ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography

Abstract

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography Clinical Standards Committee The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (

Re: ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography

“…We congratulate the authors of the recent Guideline on sonographic examination of the fetal central nervous system (CNS) 1 for their concise and cogent work, most particularly for their attention to the scanning of the fetal spine. However, we would like to offer some comments.…”

Moving beyond the diatribe on ultrasound vs MRI

“…Second, the authors found that the accuracy of the neurosonogram was not influenced by cephalic or breech fetal position, thus speculating on the usefulness of transvaginal ultrasound in cases of cephalic position. However, ISUOG guidelines on sonographic examination of the fetal central nervous system report that ‘vaginal probes have the advantage of operating at a higher frequency than do abdominal probes and therefore allow a greater definition of anatomical details’ and provide a satisfactory assessment of the fetal brain from the end of the first trimester 2 , such that even an external cephalic version might be reasonable when evaluating some breech presenting fetuses 6 .…”

Reply

“…By no means, though, do we argue that there is no role at all for fetal MRI. We strongly endorse the 2020 International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) updated neurosonography guidelines 2 , which state that ‘it is not appropriate to request MRI based only on suspicion of brain abnormality raised at screening ultrasound’. This is comparable to the 2017 ISUOG fetal MRI guidelines 3 , stating that a basic (screening) brain examination is insufficient prior to requesting MRI.…”