Examination Of Skull Research Articles

Computed tomography examination and mitochondrial DNA analysis of Japanese wolf skull covered with skin.

A Canis skull, right half of the mandible and part of the left half of the mandible were subjected to three-dimensional (3D) computed tomography (CT) observation and mitochondrial DNA (mtDNA) analysis in order to determine whether the specimens belonged to the extinct Japanese wolf, Canis lupus hodophilax (Temminck, 1839). Osteometric analysis of the skull and right half of the mandible revealed that the material (JW275) was indeed typical of the Japanese wolf. Sequence analysis of a 600-bp mtDNA region revealed that the JW275 belonged to haplotype Group B, which is characterized by an 8-bp deletion in the mtDNA control region. The findings of this study suggest that 3D CT analysis is well suited to examining fragile and valuable biological samples, as it removes the need for destructive sampling.

Correlation of trisomy 13 with atelencephalic aprosencephaly

Abstract A rare phenotype-genotype correlation of atelencephalic aprosencephaly in a fetus with free trisomy 13 karyotype, obtained by pregnancy termination for holoprosencephaly during the 26th gestational week, is presented. Lack of cerebral hemispheres and presence of rudimentary diencephalon, brain stem and hypoplastic cerebellum were revealed. Agenesis of the eyeball, of the optic nerve and of the pyramids of the medulla oblongata was established. Skull and face examination found craniostenosis, microcephaly, cella turcica agenesis, cyclopia, cleft palate and nose agenesis.The correlation between the most common karyotype of trisomy 13 and the very rare brain abnormality atelencephalic aprosencephaly suggests that the study of parental karyotype is desirable to inform parents about its accidental and non-hereditary nature in a probable future pregnancy.

X-ray population exposure from projection radiology and computed tomography in Emilia-Romagna from 2001 to 2010: comparison of ICRP 60 and ICRP 103 weighting factors

This paper shows the trends from 2001 to 2010 of per caput and collective effective dose (S) to the Emilia-Romagna population due to radiation exposure from projection radiology (PR) and computed tomography (CT), calculated according to both ICRP60 and ICRP103 tissue weighting factors. The frequency of examinations and dose calculations were based on data provided directly by Emilia-Romagna Health Trusts. In particular, effective doses were evaluated using the tissue weighting (w T) factors reported both in ICRP60 (w T,60) and in ICRP103 (w T,103). A decrease in the frequency of PR skull examinations and an increase in the frequency of mammography, CT of the abdomen, chest, and head-neck were found during the decade. In 2010, the PR/CT procedures contributed 75.4%/24.6% to examination frequency and approximately 10%/90% to dose; S was 6,169.2 man Sv when w T,60 was used and 5,855.1-6,665.5 man Sv when w T,103 in two different mathematical models was utilised. Dose estimates pre- and post-ICRP103 must be compared carefully, because changes due to different radiological practices could be confused with changes due to the use of different w T's. In general, dose evaluations with the use of w T,60 until 2007 and w T,103 from 2008 seem to be consistent and coherent.

Craniometric Analysis of Foramen Magnum for Estimation of Sex

Human skull is shown to exhibit numerous sexually dimorphic traits. Estimation of sex is a challenging task especially when a part of skull is brought for medicolegal investigation. The present research was planned to evaluate the sexing potential of the dimensions of foramen magnum in forensic identification by craniometric analysis. Length and breadth of the foramen magnum was measured using Vernier calipers and the area of foramen magnum was calculated. The length, breadth, and area of foramen magnum were found to be larger in males than females. Sexual dimorphism index was calculated to estimate the sexing potential of each variable. The study observations are suggestive of the limited utility of the craniometric analysis of foramen magnum during the examination of skull and its parts in estimation of sex. Keywords—Forensic Anthropology, Skeletal remains, Identification, Sex estimation, Foramen magnum. I. INTRODUCTION STIMATION of the sex of the skeletal remains is an essential element of any medicolegal investigation. Human skeleton shows sexually dimorphic traits, and estimation of the sex of skeletal remains is thus, based on morphological and morphometric examination. Sexing accuracy of the human skeleton varies for the different bones and in different population groups. Human skull is considered as one of the most reliable bones for sex differentiation (1). Previous studies have used different measurements on the skull to estimate its sex accurately (2)0(5). During high impact and severe disruptive injuries, only fragments of bones may be available for examination. Estimation of sex becomes challenging when only a part of skull is brought for examination and hence, a need to derive standards for sex estimation from different regions of the skull. The basal region of the occipital bone is likely to survive the physical insults than the other parts of skull owing to the abundant soft tissue cover, skull thickness in the region, and its relatively well0protected anatomical position. Thus, there is an increased possibility of recovering this part of skull even in cases of severe trauma, and studies on the occipital bone may provide useful clues in identification of significantly disrupted

The value of lateral cephalometric image in sex identification

Determination of sex and estimation of stature from the skeleton is vital to medicolegal investigations. Skull is composed of hard tissue and is the best preserved part of skeleton after death, hence, in many cases it is the only available part for forensic examination. Lateral cephalogram is ideal for the skull examination as it gives details of various anatomical points in a single radiograph. This study was undertaken to evaluate the accuracy of digital cephalometric system as quick, easy and reproducible supplement tool in sex determination in Iraqi samples in different age range using certain linear and angular craniofacial measurements in predicting sex. Materials and Method The sample consisted of 113of true lateral cephalometric radiographs for adults with age range from 22-43 years old (51 males, 62 females), using certain linear and angular craniofacial measurements with the aid of computer program AutoCAD 2007 Results: The eleven parameters measured for males and females when compared are statistically significantly different. All cranio-cephalometric measurements gave overall predictive accuracy of sex determination by discriminant analysis (86.7%). The stepwise selection method gave overall predictive accuracy of sex determination by discriminant analysis (85.8%). Age showed no statistical difference among the studied age range except for the distance from Mastoid to Frankfort plane. Conclusion: The lateral cephalometric measurements of craniofacial bones are useful to support sex determination of Iraqi population in forensic radiographic medicine. Keyword: Sex determination, lateral cephalgram, discriminant analysis, craniofacial measurements. (J Bagh Coll Dentistry 2013; 25(2):54-58).

전산화단층촬영에서 촬영 목적 부위와 주변 결정장기에 대한 피폭선량 평가: 선량 권고량 중심으로

최근 다중검출기 CT의 보편화 된 사용으로 환자의 피폭선량이 증가하고 있다. 따라서 광자극발광선량계를 이용해 촬영 목적 부위와 주변 결정장기에 대한 환자의 피폭선량을 측정하고 그에 따른 생물학적 효과를 예측하여 저감화 방안을 제시하고자 하였다. ICRP에서 권고한 표준안을 대상으로 만들어진 인체 모형 표준 팬텀에 교정상수를 부여받은 OSD 선량계를 측정하고자 하는 좌 우 수정체, 갑상선, 촬영의 중심점, 생식선에 부착하여 각 검사 부위별 노출 조건과 동일한 상태에서 환자의 피폭 선량을 모사하였다. OSL 선량계의 평균 교정상수는 <TEX>$1.0058{\pm}0.0074$</TEX>이었으며 검사 부위별 주변 결정장기의 등가선량은 좌 우측 수정체의 경우 직접 피폭이 약 50mGy로 최대였으며 간접 피폭되는 경우 0.24mGy, 원거리에서는 0.005mGy미만의 기준 준위 이하로 측정되었다. 갑상선의 경우 두부 검사에서 10.89mGy로 최대였으며 흉부에서 7.75mGy, 복부 및 요추부, 골반부에서는 기준 미만이었다. 생식선의 경우 골반검사에서 21.98mGy로 최대였으며 간접 피폭되는 검사에서 기준 준위 미만에서 6.92mGy까지 피폭되었다. CT 검사에서 DRL에 대한 저감화 방법은 국제기구에서 권고하고 있는 방사선 방어 원칙에 대한 정당한 해석과 제도적 뒷받침이 필요하다. 따라서 환자의 피폭을 최소화하기 위해서는 정당성을 충족하여야 하며 환자의 피폭선량에 미치는 영향들을 체계화하고 조직의 불필요한 피폭을 최소화 하여야 한다. In this study measured patient exposure dose for purpose exposure area and peripheral critical organs by using optically stimulated luminescence dosimeters (OSLDs) from computed tomography (CT), based on the measurement results, we predicted the radiobiological effects, and would like to advised ways of reduction strategies. In order to experiment, OSLDs received calibration factor were attached at left and right lens, thyroid, field center, and sexual gland in human body standard phantom that is recommended in ICRP, and we simulated exposure dose of patients in same condition that equal exposure condition according to examination area. Average calibration factor of OSLDs were <TEX>$1.0058{\pm}0.0074$</TEX>. In case of left and right lens, equivalent dose was measure in 50.49 mGy in skull examination, 0.24 mGy in chest, under standard value in abdomen, lumbar spine and pelvis. In case of thyroid, equivalent dose was measured in 10.89 mGy in skull examination, 7.75 mGy in chest, 0.06 mGy in abdomen, under standard value in lumber spine and pelvis. In case of sexual gland, equivalent dose was measured in 21.98 mGy, 2.37 mGy in lumber spine, 6.29 mGy in abdomen, under standard value in skull examination. Reduction strategies about diagnosis reference level (DRL) in CT examination needed fair interpretation and institutional support recommending international organization. So, we met validity for minimize exposure of patients, systematize influence about exposure dose of patients and minimize unnecessary exposure of tissue.

Assessment of entrance surface dose and health risk from common radiology examinations in Iran

Medical X-ray exposures are the largest man-made source of population exposure to ionising radiation in many countries. Although information on medical exposure is already incorporated into national legislative documents, in Isfahan there is no data on the assessment of patient's entrance surface dose (ESD) and the health risk from conventional radiography in daily clinical practice. The aim of this study was to investigate ESDs and the consequent health risk for the patients undergoing routine X-ray procedures in hospitals under the control of Isfahan University of Medical Sciences, Iran, in year 2011. The values of ESDs were measured for common radiographical examinations with the highest absorbed dose to the patient in seven hospitals (Alzahra, Ashrafi-Khomeini-shahr, Feyz, Isabne-Maryam, Kashani, Nour-Aliasghar and Seyed-Al Shohada) and six stationary X-ray machines (General Electric, USA; Phillips, The Netherlands; Siemens, Germany; Shimadzu, Japan; Toshiba, Japan and Varian, USA). The results of the ESD measurements as well as the calculated effective dose values between different X-ray examinations showed values significantly greater than those recorded in some other countries especially for the high tube potential technique (such as the skull) by factors of 2.5-5.0. Based on the fatality risk of 5 % per sievert, it was estimated that, for chest and skull examinations approximately two (40.18 person-Sv×5 % per sievert) and one (2.53 person-Sv×5 % per sievert) cases of health risk, respectively, may in the future be attributable to diagnostic X rays done in year 2011 in Isfahan. Efforts should be taken to further lower patient doses while securing image quality. The need to provide relevant education and training to staff in the radiology sections is of utmost importance.

Genetic examination of the putative skull of Jan Kochanowski reveals its female sex

We report the results of genetic examination of the putative skull of Jan Kochanowski (1530-1584), a great Polish renaissance poet. The skull was retrieved in 1791 by historian Tadeusz Czacki from the Kochanowski family tomb and became the property of the Czartoryskis Museum in Krakow. An anthropological study in 1926 questioned its male origin, which raised doubts about its authenticity. Our report presents genetic evidence that resolves this dispute.From the sole tooth we obtained a sufficient amount of DNA to perform the analysis of nuclear markers. The analysis of the sex-informative part of intron 1 in amelogenin, genotyped using AmpFiSTR® NGM PCR Amplification Kit and Powerplex® ESI17 Kit human identification systems, revealed the female origin of the tooth. The female origin was further confirmed by the analysis of a portion of amelogenin intron 2, a microsatellite marker located on the X chromosome, as well as by a lack of signal from Y chromosomal microsatellite markers and the sex-determining region Y marker. Data obtained for two hypervariable regions, HVI and HVII, in mitochondrial DNA showed that mtDNA haplotype was relatively frequent among contemporary Europeans. The analysis of a set of single nucleotide polymorphisms relevant for prediction of the iris color indicated an 87% probability that the woman had hazel or brown eye color.

Mechanisms of deaths in captive juvenile New Zealand fur seals (Arctocephalus forsteri)

Juvenile seals are sometimes encountered in waters around South Australia with injuries and/or diseases that require veterinary treatment. Two cases are reported where apparently stable animals died soon after being rescued due to quite disparate conditions. In Case 1 a juvenile male New Zealand fur seal (Arctocephalus forsteri) was found unexpectedly dead in its enclosure. A necropsy examination revealed an emaciated juvenile male with no injuries. The intestine was filled throughout its length with melena stool that was due to heavy infestation of the stomach with roundworms with adjacent gastritis. Death was due to shock from upper gastrointestinal blood loss secondary to parasitosis. In Case 2 a second juvenile male New Zealand fur seal (Arctocephalus forsteri) also died unexpectedly in its enclosure. It had been listless with loud respirations since capture. At necropsy there was no blood around the head, neck or mouth, and no acute external injuries were identified. An area of induration was, however, present over the snout with fragmentation of underlying bones. The maxilla was freely mobile and CT scanning revealed multiple comminuted fractures of the adjacent facial skeleton. Examination of the defleshed skull showed fragmentation of the facial skeleton with roughening of bones in keeping with osteomyelitis. Death was attributed to sepsis from osteomyelitis of a comminuted midfacial fracture. These cases demonstrate two unusual and occult conditions that may be present in recently retrieved juvenile fur seals. Failure to establish the correct diagnosis rapidly may result in death soon after capture. The usefulness of imaging techniques such as CT scanning in delineating underlying injuries prior to necropsy is clearly demonstrated.

Are exposure index values consistent in clinical practice? A multi-manufacturer investigation

The advent of digital radiography poses the risk of unnoticed increases in patient dose. Manufacturers have responded to this by offering an exposure index (EI) value to the clinician. Whilst the EI value is a measure of the air kerma at the detector surface, it has been recommended by international agencies as a method of monitoring radiation dose to the patient. Recent studies by the group have shown that EI values are being used in clinical practice to monitor radiation dose and assess image quality. This study aims to compare the clinical consistency of the EI value in computed radiography (CR) and direct digital radiography (DR) systems. An anthropormorphic phantom was used to simulate four common radiographic examinations: skull, pelvis, chest and hand. These examinations were chosen as they provide contrasting exposure parameters, image detail and radiation dose measurements. Four manufacturers were used for comparison: Agfa Gaevert CR, Carestream CR, Philips Digital Diagnost DR and Siemens DR. For each examination, the phantom was placed in the optimal position and exposure parameters were chosen in accordance with European guidelines and clinical practice. Multiple exposures were taken and the EI recorded. All exposure parameters and clinical conditions remained constant throughout. For both DR systems, the EI values remained consistent throughout. No significant change was noted in any examination. In both CR systems, there were noteworthy fluctuations in the EI values for all examinations. The largest for the Agfa system was a variation of 1.88-2.21 for the skull examination. This represents to the clinician a doubling of detector dose, despite all exposure parameters remaining constant. In the Kodak system, the largest fluctuation was seen for the chest examination where the EI ranged from 2560 to 2660, representing approximately an increase of 30 % in radiation dose, despite consistent parameters. The fluctuations seen with the CR systems are most likely due to image processing delay, replacing of the imaging plate and calibration factors. Fluctuations in EI values may result in confusion to the clinician and unnecessary repeat examinations. The reliability of EI values as a feedback mechanism for CR is also questionable.

EXPOSURE OF THE SWISS POPULATION BY RADIODIAGNOSTICS: 2003 REVIEW

A nationwide investigation was conducted in Switzerland to establish the exposure of the population by medical x rays and update the results of the 1998 survey. Both the frequency and the dose variations were studied in order to determine the change in the collective dose. The frequency study addressed 206 general practitioners (GPs), 30 hospitals, and 10 private radiology institutes. Except for the latter, the response rate was very satisfactory. The dose study relied on the assessment of the speed class of the screen-film combinations used by the GPs as well as the results of two separate studies dedicated to fluoroscopy and CT. The investigation showed that the total number of all medical x-ray examinations performed by GPs registered a 1% decrease between 1998 and 2003, and that the sensitivities of the film-screen combinations registered a shift towards higher values, leading to a reduction of the dose delivered by a GP of the order of 20%. The study indicated also that the total number of all x-ray examinations performed in hospitals increased by 4%, with a slight increase of radiographies by 1% but significant decrease of examinations involving fluoroscopy (39%), and a 70% increase for CT examinations. Concerning the doses, the investigation of a selection of examinations involving fluoroscopy showed a significant increase of the kerma-area product (KAP) per procedure. For CT the study showed an increase of the dose-length product (DLP) per procedure for skull and abdomen examinations, and a decrease for chest examination. Both changes in the frequency and the effective dose per examination led to a 20% increase in the total collective dose.

Development of phantom for radiographic image optimization of standard patient in the lateral view of chest and skull examination

We present the construction of a homogeneous phantom to be used in simulating the scattering and absorption of X-rays by a standard patient chest and skull when irradiated laterally. This phantom consisted of lucite and aluminium plates with their thickness determined by a tomographic exploratory method applied to the anthropomorphic phantom. Using this phantom, an optimized radiographic technique was established for chest and skull of standard sized patient in lateral view. Images generated with this optimized technique demonstrated improved image quality and reduced radiation doses.

Titian's Secret: Comparison of Eleonora Gonzaga della Rovere's Skull with the Uffizi Portrait

The present paper describes the study of a skeleton, kept at the Church of Santa Chiara in Urbino, Italy. Traditionally, this skeleton was thought to be that of the Duchess Eleonora Gonzaga della Rovere (1493-1550), but suspicion exists as to whether or not the remains might belong to another important personage of the Urbino Renaissance, Battista Sforza (1447-1472). Here, external observation of the skull and odontological examination of the mandible were conducted in an attempt to clarify the identity. Age estimates of the skeleton were found to be consistent with the age at death of Eleonora but not with that of Battista. Craniofacial superimposition using the portrait of Eleonora Gonzaga by Titian (Galleria degli Uffizi, Florence) shows that the face of Eleonora matches the skull fairly closely except for the length of the nose. The historical record and the age matching appear to provide strong evidence that the remains are those of Eleonora, and the discrepancies in the superimposition may suggest that the artist altered the dimension of the Duchess' nose, possibly to make the portrait correspond to his canons of classical beauty. The results highlight the potential of forensic methods as a key to understand the work of earlier painters.

Determination of sex by discriminant function analysis and stature by regression analysis: a lateral cephalometric study

Determination of sex and estimation of stature from the skeleton is vital to medicolegal investigations. In the present study, an attempt is made to determine sex and estimate stature of an individual using data derived from lateral cephalogram in Central Indian population. Skull is composed of hard tissue and is the best preserved part of skeleton after death, hence, in many cases it is the only available part for forensic examination. Lateral cephalogram is ideal for the skull examination as it gives details of various anatomical points in a single radiograph, also it easily provides architectural and morphological details of skull superstructures and intra-cranial details for comparisons. A discriminant function derived from 10 cephalometric variables provided 99% reliability in sex determination. The formulae obtained from regression analysis using the maximum length of skull showed very high degree of reliability for estimation of stature in males as well as females.

Bildgebende Diagnostik bei der primären Abklärung polytraumatisierter Patienten

Radiologic diagnosis in multiple trauma patients has to be fast, accurate and comprehensive. Different phases to diagnosis can be differentiated. The first step is radiologic diagnosis in the Emergency Room including ultrasound (Focused abdominal sonography for trauma, FAST) and radiographs of the chest, pelvis and cervical spine. As second step, a computed tomography (CT) scan from head to the proximal femur should be performed in stable patients as soon as possible. Further investigation of non life-threatening injuries is the third step and should be performed at a later point of time, after the acute phase. CT is gaining a more and more important role because examinations using CT are fast and offer the possibility of detailed secondary reconstructions (e.g. multi planar reconstructions MPR). In our hospital > 75% of the multiple trauma patients with an injury severity score > 28.4 had a CT examination of skull, spine, thorax, abdomen or pelvis. To minimize time loss from transfer of patients, a CT scanner should be placed in or near the Emergency Room.

Evaluation of guidelines for skull radiography in head injury

The benefits of utilisation of guidelines for radiographic skull examination of head injured patients were studied in one hundred and eleven patients. The causes of head injury were road traffic accidents (RTA) 87.4%, fall and assault 4.5% each, collapsed wall 1.8%, gunshot injury and industrial accident 0.9% each. RTA resulted predominantly from burst tyre 34%, vehicle pedestrian accidents 23.7% and vehicle collision 18.6%. Compliance with the use of the guidelines was 48%. Radiographic skull examination was carried out in 22 patients (20% of study population) and the positive yield for skull fracture was 32% (7/22 of all radiographs). At discharge, 14 of those who had radiographic examination (n=20) recovered without neurological complications while 39 among those not examined (n=58) similarly recovered, p=0.96. Among those who had skull radiography, neurological deficit occurred in 6 that had skull fractures (n=7) and in 5 of those without skull fractures (n=13), p=0.07. It was concluded that radiographic skull examination based on selective guidelines increases the yield of skull fractures and reduces unnecessary examinations, thereby saving costs. Skull radiography may not be predictive of neurological outcome of treatment. Cranial computed tomography (CT) should be obtained if available and clinically indicated.

High-speed documented experimental gunshot to a skull-brain model and radiologic virtual autopsy.

The authors documented and evaluated experimental gunshots to a skull-brain model with high-speed photography and subsequent radiographic examination for comparison of the morphologic findings in the model. The artificial skull was a polyurethane ball constructed in layers, with a porous diploe sandwiched between a tabula externa and a tabula interna. The brain itself was simulated with gelatin 10% at 4 degrees C, a material well known in wound ballistics. Gunshots were fired at the model from a distance of 10 m and documented with high-speed photography (up to 50 million frames/sec). Subsequently, a complete examination of the artificial skull was performed, including spiral computed tomography (with two-dimensional and three-dimensional reconstructions) and classic skull autopsy. The high-speed photographs clearly showed the dynamic development of the skull fracture system from an external perspective. The subsequent radiographic examination of the entire head volume created two-dimensional reformations in any plane and three-dimensional reconstructions of the gunshot injury of the polyurethane skull-brain model, especially the wound channel and the fracture system. Thanks to the model and high-speed photographs, the dynamic development of the morphology of a gunshot wound could be documented and studied. The data from computed tomography, using two-dimensional and three-dimensional postprocessing with a perspective view, were very similar to those from classic head autopsy, but derived in a hands-off and nondestructive manner. This examination method leads the way to radiographic digital autopsy or virtual autopsy.

Morphologic characteristics of early stages of reparative process in substitution of skull defects by dosed distraction (report 1)

Experimental study was performed to detect the peculiarities of reparative process in bone defects. In 131 adult mongrel dogs skull defects were performed with their following substitution using dosed distraction by Ilizarov. In the 1st series of experiments the defect was substituted by dosed transfer of full-thickness bone graft on the nutritive pedicle. In the 2nd series free bone graft was used for the defect substitution. In this report the results of morphologic examination of dogs skull in predistraction period is done. In both series the development of the reparative processes analogous to those in the long bones at transosseous osteosynthesis is detected.

Digital radiography in paediatrics: radiation dose considerations and magnitude of possible dose reduction.

The purpose of this study was to evaluate the radiation doses received by paediatric patients examined using a digital radiography unit, and to compare these doses with those received from conventional screen-film systems. In this way, guidelines could be drawn up concerning the magnitude of possible dose reductions achievable using digital radiography. The study was undertaken on approximately 900 patients undergoing abdomen, chest, pelvis and skull examinations. Patients were categorized into the following age groups: 0-1 month, 1-12 months, 1-5 years, 5-10 years and 10-15 years. Approximately half were X-rayed using a Fuji computed radiography system and half using a conventional screen-film system. Entrance surface dose was calculated from the recorded exposure parameters and measured X-ray tube outputs. Dose-area product was recorded directly. Image quality was assessed clinically using criteria recommended by a working group of the Commission of the European Communities. Apart from chest examinations, it was found possible to reduce doses by about 40% on average, by using a computed radiography system instead of a 600 speed screen-film combination. There was no significant difference in the dose for chest examinations. Satisfactory image quality can therefore be achieved by using computed radiography as a 1000 speed system for abdomen, pelvis and skull examinations, and as a 600 speed system for chests. Since very few departments appear to use screen-film systems of speeds greater than 400, then, for most departments, the use of computed radiography would result in dose reductions of at least 60%, or 33% for chests.

The early diagnosis of neural tube defects.

The sonographic diagnosis of fetal neural tube defects (NTDs) has been enhanced by the recognition of associated brain and skull anomalies. Previous reports have found these anomalies to be accurate in predicting spina bifida after 16 weeks' gestation, and an inverse correlation was suggested between the presence of these sonographic markers and gestational age. Therefore, we assumed that early second-trimester sonography would be at least as accurate as that performed after 16 weeks' gestation. To examine this hypothesis, we looked for the presence of these cranial sonographic markers suggestive of open NTDs in 8011 low-risk cases, using transvaginal sonography (TVS), between the 12th and 17th week of gestation (menstrual age). Fetal NTDs were identified in ten cases (1.25/1000). The NTDs were cervico-cranial in three, lumbo-sacral in six, and thoracal in one of the ten cases. None of the seven cases examined was dyskaryotic. Cerebellar dysmorphism, 'banana' sign, cerebellar absence, and hypoplasia were detected in all the low NTDs, usually before the detection of the spinal lesion. All the sonographically diagnosed malformations were confirmed by post-abortal examination except in one case, where the patient decided to continue the pregnancy and refused follow-up. We therefore conclude that transvaginal sonographic examination of the fetal skull before the 17th week of gestation is an accurate method for the detection of low NTDs.