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Wan Y, Zhou Y, Xu X, Lu X, Wang Y, Zhang C. An effective ultrasound fetal palate screening software based on the "sequential sector scan through the oral fissure" and three-dimensional ultrasound. BMC Pregnancy Childbirth 2024; 24:526. [PMID: 39134961 PMCID: PMC11318121 DOI: 10.1186/s12884-024-06729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Orofacial clefts are one of the most common congenital malformations of the fetal face and ultrasound is mainly responsible for its diagnosis. It is difficult to view the fetal palate, so there is currently no unified standard for fetal palate screening, and the diagnosis of cleft palate is not included in the relevant prenatal ultrasound screening guidelines. Many prenatal diagnoses for cleft palate are missed due to the lack of effective screening methods. Therefore, it is imperative to increase the display rate of the fetal palate, which would improve the detection rate and diagnostic accuracy for cleft palate. We aim to introduce a fetal palate screening software based on the "sequential sector scan though the oral fissure", an effective method for fetal palate screening which was verified by our follow up results and three-dimensional ultrasound and to evaluate its feasibility and clinical practicability. METHODS A software was designed and programmed based on "sequential sector scan through the oral fissure" and three-dimensional ultrasound. The three-dimensional ultrasound volume data of the fetal face were imported into the software. Then, the median sagittal plane was taken as the reference interface, the anterior upper margin of the mandibular alveolar bone was selected as the fulcrum, the interval angles, and the number of layers of the sector scan were set, after which the automatic scan was performed. Thus, the sector scan sequential planes of the mandibular alveolar bone, pharynx, soft palate, hard palate, and maxillary alveolar bone were obtained in sequence to display and evaluate the palate. In addition, the feasibility and accuracy of the software in fetal palate displaying and screening was evaluated by actual clinical cases. RESULTS Full views of the normal fetal palates and the defective parts of the cleft palates were displayed, and relatively clear sequential tomographic images and continuous dynamic videos were formed after the three-dimensional volume data of 10 normal fetal palates and 10 cleft palates were imported into the software. CONCLUSIONS The software can display fetal palates more directly which might allow for a new method of fetal palate screening and cleft palate diagnosis.
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Affiliation(s)
- Ying Wan
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei, Anhui Province, 230022, China
- Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, China
| | - Yi Zhou
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei, Anhui Province, 230022, China
| | - Xiangyi Xu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei, Anhui Province, 230022, China
| | - Xiaofeng Lu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei, Anhui Province, 230022, China
| | - Yadan Wang
- School of Biomedical Engineering, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, Anhui Province, 230022, China.
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei, Anhui Province, 230022, China.
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Baeza-Pagador A, Tejero-Martínez A, Salom-Alonso L, Camañes-Gonzalvo S, García-Sanz V, Paredes-Gallardo V. Diagnostic Methods for the Prenatal Detection of Cleft Lip and Palate: A Systematic Review. J Clin Med 2024; 13:2090. [PMID: 38610855 PMCID: PMC11012824 DOI: 10.3390/jcm13072090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish long-term treatment planning. The aim of this systematic review was to analyze the accuracy of various imaging techniques for the prenatal diagnosis of cleft lip and palate, assess the pregnancy phase for orofacial clefts diagnosis, and study the different cleft types in terms of diagnostic methods, timing, and predictability. Methods: A search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify potentially relevant studies published until January 2024. The quality of the selected articles was assessed using the Newcastle-Ottawa scale for methodological quality assessment of cohort studies and the QUADAS-2 scale for diagnostic test studies. Results: A total of 18 studies met the eligibility criteria and were included in the review. The findings of this review indicate that the majority of studies showed improved diagnostic accuracy when supplementary techniques, such as 3D ultrasound or magnetic resonance imaging, were added to 2D ultrasound. Conclusions: The implementation of magnetic resonance imaging as a standard procedure could significantly improve the precision of diagnosing cleft lip and palate. Therefore, the diagnostic technique used will play a crucial role in the accuracy of the diagnosis.
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Affiliation(s)
- Ana Baeza-Pagador
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Ana Tejero-Martínez
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Lucas Salom-Alonso
- Department of Maxillofacial Surgery, La Fe Hospital, 46026 Valencia, Spain;
| | - Sara Camañes-Gonzalvo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Verónica García-Sanz
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Vanessa Paredes-Gallardo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
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Weissbach T, Lev S, Haimov A, Massarwa A, Shamay I, Plaschkes R, Assa L, Elkan-Miller T, Weisz B, Nardini G, Armon N, Sharon R, Mazaki Tovi S, Kassif E. The Hard Palate Sweep: a multiplanar 2-dimensional sonographic method for the prenatal detection of cleft palate. Am J Obstet Gynecol 2024; 230:356.e1-356.e10. [PMID: 37741531 DOI: 10.1016/j.ajog.2023.09.014] [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: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.
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Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shir Lev
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adina Haimov
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Shamay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Roni Plaschkes
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Assa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Armon
- Department of Plastic and Aesthetic Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Roni Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Shali Mazaki Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Parham MJ, Simpson AE, Moreno TA, Maricevich RS. Updates in Cleft Care. Semin Plast Surg 2023; 37:240-252. [PMID: 38098682 PMCID: PMC10718659 DOI: 10.1055/s-0043-1776733] [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: 12/17/2023]
Abstract
Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.
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Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Arren E. Simpson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Renata S. Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Yang R, Chen J, Wang D, Xu Y, Ou G. Self-Assembling Peptide RADA16 Nanofiber Scaffold Hydrogel-Wrapped Concentrated Growth Factors in Osteogenesis of MC3T3. J Funct Biomater 2023; 14:jfb14050260. [PMID: 37233370 DOI: 10.3390/jfb14050260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Concentrated growth factors (CGFs) are widely used in surgery with bone grafting, but the release of growth factors from CGFs is rapid. RADA16, a self-assembling peptide, can form a scaffold that is similar to the extracellular matrix. Based on the properties of RADA16 and CGF, we hypothesized that the RADA16 nanofiber scaffold hydrogel could enhance the function of CGFs and that the RADA16 nanofiber scaffold hydrogel-wrapped CGFs (RADA16-CGFs) would perform a good osteoinductive function. This study aimed to investigate the osteoinductive function of RADA16-CGFs. Scanning electron microscopy, rheometry, and ELISA were performed, and MC3T3-E1 cells were used to test cell adhesion, cytotoxicity, and mineralization after administration with RADA16-CGFs. We found that RADA16 endowed with the sustained release of growth factors from CGFs, which can help maximize the function of CGFs in osteoinduction. The application of the atoxic RADA16 nanofiber scaffold hydrogel with CGFs can be a new therapeutic strategy for the treatment of alveolar bone loss and other problems that require bone regeneration.
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Affiliation(s)
- Renjie Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Eastern Clinic, West China Hospital of Stomatology, Sichuan University, Chengdu 610051, China
| | - Jiali Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Dingjie Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yichen Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guomin Ou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Minor K, Chueh J. Understanding the distinction between cleft lip and cleft palate: a critical step for successful prenatal detection. Curr Opin Obstet Gynecol 2023; 35:113-126. [PMID: 36912278 DOI: 10.1097/gco.0000000000000852] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Orofacial clefts (OCs) are among the most common congenital anomalies, however, prenatal detection of cleft palate without cleft lip (CP) remains low. CP is associated with a higher risk of associated structural anomalies, recurrence risk and genetic aberrations. There is opportunity to optimize prenatal diagnosis, counseling and diagnostic genetic testing for OCs. RECENT FINDINGS Improving prenatal diagnosis of CP requires understanding that embryologically, the secondary palate develops from the 6th to the 10th week and fuses with the primary palate by the 12th week. Multiple first, second and third trimester 2D ultrasonographic markers for OCs have been described including the maxillary gap, frontal space, maxilla-nasion-mandible angle, retronasal triangle, palatino-maxillary diameter, equal sign, nonvisualization or gap in the soft to hard palate interface and loss of the superimposed line. We discuss the technique, evidence and limitations of each. SUMMARY Prenatal detection of OC can be optimized by employing 2D sonographic markers. Prenatal detection of CP may be improved by recognizing its high association with retrognathia/micrognathia.
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Affiliation(s)
- Kathleen Minor
- Division of Maternal-Fetal Medicine & Obstetrics, Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California, USA
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Tonni G, Peixoto AB, Werner H, Grisolia G, Ruano R, Sepulveda F, Sepulveda W, Araujo Júnior E. Ultrasound and fetal magnetic resonance imaging: Clinical performance in the prenatal diagnosis of orofacial clefts and mandibular abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:346-361. [PMID: 36785498 DOI: 10.1002/jcu.23403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Cleft lip, with or without cleft palate, is the most common congenital craniofacial anomaly and the second most common birth defect worldwide. Micrognathia is a rare facial malformation characterized by small, underdeveloped mandible and frequently associated with retrognathia. Second- and third-trimester prenatal ultrasound is the standard modality for screening and identification of fetal orofacial abnormalities, with a detection rate in the low-risk population ranging from 0% to 73% for all types of cleft. The prenatal ultrasonography detection can also be performed during the first trimester of pregnancy. Given the potential limitations of obstetric ultrasound for examining the fetal face, such as suboptimal fetal position, shadowing from the surrounding bones, reduce amniotic fluid around the face, interposition of fetal limbs, umbilical cord and placenta, and maternal habitus/abdominal scars, the use of adjunct imaging modalities can enhance prenatal diagnosis of craniofacial anomalies in at-risk pregnancies. Fetal magnetic resonance imaging (MRI) is a potentially useful second-line investigation for the prenatal diagnosis of orofacial malformations with a pooled sensitivity of 97%. In this review, we discuss the role of ultrasound and fetal MRI in the prenatal assessment of abnormalities of the upper lip, palate, and mandible.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, UH Jackson Fetal Care, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Francisco Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Lai GP, Weng XJ, Wang M, Tao ZF, Liao FH. Diagnostic Accuracy of Prenatal Fetal Ultrasound to Detect Cleft Palate in High-Risk Fetuses: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:605-614. [PMID: 33904621 DOI: 10.1002/jum.15736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis investigated the accuracy of prenatal fetal ultrasound (US) to detect cleft palate during the second and third trimester (12-36 weeks) of pregnancy in high-risk fetuses. METHODS Pubmed and Embase databases were searched for studies that performed prenatal fetal US (comparator) and postnatal examination (reference standard) in fetuses at high risk for orofacial clefts. Risk of bias among included studies was assessed using the QUADAS-2. Area under the summary receiver operating characteristic (SROC) curve and pooled sensitivity and specificity were calculated. RESULTS This meta-analysis included 7 studies involving 663 high-risk fetuses. The individual studies showed that prenatal fetal US accurately predicted the possibility of cleft palate in these fetuses. Pooled sensitivity was 87% (95% CI 71%-95%), pooled specificity was 98% (95%CI 90%-100%), and the area under the SROC curve was 0.98 (95% CI 0.97-0.99). CONCLUSION Second and third trimester fetal US has excellent sensitivity and specificity for the detection of cleft palate in high-risk pregnancies.
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Affiliation(s)
- Guang-Ping Lai
- Department of Ultrasound, Qinzhou Maternal and Child Health Hospital, Guangxi, China
| | - Xun-Jin Weng
- Department of Ultrasound, Qinzhou Maternal and Child Health Hospital, Guangxi, China
| | - Min Wang
- Department of Ultrasound, Qinzhou Maternal and Child Health Hospital, Guangxi, China
| | - Zhao-Feng Tao
- Department of Ultrasound, Qinzhou Maternal and Child Health Hospital, Guangxi, China
| | - Feng-Hua Liao
- Department of Ultrasound, Qinzhou Maternal and Child Health Hospital, Guangxi, China
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Decreasing Incidence of Palatoplasty in the United States. J Craniofac Surg 2021; 32:2710-2712. [PMID: 34231517 DOI: 10.1097/scs.0000000000007799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cleft palate is amongst the most common birth defect across the world. Although its etiology is multifactorial, including genetic and environmental contributors, the investigators were interested in exploring whether its incidence was changing over time. METHODS The Nationwide Inpatient Sample database, the largest publically available healthcare database in the United States, was used to identify all primary palatoplasties performed under 2 years of age and births which occurred over a 17-year period from 1999 to 2015. The change in rate of palatoplasties and overall maternal demographics were assessed longitudinally using the chi-squared test. Significance level was set at P < 0.001. RESULTS A total of 13,808,795 pregnancies were reviewed during the time period, from 1999 to 2015, inclusively. A total of 10,567 primary palatoplasties were performed in that period of time reflecting an overall rate of 7.7 palatoplasties per 10,000 deliveries. Palatoplasty rates decreased across the study period from 9.5 per 10,000 in 1999 to 7.1 per 10,000 died/delivered pregnancies in 2015 which corresponds to an average compounded year-to-year decrease of 1.76%, P < 0.001. CONCLUSIONS The rate of primary palatoplasties, as a proxy for the rate of cleft palate prevalence, has been significantly decreasing over the last 2 decades and may represent improvements in early diagnosis in pregnancy, changing genetic or racial demographics, and/or environmental factors such as decreased maternal smoking in the US population. Future research may be directed at better understanding the definitive etiology of this decreasing prevalence of children undergoing primary cleft palate repairs in the United States.
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Ji C, Yang Z, Yin L, Deng X, Pan Q, Lu B, Zhang J, Jiang W, Jiang X. The application of three-dimensional ultrasound with reformatting technique in the diagnosis of fetal cleft lip/palate. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:307-314. [PMID: 33665816 DOI: 10.1002/jcu.22994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/22/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the clinical value of three-dimensional ultrasound (3D-US) with reformatting technique in the diagnosis of fetal cleft lip/palate (CL/P), especially those involving the secondary palate. METHODS A total of 113 fetuses suspected with cleft lip (CL) on two-dimensional ultrasound (2D-US) were further evaluated by 2D-US and 3D-US with reformatting technique, in order to clarify the type of oral cleft. Lesions were classified as cleft lip (CL), cleft lip and alveolus (CLA), and cleft lip and palate (CLP) (including primary and secondary palate). All fetuses were followed until birth or termination of pregnancy. The diagnostic accuracies of 2D-US and 3D-US with reformatting technology were compared. RESULTS Both 2D-US and 3D-US with reformatting successfully detected CLs in the final 103 participants. Among these, 29, 25, and 49 cases were confirmed to have CL, CLA, and CLP, respectively. CL, CLA, and CLP were diagnosed by 2D-US in 34, 66, and 3 cases, respectively, and by 3D-US with reformatting technology in 31, 27, and 45 cases, respectively. The sensitivities of 2D-US and 3D-US with reformatting technology in the diagnosis of CLA were 80% (20/25) and 92.0% (23/25), respectively, and the difference was not statistically significant. For CLP, however, the sensitivities were 6.1% (3/49) and 91.8% (45/49), respectively (P < .001). CONCLUSIONS Both 2D-US and 3D-US with reformatting technique have high diagnostic accuracy for CL and CLA. However, 3D-US has a much higher diagnostic accuracy for CLP.
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Affiliation(s)
- Chunya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Bing Lu
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Jun Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Wei Jiang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Xiaoli Jiang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
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Li Y, Kolios MC, Xu Y. 3-D Large-Pitch Synthetic Transmit Aperture Imaging With a Reduced Number of Measurement Channels: A Feasibility Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:1628-1640. [PMID: 33290216 DOI: 10.1109/tuffc.2020.3043326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 3-D synthetic transmit aperture ultrasound imaging system with a fully addressed array usually leads to high hardware complexity and cost since each element in the array is individually controlled. To reduce the hardware complexity, we had presented the large-pitch synthetic transmit aperture (LPSTA) ultrasound imaging for 2-D imaging using a 1-D phased array to reduce the number of measurement channels M (the product of number of transmissions, [Formula: see text], and the number of receiving channels in each transmission, [Formula: see text]). In this article, we extend this method to a 2-D matrix array for 3-D imaging. We present both numerical simulations and experimental measurements. We combined L × L adjacent elements into transmission subapertures (SAP) and K × K adjacent elements into receive SAPs in synthetic transmit aperture (STA) imaging. In the image reconstruction, we conducted the first attempt to apply and integrate Gaussian-approximated spatial response function (G-SRF) with delay and sum (DAS) to improve the image contrast, especially for the near-field targets. The imaging performance obtained from G-SRF was also evaluated numerically and compared with the previously presented frequency-domain SRF (Freq-domain SRF). The 3-D large-pitch synthetic transmit aperture (3-D-LPSTA) with G-SRF can provide a computationally efficient solution compared with the standard 3-D-STA method. With approximately 1900-fold reduction in the number of measurement channels, 3-D-LPSTA can provide image contrast comparable with the standard 3-D-STA with a full array and significantly better than using a periodically sparse array with similar complexity. In addition to reducing the system complexity, the 3-D-LPSTA achieves 700-fold reduction in computational complexity and 523-fold reduction in data storage. Finally, we evaluated and implemented the G-SRF using phantom data, which were consistent with the simulation results showing that the G-SRF can improve the image contrast. The results demonstrate that the proposed 3-D-LPSTA shows the great potential for designing an inexpensive ultrasound system to ensure the real-time 3-D clinical ultrasound imaging using large arrays. The limits of the proposed method were also discussed.
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Lesieur E, Degardin N, Develay-Morice JE, Quarello E. [Ultrasound scan of a fetus with facial cleft must be done from the lip to the uvula: What's new?]. ACTA ACUST UNITED AC 2021; 49:767-781. [PMID: 33766791 DOI: 10.1016/j.gofs.2021.03.007] [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: 01/21/2021] [Indexed: 10/21/2022]
Abstract
Facial cleft are the most frequent craniofacial anomalies with an incidence of one for 1000 births, all births combined, and require specialized multidisciplinary care. Since 2005, the systematic realization of two ultrasound views (nose-lip and profile) is recommended for the exploration of the fetal face in the 2nd trimester of pregnancy. Application of these recommendations should allow screening of the majority of cleft lip and palate. However, cleft palates, without labiomaxillary involvement, are currently largely underdiagnosed at prenatal ultrasound, although they can be associated with a syndromic diagnosis in up to 30% of cases. The aim of this work is to describe, from embryology to surgical consultation, the complete ultrasound examination of a fetus with a classic facial cleft.
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Affiliation(s)
- E Lesieur
- Screening and Diagnosis Unit, Department of Obstetrics and Gynecology, Saint-Joseph Hospital, 26, boulevard de Louvain, 13008 Marseille, France.
| | - N Degardin
- Department of Pediatric Plastic Surgery, Public Assistance Hospital of Marseille, University Hospital Center Timone, 278, rue Saint-Pierre, 13005 Marseille, France
| | - J-E Develay-Morice
- Department of Gynecology and Obstetrics, Gynepole, Assistance Publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - E Quarello
- Screening and Diagnosis Unit, Department of Obstetrics and Gynecology, Saint-Joseph Hospital, 26, boulevard de Louvain, 13008 Marseille, France; IMAGE2 Center, 6, rue Rocca, 13008 Marseille, France
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13
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Lakshmy SR, Rose N, Masilamani P, Umapathy S, Ziyaulla T. Absent 'superimposed-line' sign: novel marker in early diagnosis of cleft of fetal secondary palate. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:906-915. [PMID: 31763719 DOI: 10.1002/uog.21931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe a novel sign, the 'superimposed-line' sign, for early diagnosis of cleft of the fetal secondary palate on two-dimensional imaging of the vomeromaxillary junction in the midsagittal view. METHODS This was a prospective evaluation of the superimposed-line sign using two-dimensional sonography (midsagittal view) in 9576 singleton fetuses referred for routine screening between 12 and 20 weeks of gestation. In this view, the vomer bone appears as a line superimposed on the distal two-thirds of the maxillary line, as the vomer fuses with the secondary palate in the midline. If there is a midline cleft of the secondary palate, the line formed by the palate is absent and hence only the vomer bone is visualized, creating a single line instead of the normal superimposed double line. Multiplanar three-dimensional (3D) views were assessed in cases in which the superimposed-line sign was absent. RESULTS The superimposed line was absent in 17 fetuses with a cleft of the secondary palate that was confirmed by 3D evaluation. Of these, 13 had defects involving the premaxilla and four had an isolated cleft of the secondary palate. Postnatal confirmation was available in all cases. The sign was useful in ruling out cleft of the fetal secondary palate in 32 high-risk cases with a family history of cleft palate. The superimposed-line sign had a sensitivity of 89.5% in detecting cleft of the secondary palate. CONCLUSIONS The superimposed-line sign is a new sonographic marker for evaluation of cleft of the fetal secondary palate; documentation of this sign proves the presence of both the palate and vomer in the midline. This marker can be demonstrated clearly in the late first trimester, allowing early diagnosis of secondary palatine cleft. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S R Lakshmy
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - N Rose
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - P Masilamani
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - S Umapathy
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - T Ziyaulla
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
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Clark AE, Biffi B, Sivera R, Dall'Asta A, Fessey L, Wong TL, Paramasivam G, Dunaway D, Schievano S, Lees CC. Developing and testing an algorithm for automatic segmentation of the fetal face from three-dimensional ultrasound images. ROYAL SOCIETY OPEN SCIENCE 2020; 7:201342. [PMID: 33391808 PMCID: PMC7735327 DOI: 10.1098/rsos.201342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
Fetal craniofacial abnormalities are challenging to detect and diagnose on prenatal ultrasound (US). Image segmentation and computer analysis of three-dimensional US volumes of the fetal face may provide an objective measure to quantify fetal facial features and identify abnormalities. We have developed and tested an atlas-based partially automated facial segmentation algorithm; however, the volumes require additional manual segmentation (MS), which is time and labour intensive and may preclude this method from clinical adoption. These manually refined segmentations can then be used as a reference (atlas) by the partially automated segmentation algorithm to improve algorithmic performance with the aim of eliminating the need for manual refinement and developing a fully automated system. This study assesses the inter- and intra-operator variability of MS and tests an optimized version of our automatic segmentation (AS) algorithm. The manual refinements of 15 fetal faces performed by three operators and repeated by one operator were assessed by Dice score, average symmetrical surface distance and volume difference. The performance of the partially automatic algorithm with difference size atlases was evaluated by Dice score and computational time. Assessment of the manual refinements showed low inter- and intra-operator variability demonstrating its suitability for optimizing the AS algorithm. The algorithm showed improved performance following an increase in the atlas size in turn reducing the need for manual refinement.
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Affiliation(s)
- A. E. Clark
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - B. Biffi
- Imperial College London, London, UK
| | | | - A. Dall'Asta
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Italy
| | | | - T.-L. Wong
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
| | - G. Paramasivam
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - D. Dunaway
- University College London GOS Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- University College London GOS Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - C. C. Lees
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Lakshmy SR, Rose N, Masilamani P, Umapathy S, Ziyaulla T. First Trimester Ultrasound Evaluation of the Cleft Palate: Midsagittal, Axial or Coronal View-Which View is Best? JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Faure JM, Mousty E, Bigorre M, Wells C, Boulot P, Captier G, Fuchs F. Prenatal ultrasound diagnosis of cleft palate without cleft lip, the new ultrasound semiology. Prenat Diagn 2020; 40:1447-1458. [PMID: 32673416 DOI: 10.1002/pd.5794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to define the prenatal ultrasound semiology of cleft palate without cleft lip using 3D visualization of the fetal palate. METHODS A prospective longitudinal study was performed in our University Hospital Center from 2011 to 2018. The fetal secondary palate was studied in 3D, starting with 2D axial transverse ultrasound view. We defined a cleft palate as a disruption of the horizontal plate of the palatine bone of the secondary palate. Prenatal findings were correlated to anatomic postnatal examinations performed by a paediatric plastic surgeon. RESULTS Forty-three cases of cleft palate without cleft lip were prenatally diagnosed, of whom 34 were associated with malformations. We defined four types of disruptive appearances: isolated nonvisualization of the posterior nasal spine; partial-disruption or cleft velum; complete disappearance or V-shaped cleft palate; and complete disappearance or U-shaped cleft palate. The adjusted kappa coefficient, between prenatal and postnatal evaluation, was 0.88 (95% CI: 0.79-0.97), corresponding to an excellent agreement. CONCLUSIONS Using a strictly axial transverse ultrasound view, visualization of the secondary fetal palate enables to diagnose a cleft palate without cleft lip. This method offers a prenatal anatomic classification of cleft palate with a high level of concordance to postnatal findings.
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Affiliation(s)
- Jean Michel Faure
- Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France
| | - Eve Mousty
- Department of Obstetrics and Gynecology, University Hospital Center, Nîmes, France
| | - Michèle Bigorre
- Department of Plastic Pediatric and Craniofacial Surgery, University Hospital Center, Montpellier, France
| | - Constance Wells
- Department of Genetic, University Hospital Center, Montpellier, France
| | - Pierre Boulot
- Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France
| | - Guillaume Captier
- Department of Plastic Pediatric and Craniofacial Surgery, University Hospital Center, Montpellier, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France.,Inserm, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France.,EA2415, Epidemiologic Biostatistic and Clinical Research Laboratory, University of Montpellier, Montpellier, France
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17
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Giants in Obstetrics and Gynecology Series: a profile of Stuart Campbell, DSc, FRCPEd, FRCOG, FACOG. Am J Obstet Gynecol 2020; 223:152-166. [PMID: 32731955 PMCID: PMC9933493 DOI: 10.1016/j.ajog.2020.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/20/2022]
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18
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Preliminary study of real-time three-dimensional contrast-enhanced ultrasound of sentinel lymph nodes in breast cancer. Eur Radiol 2019; 30:1426-1435. [PMID: 31776739 DOI: 10.1007/s00330-019-06494-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/31/2019] [Accepted: 10/03/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the clinical value of real-time three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the detection of sentinel lymph nodes (SLNs) and drainage lymphatics in breast cancer patients. METHOD The prospective study was performed in women with pathology-confirmed T1/2 breast cancer between June 2016 and December 2017 who underwent sentinel lymph node biopsy and 3D-CEUS. The number, size, location, enhancement pattern of SLNs, and the lymphatic drainage patterns were reviewed. The routes, location of SLNs, and lymph channels (LCs) on the surface were marked. All patients underwent blue dye-guided sentinel lymph node biopsy (SLNB) finally. RESULTS According to the postoperative pathology findings and the blue dye staining of the lymphatic drainage routes, there are six patterns of lymphatic drainage routes and the coincidence rate of the 3D-CEUS was 97.4%; the sensitivity, specificity, positive predictive value, negative predictive value, the LN detection rate, and the correct diagnosis rate of the 3D-CEUS were 75%, 93.0%, 81.8%, 89.9%, 95.3%, and 87.7%, respectively. CONCLUSION 3D-CEUS is a new feasible and useful approach to detect the SLNs and LCs. 3D-CEUS can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes. KEY POINTS • The three-dimensional contrast-enhanced ultrasound can detect the sentinel lymph nodes. • The three-dimensional contrast-enhanced ultrasound can show the stereo direction of sentinel lymph nodes and lymph drainage routes. • The three-dimensional contrast-enhanced ultrasound can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes.
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Tian M, Xiao L, Jian N, Wei X, Liu S, Zhao H, Li G, Zhang S, Liang W, Lin N, Lin X. Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging. Prenat Diagn 2019; 39:883-889. [PMID: 31169321 DOI: 10.1002/pd.5499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/13/2019] [Accepted: 05/26/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing orofacial clefts and proposes specific signs for determining the type of cleft. METHODS Pregnant women in whom fetal facial malformations are suspected by ultrasonography (US) underwent 1.5 T MRI. The accuracy of the prenatal US and MRI diagnosis was compared with the postnatal findings. RESULTS A total of 71 fetuses were included in the final analysis, which comprised of 35 cases of isolated cleft lip, six cases of cleft lip and alveolus, 21 cases of cleft lip and palate, four cases of isolated cleft palate, and five normal fetuses. MRI was more sensitive than US (MRI 100%, US 77.5%; Fisher's exact test: MRI vs US P=0.000). The accuracy of MRI for all types was 100%. Specific signs (Inverted T, L/anti-L, U, and "Notch" signs) were proposed, indicating the normal hard, unilateral cleft, bilateral cleft, and cleft soft palates, respectively, which can facilitate the identification of different types of cleft palates. CONCLUSION MRI can accurately diagnose the type of cleft based on typical signs, which can serve as a definite diagnostic modality and an effective supplement of US.
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Affiliation(s)
- Mimi Tian
- School of Medicine, Shandong University, Jinan, China
| | - Lianxiang Xiao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Nan Jian
- School of Medicine, Shandong University, Jinan, China.,CT Department, Heze Municipal Hospital, Heze, China
| | - Xinhong Wei
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Shuwei Liu
- Shandong Provincial Key Laboratory of Mental Disorders, Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Jinan, China
| | - Hui Zhao
- Department of Imaging, Shandong Provincial Western Hospital, Jinan, China
| | - Guan Li
- College of Radiology, Taishan Medical University, Tai'an, China
| | - Shuai Zhang
- School of Medicine, Shandong University, Jinan, China
| | - Wenjia Liang
- Shandong Provincial Key Laboratory of Mental Disorders, Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Jinan, China
| | - Nan Lin
- School of Medicine, Shandong University, Jinan, China
| | - Xiangtao Lin
- School of Medicine, Shandong University, Jinan, China.,Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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21
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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.
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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.
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Salazar Trujillo A, Rincón-Guio C, López Narváez L, Cáceres J, Charry JD. First trimester sonographic diagnosis of orofacial defects. Review of literature. J Matern Fetal Neonatal Med 2019; 33:3200-3206. [PMID: 30688130 DOI: 10.1080/14767058.2019.1570114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Ultrasound has been used since the 1950s as a useful tool for the screening of several pregnancy abnormalities. The National Institute for Excellence in Health and Care (NICE) guidelines for prenatal control recommend its routine use between 12 and 20 weeks of gestational age, given that during the first trimester, a series of very frequent markers that determine a high risk of fetal anomalies can be evaluated. Among these markers, the most frequently studied are: increased nuchal translucency, the absence of nasal bones, increased tricuspid regurgitation, and altered flow in the venous duct. There is also a new ultrasound technique consisting of the evaluation of the retronasal triangle view, which captures the coronal plane of the face in which the primary palate and the frontal process of the maxillary are simultaneously visualized, presenting high sensitivity and specificity for malformations such as oropalatine clefts, malformations of the nasal bones, and micrognathia. The purpose of this article is to make a comprehensive review of first trimester sonographic diagnosis of orofacial defects.
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Affiliation(s)
| | - Cristian Rincón-Guio
- Research Department, Fundación Universitaria Navarra - UNINAVARRA, Neiva, Colombia
| | | | - Juan Cáceres
- Research Department, Clínica Medilaser, Neiva, Colombia
| | - José D Charry
- Research Department, Fundación Universitaria Navarra - UNINAVARRA, Neiva, Colombia
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Dall'Asta A, Paramasivam G, Lees CC. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:408-411. [PMID: 30182404 DOI: 10.1002/uog.19180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C C 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, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Searle A, Shetty P, Melov SJ, Alahakoon TI. Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports. J Med Case Rep 2018; 12:250. [PMID: 30153864 PMCID: PMC6114735 DOI: 10.1186/s13256-018-1746-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microphthalmia and anophthalmia are rare congenital fetal abnormalities. The combined incidence is estimated at 1 in 10,000 births. These two conditions arise from complex and incompletely understood genetic and/or environmental causes. Prenatal diagnosis is neither frequent nor easy and relies on precise, high-quality ultrasonography. Current antenatal ultrasound protocols for imaging of the fetal eye are inconsistent and inadequate to screen for the spectrum of ocular malformations, and there are no clear guidelines on detection of these rare abnormalities. Our study of two cases highlights the importance of early detection, and we review current practice and suggest a definitive fetal imaging protocol. CASE PRESENTATION We present two antenatal cases, one each of microphthalmia and anophthalmia, both diagnosed at the morphology scan at our tertiary fetal medicine unit. In both cases, the parents (a 36-year-old woman of Mauritanian ethnicity and a non-consanguineous partner of Nepalese descent, and a 31-year-old Caucasian woman and non-consanguineous Caucasian partner) elected to terminate their pregnancies and made unremarkable recoveries. Subsequent fetal autopsy confirmed the ultrasound scan findings. CONCLUSIONS We recommend that antenatal ultrasound guidelines are updated to specify use of a curvilinear transducer (2-9 MHz) to image both orbits in the axial and coronal planes, aided by use of a transvaginal probe when the transabdominal approach is inadequate to generate these images. When applicable, three-dimensional reverse-face imaging should be obtained to aid the diagnosis. The presence, absence, or non-visualization of lenses and hyaloid arteries should be documented in reports and these cases referred for a tertiary-level ultrasound scan and fetal medicine review. Imaging of the orbits should occur from 12 weeks' gestation. Magnetic resonance imaging and amniocentesis with chromosome microarray testing may provide additional genetic and structural information that may affect the overall morbidity associated with a diagnosis of microphthalmia or anophthalmia.
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Affiliation(s)
- A Searle
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Corner Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
| | - P Shetty
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Corner Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
| | - S J Melov
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Corner Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
| | - T I Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Corner Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.,The University of Sydney Westmead Clinical School, Sydney, NSW, Australia
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Fuchs F, Burlat J, Grosjean F, Rayssiguier R, Captier G, Faure JM, Dumont C. A score-based method for quality control of fetal hard palate assessment during routine second-trimester ultrasound examination. Acta Obstet Gynecol Scand 2018; 97:1300-1308. [PMID: 29964326 DOI: 10.1111/aogs.13418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION When an orofacial cleft lip is discovered, precise characterization of this malformation is necessary, especially the extension of this cleft to the secondary palate. We aimed to develop and evaluate the feasibility/reproducibility of a score-based quality control for the visualization of the fetal hard palate during the second-trimester scan. MATERIAL AND METHODS All ultrasound images of fetal hard palate assessed routinely during second-trimester scan were retrospectively retrieved for a 6-month period. One hundred of these images were randomly selected and analyzed by two blinded reviewers, according to a scoring system (0-6 points). Criteria retained in the score were complete palate bone horizontal plate, presence of two pterygoid processes, visible alveolar ridge, and horizontal axis of insonation. A score ≥4 defined images of good quality. Inter- and intra-reviewer reproducibility was assessed. RESULTS Inter-reviewer reproducibility was excellent with significant correlation (Pearson coefficient 0.953; P < .0001), global adjusted κ coefficient (0.86, 95% CI 0.79-0.94) and individual criteria adjusted κ coefficient always > 0.8. Rates of images of good quality (score ≥ 4) were 75%-77%, also with excellent agreement (κ coefficient 0.89, 95% CI 0.79-0.99). Intra-reviewer reproducibility retrieved the same results (excellent agreement) except for the axis of insonation (satisfactory agreement). CONCLUSIONS This simple image scoring system for the fetal palate is easy, has excellent inter- and intra-reviewer reproducibility and could also help sonographers to correctly identify the palate structure.
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Affiliation(s)
- Florent Fuchs
- Department of Obstetrics and Gynecology, CHU Montpellier, Giraud, Montpellier, France.,Inserm, CESP Center for Research in Epidemiology and Population Health - U1018, Reproduction and Child Development, Villejuif, France
| | - Julie Burlat
- Department of Obstetrics and Gynecology, CHU Montpellier, Giraud, Montpellier, France
| | - Fréderic Grosjean
- Department of Obstetrics and Gynecology, Nimes University Hospital Center, Nîmes, France
| | - Romy Rayssiguier
- Department of Obstetrics and Gynecology, CHU Montpellier, Giraud, Montpellier, France
| | - Guillaume Captier
- Department of Plastic Pediatric and Craniofacial Surgery, CHU Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Jean-Michel Faure
- Department of Obstetrics and Gynecology, CHU Montpellier, Giraud, Montpellier, France
| | - Coralie Dumont
- Department of Obstetrics and Gynecology, University Hospital of Reunion - BP 350, Saint Pierre, Réunion, France
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Wójtowicz A, Wójtowicz W, Jurek J, Huras H. Evaluation of the fetal palate at 11 to 13 (+6) weeks of gestation based on an analysis of static ultrasound images using modern IT techniques. Prenat Diagn 2018; 38:414-421. [DOI: 10.1002/pd.5251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Wójtowicz
- Department of Obstetrics & Perinatology; Jagiellonian University Medical College; Kraków Poland
| | - Wojciech Wójtowicz
- Information Technology Systems Department, Faculty of Management and Social Communication; Jagiellonian University; Kraków Poland
| | - Janusz Jurek
- Information Technology Systems Department, Faculty of Management and Social Communication; Jagiellonian University; Kraków Poland
| | - Hubert Huras
- Department of Obstetrics & Perinatology; Jagiellonian University Medical College; Kraków Poland
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Dall'Asta A, Paramasivam G, Lees CC. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:416-418. [PMID: 29512275 DOI: 10.1002/uog.18985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - G Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C C 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, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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28
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Tutschek B, Blaas HGK. 3D to boldly go where no 2D has gone before? Pitfalls in 3D reconstruction of the fetal palate. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:414-416. [PMID: 29512272 DOI: 10.1002/uog.18983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/18/2017] [Indexed: 06/08/2023]
Affiliation(s)
- B Tutschek
- Prenatal Zurich, Gladbachstrasse 95, Zürich, 8044, Switzerland
| | - H-G K Blaas
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, National Center for Fetal Medicine, St Olavs Hospital, Trondheim, Norway
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29
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Fuchs F, Grosjean F, Captier G, Faure JM. The 2D axial transverse views of the fetal face: A new technique to visualize the fetal hard palate; methodology description and feasibility. Prenat Diagn 2017; 37:1353-1359. [DOI: 10.1002/pd.5189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Florent Fuchs
- Department of Obstetrics and Gynecology; CHU Montpellier; Montpellier France
- Inserm, CESP Centre for Research in Epidemiology and Population Health; U1018, Reproduction and Child Development; Villejuif France
| | - Fréderic Grosjean
- Department of Obstetrics and Gynecology; Nimes University Hospital Center; Nîmes France
| | - Guillaume Captier
- Department of Plastic Pediatric and Craniofacial Surgery; CHU Montpellier, Hôpital Lapeyronie; Montpellier France
| | - Jean-Michel Faure
- Department of Obstetrics and Gynecology; CHU Montpellier; Montpellier France
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30
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Smarius B, Loozen C, Manten W, Bekker M, Pistorius L, Breugem C. Accurate diagnosis of prenatal cleft lip/palate by understanding the embryology. World J Methodol 2017; 7:93-100. [PMID: 29026689 PMCID: PMC5618146 DOI: 10.5662/wjm.v7.i3.93] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/09/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
Cleft lip with or without cleft palate (CP) is one of the most common congenital malformations. Ultrasonographers involved in the routine 20-wk ultrasound screening could encounter these malformations. The face and palate develop in a very characteristic way. For ultrasonographers involved in screening these patients it is crucial to have a thorough understanding of the embryology of the face. This could help them to make a more accurate diagnosis and save time during the ultrasound. Subsequently, the current postnatal classification will be discussed to facilitate the communication with the CP teams.
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Affiliation(s)
- Bram Smarius
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Charlotte Loozen
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Wendy Manten
- Division of Gynecology and Obstetrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Mireille Bekker
- Division of Gynecology and Obstetrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Lou Pistorius
- Division of Gynecology and Obstetrics, Stellenbosch University and Tygerberg Hospital, Cape Town 7500, South Africa
| | - Corstiaan Breugem
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
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31
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Merz E, Pashaj S. Advantages of 3D ultrasound in the assessment of fetal abnormalities. J Perinat Med 2017; 45:643-650. [PMID: 28157693 DOI: 10.1515/jpm-2016-0379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/20/2016] [Indexed: 11/15/2022]
Abstract
Three-/four-dimensional (3D/4D) imaging enables a more detailed survey of the embryo and the fetus compared to two-dimensional (2D) ultrasound. The availability of several display modes and standardized examinations permits the demonstration of both the normal and abnormal fetal anatomy in controlled planes and rendered images from different angles. This allows the demonstration of even subtle fetal defects in an ideal sectional plane in a precisely rendered surface or transparent image viewed from an optimal angle. When counseling the parents, the rendered images can help them understand the severity of an existing malformation or, conversely, ensure them of the absence of any fetal abnormality. This is particularly useful in cases with an increased recurrence risk of a specific fetal malformation.
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32
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Dall'Asta A, Paramasivam G, Lees CC. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:276-277. [PMID: 28782229 DOI: 10.1002/uog.17540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - G Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C C 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, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Lakshmy SR, Deepa S, Rose N, Mookan S, Agnees J. First-Trimester Sonographic Evaluation of Palatine Clefts: A Novel Diagnostic Approach. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1397-1414. [PMID: 28417474 DOI: 10.7863/ultra.16.05084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/15/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Sonographic evaluation of the palate is a difficult task, and most palatine clefts are diagnosed in the neonatal period because of the limitations of 2-dimensional (2D) sonography. The objective is to describe a sonographic technique based on 2D markers for screening of palatine clefts during the nuchal translucency scan and to assess the ability of 3-dimensional (3D) sonography in imaging the normal and abnormal palate. METHODS A total of 2014 women who enrolled for first-trimester screening were included in this prospective study. Screening for palatine clefts was done by 2D evaluation of bony landmarks of the palate, which were the appearance of the palatal line in the sagittal view, retronasal triangle in the coronal view, and alveolar ridge of the maxilla in the axial view followed, by 3D evaluation in suspicious cases. All cases included in the study were followed by second-trimester anomaly scans and evaluated postnatally. Additionally, in 100 consecutive normal cases, 3D evaluation of the palate was done. RESULTS Visualization of 2D landmarks could be done in all, and 3D assessment was feasible in 94% of cases. Fourteen cases, of which 5 were unilateral, 4 bilateral, and 2 median cleft lip and palate, 2 median cleft palate, and 1 atypical palatine cleft were identified. There were no false-positives results reported, and 1 case of a bifid uvula was missed. CONCLUSIONS The study demonstrates that evaluation of the palate can be done at the 11 to 14 week scan based on 2D markers and can also be assessed with 3D sonography. The inclusion of 2D markers in all 3 planes increases the sensitivity for detection of palatine clefts.
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Affiliation(s)
| | - Selvaraj Deepa
- Department of Conservative Dentistry and Endodontics, Rajah Muthiah Dental College, Annamalai University, Chidambaram, India
| | - Nity Rose
- Shri Lakshmi Scan Center, Kaveripattinam, India
| | - Senthilkumar Mookan
- Department of Radiology, Vinayaka Mission's Kirupananda Variyar Medical College and Hospitals, Salem, India
| | - Joy Agnees
- Department of Radiology, Vinayaka Mission's Kirupananda Variyar Medical College and Hospitals, Salem, India
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34
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Cavaco-Gomes J, Duarte C, Pereira E, Matias A, Montenegro N, Merz E. Prenatal ultrasound diagnosis of Tessier number 7 cleft: Case report and review of the literature. J OBSTET GYNAECOL 2017; 37:421-427. [PMID: 28287290 DOI: 10.1080/01443615.2017.1285274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Lateral or transverse facial clefts are the most frequent of the atypical facial clefts, classified by Tessier as no. 7 clefts. Most of the cases are diagnosed at birth, while few cases are diagnosed prenatally. We report a case of prenatal ultrasound detection and three-dimensional characterisation of a lateral facial cleft at 21 weeks of gestation, which was terminated at 22 weeks. It was a transverse cleft, running through the left cheek towards the ear, along with micrognathia and mild polyhydramnios. We also present a review on classification, anatomical features and prenatal diagnosis of Tessier no. 7 cleft.
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Affiliation(s)
- João Cavaco-Gomes
- a Department of Obstetrics and Gynecology , Centro Hospitalar de São João, EPE , Porto , Portugal
| | - Carla Duarte
- b Department of Obstetrics and Gynecology , Centro Hospitalar Alto Ave - EPE , Guimarães , Portugal
| | - Elsa Pereira
- b Department of Obstetrics and Gynecology , Centro Hospitalar Alto Ave - EPE , Guimarães , Portugal
| | - Alexandra Matias
- a Department of Obstetrics and Gynecology , Centro Hospitalar de São João, EPE , Porto , Portugal.,c Faculty of Medicine, University of Porto , Porto , Portugal
| | - Nuno Montenegro
- a Department of Obstetrics and Gynecology , Centro Hospitalar de São João, EPE , Porto , Portugal.,c Faculty of Medicine, University of Porto , Porto , Portugal
| | - Eberhard Merz
- d Center for Ultrasound and Prenatal Medicine , Frankfurt/M , Germany
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35
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Lee MS, Cho JY, Kim SY, Kim SH, Park JS, Jun JK. Value of sagittal color Doppler ultrasonography as a supplementary tool in the differential diagnosis of fetal cleft lip and palate. Ultrasonography 2017; 36:53-59. [PMID: 27764909 PMCID: PMC5207358 DOI: 10.14366/usg.16025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/28/2016] [Accepted: 08/06/2016] [Indexed: 11/05/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the feasibility and usefulness of sagittal color Doppler ultrasonography (CDUS) for the diagnosis of fetal cleft lip (CL) and cleft palate (CP). Methods We performed targeted ultrasonography on 25 fetuses with CL and CP, taking coronal and axial images of the upper lip and maxillary alveolar arch in each case. The existence of defects in and malalignment of the alveolus on the axial image, hard palate defects on the midsagittal image, and flow-through defects on CDUS taken during fetal breathing or swallowing were assessed. We compared the ultrasonography findings with postnatal findings in all fetuses. Results Alveolar defects were detected in 16 out of 17 cases with CP and four out of eight cases with CL. Alveolar malalignment and hard palate defects were detected in 11 out of 17 cases and 14 out of 17 cases with CP, respectively, but not detected in any cases with CL. Communicating flow through the palate defect was detected in 11 out of 17 cases of CL with CP. The accuracy of detection in axial scans of an alveolar defect and malalignment was 80% and 76%, respectively. Accuracy of detection of in mid-sagittal images of hard palate defect and flow was 80% and 86%, respectively. The overall diagnostic accuracy of combined axial and sagittal images with sagittal CDUS was 92%. Conclusion Sagittal CDUS of the fetal hard palate is a feasible method to directly reveal hard palate bony defects and flow through defects, which may have additional value in the differential diagnosis of fetal CL and CP.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- College of Medicine, Seoul National University, Seoul, Korea
- Correspondence to: Jeong Yeon Cho, MD, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel. +82-2-2072-3074 Fax. +82-2-747-7418 E-mail:
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- College of Medicine, Seoul National University, Seoul, Korea
| | - Joong Shin Park
- College of Medicine, Seoul National University, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Jong Kwan Jun
- College of Medicine, Seoul National University, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
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Tonni G, Panteghini M, Pattacini P, De Felice C, Centini G, Ventura A. Integrating 3D Sonography With Targeted MRI in the Prenatal Diagnosis of Posterior Cleft Palate Plus Cleft Lip. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479306294293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cleft lip and cleft palate are among the more common congenital abnormalities, present in 1.82 per 1000 live births. Although high-quality antenatal 2D sonography can diagnose clefts of the lips and the alveolar ridge, 3D may enhance detection by examining the fetal face in the frontal plane followed by a secondary rotation through 180 degrees on the vertical axis to examine the secondary palate, which has been called the “reverse face” view. Sonographically 3D targeted ultrafast magnetic resonance imaging (MRI) has been shown to improve the diagnostic accuracy of facial cleft by identifying whether a cleft in the primary palate extends to the secondary palate. Further investigation may confirm the ability of MRI to define the extent of the cleft to the secondary palate at a less advanced gestational age (18-23 weeks), where either fetal development or movements could reduce the accuracy of the technique.
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Affiliation(s)
- Gabriele Tonni
- Division of Obstetrics & Gynecology, Guastalla Civil Hospital, Via Donatori di Sangue, 42016 Guastalla (RE), AUSL Reggio Emilia, Italy
| | - Marco Panteghini
- Division of Obstetrics & Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Italy
| | | | - Claudio De Felice
- Department of Neonatology, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Giovanni Centini
- Department of Obstetrics & Gynecology, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Alessandro Ventura
- Division of Obstetrics & Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Italy
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Jackson A, Bromley R, Morrow J, Irwin B, Clayton-Smith J. In utero exposure to valproate increases the risk of isolated cleft palate. Arch Dis Child Fetal Neonatal Ed 2016; 101:F207-11. [PMID: 26408639 DOI: 10.1136/archdischild-2015-308278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Orofacial clefting (OFC) has been described in infants exposed to valproic acid (VPA) prenatally, but often no distinction is made between cleft lip and palate (CLP) and isolated cleft palate (ICP). This distinction is important as these conditions have different management implications and the distinction has implications too for understanding the teratogenic mechanisms. METHODS We searched EMBASE, Medline and Web of Science for observational studies describing OFC in association with VPA exposure. Searches for similarly exposed patients referred to a regional genetic centre and those recorded in the UK Epilepsy and Pregnancy Register (UKEPR) were undertaken. Cleft type and, where available, VPA doses prescribed were recorded. RESULTS A total of 4459 cases of VPA exposure were reported in the literature in nine separate studies with 50 cases of OFC, the majority of which did not differentiate the cleft type. Eight patients ascertained through the regional genetic centre had ICP. Thirteen cases of OFC occurred in 1282 VPA monotherapy-exposed pregnancies in the UKEPR; nine had ICP and four had CLP, representing an 11.3-fold and 3.5-fold increase risk in ICP and CLP, respectively, over general population risk. Doses ranged from 200 to 2500 mg VPA daily with 73% of monotherapy ICP cases from the local cohort and UKEPR occurring at doses over 1000 mg. CONCLUSION ICP is the predominant cleft type seen in prenatal VPA exposure. Parents should be counselled appropriately and infants should undergo review after delivery for ICP. Pregnancy registers collecting information on congenital anomalies should make the distinction between CLP and ICP as the risk differs across the two conditions.
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Affiliation(s)
- Adam Jackson
- Blackpool Victoria Hospital, Blackpool, Lancashire, UK
| | - Rebecca Bromley
- Institute of Human Development, The University of Manchester, Manchester, UK
| | - James Morrow
- Neurology Department, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Co Antrim, Northern Ireland
| | - Beth Irwin
- Neurology Department, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Co Antrim, Northern Ireland
| | - Jill Clayton-Smith
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals, Manchester, UK
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Corrélation anté- et postnatale dans le cadre de fentes du palais primaires ou secondaires : étude rétrospective de 44 cas. ACTA ACUST UNITED AC 2015; 43:767-72. [DOI: 10.1016/j.gyobfe.2015.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022]
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Fanelli T, Alberry M, Hassan W, Lees CC. Transverse septum lingual view on two-dimensional ultrasound for prenatal detection of cleft palate. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:509-510. [PMID: 25728328 DOI: 10.1002/uog.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 06/04/2023]
Affiliation(s)
- T Fanelli
- Department of Fetal Medicine, Rosie Maternity, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - M Alberry
- Department of Fetal Medicine, Rosie Maternity, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - W Hassan
- Department of Fetal Medicine, Rosie Maternity, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Du Cane Road, Imperial College Health NHS Trust, London, W12 0HS, UK
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Tonni G, Martins WP, Guimarães Filho H, Araujo Júnior E. Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1180-1211. [PMID: 25748522 DOI: 10.1016/j.ultrasmedbio.2014.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Italy; Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
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Loozen CS, Maarse W, Manten GTR, Pistorius L, Breugem CC. The accuracy of prenatal ultrasound in determining the type of orofacial cleft. Prenat Diagn 2015; 35:652-5. [DOI: 10.1002/pd.4582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 11/12/2022]
Affiliation(s)
- C. S. Loozen
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - W. Maarse
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - G. T. R. Manten
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - L. Pistorius
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - C. C. Breugem
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
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Prenatal indices for mandibular retrognathia/micrognathia. J Orofac Orthop 2015; 76:30-40. [DOI: 10.1007/s00056-014-0257-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/16/2014] [Indexed: 10/24/2022]
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Abstract
ABSTRACT
Neurological failure is the most apprehension complication of pregnancy, labor and the neonatal period. The origin and outcome correlation is frequently doubtful. The arrival of four-dimensional ultrasonography (4D US) and its function to study fetal behavior patterns have initiated to offer insight into the structural and functional fetal brain development. Although many fetal behavioral studies have been conducted, it is still questionable whether the assessment of continuity from fetal to neonatal behavior could improve our ability of early detection of brain pathology. Neurological assessment of fetus in utero is extremely difficult even having such sophisticated equipment like 4D ultrasound. As it is well known that quantity of GMs is not so informative and predictive for neurological impairment, their quality should be assessed. Gestalt perception of premature GMs we are dealing with in utero and several weeks postnatally are not as predictive for the detection of neurologically abnormal fetuses or newborns as fidgety GMs. Therefore, some additional parameters should be added to the prenatal neurological examination in order to improve our ability to make the distinction between normal and abnormal fetuses.
How to cite this article
Kurjak A, Antsaklis P, Stanojevic M. Fetal Neurology: Past, Present and Future. Donald School J Ultrasound Obstet Gynecol 2015;9(1):6-29.
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Hassan WA, Lees CC. Facial cleft detected: Is the palate normal? Best Pract Res Clin Obstet Gynaecol 2014; 28:379-89. [DOI: 10.1016/j.bpobgyn.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
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Zajicek M, Achiron R, Weisz B, Shrim A, Gindes L. Sonographic assessment of fetal secondary palate between 12 and 16 weeks of gestation using three-dimensional ultrasound. Prenat Diagn 2013; 33:1256-9. [DOI: 10.1002/pd.4242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/09/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Michal Zajicek
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Liat Gindes
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
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Lituania M, Tonni G. Bifid uvula and familial Stickler syndrome diagnosed prenatally before the sonographic "equals sign" landmark. Arch Gynecol Obstet 2013; 288:483-7. [PMID: 23771187 DOI: 10.1007/s00404-013-2920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The prenatal ultrasound visualization of the soft palate and especially the uvula may be technically difficult due to its anatomy and presence of surrounding structures. A cleft involving the soft palate and the uvula is one of the clinical features of Stickler syndrome, a rare connective tissue disorder. MATERIALS AND METHODS Third trimester scan performed at 30 weeks' gestation in a pregnant woman with a familial history of Stickler syndrome using conventional 2D ultrasound. RESULTS Transabdominal scan performed with the fetal head in oblique plane and following fetal swallowing movements enabled a previously unrecognized median cleft at the level of the uvula. Molecular biology analysis allowed a precise prenatal diagnosis of Stickler syndrome and excluded overlapping syndrome. CONCLUSIONS The prenatal ultrasound diagnosis was achieved time before the "equals signs" was proposed as a useful sonographic marker of a normal uvula. The identification of a bifid uvula by conventional 2D ultrasound led to a prenatal diagnosis of Stickler syndrome in this affected Family and allowed the neonatologist team to be available at the time of birth. Moreover, postnatal multispecialist follow up could be timely planned for targeted organ examination and appropriate management.
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Fetal uvula: navigating and lightening the soft palate using HDlive. Arch Gynecol Obstet 2013; 288:239-44. [PMID: 23689737 DOI: 10.1007/s00404-013-2888-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/04/2013] [Indexed: 12/18/2022]
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Gindes L, Weissmann-Brenner A, Zajicek M, Weisz B, Shrim A, Geffen KT, Mendes D, Kuint J, Berkenstadt M, Achiron R. Three-dimensional ultrasound demonstration of the fetal palate in high-risk patients: the accuracy of prenatal visualization. Prenat Diagn 2013; 33:436-41. [DOI: 10.1002/pd.4083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Liat Gindes
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | | | - Michal Zajicek
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | | | - David Mendes
- Department of Plastic Surgery; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Jaacov Kuint
- Department of Neonatology; The Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Michal Berkenstadt
- Danek Gertner Institute of Human Genetics; The Chaim Sheba Medical Center; Ramat-Gan Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology; The Chaim Sheba Medical Center; Ramat-Gan Israel
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Abstract
ABSTRACT
Modern 3D/4D sonography provides a routine method not only for storing single image planes as in 2D ultrasound but also for storing complete sets of volume data in the computer memory. Once acquisition is completed, all volumes can be accessed from the memory and normal and abnormal findings in both obstetrics and gynecology can be demonstrated in different display modes. Furthermore digital storage of volumes permits virtual examinations by reloading of volumes and navigating through them in the absence of the patient.
This review article would like to give an illustration of the latest technologies in 3D/4D ultrasound in obstetrics and gynecology.
How to cite this article
Merz E, Pashaj S. Current Role of 3D/ 4D Sonography in Obstetrics and Gynecology. Donald School J Ultrasound Obstet Gynecol 2013;7(4):400-408.
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Jadhav AR, Monteagudo A, Santos R, Timor I. Diagnosis of cleft lip-palate during nuchal translucency screening – case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2012. [DOI: 10.1515/crpm-2011-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Orofacial clefts are the most common group of craniofacial anomalies. The detection rate of cleft lip during the mid-trimester, using two-dimensional (2D) ultrasound screening, has improved over the last three decades. However, the detection rates of defects involving the hard palate or isolated cleft palate have remained poor. Over the last decade, many investigators have studied the use of 3D ultrasound to improve the detection rates of these defects. With the increasing use and acceptance of first-trimester aneuploidy screening in the US, there is growing interest in performing first-trimester fetal anatomy surveys. Reports of first-trimester diagnosis of cleft lip and palate are rare, and this aspect of prenatal sonographic diagnosis remains underexplored. We report a case of unilateral cleft lip and cleft palate diagnosed during a routine first-trimester screening at 12 weeks’ gestation and review the pertinent literature on first-trimester diagnosis of cleft lip/palate.
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Affiliation(s)
- Ashwin R. Jadhav
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY, USA
| | - Ana Monteagudo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY, USA
| | - Rosalba Santos
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY, USA
| | - Ilan Timor
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY, USA
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