Diagnosis of midline anomalies of the fetal brain with the three‐dimensional median view

• Published in: Ultrasound in obstetrics & gynecology 2006-05, Vol.27 (5), p.522-529
• Main Authors: Pilu, G., Segata, M., Ghi, T., Carletti, A., Perolo, A., Santini, D., Bonasoni, P., Tani, G., Rizzo, N.
• Format: Article
• Language: English
• Subjects: agenesis; Agenesis of Corpus Callosum; Biological and medical sciences; Brain - abnormalities; Cerebellum - abnormalities; Cisterna Magna - abnormalities; congenital anomalies; corpus callosum; Dandy–Walker malformation; Echocardiography; Echocardiography, Three-Dimensional; Female; fetus; Gynecology. Andrology. Obstetrics; Humans; Magnetic Resonance Imaging; Malformations of the nervous system; Medical sciences; Neurology; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; prenatal diagnosis; Sensitivity and Specificity; three‐dimensional ultrasound; Ultrasonography, Prenatal; ultrasound
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.2751

Objective To investigate the effectiveness of a simplified approach to the evaluation of the midline structures of the fetal brain using three‐dimensional (3D) ultrasound. Methods Sonographic examinations were performed in normal fetuses and in cases with anomalies involving the midline cerebral structures. Two‐dimensional (2D) median planes were obtained by aligning the transducer with the anterior fontanelle and midline sutures by either transabdominal or transvaginal scans. Median planes were also reconstructed using 3D ultrasonography from volumes acquired from transabdominal axial planes of the fetal head (3D median planes), by either multiplanar analysis of static volumes or volume contrast imaging in the coronal plane (VCI‐C). 2D and 3D median planes were compared qualitatively and quantitatively by measuring the corpus callosum and cerebellar vermis. Results 2D median planes could be visualized in 54/56 normal fetuses. 3D median planes were obtained in all, usually more easily and rapidly. There was a good correlation between 2D and 3D images. Measurements of the corpus callosum and cerebellar vermis were highly correlated, with mean variations of 6% and 14%, respectively. The abnormal group included 13 fetuses (five with partial or complete agenesis of the corpus callosum, six with posterior fossa malformations, two with a combination of these two anomalies). In all cases the diagnosis could be made by both 2D and 3D views and was always confirmed by postnatal investigation. Although 2D median views were of better quality, 3D images were always adequate for diagnosis, both in normal and abnormal fetuses. Conclusions 3D median planes are obtained more easily than 2D ones, and allow an accurate diagnosis of normal cerebral anatomy and anomalies. The 3D approach may be valuable particularly for rapid assessment of fetal cerebral anatomy in standard examinations. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.