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Pei SP, Guan HL, Jin F. Prenatal diagnosis of microcephaly through combined MRI and ultrasonography: Analysis of a case series. Medicine (Baltimore) 2023; 102:e36623. [PMID: 38115306 PMCID: PMC10727632 DOI: 10.1097/md.0000000000036623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Intrauterine microcephaly is a complex and lifelong condition that poses significant ethical challenges for clinicians and parents. The prognosis of microcephaly is highly variable and depends on the underlying cause and severity. In addition, microcephaly is often associated with various comorbidities, including intellectual disability, developmental delay, and epilepsy. Ultrasonography (US) is currently the most commonly used imaging modality for detecting microcephaly in the second trimester of pregnancy. However, antenatal brain magnetic resonance imaging (MRI) is increasingly being used as a more sensitive tool to identify structural abnormalities that may suggest a specific diagnosis. In this study, we report a case series of microcephaly diagnosed through the combination of MRI and US. PATIENT CONCERNS How to utilize a combination of MRI and US to screen for fetal microcephaly. DIAGNOSIS Based on the results of US and MRI examinations, patient 1 was found to have other craniocerebral malformations, patient 2 demonstrated macrogyria, and patient 3 exhibited skull irregularities. INTERVENTIONS The pregnancies of all 3 patients were terminated through the induction of labor by injecting Rivanol into the amniotic cavity. OUTCOMES The 3 patients were discharged after a period of observation. CONCLUSION US is an important tool for diagnosing fetal microcephaly. However, MRI can overcome the limitations of US and detect additional brain structural abnormalities, thereby providing more specific and valuable prenatal diagnostic information. Therefore, combining MRI and US has significant diagnostic value for fetal microcephaly.
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Affiliation(s)
- Shu-ping Pei
- Department of Obstetrics, Tongde hospital of Zhejiang province, Hangzhou, China
| | - Hai-lian Guan
- Department of Obstetrics, Tongde hospital of Zhejiang province, Hangzhou, China
| | - Feng Jin
- Department of Obstetrics, Tongde hospital of Zhejiang province, Hangzhou, China
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Chen Z, Ma Y, Wen H, Liao Y, Ouyang Y, Liang B, Liang M, Li S. Sonographic demonstration of the sulci and gyri on the convex surface in normal fetuses using 3D-ICRV rendering technology. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e284-e295. [PMID: 37402405 DOI: 10.1055/a-2122-6182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE To demonstrate morphological alteration of the sulci and gyri on the convex surface in normal fetuses using innovative three-dimensional inversion and Crystalvue and Realisticvue (3D-ICRV) rendering technology. MATERIALS AND METHODS 3D fetal brain volumes were collected from low-risk singleton pregnancies between 15+0 and 35+6 gestational weeks. Volumes were acquired from the transthalamic axial plane by transabdominal ultrasonography and were then post-processed with Crystalvue, Realisticvue rendering software and inversion mode. Volume quality was assessed. The anatomic definition of the sulci and gyri was determined according to location and orientation. The morphology alteration and sulcus display rates were recorded in sequential order of gestational weeks. Follow-up data were collected in all cases. RESULTS 294 of 300 fetuses (294 brain volumes) (98%) with qualified fetal brain volumes were included (n=294, median 27 gestational weeks). 6 fetuses with unsatisfactory 3D-ICRV image quality were excluded. The morphology of the sulci and gyri on the brain convex surface could be demonstrated clearly on 3D-ICRV images. The Sylvian fissure was the first structure to be recognized. From 25 to 30 weeks, other sulci and gyri became visible. An ascending trend in the display rate of the sulci was found in this period. Follow-up showed no detectable anomalies. CONCLUSION 3D-ICRV rendering technology is different from traditional 3D ultrasound. It can provide vivid and intuitive prenatal visualization of the sulci and gyri on the brain surface. Moreover, it may offer new ideas for neurodevelopment exploration.
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Affiliation(s)
- Zhixuan Chen
- Shenzhen Maternity & Child Healthcare Hospital,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ya Ma
- Department of Ultrasound, The First People's Hospital of Lanzhou City, Lanzhou, Lanzhou, China
| | - Huaxuan Wen
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Yimei Liao
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Yan Ouyang
- Ultrasound Department, Institute of Reproductive and stem cell Engineering, Central South University Xiangya Road, Changsha, Hunan Changsha, CN 410000, Changsha, China
| | - BoCheng Liang
- Shenzhen Maternity & Child Healthcare Hospital,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Meiling Liang
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Shengli Li
- Ultrasonic Diagnosis, Shenzhen Maternity and Childcare Hospital, Shenzhen, China
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Yap JLD, Concepcion NDP. Normal sulcation and gyration in neonatal cranial sonography from 24 weeks gestational age until term: a pictorial essay. Pediatr Radiol 2023; 53:2281-2290. [PMID: 37587258 DOI: 10.1007/s00247-023-05732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Cranial ultrasound remains the most practical and available imaging modality for evaluating the brain of neonates. This is a pictorial essay on preterm (≥24 weeks) and term neonates who had an unremarkable cranial ultrasound in the first week of life at St. Luke's Medical Center Quezon City and St. Luke's Medical Center Global City from January 2017 to December 2021. We present two images for each landmark week of gestation in this retrospective multicentric review. The first image is in the coronal plane depicting the foramen of Monro and the third ventricle and the second image is in the sagittal plane at the level of the caudothalamic groove. The goal is to create an easy-to-use reference for the typical appearance and progression of the normal sulcation and gyration of the neonatal brain on ultrasound, depending on the weekly gestational age. Having a reference atlas matched for gestational age is a helpful tool for screening a myriad of pathologies and is expected to help clinicians and radiologists involved in the care of neonates monitor the development of the brain.
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Affiliation(s)
- Justin Luke D Yap
- Department of Radiology, Northern Mindanao Medical Center, Capitol Compound, Corrales Avenue, 9000, Cagayan de Oro City, Philippines.
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center, Quezon City, Philippines.
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center, Quezon City, Philippines
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center Global City, Taguig, Philippines
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Gembicki M, Welp A, Scharf JL, Dracopoulos C, Weichert J. A Clinical Approach to Semiautomated Three-Dimensional Fetal Brain Biometry-Comparing the Strengths and Weaknesses of Two Diagnostic Tools: 5DCNS+ TM and SonoCNS TM. J Clin Med 2023; 12:5334. [PMID: 37629375 PMCID: PMC10455237 DOI: 10.3390/jcm12165334] [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: 07/30/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Objective: We aimed to evaluate the accuracy and efficacy of AI-assisted biometric measurements of the fetal central nervous system (CNS) by comparing two semiautomatic postprocessing tools. We further aimed to discuss the additional value of semiautomatically generated sagittal and coronal planes of the CNS. (2) Methods: Three-dimensional (3D) volumes were analyzed with two semiautomatic software tools, 5DCNS+™ and SonoCNS™. The application of 5DCNS+™ results in nine planes (axial, coronal and sagittal) displayed in a single template; SonoCNS™ depicts three axial cutting sections. The tools were compared regarding automatic biometric measurement accuracy. (3) Results: A total of 129 fetuses were included for final analysis. Our data indicate that, in terms of the biometric quantification of head circumference (HC), biparietal diameter (BPD), transcerebellar diameter (TCD) and cisterna magna (CM), the accuracy of SonoCNS™ was higher with respect to the manual measurement of an experienced examiner compared to 5DCNS+™, whereas it was the other way around regarding the diameter of the posterior horn of the lateral ventricle (Vp). The inclusion of four orthogonal coronal views in 5DCNS+™ gives valuable information regarding spatial arrangements, particularly of midline structures. (4) Conclusions: Both tools were able to ease assessment of the intracranial anatomy, highlighting the additional value of automated algorithms in clinical use. SonoCNS™ showed a superior accuracy of plane reconstruction and biometry, but volume reconstruction using 5DCNS+™ provided more detailed information, which is needed for an entire neurosonogram as suggested by international guidelines.
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Coronado-Gutiérrez D, Eixarch E, Monterde E, Matas I, Traversi P, Gratacós E, Bonet-Carne E, Burgos-Artizzu XP. Automatic Deep Learning-Based Pipeline for Automatic Delineation and Measurement of Fetal Brain Structures in Routine Mid-Trimester Ultrasound Images. Fetal Diagn Ther 2023; 50:480-490. [PMID: 37573787 DOI: 10.1159/000533203] [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: 04/12/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION The aim of this study was to develop a pipeline using state-of-the-art deep learning methods to automatically delineate and measure several of the most important brain structures in fetal brain ultrasound (US) images. METHODS The dataset was composed of 5,331 images of the fetal brain acquired during the routine mid-trimester US scan. Our proposed pipeline automatically performs the following three steps: brain plane classification (transventricular, transthalamic, or transcerebellar plane); brain structures delineation (9 different structures); and automatic measurement (from the structure delineations). The methods were trained on a subset of 4,331 images and each step was evaluated on the remaining 1,000 images. RESULTS Plane classification reached 98.6% average class accuracy. Brain structure delineation obtained an average pixel accuracy higher than 96% and a Jaccard index higher than 70%. Automatic measurements get an absolute error below 3.5% for the four standard head biometries (head circumference, biparietal diameter, occipitofrontal diameter, and cephalic index), 9% for transcerebellar diameter, 12% for cavum septi pellucidi ratio, and 26% for Sylvian fissure operculization degree. CONCLUSIONS The proposed pipeline shows the potential of deep learning methods to delineate fetal head and brain structures and obtain automatic measures of each anatomical standard plane acquired during routine fetal US examination.
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Affiliation(s)
- David Coronado-Gutiérrez
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain,
- Transmural Biotech S. L., Barcelona, Spain,
| | - Elisenda Eixarch
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Elena Monterde
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
| | - Isabel Matas
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
| | - Paola Traversi
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
| | - Eduard Gratacós
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Elisenda Bonet-Carne
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Tech, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Xavier P Burgos-Artizzu
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Barcelona, Spain
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Zeng Q, Wen H, Liao Y, Luo D, Qin Y, Liang M, Li S. A New Parameter to Evaluate Fetal Sylvian Fissure by Transabdominal 2-D Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00168-0. [PMID: 37302873 DOI: 10.1016/j.ultrasmedbio.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Evaluation of the inclination direction and degree of the Sylvian fissure plateau has not been reported. We aimed to evaluate the Sylvian fissure plateau by Sylvian fissure plateau angle (SFPA) in axial views at 23-28 wk gestation. METHODS A prospective ultrasound evaluation of 180 normal and 3 abnormal singleton pregnant women was conducted at 23-28 wk gestation. All cases were assessed in three axial planes of the fetal brain (the transthalamic, transventricular and transcerebellar plane) using transabdominal 2-D images. The SFPAs of all cases were measured between the brain midline and a line drawn along the Sylvian fissure plateau. Intraclass correlation coefficients (ICCs) were used to assess the intra- and inter-observer repeatability of SFPA measurements. RESULTS The SFPAs in normal cases in the transthalamic, transventricular and transcerebellar planes were all above y = 0, while in abnormal cases were below y = 0. However, there was no major difference between the angles measured on the transthalamic and transventricular planes (p = 0.365). There was a major difference between the SFPAs on the transcerebellar plane and transthalamic/transventricular plane (p < 0.05). The intra- and inter-observer ICCs were excellent at 0.971 (95% confidence interval [CI]: 0.945-0.984) and 0.936 (95% CI: 0.819-0.979), respectively. CONCLUSION The SFPAs of the normal cases in three axial views were stable at 23-28 wk gestation, suggesting that 0° may be a good cut-off value for evaluating abnormal SFPA. Findings offer a potential method by which the SFPA < 0°, as shown in three abnormal cases described herein, can be evaluated prenatally and thus serve as another tool for malformations of cortical development assessment, especially for frontoobitalopercula dysplasia. We recommend use of SFPA of the transthalamic plane to evaluate the Sylvian fissure in clinical work.
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Affiliation(s)
- Qing Zeng
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Huaxuan Wen
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Yimei Liao
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Dandan Luo
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Yue Qin
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Meiling Liang
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Shengli Li
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China.
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Yi F, Zhang C, Zou Y, Li X, Li J, Deng L, Chen L, Chen Z. Three-Dimensional Crystal Vue Imaging technology assessment of Sylvian fissures at 20-32+6 weeks' normal gestation. Eur Radiol 2023; 33:2358-2366. [PMID: 36385228 DOI: 10.1007/s00330-022-09253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Assess developmental pattern of Sylvian fissures (SF) with Three-Dimensional Crystal Vue Imaging (3D-CVI) at 20-32+6 weeks of gestation. METHODS This was a prospective cross-sectional study. Assess 20-32+6 weeks' gestation normal development of fetal brain SF with 3D-CVI imaging. Measure the uncovered area and perimeter of the insula on the Three-Dimensional (3D) image and establish reference ranges for the uncovered area and perimeters of the insula during normal pregnancy 20-32+6 weeks' gestation. Examine intra- and interobserver repeatability of measurements of the uncovered area and perimeter of the insula. RESULTS A total of 286 normal fetuses from 20 to 32+6 weeks of gestation were studied. The SF first was trapezoidal in the 25 weeks of gestation, gradually becoming triangular as gestational age (GA) increased, and then closing from posterior up to anterior down. The uncovered area and dimension of the insula showed a parabolic curve that first increased and then decreased as GA and head circumference (HC) increased. Reference ranges for measurements of the uncovered area and perimeters of the insula during normal pregnancy 20-32+6 weeks' gestation were established. The intra- and interobserver agreements were reproducible (all ICC > 0.850); there were more than 95% dots in the Bland-Altman plots (95 limits of agreement (LOA)) scale in every figure. CONCLUSIONS 3D-CVI can be used to observe the morphological changes of SF during middle and late pregnancy, which is an intuitive supplementary means for prenatal evaluation of cerebral cortex development, guiding subsequent follow-up and referral for assessment by expert neurosonologists. KEY POINTS • A new imaging technique was found to visualize the SF of fetal brain surface. • This technique has the advantages of good consistency and repeatability, simple operation, short time-consuming, and low cost. • Its 3D visualization images can be used to the development and changes of the sulci on the brain surface, it provides a new method to evaluate the development of cerebral cortex.
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Affiliation(s)
- Fei Yi
- Department of Ultrasound Medicine, Yichun Maternal and Children Health Hospital, Yichun City, 336000, Jiangxi Province, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang City, 330006, Jiangxi Province, China.
| | - Yaqi Zou
- Department of Ultrasound Medicine, Yichun Maternal and Children Health Hospital, Yichun City, 336000, Jiangxi Province, China
| | - Xingsheng Li
- Department of Ultrasound Medicine, Yichun Maternal and Children Health Hospital, Yichun City, 336000, Jiangxi Province, China
| | - Juan Li
- Department of Ultrasound Medicine, Yichun Maternal and Children Health Hospital, Yichun City, 336000, Jiangxi Province, China
| | - Ling Deng
- Department of Ultrasound Medicine, Yichun Maternal and Children Health Hospital, Yichun City, 336000, Jiangxi Province, China
| | - Lili Chen
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang City, 330006, Jiangxi Province, China
| | - Zhixuan Chen
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University, Shenzhen City, 518028, Guangdong Province, China
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Zeng Q, Wen H, Liao Y, Luo D, Qin Y, Li S. Five axial planes of fetal brain for comprehensive cerebral evaluation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:577-579. [PMID: 35380745 DOI: 10.1002/uog.24909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Q Zeng
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - H Wen
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Y Liao
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - D Luo
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Y Qin
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - S Li
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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Di Mascio D, Buca D, Rizzo G, Khalil A, Timor-Tritsch IE, Odibo A, Mappa I, Flacco ME, Giancotti A, Liberati M, D'Antonio F. Methodological quality of fetal brain structure charts for screening examination and targeted neurosonography: a systematic review. Fetal Diagn Ther 2022; 49:145-158. [DOI: 10.1159/000521421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Introduction: The methodological quality of fetal brain charts has not been critically appraised yet.
Material and methods: MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to December 31, 2020. The primary outcome was to evaluate the methodology of the studies assessing the growth of fetal brain structures throughout gestation. A list of 28 methodological quality criteria divided into three domains according to “study design”, “statistical and reporting methods”, and “specific relevant neurosonography aspects” was developed in order to assess the methodological appropriateness of the included studies. The overall quality score was defined as the sum of low risk of bias marks, with the range of possible scores being 0–28. This quality assessment was applied to each individual study reporting reference ranges for fetal brain structures.
Results: Sixty studies were included in the systematic review. The overall mean quality score of the studies included in this review was 51.3%. When focusing on each of the assessed domains, the mean quality score was 53.7% for “study design”, 54.2% for “statistical and reporting methods” and 38.6% for “specific relevant neurosonography aspects”. The sample size calculation, the correlation with a postnatal imaging evaluation and the whole fetal brain assessment were the items at the highest risk of bias for each domain assessed, respectively. The subgroup analysis according to different anatomical location showed the lowest quality score for ventricular and periventricular structures and the highest for cortical structures.
Conclusions: Most previously published studies reporting fetal brain charts suffers from poor methodology and are at high risk of biases, mostly when focusing on neurosonography issues. Further prospective longitudinal studies aiming at constructing specific growth charts for fetal brain structures should follow rigorous methodology to minimize the risk of biases, guarantee higher levels of reproducibility and improve the standard of care.
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Liao Y, Yang Y, Wen H, Wang B, Zhang T, Li S. Abnormal Sylvian fissure at 20-30 weeks as indicator of malformations of cortical development: role of prenatal whole-genome sequencing. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:552-555. [PMID: 34542197 DOI: 10.1002/uog.24771] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Y Liao
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Y Yang
- BGI-Shenzhen, Shenzhen, China
- Shenzhen Engineering Laboratory for Birth Defects Screening, Shenzhen, China
| | - H Wen
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - B Wang
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - T Zhang
- BGI-Shenzhen, Shenzhen, China
| | - S Li
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
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Zhang M, Wen H, Liang M, Qin Y, Zeng Q, Luo D, Zhong X, Li S. Diagnostic Value of Sylvian Fissure Hyperechogenicity in Fetal SAH. AJNR Am J Neuroradiol 2022; 43:627-632. [PMID: 35272984 PMCID: PMC8993207 DOI: 10.3174/ajnr.a7449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Fetal SAH is an intracranial malformation. The typical diagnostic features of fetal SAH in ultrasound have not been reported. This study aimed to evaluate the diagnostic value of Sylvian fissure hyperechogenicity by prenatal ultrasound in fetuses with SAH. MATERIALS AND METHODS The features on ultrasound and MR imaging of 10 fetuses with SAH were reviewed and summarized. The diagnostic value of the Sylvian fissure in fetal SAH by prenatal ultrasound was evaluated. RESULTS The typical and most obvious manifestations of SAH during the prenatal period were hyperechogenicity in the subarachnoid cavity, especially in the Sylvian fissure; all 10 cases (10/10) had such manifestations. Other manifestations included a hyperecho in other sulci (6/10), especially in the subfrontal sulcus, superior temporal sulcus, or parieto-occipital sulcus; a hyperecho in the cisterns (8/10), especially in the suprasellar cistern, posterior cranial fossa, cisterna ambiens, or quadrigeminal cistern; and a hyperecho around the anterior and posterior longitudinal fissures (2/10). Combined hemorrhage in the parenchymal layer or ventricles (9/10) was found. In addition, Doppler ultrasound showed that the peak flow velocity in the MCA increased in 6 cases (6/10). CONCLUSIONS The homogeneous hyperechogenicity of the Sylvian fissure is an important clue for detecting and diagnosing fetal SAH by prenatal ultrasound. A diagnostic approach has been proposed for fetal SAH, which has great significance in further prognosis.
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Affiliation(s)
- M Zhang
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - H Wen
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - M Liang
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Y Qin
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Q Zeng
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - D Luo
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - X Zhong
- Department of Ultrasound (X.Z.), Xiamen Maternal Child Health Care Hospital, Xiamen, China
| | - S Li
- From the Department of Ultrasound (M.Z., H.W., M.L., Y.Q., Q.Z., D.L., S.L.), Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
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A C, Sakalecha AK, B.C.R. S. Role of Ultrasonography in the Evaluation of Normal Developmental Pattern of Fetal Cerebral Sulci Between 18 and 32 Weeks of Gestational Age. Cureus 2022; 14:e22581. [PMID: 35355543 PMCID: PMC8957649 DOI: 10.7759/cureus.22581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Brain development is a crucial process of intrauterine life and can be readily visualized on ultrasonography. This study aims to visualize developmental patterns of various fetal cerebral sulci using ultrasonography between 18 and 32 weeks of gestation. Sulci are best visualized on images that are taken perpendicular to their expected course of development. Initially, they appear as small dot/dimple on the brain surface and later develop into a V-shaped indentation and finally deepen to form notch and echogenic line into the brain forming a Y-shaped configuration. Material and methods This was a cross-sectional observational study conducted on 241 antenatal mothers with a singleton pregnancy between 18 and 32 weeks of gestational age. Demographic and clinical data were obtained. Ultrasonography was performed using PHILIPS EPIQ 5, a curvilinear probe of frequency 2-5MHz. Sulci/fissures that are reported to appear early on anatomical studies were evaluated, specifically the parieto-occipital fissure, calcarine fissure, cingulate sulci, insula/Sylvian fissure, and convexity sulci. Comparison of the categorical outcomes was performed between study groups using the chi-square test. A p-value of <0.05 was considered statistically significant. Results The study included 241 participants. The mean age of antenatal mothers was 24.09 ± 4.13 years, and the mean fetal gestational age was 24.99 ± 4.13 weeks. Parieto-occipital fissure was the first fissure to develop and was present as a V-shaped indentation at 18 weeks and as a Y-shaped configuration by 21-22 weeks. Calcarine fissure was the next fissure to appear; it appeared as a dot by 18 weeks and developed into a V-shaped indentation by 20 weeks and as a Y-shaped configuration by 23 weeks. All fissures except cingulate sulci had appeared by 20 weeks, and calcarine sulci appeared later in the gestation by 21 weeks. Sylvian fissure initially appeared as a smooth surface and later underwent operculization to form obtuse and acute angulations with the adjacent temporal lobe by 20 and 24 weeks, respectively. Convexity sulci appeared later in gestation, beyond 25-26 weeks. Conclusions Ultrasonography, which is the commonest modality used in antenatal assessment of the fetus, can also be used to identify, familiarize, and provide a standard reference to assess normality of fetal sulcations. Neuronal migration disorders result in a wide spectrum of malformations of cortical development whose clinical manifestations include severe psychomotor retardation, developmental delays, motor deficits, seizures, and failure to thrive. Knowledge of normal development patterns of fetal cerebral sulci helps in early suspicion and detection of these cortical malformations, when present.
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Assessment of normal fetal cortical sulcus development. Arch Gynecol Obstet 2021; 306:735-743. [DOI: 10.1007/s00404-021-06334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
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A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures. Diagnostics (Basel) 2021; 11:diagnostics11060916. [PMID: 34063793 PMCID: PMC8223776 DOI: 10.3390/diagnostics11060916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound-based assessment of the fetal nervous system is routinely recommended at the time of the mid-trimester anatomy scan or at different gestations based on clinical indications. This review evaluates the methodological quality of studies aimed at creating charts for fetal brain structures obtained by ultrasound, as poor methodology could explain substantial variability in percentiles reported. Electronic databases (MEDLINE, EMBASE, Cochrane Library, and Web of Science) were searched from January 1970 to January 2021 to select studies on singleton fetuses, where the main aim was to construct charts on one or more clinically relevant structures obtained in the axial plane: parieto-occipital fissure, Sylvian fissure, anterior ventricle, posterior ventricle, transcerebellar diameter, and cisterna magna. Studies were scored against 29 predefined methodological quality criteria to identify the risk of bias. In total, 42 studies met the inclusion criteria, providing data for 45,626 fetuses. Substantial heterogeneity was identified in the methodological quality of included studies, and this may explain the high variability in centiles reported. In 80% of the studies, a high risk of bias was found in more than 50% of the domains scored. In conclusion, charts to be used in clinical practice and research should have an optimal study design in order to minimise the risk of bias and to allow comparison between different studies. We propose to use charts from studies with the highest methodological quality.
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Rodriguez-Sibaja MJ, Villar J, Ohuma EO, Napolitano R, Heyl S, Carvalho M, Jaffer YA, Noble JA, Oberto M, Purwar M, Pang R, Cheikh Ismail L, Lambert A, Gravett MG, Salomon LJ, Drukker L, Barros FC, Kennedy SH, Bhutta ZA, Papageorghiou AT. Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study of INTERGROWTH-21 st Project. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:614-623. [PMID: 32196791 DOI: 10.1002/uog.22017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 03/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To construct international ultrasound-based standards for fetal cerebellar growth and Sylvian fissure maturation. METHODS Healthy, well nourished pregnant women, enrolled at < 14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of INTERGROWTH-21st , an international multicenter, population-based project, underwent serial three-dimensional (3D) fetal ultrasound scans every 5 ± 1 weeks until delivery in study sites located in Brazil, India, Italy, Kenya and the UK. In the present analysis, only those fetuses that underwent developmental assessment at 2 years of age were included. We measured the transcerebellar diameter and assessed Sylvian fissure maturation using two-dimensional ultrasound images extracted from available 3D fetal head volumes. The appropriateness of pooling data from the five sites was assessed using variance component analysis and standardized site differences. For each Sylvian fissure maturation score (left or right side), mean gestational age and 95% CI were calculated. Transcerebellar diameter was modeled using fractional polynomial regression, and goodness of fit was assessed. RESULTS Of those children in the original FGLS cohort who had developmental assessment at 2 years of age, 1130 also had an available 3D ultrasound fetal head volume. The sociodemographic characteristics and pregnancy/perinatal outcomes of the study sample confirmed the health and low-risk status of the population studied. In addition, the fetuses had low morbidity and adequate growth and development at 2 years of age. In total, 3016 and 2359 individual volumes were available for transcerebellar-diameter and Sylvian-fissure analysis, respectively. Variance component analysis and standardized site differences showed that the five study populations were sufficiently similar on the basis of predefined criteria for the data to be pooled to produce international standards. A second-degree fractional polynomial provided the best fit for modeling transcerebellar diameter; we then estimated gestational-age-specific 3rd , 50th and 97th smoothed centiles. Goodness-of-fit analysis comparing empirical centiles with smoothed centile curves showed good agreement. The Sylvian fissure increased in maturation with advancing gestation, with complete overlap of the mean gestational age and 95% CIs between the sexes for each development score. No differences in Sylvian fissure maturation between the right and left hemispheres were observed. CONCLUSION We present, for the first time, international standards for fetal cerebellar growth and Sylvian fissure maturation throughout pregnancy based on a healthy fetal population that exhibited adequate growth and development at 2 years of age. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M J Rodriguez-Sibaja
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Maternal-Fetal Medicine Department, National Institute of Perinatology, Mexico City, Mexico
| | - J Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - R Napolitano
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - S Heyl
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - J A Noble
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - M Oberto
- S.C. Ostetricia 2U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - A Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - M G Gravett
- Departments of Obstetrics & Gynecology and of Public Health, University of Washington, Seattle, WA, USA
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - L Drukker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - S H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Z A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Whittle S, Finn M, Little K, Olsson CA. A methodological review of fetal neurosonographic studies: New directions in assessment of neurodevelopmental risk for mental health problems. Neurosci Biobehav Rev 2020; 114:172-193. [PMID: 32275918 DOI: 10.1016/j.neubiorev.2020.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/19/2022]
Abstract
Most mental disorders are now considered to have neurodevelopmental origins, with a growing body of research pointing to neural alterations that predate birth. However, lack of established methods for reliable investigation of fetal brain development has limited research into early neural vulnerability. Using a systematic approach and quantitative evaluation of study methodology, we review neurosonographic studies of fetal brain structure with objective quality measures. A total of 81 studies were identified. High quality studies were identified for measurement of the corpus callosum, cerebellum, vermis, ventricles and frontal cortex, with reference ranges provided to facilitate future clinical research. Fewer and lower quality studies were available for subcortical structures, prompting a need for further research to create reliable reference ranges. Development and adoption of reference ranges for fetal brain structures should facilitate future research in neurosonographic evaluation of fetal brain development and lead to a better understanding of neurodevelopmental risk and resilience processes for mental disorders.
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Affiliation(s)
- Sarah Whittle
- The University of Melbourne, Melbourne Neuropsychiatry Centre, Department of Psychiatry, Australia; The University of Melbourne, Melbourne School of Psychological Sciences, Australia.
| | | | - Keriann Little
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Australia; Royal Children's Hospital Melbourne, Department of Neurodevelopment & Disability, Australia; Barwon Child Youth & Family, Policy & Planning, Australia
| | - Craig A Olsson
- The University of Melbourne, Melbourne School of Psychological Sciences, Australia; Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital Melbourne, Australia; The University of Melbourne, Department of Paediatrics, Royal Children's Hosptial, Australia
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Welp A, Gembicki M, Rody A, Weichert J. Validation of a semiautomated volumetric approach for fetal neurosonography using 5DCNS+ in clinical data from > 1100 consecutive pregnancies. Childs Nerv Syst 2020; 36:2989-2995. [PMID: 32350601 PMCID: PMC7649164 DOI: 10.1007/s00381-020-04607-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the validity of a semiautomated volumetric approach (5DCNS+) for the detailed assessment of the fetal brain in a clinical setting. METHODS Stored 3D volumes of > 1100 consecutive 2nd and 3rd trimester pregnancies (range 15-36 gestational weeks) were analyzed using a workflow-based volumetric approach 5DCNS+, enabling semiautomated reconstruction of diagnostic planes of the fetal central nervous system (CNS). All 3D data sets were examined for plane accuracy, the need for manual adjustment, and fetal-maternal characteristics affecting successful plane reconstruction. We also examined the potential of these standardized views to give additional information on proper gyration and sulci formation with advancing gestation. RESULTS Based on our data, we were able to show that gestational age with an OR of 1.085 (95% CI 1.041-1.132) and maternal BMI with an OR of 1.022 (95% CI 1.041-1.054) only had a slight impact on the number of manual adjustments needed to reconstruct the complete volume, while maternal age and fetal position during acquisition (p = 0.260) did not have a significant effect. For the vast majority (958/1019; 94%) of volumes, using 5DCNS+ resulted in proper reconstruction of all nine diagnostic planes. In less than 1% (89/9171 planes) of volumes, the program failed to give sufficient information. 5DCNS+ was able to show the onset and changing appearance of CNS folding in a detailed and timely manner (lateral/parietooccipital sulcus formation seen in < 65% at 16-17 gestational weeks vs. 94.6% at 19 weeks). CONCLUSIONS The 5DCNS+ method provides a reliable algorithm to produce detailed, 3D volume-based assessments of fetal CNS integrity through a standardized reconstruction of the orthogonal diagnostic planes. The method further gives valid and reproducible information regarding ongoing cortical development retrieved from these volume sets that might aid in earlier in utero recognition of subtle structural CNS anomalies.
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Affiliation(s)
- Amrei Welp
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Michael Gembicki
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Jan Weichert
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Pooh RK, Machida M, Nakamura T, Uenishi K, Chiyo H, Itoh K, Yoshimatsu J, Ueda H, Ogo K, Chaemsaithong P, Poon LC. Increased Sylvian fissure angle as early sonographic sign of malformation of cortical development. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:199-206. [PMID: 30381845 PMCID: PMC6772089 DOI: 10.1002/uog.20171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate Sylvian fissure development by assessing Sylvian fissure angles in fetuses with malformation of cortical development (MCD). METHODS This was a retrospective study of 22 fetuses with MCD. Cases with a stored three-dimensional (3D) brain volume acquired at 18 + 0 to 30 + 6 weeks of gestation at an ultrasound-based research clinic between January 2010 and December 2017 were identified through a database. Of the 22 fetuses, seven had an extracranial abnormality, such as cardiac, renal, gastrointestinal and/or digital anomalies, and five had a minor abnormality such as micrognathia, low-set ears and/or single umbilical artery. To confirm the final clinical diagnosis of brain abnormality, postmortem histological findings or prenatal or postnatal magnetic resonance images were used. For measurement of Sylvian fissure angle, an anterior coronal plane of the fetal brain on transvaginal 3D volume multiplanar imaging was visualized as a single image from the three orthogonal views. The right and left Sylvian fissure angles were measured between a horizontal reference line (0°) and a line drawn along the upper side of the respective Sylvian fissure. The Sylvian fissure angle on both sides was plotted on the graphs of the reference ranges for gestational age in weeks. RESULTS In 21 (95.5%; 95% CI, 86.8-100.0%) of 22 fetuses with MCD, the Sylvian fissure angle on one or both sides was larger than the 90th percentile of the normal reference. There was one case with apparent focal MCD in the parietal lobe, but the Sylvian fissure angles were normal. A case with apparent unilateral cortical dysplasia and one with apparent unilateral schizencephaly had conspicuous discrepancies between the left and right Sylvian fissure angles. Abnormal genetic test results were obtained in six cases, including four cases with a mutation in a single gene. CONCLUSIONS This study has shown that the Sylvian fissures, as defined by the Sylvian fissure angle, have delayed development in most MCD cases prior to the diagnosis of the condition. The Sylvian fissure angle may potentially be a strong indicator for the subsequent development of cortical malformation, before the time point at which the gyri and sulci become obvious on the fetal brain surface. Further research is required to validate these findings. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. K. Pooh
- CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity ClinicOsakaJapan
| | - M. Machida
- CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity ClinicOsakaJapan
| | - T. Nakamura
- CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity ClinicOsakaJapan
| | - K. Uenishi
- CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity ClinicOsakaJapan
| | - H. Chiyo
- CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity ClinicOsakaJapan
| | - K. Itoh
- Department of Pathology and Applied Neurobiology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - J. Yoshimatsu
- Department of Obstetrics and GynecologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - H. Ueda
- Department of PathologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - K. Ogo
- Department of PathologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - P. Chaemsaithong
- Department of Obstetrics and GynaecologyPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong SAR
| | - L. C. Poon
- Department of Obstetrics and GynaecologyPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong SAR
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