1
|
Hadi E, Haddad L, Levy M, Gindes L, Hausman-Kedem M, Bassan H, Ben-Sira L, Libzon S, Kassif E, Hoffmann C, Leibovitz Z, Kasprian G, Lerman-Sagie T. Fetal intraventricular hemorrhage and periventricular hemorrhagic venous infarction: time for dedicated classification system. Ultrasound Obstet Gynecol 2024. [PMID: 38363592 DOI: 10.1002/uog.27613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Affiliation(s)
- E Hadi
- Diagnostic Ultrasound Unit, The Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Haddad
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Ultrasound Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - M Levy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - L Gindes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Ultrasound Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Hausman-Kedem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Bassan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology and Development Center, Shamir Medical Center (Assaf Harofeh), Be'er Ya'akov, Israel
| | - L Ben-Sira
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Division of Pediatric Radiology, Dana Children's Hospital, Tel- Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Libzon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - E Kassif
- Diagnostic Ultrasound Unit, The Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Hoffmann
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuroradiology Unit, Department of Diagnostic Radiology, Sheba Medical Center, Ramat Gan, Israel
| | - Z Leibovitz
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - T Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| |
Collapse
|
2
|
Miremberg H, Rosen H, Weisz B, Tirosh D, Hershkovitz R, Stern S, Porat S, Beloshevski B, Melcer Y, Goldberg Y, Boms Yonai N, Awawdeh M, Leibovitz Z, Shalev J, Gindes L. Adverse outcome following selective termination of presenting twin vs non-presenting twin. Ultrasound Obstet Gynecol 2023; 61:705-709. [PMID: 37167535 DOI: 10.1002/uog.26170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Data are lacking on the impact on pregnancy outcome of the position of the abnormal fetus in a discordant twin pregnancy undergoing selective termination (ST). Tissue maceration post ST of the presenting twin may lead to early rupture of membranes, amnionitis and preterm labor. The aim of this study was to evaluate pregnancy complications and outcome following ST of the presenting vs non-presenting twin. METHODS This was a multicenter retrospective cohort study of dichorionic diamniotic twin pregnancies that underwent ST due to a discordant fetal anomaly (structural or genetic) between 2007 and 2021. The study population was divided into two groups according to the position of the reduced twin (presenting or non-presenting) and outcomes were studied accordingly. The primary outcome was a composite of early complications following ST, including infection, preterm prelabor rupture of membranes and pregnancy loss. RESULTS A total of 190 dichorionic twin pregnancies were included, of which 73 underwent ST of the presenting twin and 117 of the non-presenting twin. The groups did not differ in either baseline demographic characteristics or mean gestational age at the time of the procedure. ST of the presenting twin resulted in a significantly higher rate of early complications compared with the non-presenting twin (19.2% vs 7.7%; P = 0.018). Moreover, the rates of preterm delivery (75.3% vs 37.6%; P < 0.001) and neonatal intensive care unit admission (45.3% vs 17.1%; P < 0.001) were higher, and birth weight was lower (P < 0.001), in those pregnancies in which the presenting twin was reduced. CONCLUSIONS ST of the presenting twin resulted in a higher rate of adverse pregnancy outcome compared with that of the non-presenting twin. These findings should be acknowledged during patient counseling and, if legislation permits, taken into consideration when planning ST. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- H Miremberg
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Rosen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - B Weisz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - D Tirosh
- Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - R Hershkovitz
- Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Stern
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Ein Kerem Campus, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Porat
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Ein Kerem Campus, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - B Beloshevski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Shamir Medical Center Assaf Harofeh, Tzrifin, Israel
| | - Y Melcer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Shamir Medical Center Assaf Harofeh, Tzrifin, Israel
| | - Y Goldberg
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - N Boms Yonai
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - M Awawdeh
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Departments of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Z Leibovitz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Departments of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - J Shalev
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Gindes
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Hagege R, Krajden Haratz K, Malinger G, Ben-Sira L, Leibovitz Z, Heron D, Burglen L, Birnbaum R, Valence S, Keren B, Blumkin L, Jouannic JM, Lerman-Sagie T, Garel C. Spectrum of brain malformations in fetuses with mild tubulinopathy. Ultrasound Obstet Gynecol 2023; 61:740-748. [PMID: 36484554 DOI: 10.1002/uog.26140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To report on a large cohort of fetuses with mild forms of tubulinopathy and to define prenatal ultrasound and magnetic resonance imaging (MRI) features that can facilitate prenatal diagnosis. METHODS This was a retrospective multicenter study of fetuses diagnosed between January 2007 and February 2022 with a mild tubulinopathy (without lissencephaly or microlissencephaly). We collected and reviewed brain imaging and genetic data, and defined major criteria as findings observed in ≥ 70% of the patients and minor criteria as those observed in ≥ 50% but < 70% of the patients. RESULTS Our cohort included 34 fetuses. The mean gestational age at ultrasound screening, when suspicion of a central nervous system anomaly was first raised, was 24.2 (range, 17-33) weeks. Callosal anomalies (n = 19 (56%)) and abnormal ventricles (n = 18 (53%)) were the main reasons for referral. The mean gestational age at neurosonography was 28.3 (range, 23-34) weeks and that at MRI was 30.2 (range, 24-35) weeks. Major ultrasound criteria were midline distortion, ventricular asymmetry, dysmorphic and/or dilated frontal horn(s) and abnormal sulcation. Minor ultrasound criteria were distortion of the cavum septi pellucidi, abnormal corpus callosum, absent or asymmetric olfactory sulci, ventriculomegaly and basal ganglia dysmorphism. Major MRI criteria were midline distortion, distortion of the cavum septi pellucidi, ventricular asymmetry, dilatation (generally unilateral) and/or distortion, dysmorphic and/or dilated frontal horn(s) and abnormal sulcation (mainly dysgyria). Minor MRI criteria were absent or asymmetric olfactory sulci, abnormal bulge of the pons, anteroposterior diameter of the pons ≤ 5th centile and brainstem asymmetry. A mutation was found in TUBB3 (44.1% of cases), TUBB (23.5%), TUBB2B (14.7%) or TUBA1A (17.6%). The mutation was inherited from a parent in 18/34 cases. The pregnancy was terminated in 23/34 cases. CONCLUSIONS Prenatal diagnosis of mild forms of tubulinopathy is possible but challenging. We have defined, in this large series of fetuses, major and minor criteria that can help identify this entity in utero. Most findings can be visualized on ultrasound. This evaluation is also important for prenatal counseling. Once a prenatal diagnosis of mild tubulinopathy is suspected, the family members should be referred for exome sequencing and MRI. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- R Hagege
- Department of Radiology, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Ashdod, Israel
- Faculty of Medicine, Ben Gurion University, Beer Sheva, Israel
| | - K Krajden Haratz
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Division of Pediatric Radiology, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Leibovitz
- Obstetrics-Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Fetal Neurology Clinic, Obstetrics-Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - D Heron
- Department of Genetics, Division of Medical Genetics, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - L Burglen
- Department of Genetics, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - R Birnbaum
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Valence
- Department of Pediatric Neurology, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - B Keren
- Department of Genetics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - L Blumkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Pediatric Neurology Unit, Magen Center for Rare Diseases, Wolfson Medical Center, Holon, Israel
| | - J-M Jouannic
- Fetal Medicine Department, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - T Lerman-Sagie
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Pediatric Neurology Unit, Magen Center for Rare Diseases, Wolfson Medical Center, Holon, Israel
| | - C Garel
- Department of Radiology, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| |
Collapse
|
4
|
Gafner M, Garel C, Leibovitz Z, Valence S, Krajden Haratz K, Oegema R, Mancini GMS, Heron D, Bueltmann E, Burglen L, Rodriguez D, Huisman TAGM, Lequin MH, Arad A, Kidron D, Muqary M, Gindes L, Lev D, Boltshauser E, Lerman-Sagie T. Medullary Tegmental Cap Dysplasia: Fetal and Postnatal Presentations of a Unique Brainstem Malformation. AJNR Am J Neuroradiol 2023; 44:334-340. [PMID: 36822823 PMCID: PMC10187821 DOI: 10.3174/ajnr.a7805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND PURPOSE Medullary tegmental cap dysplasia is a rare brainstem malformation, first described and defined by James Barkovich in his book Pediatric Neuroimaging from 2005 as an anomalous mass protruding from the posterior medullary surface. We describe the neuroimaging, clinical, postmortem, and genetic findings defining this unique malformation. MATERIALS AND METHODS This is a multicenter, international, retrospective study. We assessed the patients' medical records, prenatal ultrasounds, MR images, genetic findings, and postmortem results. We reviewed the medical literature for all studies depicting medullary malformations and evaluated cases in which a dorsal medullary protuberance was described. RESULTS We collected 13 patients: 3 fetuses and 10 children. The medullary caps had multiple characteristics. Associated brain findings were a rotated position of the medulla, a small and flat pons, cerebellar anomalies, a molar tooth sign, and agenesis of the corpus callosum. Systemic findings included the following: polydactyly, hallux valgus, large ears, and coarse facies. Postmortem analysis in 3 patients revealed that the cap contained either neurons or white matter tracts. We found 8 publications describing a dorsal medullary protuberance in 27 patients. The syndromic diagnosis was Joubert-Boltshauser syndrome in 11 and fibrodysplasia ossificans progressiva in 14 patients. CONCLUSIONS This is the first study to describe a series of 13 patients with medullary tegmental cap dysplasia. The cap has different shapes: distinct in Joubert-Boltshauser syndrome and fibrodysplasia ossificans progressive. Due to the variations in the clinical, imaging, and postmortem findings, we conclude that there are multiple etiologies and pathophysiology. We suggest that in some patients, the pathophysiology might be abnormal axonal guidance.
Collapse
Affiliation(s)
- M Gafner
- From the Department of Pediatrics B (M.G.), Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
| | - C Garel
- Department of Radiology (C.G.)
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Z Leibovitz
- Obstetrics and Gynecology Ultrasound Unit (Z.L.), Bnai-Zion Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - S Valence
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Neuropédiatrie (S.V., L.B., D.R.), Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - K Krajden Haratz
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- Division of Ultrasound in ObGyn (K.K.H.), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - G M S Mancini
- Department of Clinical Genetics (G.M.S.M.), Erasmus MC University Medical Center, GD Rotterdam, the Netherlands
| | - D Heron
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Génétique Clinique (D.H.), Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - E Bueltmann
- Institute of Diagnostic und Interventional Neuroradiology (E. Bueltmann), Hannover Medical School, Hannover, Germany
| | - L Burglen
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Neuropédiatrie (S.V., L.B., D.R.), Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Rodriguez
- Reference Center for Cerebellar Malformations and Congenital Diseases (C.G., S.V., D.H., L.B., D.R.), Hôpital d'Enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Neuropédiatrie (S.V., L.B., D.R.), Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T A G M Huisman
- Edward B. Singleton Department of Radiology (T.A.G.M.H.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - M H Lequin
- Radiology (M.H.L.), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Arad
- Department of Pathology (A.A.), Bnai-Zion Medical Center, Haifa, Israel
| | - D Kidron
- Department of Pathology (D.K.), Meir Medical Center, Kfar Saba, Israel
| | - M Muqary
- Department of Obstetrics and Gynecology (M.M.), Poriya Medical Center, Tiberias, Galilee, Israel
| | - L Gindes
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology (L.G.)
| | - D Lev
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- The Rina Mor Institute of Medical Genetics (D.L.)
- Fetal Neurology Clinic (D.L., T.L.-S.)
| | - E Boltshauser
- Pediatric Neurology (Emeritus) (E. Boltshauser), Children's University Hospital, Zürich, Switzerland
| | - T Lerman-Sagie
- Sackler Faculty ofMedicine (M.G., K.K.H., L.G., D.L., T.L.-S.), Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic (D.L., T.L.-S.)
- Magen Center for Rare Diseases (T.L.-S.)
- Pediatric Neurology Unit (T.L.-S.), Wolfson Medical Center, Holon, Israel
| |
Collapse
|
5
|
Krajden Haratz K, Oliveira Szejnfeld P, Govindaswamy M, Leibovitz Z, Gindes L, Severino M, Rossi A, Paladini D, Garcia Rodriguez R, Ben-Sira L, Borkowski Tillman T, Gupta R, Lotem G, Raz N, Hamamoto TENK, Kidron D, Arad A, Birnbaum R, Brussilov M, Pomar L, Vial Y, Leventer RJ, McGillivray G, Fink M, Krzeszowski W, Fernandes Moron A, Lev D, Tamarkin M, Shalev J, Har Toov J, Lerman-Sagie T, Malinger G. Prenatal diagnosis of rhombencephalosynapsis: neuroimaging features and severity of vermian anomaly. Ultrasound Obstet Gynecol 2021; 58:864-874. [PMID: 33942916 DOI: 10.1002/uog.23660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe the prenatal neuroimaging spectrum of rhombencephalosynapsis (RES) and criteria for its classification according to the severity of vermian anomaly. METHODS In this multicenter retrospective study of fetuses with RES between 2002 and 2020, the medical records and brain ultrasound and magnetic resonance images were evaluated comprehensively to determine the severity of the vermian anomaly and the presence of associated brain findings. RES was classified, according to the pattern of vermian agenesis and the extent of the fusion of the hemispheres, as complete RES (complete absence of the vermis) or partial RES (further classified according to the part of the vermis that was missing and, consequently, the region of hemispheric fusion, as anterior, posterior, severe or mixed RES). Findings were compared between cases with complete and those with partial RES. RESULTS Included in the study were 62 fetuses with a gestational age ranging between 12 and 37 weeks. Most had complete absence of the vermis (complete RES, 77.4% of cases), a 'round-shaped' cerebellum on axial views (72.6%) and a transverse cerebellar diameter (TCD) < 3rd centile (87.1%). Among the 22.6% of cases with partial RES, 6.5% were classified as severe partial, 6.5% as partial anterior, 8.1% as partial mixed and 1.6% as partial posterior. Half of these cases presented with normal or nearly normal cerebellar morphology and 28.5% had a TCD within the normal limits. Infratentorially, the fourth ventricle was abnormal in 88.7% of cases overall, and anomalies of the midbrain and pons were frequent (93.5% and 77.4%, respectively). Ventriculomegaly was observed in 80.6% of all cases, being more severe in cases with complete RES than in those with partial RES, with high rates of parenchymal and septal disruption. CONCLUSIONS This study provides prenatal neuroimaging criteria for the diagnosis and classification of RES, and identification of related features, using ultrasound and magnetic resonance imaging. According to our findings, a diagnosis of RES should be considered in fetuses with a small TCD (severe cerebellar hypoplasia) and/or a round-shaped cerebellum on axial views, during the second or third trimester, especially when associated with ventriculomegaly. Partial RES is more common than previously thought, but presents an extreme diagnostic challenge, especially in cases with normal or nearly-normal cerebellar morphobiometric features. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- K Krajden Haratz
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Oliveira Szejnfeld
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
- DDI UNIFESP, São Paulo, Brazil
- Fundação Instituto de Pesquisa e Estudo de Diagnostico por Imagem, São Paulo, Brazil
| | - M Govindaswamy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Severino
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - D Paladini
- Fetal Medicine Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - R Garcia Rodriguez
- Complejo Hospitalario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - L Ben-Sira
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Radiology Unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - T Borkowski Tillman
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Gupta
- Sunehri Devi Hospital, Sonepat India, Indraprastha Apollo Hospital, New Delhi, India
| | - G Lotem
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - N Raz
- Technion Faculty of Medicine, Haifa, Israel
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hedera, Israel
| | - T E N K Hamamoto
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - A Arad
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - R Birnbaum
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Brussilov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Pomar
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Y Vial
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - R J Leventer
- Department of Neurology, The Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia
| | - G McGillivray
- Royal Women's Hospital, Mercy Hospital for Women and Murdoch Children's Research Institute, Melbourne, Australia
| | - M Fink
- Department of Medical Imaging, The Royal Children's Hospital and Perinatal Unit, The Mercy Hospital for Women, Melbourne, Australia
| | | | - A Fernandes Moron
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Lev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - M Tamarkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Har Toov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - G Malinger
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
6
|
Haratz KK, Shulevitz SL, Leibovitz Z, Lev D, Shalev J, Tomarkin M, Malinger G, Lerman-Sagie T, Gindes L. Fourth ventricle index: sonographic marker for severe fetal vermian dysgenesis/agenesis. Ultrasound Obstet Gynecol 2019; 53:390-395. [PMID: 29484745 DOI: 10.1002/uog.19034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Prenatal diagnosis of midbrain-hindbrain (MB-HB) malformations relies primarily on abnormal size and shape of the cerebellum and retrocerebellar space, particularly 'open fourth ventricle' (4V), the most common indicator of MB-HB malformations. The aim of this study was to present the fourth ventricle index (4VI), and to evaluate its role as a marker for severe vermian dysgenesis/agenesis in cases without open 4V. METHODS This was a prospective cross-sectional study of patients with singleton low-risk pregnancy at 14 + 1 to 36 + 6 gestational weeks presenting between May 2016 and November 2017 for routine ultrasound examination. Axial images of the fetal 4V were obtained and the 4VI was calculated as the ratio between the laterolateral and the anteroposterior diameters. Reference ranges were constructed and retrospectively collected values from 44 fetuses with confirmed anomalies involving severe vermian dysgenesis/agenesis (Joubert syndrome and related disorders, rhombencephalosynapsis, cobblestone malformations and cerebellar hypoplasia) but without open 4V were compared with the normal values. RESULTS In total, 384 healthy fetuses were enrolled into the study, from which reference ranges were produced, and 44 cases were collected retrospectively. The 4VI in the normal fetuses was always > 1. In affected fetuses, it was always below mean -2 SD and < 1. CONCLUSIONS The 4VI is a sonographic marker for severe fetal vermian dysgenesis/agenesis in the absence of an open 4V. It may be incorporated easily into the routine brain scan; 4VI < 1 indicates a need for dedicated fetal neuroimaging for diagnosis and prenatal counseling. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- K K Haratz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S L Shulevitz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Ultrasound in ObGyn Unit, Department of ObGyn, Bnai Zion Medical Center, Haifa, Israel
| | - D Lev
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Tomarkin
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - T Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Leibovitz Z, Daniel-Spiegel E, Malinger G, Haratz K, Tamarkin M, Gindes L, Schreiber L, Ben-Sira L, Lev D, Shapiro I, Bakry H, Weizman B, Zreik A, Egenburg S, Arad A, Tepper R, Kidron D, Lerman-Sagie T. Prediction of microcephaly at birth using three reference ranges for fetal head circumference: can we improve prenatal diagnosis? Ultrasound Obstet Gynecol 2016; 47:586-592. [PMID: 26511765 DOI: 10.1002/uog.15801] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/10/2015] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the prediction of microcephaly at birth (micB) using established and two new reference ranges for fetal head circumference (HC) and to assess whether integrating additional parameters can improve prediction. METHODS Microcephaly in utero was defined as a fetal HC 3SD below the mean for gestational age according to Jeanty et al.'s reference range. The records of cases with fetal microcephaly (Fmic) were evaluated for medical history, imaging findings, biometry and postnatal examination/autopsy findings. Microcephaly was confirmed at birth (micB) by an occipitofrontal circumference (OFC) or a brain weight at autopsy 2SD below the mean for gestational age. The new INTERGROWTH-21(st) Project and a recent Israeli reference for fetal growth were applied for evaluation of the Fmic positive predictive value (PPV) for diagnosis of micB cases. Optimal HC cut-offs were determined for each of the new references with the aim of detecting all micB cases whilst minimizing the number of false positives found to have a normal HC at birth. We also assessed the difference between the Z-scores of the prenatal HC and the corresponding OFC at birth, the frequency of small-for-gestational age (SGA), decreased HC/abdominal circumference (AC) and HC/femur length (FL) ratios, the prevalence of associated malformations and family history. RESULTS Forty-two fetuses were diagnosed as having Fmic according to the Jeanty reference, but micB was confirmed in only 24 (PPV, 57.1%). The optimal INTERGROWTH and Israeli reference HC cut-offs for micB diagnosis were mean - 3SD and mean - 2.3SD, resulting in a statistically non-significant improvement in PPV to 61.5% and 66.7%, respectively. The presence of a family history of microcephaly, SGA, associated malformations and application of stricter HC cut-offs resulted in a higher PPV of micB, although not statistically significant and with a concurrent increase in the number of false-negative results. The deviation of the HC from the mean, by all references, was significantly larger compared with the actual deviation of the OFC at birth, with mean differences between the corresponding Z-scores of -1.15, -1.95 and -0.74 for the Jeanty, INTERGROWTH and Israeli references, respectively. CONCLUSIONS The evaluated reference ranges all result in considerable over-diagnosis of fetal microcephaly. The use of the two new HC reference ranges did not significantly improve micB prediction compared with that of Jeanty et al., whilst use of additional characteristics and stricter HC cut-offs could improve the PPV with an increase in false negatives. The postnatal OFC deviates significantly less from the mean compared with the prenatal HC, and we propose that adjustment for this would enable better prediction of the actual OFC deviation at birth. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- Z Leibovitz
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - E Daniel-Spiegel
- Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel
| | - G Malinger
- Lis Maternity Hospital, Division of OB-GYN Ultrasound, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Haratz
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Tamarkin
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Schreiber
- Department of Pathology, Wolfson Medical Center, Holon, Israel
| | - L Ben-Sira
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - D Lev
- Genetics Institute, Wolfson Medical Center, Holon, Israel
| | - I Shapiro
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - H Bakry
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - B Weizman
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - A Zreik
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - S Egenburg
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - A Arad
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - R Tepper
- Ultrasound Unit, Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - D Kidron
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - T Lerman-Sagie
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| |
Collapse
|
8
|
Leibovitz Z, Shiran C, Haratz K, Tamarkin M, Gindes L, Schreiber L, Malinger G, Ben-Sira L, Lev D, Shapiro I, Bakry H, Weizman B, Zreik A, Kidron D, Egenburg S, Arad A, Lerman-Sagie T. Application of a novel prenatal vertical cranial biometric measurement can improve accuracy of microcephaly diagnosis in utero. Ultrasound Obstet Gynecol 2016; 47:593-599. [PMID: 26916564 DOI: 10.1002/uog.15886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To construct a reference range for a new vertical measurement of the fetal head and to assess whether its combination with fetal head circumference (HC) can prevent the misdiagnosis of microcephaly in fetuses with an acrocephalic-like head deformation. METHODS A new vertical cranial biometric measurement was defined: the foramen magnum-to-cranium distance (FCD), measured between the foramen magnum and the upper inner cranial border along the posterior wall of the brainstem. The measurement was performed in a precise mid-sagittal plane using a three-dimensional multiplanar display of a sagittally acquired sonographic volume of the fetal head. The normal reference range was developed by measuring 396 healthy fetuses of low-risk singleton pregnancies between 15 and 40 gestational weeks. This reference was applied to 25 fetuses with microcephaly diagnosed prenatally (Fmic) based on HC ≥ 3 SD below the mean for gestational age. We determined an optimal FCD cut-off for combination with HC to detect all cases found with microcephaly at birth (micB), while excluding the fetuses with normal head circumference at birth (NHCB), who were described postnatally as having an acrocephalic-like cranial deformation. RESULTS In the healthy singleton fetuses, FCD increased with gestational age, with a quadratic equation providing an optimal fit to the data (adjusted R(2) = 0.934). The measurement could be assessed in 95.2% of cases. Of the 25 cases diagnosed with Fmic prenatally, on the basis of HC alone, 14 were micB and 11 were NHCB. We observed FCD below the mean - 2SD for gestational age in all 14 micB cases, but in only four of the 11 NHCB cases (P < 0.003). An acrocephalic-like cranial deformation was described at birth in five of the seven NHCB cases with normal FCD. The mean ± SD FCD Z-score of the micB cases was significantly lower (P < 0.001) than that of the false-positive ones: -3.85 ± 0.96 SD and -1.59 ± 1.45 SD, respectively. Based on HC measurement alone, the positive predictive value (PPV) was 56%. Combination of the HC and FCD criteria raised the PPV to 78%, decreasing the number of false positives from 11 to four, without missing any of the 14 micB cases. CONCLUSIONS Fetal vertical cranial biometric assessment in the mid-sagittal plane is feasible and correlates well with gestational age. In our series, a vertical cranial deformation was a frequent cause of a false Fmic diagnosis made on the basis of HC alone. Combination of the new vertical cranial biometric measurement with HC measurement can exclude these cases and thus improve diagnostic accuracy for Fmic. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- Z Leibovitz
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - C Shiran
- Maccabi Healthcare Services, North District, Israel
| | - K Haratz
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Tamarkin
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Schreiber
- Department of Pathology, Wolfson Medical Center, Holon, Israel
| | - G Malinger
- Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Division of Ob-Gyn Ultrasound, Tel Aviv, Israel
| | - L Ben-Sira
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - D Lev
- Genetics Institute, Wolfson Medical Center, Holon, Israel
| | - I Shapiro
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - H Bakry
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - B Weizman
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - A Zreik
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - D Kidron
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - S Egenburg
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - A Arad
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - T Lerman-Sagie
- Pediatric Neurology, Wolfson Medical Center, Holon, Israel
| |
Collapse
|
9
|
Leibovitz Z, Shkolnik C, Haratz KK, Malinger G, Shapiro I, Lerman-Sagie T. Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 2: application of nomograms to fetuses with posterior fossa malformations. Ultrasound Obstet Gynecol 2014; 44:581-587. [PMID: 24478245 DOI: 10.1002/uog.13312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To apply fetal midbrain (MB) and hindbrain (HB) nomograms, developed using three-dimensional multiplanar sonographic reconstruction (3D-MPR) in the mid-sagittal cranial plane, to fetuses with known posterior fossa malformations. METHODS In this retrospective study we examined sonographic volumes obtained by sagittal acquisition in 43 fetuses diagnosed with posterior fossa abnormalities and evaluated in the mid-sagittal cranial plane, using 3D-MPR, the following: MB parameters tectal length (TL) and anteroposterior midbrain diameter (APMD), and HB parameters anteroposterior pons diameter (APPD), superoinferior vermian diameter (SIVD) and anteroposterior vermian diameter (APVD). Fetuses were grouped, according to malformation, into eight categories: cobblestone malformation complex (CMC, n = 3), Chiari-II malformation (C-II, n = 7), pontocerebellar hypoplasia (PCH, n = 2), rhombencephalosynapsis (RES, n = 4), Dandy-Walker malformation (n = 8), vermian dysgenesis (VD, n = 7), persistent Blake's pouch cyst (n = 6) and megacisterna magna (n = 6). In each case and for each subgroup, the MB-HB biometric parameters and their z-scores were evaluated with reference to our new nomograms. RESULTS The new MB-HB nomograms were able to identify the brainstem and vermian anomalies and differentiate fetuses with MB-HB malformations from those with isolated enlarged posterior fossa cerebrospinal fluid spaces. Use of the nomograms enabled detection of an elongated tectum in fetuses with CMC, C-II and RES, and a flattened pontine belly in cases of CMC, PCH and VD. In the fetuses with VD, the nomograms enabled division into three distinctive groups: (1) those with small SIVD and APVD, (2) those with normal SIVD but small APVD, and (3) those with small SIVD but normal APVD. CONCLUSIONS Application of our new reference data, that for the first time include the MB, enables accurate diagnosis of brain malformations affecting the MB and HB and makes possible novel characterization of previously described features of posterior fossa anomalies.
Collapse
Affiliation(s)
- Z Leibovitz
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
10
|
Leibovitz Z, Shkolnik C, Haratz KK, Malinger G, Shapiro I, Lerman-Sagie T. Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 1: comparison of new and established nomograms. Ultrasound Obstet Gynecol 2014; 44:575-580. [PMID: 24448830 DOI: 10.1002/uog.13308] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To construct nomograms for fetal midbrain (MB) and hindbrain (HB) dimensions, assessed in the mid-sagittal cranial plane by three-dimensional multiplanar sonographic reconstruction (3D-MPR). METHODS This was a prospective cross-sectional study of 334 healthy fetuses in low-risk singleton pregnancies between 16 and 35 gestational weeks. All sonographic volumes were obtained by sagittal acquisition. The following MB and HB parameters were evaluated in the mid-sagittal cranial plane using 3D-MPR: MB parameters tectal length (TL) and anteroposterior midbrain diameter (APMD), and HB parameters anteroposterior pons diameter (APPD), superoinferior vermian diameter (SIVD), anteroposterior vermian diameter (APVD) and anteroposterior diameter of the fourth ventricle (APDFV). The measurements were presented as growth charts according to gestational age. RESULTS MB and HB biometry were best assessed between 19 and 29 weeks. During this period, adequate visualization was achieved for successful measurement of TL in 90.9% of cases, APMD in 86.6%, APPD in 73.7%, SIVD in 74.2%, APVD in 71% and APDFV in 71%. There was a linear growth pattern, with Pearson correlation coefficients of 0.79 for TL, 0.88 for APMD, 0.91 for APPD, 0.95 for SIVD, 0.88 for APVD and 0.88 for APDFV (P < 0.0001 for each). The mean intra- and interobserver variations for the MB measurements and vermian diameters ranged between 4.3% and 9%. APPD and APDFV showed highest mean variations: 9.0% and 19.4% (intraobserver) and 11.6% and 17.7% (interobserver), respectively. CONCLUSION We present new nomograms for assessment of the fetal MB and HB using 3D-MPR in the mid-sagittal cranial plane. To our knowledge, these are the first proposed nomograms for fetal MB dimensions.
Collapse
Affiliation(s)
- Z Leibovitz
- Unit of Fetal Neurology and Prenatal Diagnosis, Depassrtment of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
11
|
Leibovitz Z, Haratz KK, Malinger G, Shapiro I, Pressman C. Fetal posterior fossa dimensions: normal and anomalous development assessed in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Ultrasound Obstet Gynecol 2014; 43:147-153. [PMID: 23671019 DOI: 10.1002/uog.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 04/19/2013] [Accepted: 05/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To construct nomograms of the dimensions of the fetal posterior fossa (PF), assessed in the mid-sagittal plane in the second and third trimesters, and to assess how measurements from fetuses with PF abnormalities deviate from our normal ranges. METHODS This was a prospective cross-sectional study of 378 healthy fetuses in low-risk singleton pregnancies between 15 and 35 weeks. PF size was evaluated in the mid-sagittal plane of the fetal head using three-dimensional multiplanar reconstruction (3D-MPR). The borders of the PF were defined from the clivus to the tentorium (clivotentorial distance, CTD) and from the occipital bone to the level of the upper mesencephalic edge (tecto-occipital distance, TOD), and the posterior fossa area (PFA) and perimeter (PFP) were assessed. Growth charts were produced. Thirty-nine fetuses diagnosed with PF malformations were analyzed by calculating the z-scores of PFA, PFP, TOD and CTD, relative to the developed nomograms. RESULTS Of the 378 healthy fetuses initially included, there were 281 with adequate visualization of the PF borders; i.e. PF mid-sagittal plane morphometry was feasible in 74.3% of cases. There was a linear relationship between each of PFA, PFP, TOD and CTD, and gestational age, with Pearson correlation coefficients of 0.97, 0.97, 0.96 and 0.95, respectively (P < 0.001 for each). Chiari II malformation (CM-II) and Dandy-Walker malformation (DWM) were associated with the greatest difference in PF size compared with normal; PFA z-scores exceeded 2.6 in all five DWM cases and were below -2.66 in all 11 CM-II cases. CONCLUSIONS Sonographic evaluation of fetal PF size in the mid-sagittal plane is feasible. Our constructed nomograms provide reference data that may be helpful when evaluating PF congenital malformations.
Collapse
Affiliation(s)
- Z Leibovitz
- Division of Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | | | | | | | | |
Collapse
|
12
|
Leibovitz Z, Egenburg S, Bronshtein M, Shapiro I, Tepper R, Malinger G, Ohel G. Sonographic imaging of fetal tympanic rings. Ultrasound Obstet Gynecol 2013; 42:536-544. [PMID: 23349078 DOI: 10.1002/uog.12416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/23/2012] [Accepted: 01/04/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine the feasibility of ultrasonographic imaging of fetal tympanic rings. METHODS This was an observational cohort study of 80 healthy fetuses in low-risk pregnancies, divided into four gestational-age subgroups (12, 16, 23 and 32 weeks), each comprising 20 consecutive fetuses. Tympanic ring visualization was achieved by two-dimensional and three-dimensional (3D) sonography. A standard algorithm for tympanic ring examination was constructed using 3D multiplanar reconstruction. The volume acquisition plane was directed to the inferolateral aspect of the fetal temporal bone. Transvaginal scans were carried out in the 12-week and 16-week subgroups, and transabdominal scans in the 23-week and 32-week subgroups. Study parameters included the inferomedial inclination angle (IMIA) of the tympanic ring relative to the vertical skull axis, the anteromedial inclination angle (AMIA) of the tympanic ring relative to the anteroposterior skull axis and the longest (LTRD) and shortest (STRD) tympanic ring diameter, the latter measured perpendicular to the LTRD. The feasibility of tympanic ring demonstration was assessed in each gestational-age subgroup. RESULTS Tympanic rings appeared as round-oval, thin, echogenic structures in a plane tangential to the inferolateral surface of the fetal skull below the inferior border of the squamous part of the temporal bone. Higher demonstration rates were achieved in the 16-week and 23-week subgroups (90% and 80%, respectively) than in the others. LTRD and STRD each showed a linear correlation with gestational age (r = 0.96 for both measurements; P < 0.01). Mean IMIA ranged from 41.0 to 60.4° and mean AMIA from 17.3 to 23.4° across the different gestational-age subgroups. The malleal manubrium was observed only in examinations in the second half of pregnancy, appearing as a bright echo within the upper area of the tympanic ring in 56% (9/16) and 82% (9/11) of cases with tympanic ring imaging appropriate for measurement of the study parameters in the 23-week and 32-week subgroups, respectively. CONCLUSION This is the first report of sonographic imaging of fetal tympanic rings and shows that this is feasible in the second trimester. We discuss the possible implications of our findings for the prenatal diagnosis of congenital hearing loss.
Collapse
Affiliation(s)
- Z Leibovitz
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | | | | | | | | | | | | |
Collapse
|
13
|
Sammour RN, Gonen R, Ohel G, Leibovitz Z. Cervical varices complicated by thrombosis in pregnancy. Ultrasound Obstet Gynecol 2011; 37:614-616. [PMID: 21308832 DOI: 10.1002/uog.8946] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 05/30/2023]
Abstract
We present a case of a 36-year-old pregnant woman with varicose veins of the uterine cervix diagnosed during the second trimester. The cervical tissue was completely replaced with dilated venous plexus. Therapeutic decisions were further complicated by the presence of blood clots within the dilated vessels. Pregnancy proceeded uneventfully, no bleeding occurred and the patient underwent a planned Cesarean delivery. This is the first reported case in the medical literature where the rare phenomenon of cervical varices was accompanied by thrombosis.
Collapse
Affiliation(s)
- R N Sammour
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
| | | | | | | |
Collapse
|
14
|
Degani S, Tamir A, Leibovitz Z, Shapiro I, Gonen R, Ohel G. Three-dimensional power Doppler in the evaluation of painful leiomyomas and focal uterine thickening in pregnancy. Int J Gynaecol Obstet 2007; 99:122-6. [PMID: 17888922 DOI: 10.1016/j.ijgo.2007.04.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 04/26/2007] [Accepted: 04/27/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the usefulness of 3-dimensional (3D) power Doppler ultrasound in distinguishing painful leiomyomas from focal myometrial contractions or nonpainful leiomyomas in pregnancy. METHODS A 2D section of the area of interest in the uterine wall was first obtained in 29 patients to determine whether the pain originated from a myoma or a uterine contraction. Then, volume acquisition was activated and Doppler indices (vascularization index, flow index, and vascularization-flow index) were calculated for thickened and normal uterine wall. RESULTS Of 15 patients found to have uterine myomas, 11 had multiple tumors and 4 had single tumors. In the remaining 14 patients the painful uterine thickening proved to be a focal contraction. Painful segments of uterine thickening were associated with lower Doppler indices. Painful myomas were found to have significantly lower indices than normal uterine wall (P=0.008, 0.03, and 0.01 for VI, FI, and VFI, respectively, vs. 0.001, 0.003, and 0.01). However, the differences in indices between nonpainful myomas and uterine wall on the one hand, and nonpainful myomas and focal uterine contractions on the other, were not statistically significant. CONCLUSION Three-dimensional power Doppler ultrasound may be a sensitive and reliable tool for distinguishing painful uterine myomas from focal myometrial contractions and nonpainful myomas.
Collapse
Affiliation(s)
- S Degani
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
| | | | | | | | | | | |
Collapse
|
15
|
Aharoni A, Leibovitz Z, Levitan Z, Degani S, Ohel G. Complication of laparoscopic detorsion of adnexal mass. Gynecol Obstet Invest 2007; 65:39-40. [PMID: 17703093 DOI: 10.1159/000107459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 03/20/2007] [Indexed: 11/19/2022]
Abstract
Detorsion of an ischemic adnexal mass has recently been advocated for most cases of twisted adnexa. Usually, the affected ovary regains some or all of its vitality and function. However, when the ovary is completely necrotic, it may form an abscess if it contains tissue components that cannot be eliminated by the peritoneal immune system. We report a case of pelvic abscess formation in a detorsed ovary that previously contained an unsuspected dermoid cyst. We call for an extensive inspection of the detorsed ovary before ending the laparoscopic operation, and if it remains necrotic and is suspected of containing a dermoid cyst, it should be removed promptly.
Collapse
Affiliation(s)
- A Aharoni
- Gynecology and Obstetrics Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
| | | | | | | | | |
Collapse
|
16
|
Tal J, Ziskind G, Paltieli Y, Leibovitz Z, Fishman A, Ohel G, Paz G, Lewit N, Calderon I. ICSI outcome in patients with transient azoospermia with initially motile or immotile sperm in the ejaculate. Hum Reprod 2005; 20:2584-9. [PMID: 15980009 DOI: 10.1093/humrep/dei103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In patients with transient azoospermia, few sperm may be found in the ejaculate. We investigated the outcome of ICSI in patients with transient azoospermia. METHODS Records of patients with transient azoospermia referred during a 42 month period were reviewed. If only immotile sperm were found, the sample was incubated with 30% human serum albumin (HSA) before motility re-assessment. If still immotile, mechanical assessment of sperm viability was utilized. Study groups were: (A) motile sperm; (B) motility achieved by HSA; (C) no motility, but viability assessed by a mechanical technique; and (D) control group with sperm counts from 1 to 5 x 10(6)/ml. There were 57 couples (cycles) in the study group and 43 couples (cycles) in the control group. RESULTS Age, days of stimulation and endometrial thickness were comparable among groups. In 29.8% of the cycles, only immotile sperm were found. Fertilization and cleavage rates were higher in groups A and D than in groups B and C. Clinical pregnancy rate/cycle and live birth rate/cycle were not different among groups. No congenital malformations were found in newborns. CONCLUSION Fertilization and cleavage rates were lower in patients with initially immotile sperm compared with those with initially motile sperm and oligoasthenoteratozoospermia patients. Clinical pregnancy and viable pregnancy rates were not statistically different among groups, although when only immotile sperm were present both clinical pregnancy and live birth rate were lower in comparison with cycles with motile sperm.
Collapse
Affiliation(s)
- J Tal
- IVF Unit, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, the Technion, Haifa, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Riskin A, David M, Peskin B, Tamir A, Vafsi O, Leibovitz Z, Riskin-Mashiah S, Israel N, Merksamer R, Bader D. The role of umbilical cord alpha fetoprotein as a screening tool for neonatal hyperbilirubinemia. Am J Perinatol 2004; 21:93-8. [PMID: 15017473 DOI: 10.1055/s-2004-820518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Our aim was to test whether alpha fetoprotein (AFP) might serve as a marker of hepatic immaturity sufficient to predict an increased risk for neonatal hyperbilirubinemia (NHB) in term babies. We checked umbilical cord AFP (UC AFP) levels in 174 healthy full-term infants (male/female ratio 1.26:1) at birth. Bilirubin levels were measured upon discharge from the nursery on day 3 of life (mean, 57 +/- 10 hours of life). Mean UC AFP was 60.2 +/- 45.9 mg/L. UC AFP levels were linearly correlated with subsequent bilirubin levels, and significantly higher bilirubin levels were found in neonates whose UC AFP levels were 100 mg/L or more. Although statistically significant correlation between UC AFP and subsequent NHB exists, UC AFP cannot currently be recommended for use in clinical practice because of its inability to serve as a screening tool for significant NHB in the individual newborn.
Collapse
Affiliation(s)
- A Riskin
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Aharoni A, Condrea A, Leibovitz Z, Paz B, Levitan Z. A comparative study of Foley catheter and suturing to control trocar‐induced abdominal wall haemorrhage. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1365-2508.1997.680474.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A. Aharoni
- Bnai Zion Medical Center Technion Institute of Technology Haifa Israel
| | - A. Condrea
- Bnai Zion Medical Center Technion Institute of Technology Haifa Israel
| | - Z. Leibovitz
- Bnai Zion Medical Center Technion Institute of Technology Haifa Israel
| | - B. Paz
- Bnai Zion Medical Center Technion Institute of Technology Haifa Israel
| | - Z. Levitan
- Bnai Zion Medical Center Technion Institute of Technology Haifa Israel
| |
Collapse
|
19
|
Abstract
OBJECTIVE To construct nomograms for cranial base parameters of normal fetuses. STUDY DESIGN A cross-sectional study of 386 normal singleton fetuses at 14-40 weeks' gestation. Measurements of the length and width of the sphenoid bone anteriorly and the otic cartilage posteriorly and of the angles between the ridges were obtained. RESULTS Nomograms of the length and width of sphenoid ridge and otic cartilage, and of the angles in the cranial fossae are presented. A linear growth function was observed between cranial base measurements (sphenoid ridge length, otic cartilage length, cranial base angles) and gestational age, femur length and biparietal diameter. CONCLUSION Measurements of the length of cranial base ridges and the angles between them can be obtained easily in the second and third trimesters and might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities.
Collapse
Affiliation(s)
- S Degani
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | | | | | | | |
Collapse
|
20
|
Abstract
We present a case of the diagnosis of an appendiceal mucocele in a 23-year-old woman. The unusual preoperative sonographic appearance of the lesion is described and its clinical significance and differential diagnosis are discussed.
Collapse
Affiliation(s)
- S Degani
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVE To evaluate cardiac dimensions and function in euploid fetuses with intracardiac echogenic foci. STUDY DESIGN Forty-eight fetuses with a single cardiac echogenic focus situated in the left ventricle had echocardiography performed at 22-24 weeks of gestation. Fifty normal fetuses at 22-24 weeks' gestation served as controls. Two-dimensional and M-mode directed fetal echocardiography were used to exclude cardiac anomalies and measure right and left ventricular free walls and interventricular septal thickness and ventricular systolic and diastolic dimensions. Cardiac size was expressed as a ratio of ventricular wall thickness/biparietal diameter, and cardiac function was expressed as ventricular shortening fraction. Doppler fetal echocardiography measurements included pulmonary and aortic maximum systolic velocities and time to peak velocities as indices of ventricular systolic function, and the ratio between early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities at the level of the atrioventricular valves as an index of ventricular diastolic function. RESULTS Early ventricular filling/active atrial filling peak velocity ratios were significantly lower in fetuses with intracardiac echogenic foci than in control fetuses. In the mitral valve the ratio was 0.37 +/- 0.14 (0.039) (mean +/- SD (95% confidence interval for difference between the means)) vs. 0.59 +/- 0.19 (0.052) and in the tricuspid valve it was 0.42 +/- 0.16 (0.045) vs. 0.62 +/- 0.21 (0.058). No significant differences were found in cardiac dimensions, ventricular shortening fraction and Doppler systolic indices. CONCLUSION Euploid fetuses with intracardiac echogenic foci show low E/A ratio values in midtrimester echocardiography. This finding might indicate cardiac diastolic dysfunction.
Collapse
Affiliation(s)
- S Degani
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa 31048, Israel.
| | | | | | | | | |
Collapse
|
22
|
Leibovitz Z, Degani S, Rabia R, Tal J, Eibchitz I, Shapiro I, Paltieli Y, Aharoni A, Steinkuler M, Ohel G. Endometrium-to-myometrium relative echogenicity coefficient. A new sonographic approach for the quantitative assessment of endometrial echogenicity. Gynecol Obstet Invest 2000; 45:121-5. [PMID: 9517805 DOI: 10.1159/000009938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A computer program was developed to assess the endometrial echogenicity relative to the myometrial one, based on the gray-level processing of the midsagittal uterine image. The endometrial region of interest was specified within the upper part of the uterine cavity. The adjacent area of the myometrium was used to determine the reference brightness. The endometrial region of interest was analyzed along the anteroposterior uterine axis, as a set of thin strips directed parallelly to the midcavitary line. The endometrial/myometrial relative echogenicity coefficient (E/M REC) was computed for each strip and displayed graphically as a function of the distance from the midcavitary line. The area under the E/M REC curve within the limits of the total endometrial width was defined as total area (TA) and was used as a measure of the endometrial echogenicity. This parameter was assessed in 9 patients during their normal ovulatory cycles and in 29 IVF-treated patients with mechanical infertility. TA has a significant linear increase during the days of the ovulatory cycles. TA was found in high correlation with log(estradiol). TA can be used reliably for sonographic endometrial dating in ovulatory cycles.
Collapse
Affiliation(s)
- Z Leibovitz
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Leibovitz Z, Grinin V, Rabia R, Degani S, Shapiro I, Tal J, Eibschitz I, Harari O, Paltieli Y, Aharoni A, Zeevi J, Ohel G. Assessment of endometrial receptivity for gestation in patients undergoing in vitro fertilization, using endometrial thickness and the endometrium-myometrium relative echogenicity coefficient. Ultrasound Obstet Gynecol 1999; 14:194-199. [PMID: 10550880 DOI: 10.1046/j.1469-0705.1999.14030194.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the outcome of in vitro fertilization (IVF) treatment in relation to the sonographic parameters of the endometrium. DESIGN AND METHODS Seventy-five patients with no uterine pathology (age 31.1 +/- 5.4 years) treated in our IVF clinic for various indications were assessed during 75 cycles in which good-quality (grades 1 and 2) embryos were transferred. Controlled ovarian stimulation was achieved by the long protocol (gonadotropin releasing hormone agonist and gonadotropins). The bilayered endometrial thickness (BET), estradiol, luteinizing hormone and progesterone serum levels were measured in 272 tests. A special computer program was used to measure endometrial echogenicity relative to myometrial echogenicity. The gray-level data were analyzed on the basis of the midsagittal sonographic uterine image. Endometrium-myometrium relative echogenicity coefficient (E/M REC) values were computed and displayed graphically along the anteroposterior axis of the endometrial layers in the upper part of the uterine cavity. The area under the E/M REC curve within the BET limits was defined as the relative echogenicity area (REA) and was used as a measure of endometrial echogenicity. Each cycle was sampled in six time segments representing desensitization, follicular and luteal phases. Assigning the day of ovum pick-up as day 0, the time segments of each cycle were: first, day -20 to day -11; second, day -10 to day -6; third, day -5 to day -2; fourth, day 0; fifth, day +7 to day +14; sixth, day +15 to day +21. RESULTS A total of 276 embryos were transferred (3.68 +/- 1.01 per cycle), of which 223 were of good quality (2.97 +/- 1.51 per cycle). An intrauterine pregnancy was diagnosed in 29 patients. All patients in this study had a BET of > 5 mm in the third and the fourth time segments. There was no significant difference in BET and REA between pregnant and non-pregnant patients tested in the first to the fifth time segments of the IVF cycles. Both BET and REA measured in the sixth time segment were significantly higher in pregnant compared to non-pregnant patients. CONCLUSIONS Our results suggest that the proposed sonographic assessment of the endometrium shows no benefit in characterization of uterine receptivity in IVF patients with a reactive endometrium. High BET and REA values can indicate pregnancy during the sixth time segment, when the decidualization of the endometrium is well established.
Collapse
Affiliation(s)
- Z Leibovitz
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Tal J, Schliamser LM, Leibovitz Z, Ohel G, Attias D. A possible role for activated protein C resistance in patients with first and second trimester pregnancy failure. Hum Reprod 1999; 14:1624-7. [PMID: 10357988 DOI: 10.1093/humrep/14.6.1624] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Thrombophilia was recently suggested as a possible factor in recurrent pregnancy losses. We studied prospectively 125 patients (mean age 31.4 +/- 5.6 years) with one or more first or second trimester pregnancy losses for the prevalence of activated protein C resistance (APCR). Proteins C and S antigens, antithrombin III, anticardiolipin, and lupus anti-coagulant were also evaluated. Patients with uterine malformations, hormonal abnormalities, chromosomal translocations and infectious causes were excluded. A control group of 125 women with no past fetal loss were matched with the study group. Whenever the APC-sensitivity ratio (APC-SR) was </=2.2, polymerase chain reaction for factor V mutation (Leiden) was performed. Heterozygosity for the mutation was found in 18 patients (14.4%) compared with seven heterozygous among 125 control group (5. 6%; P < 0.05). Acquired APCR (APC-SR 1.8 and Leiden negative) was revealed in seven patients (5.6%) in the study group and in three of the controls (2.4%; not significant). The rate of preclinical pregnancy losses (17/48) and second trimester miscarriages (10/48) in mutation carriers was significantly higher than in patients with no APCR (25/214) and (14/214) respectively (P < 0.001 and P < 0.01 respectively). Live birth rate was not different between the two groups. Occurrence of APCR with any kind of pregnancy loss calculated per patient, in our study group, was approximately 1/7, 1/4 and 1/5 with one, two and three or more pregnancy losses respectively. These findings suggest that assessment of APCR should be considered in a more extended evaluation of such patients.
Collapse
Affiliation(s)
- J Tal
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Rappaport Faculty of Medicine, Technion, 47 Golomb St, PO Box 4049, Haifa 31048, Israel
| | | | | | | | | |
Collapse
|
25
|
Shapiro I, Degani S, Leibovitz Z, Ohel G, Tal Y, Abinader EG. Fetal cardiac measurements derived by transvaginal and transabdominal cross-sectional echocardiography from 14 weeks of gestation to term. Ultrasound Obstet Gynecol 1998; 12:404-418. [PMID: 9918089 DOI: 10.1046/j.1469-0705.1998.12060404.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Most of the routine ultrasound screening in our institution consists of early transvaginal examinations at 14-17 weeks. Complete fetal echocardiography is performed in every case. However, normal values for most fetal cardiac structures at this stage of gestation are not available. Our aim was to construct normal ranges for fetal cardiac structures, derived from cross-sectional echocardiography, at 14-40 weeks of gestation. DESIGN A prospective study was performed. The study group consisted of 637 pregnant women referred for a routine sonographic examination. Women with abnormal prenatal or postnatal outcome were not included in the study. Transvaginal examinations were used for 14-17 weeks of gestation. More advanced pregnancies were examined transabdominally. RESULTS We constructed normal ranges for the left and right end-diastolic transverse ventricular diameters (n = 637), left/right ventricular ratio (n = 637), aortic root diameter (n = 637), pulmonary artery diameter (n = 637), aortic/pulmonary ratio (n = 490), left and right transverse atrial diameters (n = 201) and left/right atrial ratio (n = 201). CONCLUSIONS The results provide the examiner with normal ranges for fetal cardiac structures for the early transvaginal examination. The continuity of all curves from 14 to 40 weeks of gestation allows follow-up of any specific fetus to term.
Collapse
Affiliation(s)
- I Shapiro
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion, Faculty of Medicine, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
The purpose of this study was to evaluate in vivo the changes in myometrial thickness throughout pregnancy. Myometrial thickness was measured in 25 singleton uncomplicated pregnancies. Ultrasonographic sagittal and transverse sections were used to measure uterine wall thickness from the low anterior wall (lower segment) and the anterior, posterior, right, and left walls of the upper segment and from the fundus. In each case four measurements were made in the second and third trimesters. Myometrial thickness of the upper uterine segment remains fairly constant in the first and second trimesters of pregnancy, whereas a significant linear trend was found between a decreasing thickness of the lower uterine segment and advancing gestational age. Myometrial thickness is significantly increased behind the placental insertion site as compared to other portions of the uterine wall. These data may serve as baseline reference values for further studies in the antepartum fetal surveillance of high-risk pregnancies.
Collapse
Affiliation(s)
- S Degani
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | | | | | | | | |
Collapse
|
27
|
Leibovitz Z. Humour and dialysis. EDTNA ERCA J 1998; 24:17-8. [PMID: 10222908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
There are many articles on the connection between the spirit and the body and the influence of a good mood on the way people deal with physical problems. This paper will demonstrate that the use of humour is a way of influencing our patients' spirit in order to help them deal with problems relating to their illness. In our every day experience with renal patients, we have noticed that humour helps us reduce patients' anxiety, before the first dialysis, before using the dialysis needles, or before performing painful procedures. Humour also helps us to offset the anger patients often express during treatment. Humour brings about a better atmosphere and the possibility of creating positive communication with the patients in a more relaxed environment and in a much more effective way. Our findings are similar to those in the literature and conclude that humour is an aid for dealing with patients' problems.
Collapse
|
28
|
Shapiro I, Friedman Z, Lysyansky P, Leibovitz Z, Degani S, Ohel G. The instantaneous measurement of multiple Doppler spectra in the investigation of ovarian masses. Ultrasound Obstet Gynecol 1998; 11:353-356. [PMID: 9644776 DOI: 10.1046/j.1469-0705.1998.11050353.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The use of Doppler indices of tumor vascularity as markers for malignancy has been a subject of debate, with inconsistencies in specificity and sensitivity as well as in the diagnostic cut-off values. Part of the discrepancy might be explained by the limited number of vessels selected within the tumor for Doppler evaluation. A typical sample of three or four vessels may not be sufficiently large for correct representation of the vasculature of the tumor, which may contain many vessels. The existing conventional Doppler (color and spectral) techniques clearly have limitations. We present here a novel Doppler modality, namely two-dimensional spectral Doppler imaging (SDI), which allows the acquisition of many Doppler spectra within a few seconds. The operator selects a region of interest within a color Doppler image. The Doppler sequence is initiated and the entire selected region is automatically scanned for about 20 s until all spectral Doppler data have been acquired and processed. The system computer generates a color-coded map of the desired Doppler indices overlaid on the gray-scale image. The system also displays a cumulative histogram or a table of the requested Doppler index from all the sections in the tissue. The whole process is automatically performed by the system computer, without any need for operator intervention. The system provides the examiner with a 'fishing net' for Doppler indices, instead of the 'fishing hook' used in current techniques.
Collapse
Affiliation(s)
- I Shapiro
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
29
|
Degani S, Leibovitz Z, Shapiro I, Gonen R, Ohel G. Fetal pyelectasis in consecutive pregnancies: a possible genetic predisposition. Ultrasound Obstet Gynecol 1997; 10:19-21. [PMID: 9263418 DOI: 10.1046/j.1469-0705.1997.10010019.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Mild fetal pyelectasis is a relatively common finding. The objective of this study was to assess its recurrence rate in subsequent pregnancies. The study comprised 420 women with two consecutive normal uncomplicated pregnancies screened at 15-24 weeks' gestation by ultrasound. Pyelectasis was defined as a fetal pelvis of 4 mm or more in its anterior-posterior dimensions. Of 64 fetuses with pyelectasis, 43 (67%) had a recurrence of this finding in their subsequent pregnancy. Compared with normal fetuses, those with pyelectasis had a relative risk of 6.1 to have a recurrence of this finding in their next pregnancy (95% confidence interval, 4.3-7.5, p < 0.001). These results suggest a predisposition for pyelectusis that may be influenced by genetic and/or environmental factors. More data are needed before an accurate adjustment based on previous results can be made.
Collapse
Affiliation(s)
- S Degani
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | | | | | | | | |
Collapse
|
30
|
Leibovitz Z, Levitan Z, Aharoni A, Sharf M. Cervical cerclage in uterine malformations. Int J Fertil 1992; 37:214-7. [PMID: 1354207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
This retrospective study represents our experience with cervical cerclage (suture) in pregnancies with uterine malformation. Seventeen patients with uterine malformations were involved. In these patients, the outcome of 31 gestations with cervical cerclage was evaluated. Uterine malformation was associated with cervical incompetence in 41% of the patients. Term delivery rate and fetal loss were observed in 56% and 26% of pregnancies, respectively. Infant salvage was not significantly different regardless of whether cervical incompetence was present or absent. A prolonged hospital stay and frequent use of tocolysis were noted during gestations with cerclage. Our data suggest that the outcome of pregnancies with uterine malformation was not improved by cervical cerclage when the indication for cerclage was the malformation itself.
Collapse
Affiliation(s)
- Z Leibovitz
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | | | | | | |
Collapse
|
31
|
Abstract
Colonization of the vagina by Candida is common during pregnancy, while candida sepsis in pregnancy is rare. A case of candida sepsis complicating an abortion prompted us to review seven additional cases that occurred during pregnancy or the postpartum period. In four women candidemia developed during pregnancy or following abortion, while in the other four it developed postpartum. Seven women had an apparent predisposing factor, such as antibiotic treatment or an intrauterine device. The clinical course was difficult in four patients and ended in death in three instances. Both amphotericin B and 5-fluorocytosine proved effective for treatment.
Collapse
Affiliation(s)
- I Potasman
- Infectious Diseases Unit, Bnai Zion Medical Center, Haifa, Israel
| | | | | |
Collapse
|
32
|
|
33
|
Affiliation(s)
- Z. Leibovitz
- H.L.S. Ltd., Industrial Engineering Co.; P.O. Box 193 Kiriat Ayre, Petah-Tikva Israel
| | - C. Ruckenstein
- H.L.S. Ltd., Industrial Engineering Co.; P.O. Box 193 Kiriat Ayre, Petah-Tikva Israel
| |
Collapse
|
34
|
|
35
|
|
36
|
Leibovitz Z, Gatt S. Enzymatic hydrolysis of sphingolipids. VII. Hydrolysis of gangliosides by a neuraminidase from calf brain. Biochim Biophys Acta 1968; 152:136-43. [PMID: 4296329 DOI: 10.1016/0005-2760(68)90015-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
37
|
Benbassat J, Groen JJ, Heiman-Hollander E, Leibovitz Z. The influence of packing, stagnation and isoagglutination on glucose utilization, glutathione and cation content of human red blood cells in vitro. Clin Sci (Lond) 1966; 30:51-62. [PMID: 5910937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|