Prenatal sonographic assessment of Sylvian fissure operculization (SFO): importance of distinguishing between screening and diagnostic tools and selecting precise anatomical landmarks

Abstract

Linked article: This Correspondence comments on Pooh et al. and on Poon et al.

Applicability of a Semiautomated Volumetric Approach (5D CNS+™) for Detailed Antenatal Reconstruction of Abnormal Fetal CNS Anatomy

“…Another (methodologically) relevant fact has been stressed by Quarello et al, who stated that the choice of CSP instead of fornices as the anterior most structure (or pivotal point for automatic plane reconstruction) for cortical maturation assessment may lead to misinterpretation of the modi cation of the SF shape and is prone to a certain variation in cutting Sect. 35 Although we generally agree, we believe that adherence to work ow-based volumetric approaches might considerably limit the extent of variation, imprecise diagnostic planes, and the need for manual plane adjustments.…”

“…14,29,30 Detailed prenatal judgment of even subtle changes in terms of cortical grading and sulci shape and depth is feasible [31][32][33][34] , but it necessitates exact image alignment and, more strikingly, an awareness of the adequacy of planar image adjustment based on anatomical landmarks, as described in the current literature. 29,35 In fact, quite a number of the studies analyzed volume information derived from transvaginally acquired 3D datasets, as these showed a higher image resolution (through US propagation via the sagittal suture and subsequent volume postprocessing). [36][37][38] Three-dimensional TVS has been reported to have higher success rates than the 2D approach and is capable of multiplanar volume manipulation along the x-, y-, and z-axes to achieve high-quality images without requiring acquisition in the exact mid-sagittal plane.…”

Sylvian fossa sonographic measurements in 18 to 23 weeks fetuses with and without cerebral malformations

“…Indeed, formation of the Sylvian fissure is a complex 3-dimensional process, and we do agree with others that quantification in late gestation is not straightforward. 21 However, at 19 to 23 weeks, when most efforts are made to diagnose cerebral anomalies, the Sylvian fossa is a simple concavity with the shape of a bowl that we believe is adequately described by the measurement of depth. Previous studies have addressed the problem of quantifying sonographically the process of opercularization and formation of the Sylvian fissure.…”

Examination of fetal Sylvian fissure can and should be performed bilaterally during ultrasound screening

“…idea that the Sylvian fissure should be screened using axial sections, according to well‐defined anatomical points of reference, in order to be as standardized and, thus, as reproducible as possible 6 . Reports of the analysis of axial sections of the Sylvian fissure refer to the hemisphere distal to the probe.…”

“…It is now accepted generally that a subjective assessment of the Sylvian fissure 1,5 , as well as, for some groups 3,4 , an objective assessment, is the cornerstone of this analysis. For several years, we have supported the idea that the Sylvian fissure should be screened using axial sections, according to well-defined anatomical points of reference, in order to be as standardized and, thus, as reproducible as possible 6 . Reports of the analysis of axial sections of the Sylvian fissure refer to the hemisphere distal to the probe.…”