Assessment of pericallosal artery at 11–14 weeks of gestation: Cohort study and meta‐analysis

Abstract

Objectives: To report the rate of visualization of the pericallosal artery (PCA) in the first trimester of pregnancy (11-14 weeks).Methods: Prospective observational study of consecutive fetuses undergoing first trimester risk assessment for chromosomal anomalies. The presence of PCA was assessed in a midsagittal view of fetal brain using high-definition power Color Doppler. A normal course of the PCA was defined as the visualization of an artery emerging from the anterior cerebral artery running parallel the corpus callosum (CC).The reference standard was the visualization of CC and PCA between the 20 and 22 weeks of gestation. We also performed a systematic review and meta-analysis of the published literature. Multivariate logistic regression and random-effect metaanalyses of proportion were used to analyze the data.Results: Cohort study: Five-hundred women were included. PCA was identified trans-abdominally or transvaginally at 11-14 weeks of gestation in 98.8% (95% CI 97.4-99.6: 494/500); of the four cases of PCA not identified one had a diagnosis of complete agenesis of the corpus callosum during the anomaly scan which was confirmed at birth. Systematic review of the published literature: Six studies (1093 fetuses, including the present series) were included. The PCA was detected at the 11-14 weeks scan and confirmed to co-exist with a normal CC at time of the anomaly scan in 96.9% (95% CI 93.8-99.0); 20.6% (95% CI 5.7-41.7) of fetuses with no clear identification of the PCA at the 11-14 weeks scan had a normal appearance of the CC at the time of anomaly scan. Conclusion:Prenatal ultrasonography has a high diagnostic accuracy in detecting PCA in the first trimester. Visualization of the PCA at the time of 11-14 scan is highly specific for the presence of a normal CC later in pregnancy.

Ectrodactyly‐ectodermal dysplasia‐clefting syndrome. Prenatal prospective ultrasound diagnosis

“…First trimester scan remains a very relevant step in foetal anatomic assessment and proper training and scanning protocols should be accurately defined to not miss syndromic and rare cases. [32][33][34][35] Future goal should be the reduction of false negative cases, paying careful attention to hands and feet when renal dysplasia is found, and vice versa when "lobster claw" or facial clefting are noted, it is advised to check the genitourinary tract. Likewise, after scanning the limbs, mid-facial cleft should be excluded and, invasive prenatal diagnosis should be offered when at least two of these signs are detected.…”

“…Renal dysplasia is not easily observed in the first trimester, but limb evaluation and mid‐facial cleft could be evaluated. First trimester scan remains a very relevant step in foetal anatomic assessment and proper training and scanning protocols should be accurately defined to not miss syndromic and rare cases 32–35 …”

3D ultrasound angioscan with MV‐Flow™: Enhancing fetal brain low‐flow microvascular neuroimaging

“…Previous investigations have demonstrated the usefulness of including Doppler ultrasound interrogation of the pericallosal artery as an indirect sign of normal development of the corpus callosum, from 11 to 13 weeks' gestation onwards 6–8 …”

“…Previous investigations have demonstrated the usefulness of including Doppler ultrasound interrogation of the pericallosal artery as an indirect sign of normal development of the corpus callosum, from 11 to 13 weeks' gestation onwards. [6][7][8] MV-Flow™ provides sonographers with a 3D ultrasound technology that, compared with conventional Doppler techniques, displays images with much higher definition and resolution at a higher frame rate, in the range of 30 to 60 Hz. As a 3D application, MV-Flow™ is based on interleaving technology, an advanced algorithm for improving sensitivity and suppressing flash and tissue artifacts, with the advantage of low-velocity flow visualization, high resolution, minimal motion artifacts, and high frame rate at the expense of low penetration and low black and white image quality.…”

First‐trimester ventriculomegaly in fetuses with callosal agenesis: Cause or association?

“…Those secondary structures that provide indirect signs of the condition in the second trimester, such as the cavum septi pellucidi that usually appears on ultrasound at around 18 weeks, do not help in the early diagnosis either. Nevertheless, identification of an abnormal developmental pattern of the pericallosal artery has been attempted, with relatively good efficiency in limited series 15,16. However, safety issues regarding the exposure to Doppler ultrasound in the first trimester raise questions regarding the incorporation of this technique for screening or diagnostic purposes.One key issue that arises from our observation is the temporal relationship between early ventriculomegaly and ACC.…”