First trimester detection of fetal open spina bifida using BS/BSOB ratio

• Published in: Archives of gynecology and obstetrics 2020-02, Vol.301 (2), p.333-340
• Main Authors: Sirico, Angelo, Raffone, Antonio, Lanzone, Antonio, Saccone, Gabriele, Travaglino, Antonio, Sarno, Laura, Rizzo, Giuseppe, Zullo, Fulvio, Maruotti, Giuseppe Maria
• Format: Article
• Language: English
• Subjects: Accuracy; Brain Stem - diagnostic imaging; Brain Stem - embryology; Endocrinology; Female; Fetus; Fetuses; Gestational Age; Gynecology; Health risk assessment; Human Genetics; Humans; Medicine; Medicine & Public Health; Meningomyelocele; Obstetrics/Perinatology/Midwifery; Occipital Bone - diagnostic imaging; Occipital Bone - embryology; Pregnancy; Pregnancy Trimester, First; Prenatal Care; Prenatal Diagnosis - methods; Review; Sensitivity and Specificity; Spina bifida; Spina Bifida Cystica - diagnostic imaging; Spinal Dysraphism - diagnostic imaging; Ultrasonic imaging; Ultrasonography, Prenatal - methods
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-019-05422-3

Background Despite the well-known second trimester ultrasound signs, current possibilities of in utero surgical repair of open spina bifida require a timely detection of the spine defect. Objective To evaluate the diagnostic accuracy of the ratio between brain stem (BS) diameter and its distance to the occipital bone (BSOB) (BS/BSOB ratio) in the detection of fetuses with open spina bifida at first trimester ultrasound. Methods A systematic review and meta-analysis of diagnostic accuracy was performed by searching seven electronic databases from their inception to February 2019 for all studies assessing the association between BS/BSOB ratio and diagnosis of spine bifida . Diagnostic accuracy of BS/BSOB ratio in prenatal diagnosis of spine bifida was assessed as sensitivity, specificity, positive and negative likelihood ratios (LR + and LR−), and area under the curve (AUC) on SROC curves. Results Four studies, including 17,598 fetuses with 23 cases of open spina bifida, were included in the meta-analysis. BS/BSOB ratio showed pooled sensitivity of 0.70 (95% CI 0.47–0.87; I 2  = 78.3%), specificity of 1.00 (95% CI 0.99–1.0; I 2  = 99.2%), LR + and LR− of 51.44 (95% CI 9.53–277.64; I 2  = 85.5%) and 0.23 (95% CI 0.04–1.17; I 2  = 64.8%), respectively, and an AUC of 0.9649. Conclusion First trimester BS/BSOB ratio has a high diagnostic accuracy in detecting fetuses with open spina bifida.