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Choi JJ, Yang E, Soul JS, Jaimes C. Fetal magnetic resonance imaging: supratentorial brain malformations. Pediatr Radiol 2020; 50:1934-1947. [PMID: 33252760 DOI: 10.1007/s00247-020-04696-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Abstract
Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence of events that occurs during prenatal brain development; this includes familiarity with the processes of hemispheric cleavage, formation of interhemispheric commissures, neuro-glial proliferation and migration, and cortical folding. Disruption of these processes results in malformations observed on fetal MRI including holoprosencephaly, callosal agenesis, heterotopic gray matter, lissencephaly and other malformations of cortical development (focal cortical dysplasia, polymicrogyria). The radiologist should also be familiar with findings that have high association with specific conditions affecting the central nervous system or other organ systems. This review summarizes and illustrates common patterns of supratentorial brain malformations and emphasizes aspects that are important to patient care.
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Affiliation(s)
- Jungwhan John Choi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Janet S Soul
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
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Tao G, Lu G, Zhan X, Li J, Cheng L, Lee K, Poon WS. Sonographic appearance of the cavum septum pellucidum et vergae in normal fetuses in the second and third trimesters of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:525-531. [PMID: 24037650 DOI: 10.1002/jcu.22084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 04/28/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND To characterize the cavum septum pellucidum et vergae (CSPV) in normal fetuses in the second to third trimester. METHODS The cavum septum pellucidum (CSP) and CSPV were investigated in 322 uncomplicated singleton pregnancies from 25 to 39 weeks' gestation. Visualization rate, width, and morphology of both CSP and cavum vergae (CV) were assessed by ultrasound and MRI. RESULTS The CSP and CSPV visualization rates were 100% and 7.8% (25/322), respectively. The mean widths were 6.3 ± 1.2 mm (3.4-10 mm) and 6.7 ± 1.0 mm (5.1-9 mm), respectively, with no significant correlation between width and gestational age (r = -0.108, p > 0.05 and r = -0.182, p > 0.05, respectively). In CSPV fetuses, the CV to CSP ratio was 1.004 ± 0.018 (0.967-1.033). All CSPVs were rectangular in the transverse plane and extended posteriorly beyond the midpoint of the brain. CONCLUSIONS Common features of CSPVs include (1) a rectangular morphology, (2) communication between the two cavities, (3) a CV width within the normal range for CSP, and (4) a CV-CSP ratio of 1. These findings may help distinguish normal from abnormal CSPV.
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Affiliation(s)
- Guowei Tao
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan, China; Division of Neurosurgery, The Chinese University of Hong Kong, Hong Kong, China
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Lam P, Samson A, Magotti R, Benzie R. The effect of preliminary training on quantitative evaluation of sonographer performance in the fetal morphology ultrasound examination. Australas J Ultrasound Med 2013; 16:142-146. [PMID: 28191188 PMCID: PMC5030000 DOI: 10.1002/j.2205-0140.2013.tb00102.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: The aim of this study is to provide a quantitative scoring system to assess sonographer performance by reviewing images from the fetal morphology examination. Methods: Ten ultrasound images from patients at 18–22 weeks gestation were assessed and scored for quality according to predefined criteria. One hundred normal cases were randomly selected and 10 images from each case were analysed by four experienced reviewers. The preliminary training incorporated the first 25 cases and involved a training period for reviewers; the remaining 75 cases were allocated to post training. The scores acquired by each reviewer were statistically analysed using Pearson's and intra‐class correlations to determine the reproducibility of the results. Results: The preliminary training results were calculated separately and compared to the post training study. The preliminary intra‐class correlation coefficient was 0.12. In the post training study the intra‐class correlation coefficient was doubled at 0.24. The greatest correlation was observed between reviewers 1 and 4 with a coefficient of 0.71. Reviewers 3 and 4 demonstrated the lowest correlation coefficient of 0.30. Discussion: A significant increase in the intra‐class correlation coefficient indicated that training reviewers achieves more reproducible results. Suggested improvements to the study include recording fetal position, maternal BMI and assessing individual reviewer variability. An instruction manual defining each criterion might also yield better results. Conclusion: The quantitative method used in this study assessed ultrasound images by placing a numerical value on image quality. Analysis of the preliminary training period demonstrates improved reproducibility of the results. Further investigation into the criteria is necessary to refine the quantitative method.
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Affiliation(s)
- Penny Lam
- Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital University of Sydney Penrith New South Wales Australia
| | - Armie Samson
- Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital University of Sydney Penrith New South Wales Australia
| | - Robert Magotti
- Christopher Kohlenberg Department of PerinatalUltrasound Nepean HospitalUniversity of SydneyPenrithNew South WalesAustralia; Obstetrics and Gynaecology DepartmentUniversity of SydneySydneyNew South WalesAustralia
| | - Ronald Benzie
- Christopher Kohlenberg Department of PerinatalUltrasound Nepean HospitalUniversity of SydneyPenrithNew South WalesAustralia; Obstetrics and Gynaecology DepartmentUniversity of SydneySydneyNew South WalesAustralia
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de Barros FSB, Bussamra LCDS, Araujo Júnior E, de Freitas LDSV, Nardozza LMM, Moron AF, Aldrighi JM. Comparison of Fetal Cerebellum and Cisterna Magna Length by 2D and 3D Ultrasonography between 18 and 24 Weeks of Pregnancy. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:286141. [PMID: 23209923 PMCID: PMC3504390 DOI: 10.5402/2012/286141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/08/2012] [Indexed: 11/23/2022]
Abstract
To compare the fetal cerebellum and cisterna magna length measurements by means of two- (2DUS) and three-dimensional (3DUS) ultrasonography using the three-dimensional extended imaging (3D XI), a cross-sectional study with 69 healthy pregnant women between 18 and 24 weeks was performed. For the measurements by 2DUS, the axial planes were used and for the 3DUS a sequence of adjacent axial slices (multislice view). To evaluate the difference between the two techniques, we used the Wilcoxon test. To evaluate the correlation between the cerebellum and cisterna magna length measurements and the gestational age, we used the Spearman correlation coefficient (r). For the calculation of reproducibility, we used the intraclass correlation coefficient (ICC). The mean of the transverse and anterior-posterior diameter of cerebellum and cisterna magna by 3DUS was 9.23 and 6.62 mm, respectively. It was observed that the average of the measurements obtained by 3DUS was significantly higher, 0.76 and 1.02 mm for the length of the cerebellum and cisterna magna, respectively (P < 0.001). There was a high correlation between the length measurement of the cerebellum 3D (r = 0.940, P < 0.001), but low correlation of cisterna magna 3D (r = 0.462, P = 0.080) with the gestational age. There was good intra- and interobserver reproducibility for the cerebellum and cisterna magna 3D with ICC = 0.792
, 0.668, 0.691, and 0.287, respectively. The measurements of the fetal cerebellum and cisterna magna length by 3DUS using the software 3D XI were significantly higher than those obtained by 2DUS.
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Affiliation(s)
- Fernanda Silveira Bello de Barros
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo (FCMSCSP), 05303-000 São Paulo, SP, Brazil
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Kline-Fath BM, Calvo-Garcia MA. Prenatal Imaging of Congenital Malformations of the Brain. Semin Ultrasound CT MR 2011; 32:167-88. [DOI: 10.1053/j.sult.2011.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zmistowski HM, Fox T, Baxter JK. Differential Diagnosis of Intracranial Anomalies. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010. [DOI: 10.1177/8756479310361376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The sonographic differentiation between hydranencephaly, severe hydrocephalus, and holoprosencephaly can be difficult. Careful examination of cranial anatomy has proven quite useful in differentiating these three anomalies. The presence or absence of a complete midline falx, cortical tissue, facial and cardiac anomalies, internal carotid arteries, and fetal circle of Willis is useful in providing accurate diagnoses. This case reports a failure to recognize hydrocephalus despite the presence of well-established identifiers.
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Affiliation(s)
| | - Traci Fox
- Thomas Jefferson University, Philadelphia, PA, USA
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Winter TC, Kennedy AM, Byrne J, Woodward PJ. The cavum septi pellucidi: why is it important? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:427-444. [PMID: 20194938 DOI: 10.7863/jum.2010.29.3.427] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The cavum septi pellucidi (CSP) is routinely imaged in the fetal brain during obstetric sonography; in fact, for well over a decade, assessment of the CSP has been considered part of the required elements of a standard examination of fetal morphology in guidelines developed by multiple specialty societies. Our objective is to present the 4 reasons why all practicing sonologists and sonographers should be familiar with this anatomic structure. METHODS Prenatal sonograms and magnetic resonance imaging examinations are used to review the following topics: terminology, embryology, and anatomy of the CSP; pitfalls in its identification; and a wide variety of abnormalities (predominantly relating to nonvisualization) associated with the CSP. RESULTS Embryologic development of the CSP is intimately associated with the corpus callosum (CC); thus, correct identification of the CSP essentially excludes complete agenesis of the CC. Absence of the CSP is associated with an extremely wide spectrum of neuroanatomic malformations: these range from the lethal entities of hydranencephaly and alobar holoprosencephaly; to the potentially serious but nonlethal entities of schizencephaly, porencephaly, basilar encephaloceles, severe hydrocephalus, and the less severe prosencephalic cleavage disorders (including syntelencephaly); to the normal variant, the rare and somewhat controversial entity of isolated septal deficiency. The value of noting that the absent CSP allows diagnosis of very subtle and easily overlooked abnormalities such as septo-optic dysplasia is presented. CONCLUSIONS Correct recognition of the CSP provides welcome reassurance of proper development of the central forebrain.
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Affiliation(s)
- Thomas C Winter
- Department of Diagnostic Radiology, University of Utah Medical Center, Salt Lake City, Utah, USA
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Callen PW, Callen AL, Glenn OA, Toi A. Columns of the fornix, not to be mistaken for the cavum septi pellucidi on prenatal sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:25-31. [PMID: 18096727 DOI: 10.7863/jum.2008.27.1.25] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Visualization of the cavum septi pellucidi (CSP) is considered an integral part of the prenatal second-and third-trimester sonographic evaluations of the fetal neural axis. We have noted that another anatomic structure, the columns of the fornix, can be mistaken for the CSP and result in the missed diagnosis of agenesis of the corpus callosum. METHODS We describe a case in which the columns of the fornix were misinterpreted as representing the CSP during a sonographic evaluation at 18 weeks' gestation. After a follow-up sonogram at 35 weeks, agenesis of the corpus callosum was detected. A retrospective evaluation of the prevalence of forniceal columns was then performed in 100 consecutive sonograms of pregnancies between 18 and 24 weeks' gestation. A prospective study was then performed in 20 patients to determine the prevalence of visualization of the columns of the fornix. RESULTS In 86 of 100 patients, the columns of the fornix were retrospectively identified as discrete and separate structures from the CSP. When additional views were obtained prospectively in the forebrain, the fornix could be identified in all 20 patients. CONCLUSIONS The columns of the fornix may simulate the appearance of the CSP on second- and third-trimester sonograms. The distinction between these structures can be made because the columns of the fornix will show a linear reflection (3 lines) at their interface, whereas the CSP will appear as a fluid-filled triangular or rectangular fluid-filled space without a central line.
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Affiliation(s)
- Peter W Callen
- Department of Radiology, University of California, San Francisco, CA 94143-0628, USA.
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