Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study of<scp>INTERGROWTH</scp>‐21<sup>st</sup>Project

Rodríguez-Sibaja, Maria Jose; Ohuma, Eric O; Napolitano, R.; Heyl, S; Carvalho, Maria; Jaffer, Y A; Noble, J. Alison; Purwar, Manorama; Pang, Ruoming; Ismail, Leila Cheikh; Lambert, Ann; Gravett, Michael G.; Salomon, Laurent; Drukker, Lior; Barros, Fernando C.; Kennedy, Stephen; Bhutta, Zulfiqar A; Papageorghiou, Aris T.

doi:10.1002/uog.22017

Cited by 20 publications

(24 citation statements)

References 67 publications

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“…Excluded studies and reasons for exclusion are reported in Table S3 . Finally, 42 studies, reported between January 1970 and 2021, met the inclusion criteria, and these provided data for 45,626 fetuses, included in the final analysis ( Table 1 ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The median sample size of participating fetuses was 372.5 (range: 50 to 8313; 25th percentile: 175.8; 75th percentile: 709.3).…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies reported more than one fetal brain structure [ 9 , 10 , 17 , 32 , 34 , 36 , 41 , 42 , 43 ]. In addition, 4 studies reported charts for POF [ 9 , 10 , 17 , 36 ], 6 for SF [ 9 , 10 , 17 , 35 , 36 , 44 ], 3 for AV [ 22 , 36 , 43 ], 14 for PV [ 7 , 8 , 14 , 19 , 23 , 26 , 27 , 30 , 32 , 34 , 36 , 38 , 40 , 43 ], 20 for TCD [ 12 , 15 , 16 , 18 , 20 , 21 , 24 , 25 , 28 , 31 , 32 , 34 , 39 , 41 , 42 , 43 , 45 ,…”

Section: Resultsmentioning

confidence: 99%

“…In 34 out of 42 studies (80%), a high risk of bias was found in >50% of the domains scored ( Figure 2 ). Only the studies by Napolitano et al and Rodriguez-Sibaja et al were at low risk of bias in a significantly high number of quality criteria, respectively, in 93% and 86%; all other studies were below 60% [ 36 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, only two studies reported a low risk of bias in the definition of inclusion/exclusion criteria. In addition, only two studies described detailed neonatal and development outcomes [ 36 , 39 ]. In two other studies, there was neurological follow-up described, but this was never assessed with a standardised approach in all fetuses included.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for this high source for bias identified in these fields is also probably related to the retrospective design (around 30% of the studies). Furthermore, in only four studies sample size estimation was performed [ 18 , 36 , 39 , 44 ], and only three studies had population-based sample selection [ 36 , 39 , 47 ], with all other studies reporting either convenience sampling or arbitrary recruitment or sampling methods that were not reported ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures

et al. 2021

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Ultrasound-based assessment of the fetal nervous system is routinely recommended at the time of the mid-trimester anatomy scan or at different gestations based on clinical indications. This review evaluates the methodological quality of studies aimed at creating charts for fetal brain structures obtained by ultrasound, as poor methodology could explain substantial variability in percentiles reported. Electronic databases (MEDLINE, EMBASE, Cochrane Library, and Web of Science) were searched from January 1970 to January 2021 to select studies on singleton fetuses, where the main aim was to construct charts on one or more clinically relevant structures obtained in the axial plane: parieto-occipital fissure, Sylvian fissure, anterior ventricle, posterior ventricle, transcerebellar diameter, and cisterna magna. Studies were scored against 29 predefined methodological quality criteria to identify the risk of bias. In total, 42 studies met the inclusion criteria, providing data for 45,626 fetuses. Substantial heterogeneity was identified in the methodological quality of included studies, and this may explain the high variability in centiles reported. In 80% of the studies, a high risk of bias was found in more than 50% of the domains scored. In conclusion, charts to be used in clinical practice and research should have an optimal study design in order to minimise the risk of bias and to allow comparison between different studies. We propose to use charts from studies with the highest methodological quality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures

et al. 2021

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Diagnosis of fetal cortical abnormalities by new reference charts for assessment of sylvian fissure biometry

et al. 2023

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Objective To develop novel fetal reference ranges for the characterization of the normal appearance of the Sylvian fissures (SF) along gestation and to apply them to fetuses with cortical abnormalities affecting the SF. Methods In this cross‐sectional study, we used three‐dimensional sonographic multiplanar reformatting (3D‐MPR) to examine the fetal SF. Normal development was assessed in the second and third trimesters. SF parameters were evaluated in predefined axial and coronal planes: insular height and length, SF depth, and the extent of the coverage of the insula by the frontal and temporal lobes. Intra‐observer variability and inter‐rater reliability for the studied parameters were evaluated. The new reference charts were applied to 19 fetuses with cortical abnormalities involving the SF who had appropriate sonographic volumes for 3D‐MPR analysis. Their diagnoses were confirmed by autopsy, fetal or postnatal MRI, genetic findings related to cortical malformations, or an abnormal cortical imaging pattern with similar MRI findings in an affected sibling. We applied the two previously published references for the evaluation of fetal SF development to these cases and compared the ability of the references to correctly detect SF abnormalities. Results The study included 189 fetuses of low‐risk singleton pregnancies between 24 and 34 gestational weeks. The insular length or height increased with gestational age in the axial and coronal planes with adjusted R2 = 0.621, p < 0.0001 and R2 = 0.384, p < 0.0001, respectively. The SF depth also increased with gestational age in the axial and coronal planes with adjusted R2 = 0.695, p < 0.0001 and R2 = 0.219, p = 0.008, respectively. The extent of the coverage of the insula by the frontal and temporal lobes in the coronal plane increased with gestational age (adjusted R2 = 0.627, p < 0.0001 and R2 = 0.589, p < 0.0001, respectively). The interclass correlation coefficients of the intra‐ and inter‐rater reliability of the studied parameters ranged between 0.71 and 0.97. The cortical anomalies in the 19 fetuses were polymicrogyria (7), simplified gyral pattern (3), dysgyria (3), lissencephaly (2), cortical malformation related to tubulinopathy (1), brain atrophy (1), cortical dysplasia (1), and cobblestone malformation (1). Three of the fetuses had multiple cortical anomalies. In 17 of 19 (89%) cases, at least one of our 6 SF parameters was found to be out of the normal range. In the coronal plane, SF height and depth were measured below 2SD in 9 (47%) and 4 (21%) cases, respectively. In the axial plane, SF length and depth were out of the normal ranges in six (31.5%) and four (21%), correspondingly. In the coronal plane, the opercular coverage by the frontal and temporal lobes was below 2 SD in 10 (52%) and 11 (57%), respectively. The scoring of the SF operculization by Quarello et al. was abnormal in 8 cases (42%). The measurement of the SF angle according to Poon et al. was abnormal in 14 cases (74%). Conclusions The fetal SF is a complex developing structure th...

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Use of focus point for plane acquisition to improve reproducibility in fetal biometry

Vignola

Donadono

Cavalli

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesTo assess reproducibility of ultrasound measurements for fetal biometry, using a ‘focus point’ (FP) for the acquisition of the relevant plane.Methods80 women with singleton normal pregnancies were included in the study at University College London Hospital, UK, between 18 and 37 weeks. Planes to measure head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained twice by sonographers with different experience, blind to each other, the first time requesting to obtain the plane referring to a standard image, the second time using the focus point. The focus point is a unique plane landmark that once identified, the sonographer is asked to rotate the probe along the 3 axes (x, y, z) to acquire the relevant plane keeping the focus point in view (cavum septum pellucidum for HC, 2/3 of the umbilical vein for AC and one of the two diaphyses for FL). Sonographers were either in training or with the experience of >3000 scans performed. Intra‐ and interobserver reproducibility were assessed using Bland‐Altman plots reporting absolute values or percentages.ResultsOverall reproducibility was good with 95% confidence intervals (CI) being <8%. Reproducibility was improved using the focus point compared with acquiring the plane without using the focus point, (95% CI <4% versus <6% for intra‐ and <7% versus <8% for interobserver reproducibility respectively). Findings were independent from sonographer seniority and plane acquired.ConclusionsFetal biometry reproducibility is improved with the use of the focus point for plane acquisition regardless of sonographer experience. We propose this method to be implemented in clinical practice and for training in fetal biometry.This article is protected by copyright. All rights reserved.

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Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study ofINTERGROWTH‐21^stProject

Cited by 20 publications

References 67 publications

A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures

A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures

Diagnosis of fetal cortical abnormalities by new reference charts for assessment of sylvian fissure biometry

Use of focus point for plane acquisition to improve reproducibility in fetal biometry

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Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study ofINTERGROWTH‐21stProject

Cited by 20 publications

References 67 publications

A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures

A Systematic Review of Methodology Used in Studies Aimed at Creating Charts of Fetal Brain Structures

Diagnosis of fetal cortical abnormalities by new reference charts for assessment of sylvian fissure biometry

Use of focus point for plane acquisition to improve reproducibility in fetal biometry

Contact Info

Product

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About

Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study ofINTERGROWTH‐21^stProject