1
|
Yin J, Wang Y, Wang S, Li G, Gu H, Chen L. Research progress on ultrasound and molecular markers for prenatal diagnosis of neural tube defects. Heliyon 2024; 10:e36060. [PMID: 39247260 PMCID: PMC11378877 DOI: 10.1016/j.heliyon.2024.e36060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Neural tube defects (NTDs) are severe congenital anomalies that result from the failure of early neural tube closure during fetal neurogenesis. They are the most common and severe congenital malformations of the central nervous system. Identifying reliable prenatal diagnostic ultrasound and molecular markers that can predict NTDs is of paramount importance. Early diagnosis of NTDs allows embryonic treatment and prevention strategies, which are crucial for reducing the disability rate associated with these malformations, reducing the burden on individuals and on society. The purpose of this comprehensive review was to summarize the ultrasound biomarkers between 11 and 13 weeks of gestation and the molecular biomarkers used in the diagnosis of NTDs, providing additional insights into early screening for NTDs.
Collapse
Affiliation(s)
- Jiao Yin
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sihong Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gang Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lizhu Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
2
|
Guilbaud L, Carreras E, Garel C, Maiz N, Dhombres F, Deprest J, Jouannic JM. Proposal for standardized prenatal assessment of fetal open dysraphisms by the European reference network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies (ITHACA) and eUROGEN. Prenat Diagn 2024; 44:1073-1087. [PMID: 38898590 DOI: 10.1002/pd.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Open dysraphisms, that is, myelomeningocele and myeloschisis, are rare diseases associated with a risk of severe disability, including lower limb motor and sensory deficiency, sphincter deficiency, and potential intellectual deficiency. Open dysraphism is diagnosed in Europe in 93.5% of cases. In case of suspicion of fetal open dysraphism, a detailed fetal morphologic assessment is required to confirm the diagnosis and exclude associated structural anomalies, as well as genetic assessment. In case of isolated fetal open dysraphism, assessment of prognosis is based on fetal imaging including the level of the lesion, the presence or not of a sac, the presence and nature of intra cranial anomalies, and the anatomical and functional evaluation of the lower extremities. Based on these biomarkers, a personalized prognosis as well as comprehensive information about prenatal management alternatives will allow parents to decide on further management options. Standardization of prenatal assessment is essential to compare outcomes with benchmark data and make assessment of surgical innovation possible. Herein, we propose a protocol for the standardized ultrasound assessment of fetuses with isolated open dysraphism.
Collapse
Affiliation(s)
- Lucie Guilbaud
- Fetal Medicine Department, Armand Trousseau University Hospital, Spin@ Reference Center, Sorbonne University, Paris, France
| | - Elena Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Catherine Garel
- Pediatric Radiology Department, Armand Trousseau University Hospital, Sorbonne University, Paris, France
| | - Nerea Maiz
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ferdinand Dhombres
- Fetal Medicine Department, Armand Trousseau University Hospital, Spin@ Reference Center, Sorbonne University, Paris, France
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London, London, UK
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Armand Trousseau University Hospital, Spin@ Reference Center, Sorbonne University, Paris, France
| |
Collapse
|
3
|
First Trimester Ultrasound Detection of Fetal Central Nervous System Anomalies. Brain Sci 2023; 13:brainsci13010118. [PMID: 36672099 PMCID: PMC9857041 DOI: 10.3390/brainsci13010118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the potential of the first-trimester ultrasound (US) features for the detection of central nervous system (CNS) anomalies. Methods/Methodology: This is a prospective one-center three-year study. Unselected singleton pregnant women were examined using an extended first-trimester anomaly scan (FTAS) that included the CNS assessment: the calvaria shape, the septum (falx cerebri), the aspect of the lateral ventricles, the presence of the third ventricle and aqueduct of Sylvius (AS) and the posterior brain morphometry: the fourth ventricle, namely intracranial translucency (IT), brain stem/brain stem-occipital bone ratio (BS/BSOB) and cisterna magna (CM). The spine and underlying skin were also evaluated. The cases were also followed during the second and third trimesters of pregnancy and at delivery. FTAS efficiency to detect major CNS abnormalities was calculated. RESULTS We detected 17 cases with CNS major abnormalities in a population of 1943 first-trimester (FT) fetuses, including spina bifida with myelomeningocele, exencephaly-anencephaly, holoprosencephaly, hydrocephaly, cephalocele and Dandy-Walker malformation. The CNS features in the abnormal group are presented. In the second trimester (ST), we further diagnosed cases of corpus callosum agenesis, cerebellar hypoplasia, vein of Galen aneurysm and fetal infection features (ventriculomegaly, intraventricular bands, intraventricular cyst and hyperechoic foci), all declared normal at the FTAS. During the third trimester (TT) scan we identified a massive fetal cerebral haemorrhage absent at previous investigations. We report a detection rate of 72.7% of fetal brain anomalies in the FT using the proposed CNS parameters. The sensitivity of the examination protocol was 72.7%, and the specificity was 100%. CONCLUSION A detailed FT CNS scan is feasible and efficient. The majority of cases of major CNS abnormalities can be detected early in pregnancy. The visualization rates of the CNS parameters in the FT are great with short, if any, additional investigation time. FT cerebral disorders such as haemorrhage or infections were missed in the FT even when an extended evaluation protocol was used.
Collapse
|
4
|
Bilardo CM, Chaoui R, Hyett JA, Kagan KO, Karim JN, Papageorghiou AT, Poon LC, Salomon LJ, Syngelaki A, Nicolaides KH. ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:127-143. [PMID: 36594739 DOI: 10.1002/uog.26106] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, and Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Hyett
- Western Sydney University, Sydney, Australia
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - J N Karim
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - L C Poon
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Paris Cité University, Assistance Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| |
Collapse
|
5
|
[Prenatal ultrasound prognostic of myelomeningocele at the era of fetal surgery]. ACTA ACUST UNITED AC 2021; 49:617-629. [PMID: 34020095 DOI: 10.1016/j.gofs.2021.05.003] [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: 11/11/2020] [Indexed: 11/21/2022]
Abstract
Myelomeningocele (MMC) is a severe congenital condition responsible for motor and sensory impairments of the lower limbs, incontinence and cognitive impairment. Its screening, sometimes as early as the first trimester, is one of the major goals of modern prenatal care, supported by the emergence of prenatal surgery that results in a significant improvement in motor function, ambulation and ventriculoperitoneal shunt rate in patients undergoing in-utero surgery. From screening to pre- and post-operative prognostic evaluation, prenatal ultrasound is now an essential tool in the antenatal management of this condition. Using the multi planar and three-dimensional modes, it can be used to assess the vertebral level of MMC, which remains the key antenatal prognostic marker for motor function and ambulation, incontinence and the need for a ventriculo-peritoneal shunt. A careful and systematic ultrasound examination also makes it possible to assess the severity and progression of ventriculomegaly, to search for associated cerebral, spinal cord or vertebral anomalies, or to rule out exclusion criteria for in-utero surgery such as severe kyphosis or serious cortical anomalies. New tools from post-natal evaluation, such as the "metameric" ultrasound assessment of lower limb mobility, appear to be promising either for the initial examination or after in-utero surgery. Ultrasonography, associated with fetal MRI, cytogenetic and next generation sequencing, now allows a highly customized prognostic evaluation of these fetuses affected by MMC and provides the parents with the best possible information on the expected benefits and limitations of fetal surgery.
Collapse
|
6
|
AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:E1-E16. [PMID: 32852128 DOI: 10.1002/jum.15477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
|
7
|
Mace P, Mancini J, Gorincour G, Quarello E. Accuracy of qualitative and quantitative cranial ultrasonographic markers in first-trimester screening for open spina bifida and other posterior brain defects: a systematic review and meta-analysis. BJOG 2020; 128:354-365. [PMID: 32966672 DOI: 10.1111/1471-0528.16530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The significant number of qualitative and quantitative ultrasound markers described for first-trimester screening of open spina bifida (OSB) and other posterior brain defects (oPBD) has resulted in their complex implementation and interpretation for a widespread screening and in a lack of consensus regarding diagnostic accuracy. OBJECTIVES To assess and compare the accuracy of qualitative and quantitative cranial sonographic markers at 11-14 weeks of gestation for the detection of OSB and oPBD. SEARCH STRATEGY A systematic literature search was performed in MEDLINE and COCHRANE from 2009 to April 2020. SELECTION CRITERIA Studies assessing the diagnostic accuracy of quantitative and/or qualitative ultrasound signs to predict OSB and oPBD were included. Cohort studies and case-control studies were also considered. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the risk of bias. The overall pooled estimate and a summary receiver operating characteristic curve was estimated for each subgroup (qualitative and quantitative assessment). MAIN RESULTS Twenty-three studies were included in our meta-analysis. The pooled sensitivity and specificity for qualitative assessment were 76.5% and 99.6%, and for quantitative assessment were 84.5% and 96.3%, respectively; specificity for the qualitative ultrasound signs was significantly higher (P = 0.001). The overall sensitivity of cranial sonographic markers for the screening of oPBD was 76.7% and specificity was 97.5%. CONCLUSIONS The qualitative approach demonstrated greater specificity, so this would appear to be more appropriate for daily screening, as a first-line tool, whereas the quantitative approach should be reserved for expert ultrasound. TWEETABLE ABSTRACT This study highlights the relevance of first-trimester qualitative ultrasound signs in the screening of open spina bifida.
Collapse
Affiliation(s)
- P Mace
- Institut méditerranéen d'imagerie médicale appliquée à la gynécologie, la grossesse et l'enfance IMAGE2, Marseille, France.,Unité de dépistage et de diagnostic prénatal, Hôpital Privé Marseille Beauregard, Marseille, France
| | - J Mancini
- Public Health Department (BIOSTIC), APHM, INSERM, IRD, SESSTIM, Hop Timone, Aix Marseille Univ, Marseille, France
| | - G Gorincour
- Institut méditerranéen d'imagerie médicale appliquée à la gynécologie, la grossesse et l'enfance IMAGE2, Marseille, France.,Elsan, Clinique Bouchard, Marseille, France
| | - E Quarello
- Institut méditerranéen d'imagerie médicale appliquée à la gynécologie, la grossesse et l'enfance IMAGE2, Marseille, France.,Elsan, Clinique Bouchard, Marseille, France
| |
Collapse
|
8
|
Ungureanu DR, Zorila LG, Capitanescu RG, Iliescu DG. First trimester cerebral appearance in the presence of closed spina bifida with myelomeningocele, part of the oeis complex. BMJ Case Rep 2020; 13:13/10/e235395. [PMID: 33033002 DOI: 10.1136/bcr-2020-235395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Our communication presents a prenatally detected case with severe spinal defect detected in the first trimester of pregnancy, accompanied by a large skin-covered myelomeningocele but normal cranio-cerebral structural appearance.These findings suggest that in the first trimester, the extent of the spinal defect, the cerebrospinal fluid leakage to a large, but skin-covered, meningocele and fixation of the spinal cord at the lesion are not sufficient to determine downward hindbrain displacement and the development of secondary signs for open spina bifida.Therefore, we suggest a careful evaluation of the fetal cerebral features if a meningocele is detected. The presence of the skin covering the lesion may not be evident in the first trimester, but the absence of intracranial open spina bifida markers may indicate a 'closed' spinal defect, which generally associates a good neurological outcome. Also, studies aimed to investigate the accuracy of the intracranial features for open spina bifida detection should consider the possibility of 'closed' myelomeningoceles to avoid incorrect correlations.
Collapse
Affiliation(s)
- Delia Roxana Ungureanu
- Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova Faculty of Medicine, Craiova, Romania
| | - Lucian George Zorila
- Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova Faculty of Medicine, Craiova, Romania .,Obstetrics and Gynecology, Medgin Prenatal Diagnostic Unit, Craiova, Dolj, Romania
| | - Razvan Grigoras Capitanescu
- Obstetrics and Gynecology, Medgin Prenatal Diagnostic Unit, Craiova, Dolj, Romania.,Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dominic Gabriel Iliescu
- Obstetrics and Gynecology, Medgin Prenatal Diagnostic Unit, Craiova, Dolj, Romania.,Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| |
Collapse
|
9
|
Arbuzova S, Nikolenko M, Cuckle H. Maternal weight as an additional first trimester spina bifida screening marker. J Matern Fetal Neonatal Med 2020; 35:3353-3358. [PMID: 32928009 DOI: 10.1080/14767058.2020.1818217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate first trimester maternal weight as a spina bifida screening marker. METHODS Case-control study of spina bifida and unaffected pregnancies; cases were from national records and controls from women referred to prenatal screening centers in the Ukraine. The median and inter-quartile range of weight, body mass index (BMI) and the obesity rate (BMI ≥ 30 kg/m2) were compared. Discriminatory power was assessed by logistic regression. Gaussian modeling was used to predict the additional spina bifida detection when weight was included as a screening marker risk in addition to first trimester biparietal diameter (BPD) and serum α-fetoprotein (AFP). RESULTS There were 97 cases and 274 controls. The distribution of maternal weight was increased in cases by 3 kg, on average, about 5% (p < .05); BMI was increased about 8% (p < .005). Some 15% of cases were obese compared with 6.9% of controls (p < .02). In logistic regression including BMI and maternal age, 29% cases and 9.8% controls had high risk of spina bifida. Modeling predicted that incorporating weight would increase the detection rate compared with BPD and AFP alone by 3% and BMI would increase it by 4%. CONCLUSION Incorporating maternal weight into first trimester spina bifida screening protocols will increase detection.
Collapse
Affiliation(s)
- Svetlana Arbuzova
- Center of Medical Genetics and Prenatal Diagnosis, Mariupol, Ukraine
| | | | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Chaoui R, Benoit B, Entezami M, Frenzel W, Heling KS, Ladendorf B, Pietzsch V, Sarut Lopez A, Karl K. Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11-13 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:81-86. [PMID: 31559662 DOI: 10.1002/uog.20856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To measure the ratio of choroid plexus (CP) size to head size in normal fetuses and to compare it to that in fetuses with open spina bifida (OSB) and quantify the subjective sign of a 'dry brain'. METHODS This was a retrospective study of ultrasound images, obtained during first-trimester screening between 11 and 13 weeks of gestation, from 34 fetuses with OSB and 160 normal fetuses. From the hospital databases, we retrieved images of the fetal head in the transventricular axial plane. We measured the areas of both CPs and the head and calculated the ratio between them. We also measured the longest diameter of each CP and calculated their mean (CP length), and measured the occipitofrontal diameter (OFD) and calculated the ratio of CP length to OFD. Measurements from the OSB fetuses were plotted on crown-rump length (CRL) reference ranges constructed using data from the normal fetuses, and Z-scores were calculated. RESULTS In the normal fetuses, the CP area increased, while the ratios of CP area to head area and CP length to OFD decreased, with increasing CRL. In 30 of the 34 (88%) fetuses with OSB, both ratios were increased significantly and the CPs filled the entirety of the head, giving the impression of a dry brain. In these cases, the borders of the lateral ventricles could not be identified. CONCLUSIONS At 11-13 weeks, the majority of fetuses with OSB have reduced fluid in the lateral ventricles such that the CPs fill the head. The dry brain sign is easily visualized during routine first-trimester ultrasound examination while measuring the biparietal diameter, and can be quantified by comparing the size of the CPs to the head size. Until prospective data confirm the usefulness of this sign in screening for OSB, it should be considered as a hint to prompt the examiner to assess thoroughly the posterior fossa and spine. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - B Benoit
- Department of Obstetrics and Gynecology, Princess Grace Hospital, Monaco
| | - M Entezami
- Center for Prenatal Diagnosis, Berlin, Germany
| | - W Frenzel
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - K S Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - B Ladendorf
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - V Pietzsch
- Prenatal Diagnosis Clinic, Waiblingen, Germany
| | - A Sarut Lopez
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - K Karl
- Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
11
|
Wertaschnigg D, Ramkrishna J, Ganesan S, Tse C, Scheier M, Volpe N, Ghi T, Meagher S, Rolnik DL. Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation. Prenat Diagn 2019; 40:365-372. [PMID: 31742707 DOI: 10.1002/pd.5614] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare the sonographic signs of spina bifida obtained on axial and sagittal views of the fetal head between 11 and 13+6 weeks of gestation. METHODS This was a retrospective study including 27 cases of spina bifida and 1003 randomly selected controls. Indirect markers of spina bifida were evaluated on stored ultrasound images. Intracranial translucency (IT), ratio between the brainstem and the brainstem-occipital bone distance (BS/BSOB), and maxillo-occipital (MO) line were assessed on sagittal view, whereas biparietal diameter (BPD), BPD to abdominal circumference ratio (BPD/AC), and aqueduct to occipital bone (aqueduct of Sylvius [AoS]) distance were measured on the axial plane. Reference ranges were developed, and cases of spina bifida were examined in relation to the reference range. RESULTS On the sagittal view, detection rates for IT below the fifth percentile, BS/BSOB above the 95th percentile, and an abnormal MO line were 52.3%, 96.3%, and 96.3%, respectively. On the axial view, detection rates for BPD, BPD/AC, and AoS below the fifth percentile were 66.7%, 70.4%, and 77.8%, respectively. CONCLUSION The MO line and the BS/BSOB ratio appear to be the best indirect ultrasound markers of spina bifida and can be easily obtained during the routine first-trimester scan.
Collapse
Affiliation(s)
- Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Jayshree Ramkrishna
- Fetal Medicine Service, Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - Sujatha Ganesan
- Fetal Medicine Service, Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - Cheryl Tse
- Fetal Medicine Service, Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - Matthias Scheier
- Fetal Medicine Service, Ambulatorium für Fetalmedizin, Feldkirch, Austria
| | - Nicola Volpe
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Simon Meagher
- Fetal Medicine Service, Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Suresh S, Sudarshan S, Rangaraj A, Indrani S, Cuckle H. Spina bifida screening in the first trimester using ultrasound biparietal diameter measurement adjusted for crown-rump length or abdominal circumference. Prenat Diagn 2019; 39:314-318. [PMID: 30720874 DOI: 10.1002/pd.5433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Compare the performance of first trimester ultrasound biparietal diameter (BPD) screening for open spina bifida (OSB) when BPD is adjusted for crown-rump length (CRL) or abdominal circumference (AC). METHODS For 63 OSB and 24 265 unaffected pregnancies, BPD was expressed as multiple of the normal median (MoM) based on CRL and on AC, and as the ratio BPD/AC. Screening performance was assessed by the Mahalanobis distance, the observed detection rate with normal fifth and 10th percentile cut-offs and the area under the receiver-operator characteristic curve (AUC). RESULTS Mahalanobis distance for BPD MoM was considerably higher when based on AC than on CRL: 1.69 versus 1.14. Screening performance was also higher: using a fifth percentile cut-off, the detection rate was 59% compared with 41%; using a 10th percentile cut-off, the rates were 63% and 51%. Whilst the false-positives rates were slightly higher too-5.3% versus 5.1% and 10.8% versus 9.9%-the AUC was statistically significantly higher: 0.872 (95% CI, 0.816-0.928) compared with 0.735 (95% CI, 0.664-0.806). BPD/AC had intermediate performance. CONCLUSION The best results are obtained when AC, rather than CRL, is used to express BPD values in MoMs. First trimester OSB screening can detect half to two-thirds of cases.
Collapse
Affiliation(s)
- Seshadri Suresh
- Department of Fetal Medicine, Mediscan Systems and Fetal Care Research Foundation, Chennai, India
| | - Suresh Sudarshan
- Department of Fetal Medicine, Mediscan Systems and Fetal Care Research Foundation, Chennai, India
| | - Arthi Rangaraj
- Department of Fetal Medicine, Mediscan Systems and Fetal Care Research Foundation, Chennai, India
| | - Suresh Indrani
- Department of Fetal Medicine, Mediscan Systems and Fetal Care Research Foundation, Chennai, India
| | - Howard Cuckle
- Reproductive Epidemiology, Leeds Screening Centre, Leeds, UK.,Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| |
Collapse
|
13
|
Cuckle H, Neiger R. Prenatal Screening Strategies in Localities with Limited Resources. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0140-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Fetal Anatomic Imaging Between 11 and 14 Weeks Gestation. Clin Obstet Gynecol 2017; 60:621-635. [PMID: 28742595 DOI: 10.1097/grf.0000000000000296] [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
Fetal imaging between 11 and 14 weeks is a standard component of prenatal risk assessment for aneuploidy. Evaluating the fetus during this gestational age window provides the opportunity to reliably examine anatomic structures. Using a defined imaging protocol, approximately 50% of major abnormalities can be detected. Some abnormalities should almost always be detected, some may be detected on occasion and others are not currently detectable. Imagers must be familiar with embryologic patterns of development and natural history of anomalies. Patients must be informed of the limitations of early anatomic evaluation. Currently, early anatomic evaluation does not replace the standard second trimester evaluation.
Collapse
|
15
|
Meller C, Aiello H, Otaño L. Sonographic detection of open spina bifida in the first trimester: review of the literature. Childs Nerv Syst 2017; 33:1101-1106. [PMID: 28510070 DOI: 10.1007/s00381-017-3443-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
In the beginnings, sonographic diagnosis of open spina bifida (OSB) relied on the meticulous scanning of the fetal vertebrae for abnormalities but many defects were missed. After the mid-1980s, however, with the description of the intracranial findings in the second trimester (the "lemon sign" and the "banana sign"), the prenatal diagnosis of OSB was enhanced. In the last 2 decades, there has been widespread uptake of routine ultrasound examination in the first trimester of pregnancy with the purpose of the measurement of fetal crown-rump length to determine gestational age, to screen for trisomy 21 and other aneuploidies, mainly with the nuchal translucency, and for diagnosis of many major abnormalities. Many papers were published focusing on early diagnosis of myelomeningocele (MMC), and the objective of this review is to summarize the different techniques described regarding prenatal diagnosis of OSB in the first trimester of pregnancy.
Collapse
Affiliation(s)
- César Meller
- Obstetrics Division, Fetal Medicine Unit, Hospital Italiano de Buenos Aires, Potosí 4135, C1199ACI, Buenos Aires, Argentina.
| | - Horacio Aiello
- Obstetrics Division, Fetal Medicine Unit, Hospital Italiano de Buenos Aires, Potosí 4135, C1199ACI, Buenos Aires, Argentina
| | - Lucas Otaño
- Obstetrics Division, Fetal Medicine Unit, Hospital Italiano de Buenos Aires, Potosí 4135, C1199ACI, Buenos Aires, Argentina
| |
Collapse
|
16
|
Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F. Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery. Childs Nerv Syst 2017; 33:1083-1099. [PMID: 28593553 DOI: 10.1007/s00381-017-3445-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Accurate and timely prenatal diagnosis of spina bifida (SB) is a major goal of modern antenatal care. Prenatal screening for open SB should be first performed at the time of routine first-trimester ultrasound by examining the posterior fossa for obliteration or non-visualization of the fourth ventricle ("intracranial translucency") and cisterna magna. The second step of screening is the second-trimester anatomy scan, at which time the features of the Chiari type II malformation should be looked for, including ventriculomegaly, scalloping of the frontal bones ("lemon" sign), and backward and caudal displacement of the cerebellar vermis with obliteration of the cisterna magna ("banana" sign). In cases with positive findings, evaluation must include a focused examination of the spine for defects. In cases of closed SB and SB occulta, the cranial and posterior fossa features will not be present as they are not associated with leaking of spinal fluid and resultant hindbrain herniation, highlighting the fact that the spine should be examined thoroughly whenever possible during the second-trimester scan. In tertiary fetal medicine centers, two-dimensional and three-dimensional ultrasound allows an accurate determination of the location, type, extent, and upper level of the spinal defect as well as the presence of associated anomalies. Fetal magnetic resonance imaging should be restricted to candidates for intrauterine surgery as part of the preoperative protocol.
Collapse
Affiliation(s)
- Waldo Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Estoril 50, Suites 203 & 515, Las Condes, 7591047, Santiago, Chile.
| | - Amy E Wong
- Department of Maternal-Fetal Medicine, Palo Alto Medical Foundation, Mountain View, CA, 94040, USA
| | - Francisco Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Estoril 50, Suites 203 & 515, Las Condes, 7591047, Santiago, Chile
| | - Juan L Alcalde
- Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Juan C Devoto
- Department of Anesthesiology, Clinica Las Condes, Santiago, Chile
| | - Felipe Otayza
- Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
| |
Collapse
|
17
|
Matuszewski L, Perdriolle-Galet E, Clerc-Urmès I, Bach-Segura P, Klein O, Masutti J, Morel O. Diagnostic prénatal des dysraphismes spinaux : corrélation des données anténatales et postnatales. J Gynecol Obstet Hum Reprod 2017; 46:291-296. [DOI: 10.1016/j.jogoh.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
|
18
|
|
19
|
Cuckle H. Rational and irrational ratios. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:275-278. [PMID: 27299851 DOI: 10.1002/uog.15992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/01/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- H Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
20
|
Abstract
First-trimester pregnancy evaluation using fetal and maternal parameters not only allows for diagnoses to be made early in gestation but can also assess the risk of complications that become clinically evident later in pregnancy. This evaluation makes it possible for pregnancy care to be individualized. In select cases, treatment that reduces the risk of complications can be started early in pregnancy. Even though cell free DNA is a significant advance in diagnosing fetal aneuploidy, the combination of first-trimester ultrasound and maternal serum biochemistries casts a much wider diagnostic net; therefore, the 2 technologies are best used in combination.
Collapse
Affiliation(s)
- Jiri D Sonek
- Center for Maternal-Fetal Medicine, Ultrasound, and Genetics, Fetal Medicine Foundation of USA, Wright State University, Berry Pavilion, 1 Wyoming Street, Dayton, OH 45409, USA.
| | - Karl Oliver Kagan
- Department of Gynecology and Obstetrics, Universitäts-Frauenklinik, Calwerstrasse, Tübingen 772076, Germany
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, 16-20 Windsor Walk, London SE5 8BB, UK
| |
Collapse
|
21
|
Engels AC, Joyeux L, Brantner C, De Keersmaecker B, De Catte L, Baud D, Deprest J, Van Mieghem T. Sonographic detection of central nervous system defects in the first trimester of pregnancy. Prenat Diagn 2016; 36:266-73. [PMID: 26732542 DOI: 10.1002/pd.4770] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/31/2015] [Accepted: 01/01/2016] [Indexed: 11/09/2022]
Abstract
The fetal central nervous system can already be examined in the first trimester of pregnancy. Acrania, alobar holoprosencephaly, cephaloceles, and spina bifida can confidently be diagnosed at that stage and should actively be looked for in every fetus undergoing first-trimester ultrasound. For some other conditions, such as vermian anomalies and agenesis of the corpus callosum, markers have been identified, but the diagnosis can only be confirmed in the second trimester of gestation. For these conditions, data on sensitivity and more importantly specificity and false positives are lacking, and one should therefore be aware not to falsely reassure or scare expecting parents based on first-trimester findings. This review summarizes the current knowledge of first-trimester neurosonography in the normal and abnormal fetus and gives an overview of which diseases can be diagnosed.
Collapse
Affiliation(s)
- A C Engels
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - L Joyeux
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - C Brantner
- Department of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - L De Catte
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - D Baud
- Feto-Maternal Medicine Unit, Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - J Deprest
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - T Van Mieghem
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
22
|
Analyse de la fosse postérieure fœtale lors de l’échographie du premier trimestre de la grossesse. ACTA ACUST UNITED AC 2016; 44:43-55. [DOI: 10.1016/j.gyobfe.2015.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/30/2015] [Indexed: 11/24/2022]
|
23
|
Orlandi E, Rossi C, Perino A, Cucinella G, Orlandi F. Prospective sonographic detection of spina bifida at 11-14 weeks and systematic literature review. J Matern Fetal Neonatal Med 2015; 29:2363-7. [PMID: 26381234 DOI: 10.3109/14767058.2015.1085967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To conduct a literature review to assess the effectiveness of first trimester ultrasonographic markers of spina bifida (SB) integrating data with our prospective experience. METHODS The analysis of the SB cases that we prospectively detected in the first trimester, between January 2012 and February 2014, and a systematic review of all the papers evaluating the effectiveness of SB ultrasonographic markers at 11-14 weeks, namely brain stem diameter (BS), fourth ventricle/intracranial translucency (IT), cisterna magna (CM), brain stem/occipital bone distance (BSOB), the ratio between BS and BSOB. Some studies assess only the effectiveness of IT, others include more parameters, and few include them all. RESULTS We prospectively detected four SB cases, three open (OSB) and one closed (CSB), in a low risk population undergoing first trimester screening. In the three OSB, CM (in 2/3 cases) and BSOB (3/3) distance were below the 5th percentile, BS and BS/BSOB ratio (3/3) were above the 95th percentile. In the CSB, all the measurements were within normal limits. CONCLUSION The literature and our data agree that most fetuses with OSB demonstrate in the first trimester positive sonographic markers in the posterior fossa, but additional prospective studies are needed to establish the best protocol for OSB screening.
Collapse
Affiliation(s)
- Emanuela Orlandi
- a Department of Obstetrics and Gynecology , University of Palermo and Hospital "V.Cervello" , Palermo , Italy and
| | - Cinzia Rossi
- b Center for Prenatal Diagnosis , Palermo , Italy
| | - Antonio Perino
- a Department of Obstetrics and Gynecology , University of Palermo and Hospital "V.Cervello" , Palermo , Italy and
| | - Gaspare Cucinella
- a Department of Obstetrics and Gynecology , University of Palermo and Hospital "V.Cervello" , Palermo , Italy and
| | | |
Collapse
|
24
|
Advancing Horizons in Fetal Medicine. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|