P25.13: Case report of spinal dysraphism with lemon and banana signs in the second trimester and normal intracranial translucency in the first trimester

Hynek, M.; Smetanová, D.; Hlavova, E.; Stejskal, D.

doi:10.1002/uog.8660

Cited by 2 publications

(4 citation statements)

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“…Hence, there is a growing body of literature providing evidence that the presence of the IT does not exclude a neural tube defect. Among others, Hynek et al [11] and Arigita et al [12] reported cases with open spina bifida where the IT was normal at 13 weeks of gestation. In the most recent study published on first trimester screening for open spina bifida, Mangione et al performed a retrospective study on 52 cases with open spina bifida and 208 normal fetuses and found that the absence of the cisterna magna is the best single screening parameter, superior to IT or posterior shift of the brainstem [13].…”

Section: Discussionmentioning

confidence: 99%

Detection of Spina Bifida by First Trimester Screening – Results of the Prospective Multicenter Berlin IT-Study

Chen

Gerhardt

Entezami³

et al. 2015

Ultraschall in Med

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To evaluate the potential of routine assessment of intracranial translucency (IT) and other posterior brain parameters in the early detection of open spina bifida during the 11 - 14 weeks screening examination. This prospective, multicenter longitudinal study was conducted with the participation of 20 certified DEGUM II or III experts in Berlin, Germany, between June 2010 and October 2013. All pregnant women undergoing a first trimester screening were included in the study and in every patient were the IT, brain stem (BS), cisterna magna (CM), BS to occipital bone distance (BSOB) and BS/BSOB ratio measured. All patients with continuing pregnancy underwent a second trimester scan. Our data was used to develop our own reference ranges. The primary outcome parameter was the presence of open spina bifida. A total of 15 526 women with 16 164 fetuses were examined. Median of the IT was 2.1 mm, of the CM 1.6 mm, of the BS 2.7 mm, of the BSOB 5.5 mm, and of the BS/BSOB ratio 0.49. There were 11 cases with open spina bifida (incidence of 6.8/10 000). The detection rate was 100 % and in all cases of spina bifida, the anomaly was detected either at the first examination (n = 8) or considered suspicious and the lesion then detected a few weeks later (n = 3). Considering individual measurements, however, the detection rate was 18 % with the complete absence of the IT and 45 % with cut-off values. For the CM measurement, the detection rate was 64 % with the absence of the CM and 73 % with cut-off values. The other parameters proved not to be predictive of open spina bifida. In the hands of an expert, open spina bifida can be reliably diagnosed early in gestation during the 11 - 14 weeks screening. The measurement of different parameters of the posterior brain, especially the CM and the use of cut-off values are of tremendous benefit in achieving a high sensitivity in the detection rate.

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Section: Discussionmentioning

confidence: 99%

Detection of Spina Bifida by First Trimester Screening – Results of the Prospective Multicenter Berlin IT-Study

Chen

Gerhardt

Entezami³

et al. 2015

Ultraschall in Med

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“…However, none of the pathophysiologic theories on the development of the Chiari II malformation consider the fourth ventricle a central anatomic structure affected by the neural tube defect. It is conceivable that the fourth ventricle is not always obliterated in first‐trimester fetuses with spina bifida, as was observed by other authors as well 2 , 3 . Considering the small number of first‐trimester spina bifida cases in the study by Chaoui et al 1 and in our own, it is possible that study patients were truly anatomically discrepant with respect to fourth ventricle obliteration by chance, thereby skewing the observed efficacy of this marker.…”

Section: Discussionmentioning

confidence: 44%

“…We performed a retrospective analysis of 250 first‐trimester sonographic examinations, consisting of 245 healthy fetuses and 5 fetuses with spina bifida. Images had been acquired in the process of nuchal translucency screening at Cedars‐Sinai Medical Center, in concordance with the guidelines of the Fetal Medicine Foundation 3 , 4 . The gestational ages ranged between 11 weeks and 13 weeks 6 days, consistent with a range of crown‐rump lengths between 45 and 83 mm.…”

Section: Methodsmentioning

confidence: 99%

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First‐Trimester Visualization of the Fourth Ventricle in Fetuses With and Without Spina Bifida

Solt

Acuna

Adeniji

et al. 2011

J of Ultrasound Medicine

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Objectives-The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle for first-trimester detection of spina bifida.Methods-A total of 250 digitally stored sonographic examinations at gestational ages of 11 weeks to 13 weeks 6 days (245 normal and 5 randomly interspersed spina bifida cases) were retrospectively analyzed by 4 blinded reviewers for the presence or absence of the fourth ventricle followed by an anteroposterior ventricular dimension measurement. The ventricle size was related to the crown-rump length and gestational age by linear regression analysis and Pearson correlation.Results-The fourth ventricle was identified in 971 of 1000 image readings (97.1%). False-negative and false-positive readings occurred in 11 of 20 (55.0%) and 20 of 980 (2.0%) cases, respectively (sensitivity, 0.45; specificity, 0.98.). False-negative and falsepositive readings were evenly distributed throughout the gestational age range. When the ventricular size was measurable, its mean dimensions increased linearly with gestational age and were below the fifth percentile in 10 of 245 (4.0%) normal and 0 of 4 spina bifida cases, respectively. Intraclass correlation coefficient estimates were calculated based on the 2-way analysis of variance model and found to be 0.30 for a single rater and 0.64 for the mean of 4 raters.Conclusions-Nonvisualization of the first-trimester fourth ventricle is a less robust screening parameter for spina bifida than previously published.

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P25.13: Case report of spinal dysraphism with lemon and banana signs in the second trimester and normal intracranial translucency in the first trimester

Cited by 2 publications

References 0 publications

Detection of Spina Bifida by First Trimester Screening – Results of the Prospective Multicenter Berlin IT-Study

Detection of Spina Bifida by First Trimester Screening – Results of the Prospective Multicenter Berlin IT-Study

First‐Trimester Visualization of the Fourth Ventricle in Fetuses With and Without Spina Bifida

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