Small biparietal diameter in fetuses with spina bifida on 11–13‐week and mid‐gestation ultrasound

Karl, K.; Benoit, B.; Entezami, Michael; Heling, K. S.; Chaoui, Rabih

doi:10.1002/uog.11175

Cited by 54 publications

(66 citation statements)

References 25 publications

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“…Recent studies support an association between lower BPD values at 11-13 weeks and spina bifida [21,22,23]. Nicolaides et al [5] first observed that the BPD was below the 5th centile in 61% cases of spina bifida at 16-23 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

“…Nicolaides et al [5] first observed that the BPD was below the 5th centile in 61% cases of spina bifida at 16-23 weeks of gestation. At 11-14 weeks, Karl et al [22] reported a low sensitivity (26%) for open spina bifida cases with a BPD <5th centile in a retrospective study with 23 abnormal cases. In a screening study, Bernard et al [23] detected 50% of cases with spina bifida when BPD was below the 10th centile; the detection rate increased to 58% for 5% FPR and 70% for 10% FPR when BPD was combined with alpha-fetoprotein (AFP) and free b-HCG serum levels at 11-13 weeks.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Towards Detecting Open Spina Bifida in the First Trimester: The Examination of the Posterior Brain

Kappou

Papastefanou²,

Pilalis³

et al. 2015

Fetal Diagn Ther

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Introduction: Our aim was to examine the value of indirect signs of open spina bifida in the mid-sagittal view of the posterior brain at the 11-13 weeks' ultrasound examination and to summarize the current evidence for the first-trimester diagnosis of spina bifida. Methods: This was a prospective study in routine obstetric population.The presence of four almost parallel lines (four-line view) in the posterior brain was recorded. Biparietal diameter (BPD), intracranial translucency (IT) and cisterna magna (CM) were measured. The ratio of IT to CM (R ratio) was calculated. Results: 2,491 pregnancies were examined prospectively. Updated reference ranges for IT and CM were constructed. There were 3 cases with open spina bifida, and the four-line view was abnormal in 2 of them. The abnormal fetuses had smaller BPD as well as pronounced reduction in the CM and increase in the R ratio. Discussion: Examination of the posterior brain was feasible in all fetuses in the setting of the routine 11-13 weeks' ultrasound examination. Indirect signs of spina bifida are visible in the mid-sagittal view of the posterior brain, and the assessment of these structures can be a reliable tool in the early identification of this abnormality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Towards Detecting Open Spina Bifida in the First Trimester: The Examination of the Posterior Brain

Kappou

Papastefanou²,

Pilalis³

et al. 2015

Fetal Diagn Ther

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show abstract

“…In the transthalamic axial view, also the 'acorn-shaped head' was described, with the cerebral peduncles appearing parallel to each other, 68 and more recently, the posterior-caudal displacement of the mesencephalon and its flattening against the occipital bone ('crash sign'). 69 Moreover, it have been demonstrated that fetuses with OSB have smaller heads, [70][71][72] thus have altered intrafetal ratios. 73 Easy to see, the screening in the FT using only the two axial planes recommended in recent guidelines, without searching for any other marker, will miss virtually all OSB cases, especially if performed by a less experienced observer.…”

Section: Normal Aspects Osb Findingsmentioning

confidence: 99%

First Trimester Anomaly Scan—The Last Redoubt Won: Open Spina Bifida

Novac¹,

Tudorache²,

Gabriel³

et al. 2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Open spina bifida (OSB) is a non-lethal fetal anomaly, yet often leads to severe disability. Most cases of open spina bifida are detected at the second trimester fetal anomaly ultrasound scan. The 11 to 13 weeks of amenorrhea scan evolved over the last 20 years from essentially a dating scan, to a genetic scan, and recently to one which includes, in addition to the genetic markers, a basic checklist for examination of the whole fetal anatomy. The direct visualization of the spine at the first trimester (FT) scan remained difficult, despite the wider use of high-reso lution ultrasound machines and the volumetric approach. Thus, indirect intracranial morphological markers for OSB were proposed to diagnose this neural tube defect.The present review aims to describe the specific anatomical feature of the spine and the posterior brain, both on parasagittal and on axial planes, recently proposed for the early detection of OSB.Specialists involved in the prenatal diagnosis will eventually elaborate in the future a screening protocol for OSB in the FT of pregnancy, using the most valuable and easy to obtain marker, in a single 2D plane.The offer of an early diagnosis of possible severe anomalies, such as OSB, is a tool enhancing the autonomy of the pregnant woman.

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“…Midsagittal view images of the face of fetuses with retrospectively and prospectively diagnosed open spina bifida were collected over the years from different prenatal centers [6,11]. Digitally stored images from the same ultrasound equipment were imported into the ultrasound system for the measurements.…”

Section: Methodsmentioning

confidence: 99%

“…The presence of fluid can however mislead some examiners to assume it is a normal finding [7] but it was shown that affected posterior brains did not have the typical landmarks of a normal IT [6,8]. In this context, additional approaches and measurements were proposed for a better differentiation of a normal from a suspicious finding for spina bifida in early gestation [4,9,10,11]. The presence of fluid despite a distortion of the posterior brain region in OSB can be considered a step within the sequential process of the development of a Chiari II malformation.…”

Section: Introductionmentioning

confidence: 99%

Fluid Area Measurements in the Posterior Fossa at 11-13 Weeks in Normal Fetuses and Fetuses with Open Spina Bifida

Karl

Chaoui²

2015

Fetal Diagn Ther

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Objectives: To measure the area of the intracranial translucency (IT) (syn: 4th ventricle) and the future cisterna magna (CM) in normal fetuses and to compare with fetuses with open spina bifida. Patients: In the midsagittal plane of the face of 220 fetuses between 11 and 13 weeks' gestation, the areas of the IT and CM were measured and the sum, defined as the posterior fossa fluid (PFF) area was calculated. Reference ranges were constructed in relation to the crown-rump length. The study group consisted of 21 fetuses with open spina bifida and showed in all cases a single pocket of fluid in the posterior fossa. Fetuses with no fluid in the fossa were excluded. This PFF-area was measured and compared with the reference range of the IT-area and the PFF-area of normal fetuses and Z-scores were calculated. Results: In normal fetuses, a significant increase of the IT-, the CM- and the PFF-area was found as a sign of the expanding posterior fossa. The mean PFF-area increased from 8.55 to 29.72 mm² in the observation period. Fetuses with open spina bifida had reduced fluid in the posterior fossa with values ranging between 2.39 and 5.08 mm² and significantly lower Z-scores. Conclusions: Fetuses with open spina bifida have an abnormally small posterior fossa at 11-13 weeks' and in cases where the cerebrospinal fluid is still present, the fluid area in the midsagittal plane is reduced when compared to normal fetuses. Area fluid assessment can be an additional useful measurement in suspicious cases for open spina bifida in early gestation.

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Small biparietal diameter in fetuses with spina bifida on 11–13‐week and mid‐gestation ultrasound

Abstract: Objectives To assess whether, at 11-13-week and mid-trimester ultrasound

Cited by 54 publications

References 25 publications

Towards Detecting Open Spina Bifida in the First Trimester: The Examination of the Posterior Brain

Towards Detecting Open Spina Bifida in the First Trimester: The Examination of the Posterior Brain

First Trimester Anomaly Scan—The Last Redoubt Won: Open Spina Bifida

Fluid Area Measurements in the Posterior Fossa at 11-13 Weeks in Normal Fetuses and Fetuses with Open Spina Bifida

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