Sonography of the fetal central nervous system

[Significance of magnetic resonance studies in prenatal diagnosis of malformations of the fetal central nervous system]

MRI investigation, as an imaging technique, has been gaining more and more importance in prenatal diagnostics. It has become essential due to its advantages in diagnosing the malformations of the central nervous system. Similarly to ultrasonography, its reliability is greatly dependent on the knowledge of the person performing the investigation. In addition to the knowledge of the exact anatomy of central nervous system, the researcher should have a multidisciplinary approach. In the case of malformations where repeated investigations are needed to provide a diagnosis in early pregnancy (e.g. neural tube defects), ultrasonography is more effective than MRI. In case of intrauterine infections and malformations of the posterior fossa, however, the two imaging techniques are excellent supplements to each other. MRI also plays an important role in making the prognosis for fetal ventriculomegaly, as well as in the short term diagnosis of ischaemias affecting the fetal nervous system. Difficulties in evaluating ultrasonographic images (owing to maternal obesity, oligohydramnion) render MRI an important technique in making the final diagnosis. Currently, the drawbacks of MRI include reduced accessibility, poor cost-effectiveness and shortage of skilled experts in this technique.

Scoliosis: Review of diagnosis and treatment

Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, syndrome-related, idiopathic and spinal curvature due to secondary reasons. The majority of scoliosis cases encountered by the general practitioner will be idiopathic. The natural history relates to the etiology and age at presentation, and usually dictates the treatment. However, it is the patient's history, physical examination and radiographs that are critical in the initial evaluation of scoliosis, and in determining which patients need additional considerations. Scoliosis with a primary diagnosis (nonidiopathic) must be recognized by the physician to identify the causes, which may require intervention. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. School screening for scoliosis is controversial and is falling out of favour. The treatment for idiopathic scoliosis is based on age, curve magnitude and risk of progression, and includes observation, orthotic management and surgical correction with fusion. A child should be referred to a specialist if the curve is greater than 10 degrees in a patient younger than 10 years of age, is greater than 20 degrees in a patient 10 years of age or older, has atypical features or is associated with back pain or neurological abnormalities.

MRI of the foetal brain

Ultrasound examinations for foetal brain abnormalities have been a part of the routine antenatal screening programme in the UK for many years. In utero brain magnetic resonance imaging (MRI) is now being used increasingly successfully to clarify abnormal ultrasound findings, often resulting in a change of diagnosis or treatment plan. Interpretation requires an understanding of foetal brain development, malformations and acquired diseases. In this paper we will outline the technique of foetal MRI, relevant aspects of brain development and provide illustrated examples of foetal brain pathology.

Ultrasound Imaging of Fetal Brain Abnormalities

Prenatal ultrasound evaluation of the fetal brain requires documentation of specific structures according to guidelines set by the American College of Radiology and the American Institute of Ultrasound in Medicine. Among these required structures are: cerebellum, cisterna magna, lateral cerebral ventricles, choroid plexus, midline falx, and cavum septum pellucidum. All these structures can be visualized in three crucial planes of imaging that include cisterna magna/cerebellum, cavum septum pellucidum, and ventricular atria. A systematic approach can be achieved by instituting a protocol that includes these three basic levels of imaging of the fetal head. These anatomical levels should be incorporated in daily routine for complete obstetric ultrasound evaluation.