Maxillo–occipital line: a sonographic marker for screening of open spina bifida in the first trimester of pregnancy

Ramkrishna, Jayshree; Júnior, Edward Araujo; Peixoto, Alberto Borges; Costa, Fabrício da Silva; Meagher, Simon

doi:10.1080/14767058.2018.1481384

Cited by 9 publications

(22 citation statements)

References 26 publications

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“…A previously published study evaluating the MO line has shown excellent results with detection of 100% of spina bifida cases and no false positives . In our study, all but one case with sacral open spina bifida had an abnormal MO line (false positive 0.1%).…”

Section: Discussionmentioning

confidence: 93%

“…On a sagittal view of the fetal head, measurements of the IT, BS, and BSOB were obtained on the stored images according to the original description by their authors (Figure ). The ratio between the BS and the BSOB was calculated.…”

Section: Methodsmentioning

confidence: 99%

“…In Feldkirch, Austria, ethical approval was not required because of the study design; however, all patients provided informed consent to use the data. On a sagittal view of the fetal head, measurements of the IT, BS, and BSOB were obtained on the stored images according to the original description by their authors 8,12,13 (Figure 1). The ratio between the BS and the BSOB was calculated.…”

Section: Study Design and Populationmentioning

confidence: 99%

“…It has been suggested that combining these two diameters into a BS/BSOB ratio may be more accurate when the ratio is above the 95th percentile for gestation or above 1 irrespective of the gestational age . Also in the sagittal view, the junction between the midbrain and the BS below the maxillo‐occipital (MO) line was reported as a sign of open spina bifida . In the axial view, a smaller biparietal diameter (BPD) has been suggested as a useful marker, either alone or after adjustment for the crown‐rump length (CRL) or abdominal circumference (AC) .…”

Section: Introductionmentioning

confidence: 99%

“…12 Also in the sagittal view, the junction between the midbrain and the BS below the maxillo-occipital (MO) line was reported as a sign of open spina bifida. 13 In the axial view, a smaller biparietal diameter (BPD) has been suggested as a useful marker, either alone or after adjustment for the crown-rump length (CRL) or abdominal circumference (AC). [14][15][16][17] In the same section, subjective posterior displacement of the midbrain against the occipital bone was first observed and then objectively quantified via measurement of the distance between the occipital bone and the aqueduct of Sylvius (AoS).…”

Section: Introductionmentioning

confidence: 99%

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Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation

Wertaschnigg

Ramkrishna²,

Ganesan³

et al. 2019

Prenatal Diagnosis

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Objectives To compare the sonographic signs of spina bifida obtained on axial and sagittal views of the fetal head between 11 and 13+6 weeks of gestation. Methods This was a retrospective study including 27 cases of spina bifida and 1003 randomly selected controls. Indirect markers of spina bifida were evaluated on stored ultrasound images. Intracranial translucency (IT), ratio between the brainstem and the brainstem–occipital bone distance (BS/BSOB), and maxillo‐occipital (MO) line were assessed on sagittal view, whereas biparietal diameter (BPD), BPD to abdominal circumference ratio (BPD/AC), and aqueduct to occipital bone (aqueduct of Sylvius [AoS]) distance were measured on the axial plane. Reference ranges were developed, and cases of spina bifida were examined in relation to the reference range. Results On the sagittal view, detection rates for IT below the fifth percentile, BS/BSOB above the 95th percentile, and an abnormal MO line were 52.3%, 96.3%, and 96.3%, respectively. On the axial view, detection rates for BPD, BPD/AC, and AoS below the fifth percentile were 66.7%, 70.4%, and 77.8%, respectively. Conclusion The MO line and the BS/BSOB ratio appear to be the best indirect ultrasound markers of spina bifida and can be easily obtained during the routine first‐trimester scan.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Study Design and Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation

Wertaschnigg

Ramkrishna²,

Ganesan³

et al. 2019

Prenatal Diagnosis

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First‐Trimester Cranial Ultrasound Markers of Open Spina Bifida

Zhu¹,

Zhao²,

Yang³

et al. 2020

J of Ultrasound Medicine

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Objectives To evaluate cranial ultrasound markers during a first‐trimester routine ultrasound examination for screening for open spina bifida (OSB). Methods Midsagittal and axial images of the fetal head obtained from fetuses with spina bifida and unaffected control fetuses at 11 weeks to 13 weeks 6 days were analyzed retrospectively. The observed markers of the posterior brain included the 4‐ versus 3‐line view, the brain stem (BS)‐to‐brain stem‐occipital bone (BSOB) distance ratio (BS/BSOB), the position relationship between the maxillo‐occipital (MO) line and the midbrain‐BS junction, and the crash sign status. Results This study included 9 OSB cases, 2 closed spina bifida (CSB) cases, and 200 unaffected controls. Eight of 9 OSB cases had informative midsagittal views of the head. The 3‐line view (abnormal) and BS/BSOB greater than 1 (abnormal) were observed in 87.5% (7 of 8) and 100% (8 of 8), respectively. The midbrain‐BS junction was below or nearly on the MO line (abnormal) in 100% (8 of 8). Seven of the cases had informative axial views of the head. The crash sign (abnormal) was observed in 85.7% (6 of 7). A 3‐line view was seen in all of the cases that had a positive crash sign. Neither of the 2 cases of CSB and none of the controls had any of the 4 first‐trimester intracranial ultrasound markers of OSB. Conclusions The 4 first‐trimester intracranial ultrasound markers investigated in this study appear to be very good markers of OSB, especially a BS/BSOB greater than 1 and an abnormal MO line. The crash sign and 3‐line view were observed in the same fetus. In our study, these ultrasound findings were not helpful in CSB.

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Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11–13 weeks' gestation

Chaoui¹,

Benoit

Entezami³

et al. 2019

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Increased fetal choroid-plexus-to-head-size ratio is a new sign for the easy detection of spina bifida in the first trimester. What are the clinical implications of this work?This sign should facilitate detection of spina bifida during the routine first-trimester scan. ABSTRACTObjectives To measure the ratio of choroid plexus (CP) size to head size in normal fetuses and to compare it to that in fetuses with open spina bifida (OSB) and quantify the subjective sign of a 'dry brain'.Methods This was a retrospective study of ultrasound images, obtained during first-trimester screening between 11 and 13 weeks of gestation, from 34 fetuses with OSB and 160 normal fetuses. From the hospital databases, we retrieved images of the fetal head in the transventricular axial plane. We measured the areas of both CPs and the head and calculated the ratio between them. We also measured the longest diameter of each CP and calculated their mean (CP length), and measured the occipitofrontal diameter (OFD) and calculated the ratio of CP length to OFD. Measurements from the OSB fetuses were plotted on crown-rump length (CRL) reference ranges constructed using data from the normal fetuses, and Z-scores were calculated. ResultsIn the normal fetuses, the CP area increased, while the ratios of CP area to head area and CP length to OFD decreased, with increasing CRL. In 30 of the 34 (88%) fetuses with OSB, both ratios were increased significantly and the CPs filled the entirety of the head, Correspondence to: Prof. R. Chaouigiving the impression of a dry brain. In these cases, the borders of the lateral ventricles could not be identified.Conclusions At 11-13 weeks, the majority of fetuses with OSB have reduced fluid in the lateral ventricles such that the CPs fill the head. The dry brain sign is easily visualized during routine first-trimester ultrasound examination while measuring the biparietal diameter, and can be quantified by comparing the size of the CPs to the head size. Until prospective data confirm the usefulness of this sign in screening for OSB, it should be considered as a hint to prompt the examiner to assess thoroughly the posterior fossa and spine.

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Maxillo–occipital line: a sonographic marker for screening of open spina bifida in the first trimester of pregnancy

Abstract: Maxillo-occipital line is an easy addition to the evaluation of first-trimester screening of open spina bifida. Further studies are needed to determine the false-positive and false-negative rates of this technique.

Cited by 9 publications

References 26 publications

Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation

Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation

First‐Trimester Cranial Ultrasound Markers of Open Spina Bifida

Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11–13 weeks' gestation

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