albert Tubau
- Obstetrics Unit, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | - Vicente Serra
- Instituto Universitario IVI Valencia, IVIRMA, Universidad de Valencia, Valencia, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit - Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Lorena Hormazabal
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Gabriel Quiroz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Constanza Saint-Jean
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Linder Diaz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Belkys Zambrano
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Alberto Galindo
- Fetal Medicine Unit - Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
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11
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Ho Y, Herrero T, Aguinaldo J, Hahn ME, Klisser K, Ghassemi N, Alagh A, Hamlin A, Pretorius M, Horton K, Hull A, Pretorius DH. Ultrasound Measurements of Frontal Horns and the Cavum Septi Pellucidi in Healthy Fetuses in the Second and Third Trimesters of Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:127-137. [PMID: 31281992 DOI: 10.1002/jum.15086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 06/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the visualization rate and size of the frontal horns (FHs) and cavum septi pellucidi (CSP) in healthy fetuses throughout pregnancy. METHODS After Institutional Review Board approval, 522 consecutive uncomplicated singleton pregnancies between 15 and 39 gestational weeks were enrolled in the study. Ultrasound measurements of the anterior horn width (AHW), center from the horn distance (CFHD), distance from the FHs to the CSP, and CSP width were retrospectively performed using axial transventricular or transcerebellar planes. Available maternal body mass indices were recorded. RESULTS At least 1 FH was seen in 78% of the cases. The mean AHW decreased over the second trimester and plateaued in the third trimester. The CFHD plateaued in the second trimester and increased in the third trimester. Downside FHs were generally larger than upside FHs. More FHs were measured in transventricular (69%) than transcerebellar (31%) planes. Frontal horns were seen with high, low, and no confidence in 57%, 21%, and 22% of cases, respectively. No-confidence rates were 17% in the second trimester and 42% in the third trimester. The CSP was not visualized in 4% of cases; 15 of 19 cases of a nonvisualized CSP were scanned between 18 and 37 weeks. Mean body mass indices ± SDs were 27.6 ± 6.7 kg/m2 for the patients in cases of a visualized CSP and 32.4 ± 9.1 kg/m2 for the patients in cases of a nonvisualized CSP. CONCLUSIONS Normative data for the fetal FH and CSP width were established. Frontal horns are more frequently seen on transventricular views and are difficult to confidently assess in the late third trimester. This study challenges previously reported data that the CSP is seen in 100% of cases from 18 to 37 weeks.
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Affiliation(s)
- Yoona Ho
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
| | - Tiffany Herrero
- Reproductive Medicine, University of California, San Diego, California, USA
- Stanford University Maternal-Fetal Medicine, Stanford, California, USA
| | - Jennifer Aguinaldo
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
| | - Michael E Hahn
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
| | - Kristin Klisser
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
| | - Neda Ghassemi
- University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Amy Alagh
- Department of Obstetrics and Gynecology, University of California, San Francisco, Fresno, California, USA
| | - Alyssa Hamlin
- Department of Obstetrics and Gynecology, University of Colorado, Boulder, Colorado, USA
| | | | | | - Andrew Hull
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Reproductive Medicine, University of California, San Diego, California, USA
| | - Dolores H Pretorius
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
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