Fetal Anatomy Research Articles

Detection of fetal facial anatomy in standard ultrasonographic sections based on real-time target detection network.

At present, prenatal ultrasound is one of the important means for screening fetal malformations. In the process of prenatal ultrasound diagnosis, the accurate recognition of fetal facial ultrasound standard plane is crucial for facial malformation detection and disease screening. Due to the dense distribution of fetal facial images, no obvious structure contour boundary, small structure area, and large area overlap in the middle of the structure detection frame, this paper regards the fetal facial standard plane and its structure recognition as a universal target detection task for the first time, and applies real-time YOLO v5s to the fetal facial ultrasound standard plane structure detection and classification task. First, we detect the structure of a single slice, and take the structure of a slice class as the recognition object. Second, we carry out structural detection experiments on three standard planes; then, on the basis of the previous stage, the images of all parts included in the ultrasound examination of multiple fetuses were collected. In the single-class structure detection experiment and the structure detection and classification experiment of three types of standard planes, the overall recognition effect of Precision and Recall index data is better, with Precision being 98.3% and 98.1%, and Recall being 99.3% and 98.2%, respectively. The experimental results show that the model has the ability to identify fetal facial anatomy and standard sections in different data, which can help the physician to automatically and quickly screen out the standard sections of each fetal facial ultrasound.

Fast fetal head compounding from multi-view 3D ultrasound.

The diagnostic value of ultrasound images may be limited by the presence of artefacts, notably acoustic shadows, lack of contrast and localised signal dropout. Some of these artefacts are dependent on probe orientation and scan technique, with each image giving a distinct, partial view of the imaged anatomy. In this work, we propose a novel method to fuse the partially imaged fetal head anatomy, acquired from numerous views, into a single coherent 3D volume of the full anatomy. Firstly, a stream of freehand 3D US images is acquired using a single probe, capturing as many different views of the head as possible. The imaged anatomy at each time-point is then independently aligned to a canonical pose using a recurrent spatial transformer network, making our approach robust to fast fetal and probe motion. Secondly, images are fused by averaging only the most consistent and salient features from all images, producing a more detailed compounding, while minimising artefacts. We evaluated our method quantitatively and qualitatively, using image quality metrics and expert ratings, yielding state of the art performance in terms of image quality and robustness to misalignments. Being online, fast and fully automated, our method shows promise for clinical use and deployment as a real-time tool in the fetal screening clinic, where it may enable unparallelled insight into the shape and structure of the face, skull and brain.

EP08.16: Sonographic assessment of the fetal anatomy in the first trimester: a comparative study of the accuracy of two‐ and three‐dimensional ultrasound

EP08.16: Sonographic assessment of the fetal anatomy in the first trimester: a comparative study of the accuracy of two‐ and three‐dimensional ultrasound

Anatomically Guided Cross-Domain Repair and Screening for Ultrasound Fetal Biometry.

Ultrasound based estimation of fetal biometry is extensively used to diagnose prenatal abnormalities and to monitor fetal growth, for which accurate segmentation of the fetal anatomy is a crucial prerequisite. Although deep neural network-based models have achieved encouraging results on this task, inevitable distribution shifts in ultrasound images can still result in severe performance drop in real world deployment scenarios. In this article, we propose a complete ultrasound fetal examination system to deal with this troublesome problem by repairing and screening the anatomically implausible results. Our system consists of three main components: A routine segmentation network, a fetal anatomical key points guided repair network, and a shape-coding based selective screener. Guided by the anatomical key points, our repair network has stronger cross-domain repair capabilities, which can substantially improve the outputs of the segmentation network. By quantifying the distance between an arbitrary segmentation mask to its corresponding anatomical shape class, the proposed shape-coding based selective screener can then effectively reject the entire implausible results that cannot be fully repaired. Extensive experiments demonstrate that our proposed framework has strong anatomical guarantee and outperforms other methods in three different cross-domain scenarios.

Memory-based unsupervised video clinical quality assessment with multi-modality data in fetal ultrasound

In obstetric sonography, the quality of acquisition of ultrasound scan video is crucial for accurate (manual or automated) biometric measurement and fetal health assessment. However, the nature of fetal ultrasound involves free-hand probe manipulation and this can make it challenging to capture high-quality videos for fetal biometry, especially for the less-experienced sonographer. Manually checking the quality of acquired videos would be time-consuming, subjective and requires a comprehensive understanding of fetal anatomy. Thus, it would be advantageous to develop an automatic quality assessment method to support video standardization and improve diagnostic accuracy of video-based analysis. In this paper, we propose a general and purely data-driven video-based quality assessment framework which directly learns a distinguishable feature representation from high-quality ultrasound videos alone, without anatomical annotations. Our solution effectively utilizes both spatial and temporal information of ultrasound videos. The spatio-temporal representation is learned by a bi-directional reconstruction between the video space and the feature space, enhanced by a key-query memory module proposed in the feature space. To further improve performance, two additional modalities are introduced in training which are the sonographer gaze and optical flow derived from the video. Two different clinical quality assessment tasks in fetal ultrasound are considered in our experiments, i.e., measurement of the fetal head circumference and cerebellar diameter; in both of these, low-quality videos are detected by the large reconstruction error in the feature space. Extensive experimental evaluation demonstrates the merits of our approach.

Fetal Third-Trimester Functional Cardiovascular Abnormalities and Neonatal Elevated Bilirubin Level.

The aim of the study was to analyze the neonatal outcomes of fetuses with diagnosed functional cardiovascular abnormalities, also considering the connection with neonatal hyperbilirubinemia. It was an observational study of 100 neonates who had fetal echocardiography examinations in the third trimester (mean gestational age during the last echocardiography was 34 ± 3 weeks and mean birth weight was 3550 g). There were two groups: A: normal heart anatomy + no functional anomalies; group B: normal heart anatomy + functional abnormalities. Hyperbilirubinemia was defined as a bilirubin level of >10 mg%. In group A, there were 72 cases and only 5 cases despite having normal heart anatomy and normal heart study that presented additional problems. In group B (28 cases), the prenatal functional findings included tricuspid regurgitation (TR) (15 cases, 53%), pericardial effusion (4 cases, 14%), myocardial hypertrophy (4 cases, 14%), cardiomegaly (2 cases, 7%), abnormal bidirectional blood flow across the foramen ovale (3 cases, 11%), aneurysm of atrial septum (2 case, 7%), abnormal E/A ratio for mitral and tricuspid valve (1 case, 3%), bright spot (3 case, 11%), abnormal Doppler flow in ductus arteriosus compared to aortic arch (difference >60 cm/s) (1 case, 3%), supraventricular tachycardia (SVT) (1 case), and mitral regurgitation (1 case, 3%). In group A (n = 72 cases), bilirubin levels of >10 mg/dL were observed in 8% of newborns. In group B (n = 28), bilirubin levels of > 10 m/dL were observed in 46% of cases and TR was present in group B in 53% of cases (15/28 cases). The difference between group A and B in terms of elevated bilirubin levels was statistically significant (p < 0.001). In the case of fetal normal heart anatomy and normal heart study, a good neonatal outcome may be expected. When fetal cardiovascular functional abnormalities in normal heart anatomy are detected, with special attention paid to tricuspid valve regurgitation, a neonatal elevated bilirubin level (mean 11 mg/dL, range 10-15 mg/dL) may be expected.

АНАТОМИЧЕСКАЯ ХАРАКТЕРИСТИКА ЗУБНЫХ АЛЬВЕОЛ НИЖНЕЙ ЧЕЛЮСТИ ПЛОДА В ПРОМЕЖУТОЧНОМ ПЛОДНОМ ПЕРИОДЕ ОНТОГЕНЕЗА ЧЕЛОВЕКА

Fundamental research on human fetal anatomy today has serious applied significance for the &#x0D; implementation of the principles of prediction and prevention of congenital pathology. The aim is to give an &#x0D; anatomical characteristic of the dental alveoli of the mandible of the fetus in the intermediate fetal period of &#x0D; human ontogenesis. Materials and methods. 110 lower jaws of human fetuses of the second trimester of &#x0D; different sex were studied using ultrasound scanning and morphological techniques. Results. In the body of &#x0D; 69&#x0D; the mandible, dental alveoli can be visualized using morphological techniques throughout the intermediate &#x0D; fetal period of ontogenesis and by ultrasound scanning from week 19 of intrauterine development in an amount &#x0D; of 8-10. The average sizes of the dental alveoli are 2.2±0.6 mm for medial incisors, 2.3±0.7 mm for lateral &#x0D; incisors, 2.4± 0.7 mm for canines, and 3.3±1.0 mm for molars. Dental alveoli of the lower jaw in fetuses from &#x0D; 14 to 28 weeks of fetal development grow with a growth intensity range of 57.8-83.3%. The incisors and &#x0D; canines change heterochronously from 14 to 23 weeks of gestation with a growth rate of IR=51-52.6%, from &#x0D; 24 to 27 weeks of pregnancy with a growth rate of 34%-34.5%. The dental alveoli of molars are characterized &#x0D; by uniform growth. Conclusion. The anatomical features of the structure of dental alveoli have been estab lished, which can be used as additional markers for the detection of congenital pathology of the fetus during a &#x0D; screening study of pregnant women. Keywords: dental alveolus, mandible, fetus, intermediate fetal period, &#x0D; ultrasound scanning method, morphological techniques

First trimester anatomy ultrasound for patients with obesity: a randomized controlled trial

Second-trimester ultrasound is the standard technique for fetal anatomy evaluation in the United States despite international guidelines and literature that suggest that first-trimester timing may be superior in obese patients. First-trimester imaging performs well in cohorts of obese participants. Our aim was to compare the completion rate of first-trimester fetal anatomy to second-trimester fetal anatomy ultrasound in pregnant people with body mass index (BMI) ≥ 35 kg/m2. This randomized controlled trial enrolled participants with BMI ≥ 35 kg/m2 with singleton gestation, presenting before 14 0/7 weeks of gestation. Participants were randomized to receive ultrasound assessment of anatomy at either 12 0/7 to 13 6/7 weeks, or at 18 0/7 to 22 6/7 weeks. The primary outcome was completion rate (percent of scans that optimally imaged all required fetal structures). Secondary outcomes included the necessity of a transvaginal approach, completion rates of each individual view, number of anomalies identified and missed in each group, scan duration, and patient perspectives. A one-year pilot sample was analyzed using Bayesian methods for the primary outcome with a neutral prior, and frequentist analyses for the remaining outcomes. A total of 128 participants enrolled, 1 withdrew consent; 62 subjects received a first-trimester ultrasound and 62 received a second-trimester ultrasound; 2 did not attend research visits, and 1 sought termination of pregnancy. In the first-trimester group, 66% (41/62) of ultrasounds were completed compared to 53% (33/62) in the second-trimester ultrasound group (Bayesian relative risk (RR) 1.20, 95% credible interval 0.91-1.73). Compared to a second-trimester scan plus one follow-up ultrasound, a first-trimester ultrasound plus a second-trimester ultrasound was equally successful for completing anatomy (76%). First-trimester anatomy ultrasounds required a transvaginal approach in 63% (39/62) of cases and had a longer duration compared to a second-trimester ultrasounds. No anomalies were missed in either group. First-trimester ultrasound participants who responded to a survey described that they were very satisfied with the technique. Inpregnant subjects with BMI>35, a single first-trimester anatomy ultrasound is more likely to obtain all recommended anatomic views compared to a single second-trimester ultrasound. An evaluation of anatomy at 12 0/7 to 13 6/7 weeks, plus an evaluation at 18 0/7 to 22 6/7 resulted in complete evaluation 4 weeks earlier than two second trimester scans. Assessment of ultrasound duration in a clinical setting is needed to ensure feasibility outside of a research setting.

Technical Update No. 352: The Role of Early Comprehensive Fetal Anatomy Ultrasound Examination

Tweetable AbstractMost detectable fetal anomalies are present in early pregnancy. Early fetal anatomy at 13-16 weeks, performed by trained operator, should be considered for women at high risk for fetal anomalies or when the routine mid-trimester anatomy scan may be technically challenging. SUMMARY STATEMENTS1.Development of fetal organs begins early in the first trimester, with the majority of organs visible by ultrasound evaluation towards the end of the first trimester of pregnancy (high).2.The majority of significant and sonographically detectable fetal anomalies can be detected on early fetal anatomic ultrasound assessment (high).3.Early detection of fetal anomalies allows patients to obtain counselling consultations, and genetic testing at an earlier gestational age, as well as more time to consider options for pregnancy management (high). RECOMMENDATIONS1.Medical personnel (physicians, technologists, or ultrasound practitioners) who have substantial experience or training in the assessment and interpretation of early comprehensive fetal anatomic scanning should be performing the examination (strong, high).2.The examination can be performed transvaginally, transabdominally, or by both approaches, and the choice for each mode depends on the fetal position, the gestational age, and the experience of the operator (strong, high).3.Early comprehensive fetal anatomic scanning at 13–16 weeks’ gestation should be considered for women who have higher risk for significant fetal anomalies or in whom it is anticipated that a midtrimester transabdominal scan will be technically challenging (strong, high). This scan does not replace the routine 18- to 22-week anatomy scan.

Completion of Fetal Anatomy Evaluations in Women With Body Mass Index ≥ 50 kg/m2.

As maternal body mass index (BMI) increases, fetal anatomy ultrasound becomes more challenging, less sensitive, and less likely to be complete. We sought to report our experience of incomplete evaluation of anatomy in patients with BMI of 50 kg/m2 or greater. This is a retrospective cohort of singleton gestations in mothers with BMI of 50 kg/m2 or greater, undergoing anatomy evaluations between 2017 and 2021 at 9 maternal-fetal-medicine sites in Houston, TX. Patient variables and scan results were collected throughout pregnancy to provide a longitudinal assessment of the primary outcome, completion rate (percent of all scans which optimally captured 24 American Institute of Ultrasound in Medicine-recommended images). Secondary outcomes included the rate of optimal capture of each individual structure. In total, 293 patients with BMI ≥50 kg/m2 were identified. Only 28% of initial scans were complete, but over the entire pregnancy, a complete anatomic evaluation was achieved in 76% of women, largely due to weekly ultrasounds done for antenatal testing later in pregnancy. Neither BMI, placental location, nor amniotic fluid volume affected completion rate. The most difficult views are the outflow tracts, 4-chamber view, and spine. One quarter of women with BMI of 50 kg/m2 or greater will not have a complete fetal anatomic evaluation by the end of pregnancy, since even basic fetal anatomic views are technically challenging to complete. Solutions deserve further attention, and may include first trimester imaging, transvaginal imaging, and optimization of ultrasound machine settings.

Efficacy of Systematic Early-Second-Trimester Ultrasound Screening for Facial Anomalies: A Comparison between Prenatal Ultrasound and Postmortem Findings.

Second-trimester 2D ultrasound (US) assessment of the fetal anatomy, as proposed by worldwide guidelines, allows detecting the majority of fetal malformation. However, the detection rates of fetal facial anomalies seem to still be low, mostly in cases of isolated facial malformation. The purpose of this research was to assess and analyze the concordance between the antenatal imaging findings from second-trimester US screening and the results of fetal postmortem autopsy. Between January 2010 and January 2020, there were 43 cases where fetuses with prenatal ultrasound diagnosis of a face abnormality, associated or not with a genetic syndrome or chromosomal disorder, following intrauterine death (IUD) or termination of pregnancy (TOP) after the 13 weeks of pregnancy, underwent autopsy in the Pathological Anatomy section of Bari Polyclinic specializing in feto-placental autopsies. The diagnosis of the fetal facial defects at ultrasound was compared with the findings at autopsy in all cases. A very high level of agreement between prenatal ultrasound and autopsy findings was found for facial abnormalities associated with genetic syndromes or numerical abnormality of chromosomes. A lower level of concordance was instead found in isolated facial defects or those associated with other organ anomalies, but not associated with genetic syndrome or numerical chromosome anomaly. A detailed examination of aborted fetuses led to successful quality control of early-second-trimester ultrasound detection of facial anomalies; however, it was less accurate for the isolated ones. It is, thus, reasonable to propose a systematic early-second-trimester prenatal ultrasound screening for facial anatomy by operators specialized in fetal medicine field, using 2D, 3D, and 4D techniques (two-, three-, and four-dimensional ultrasound).

Artificial intelligence in obstetric ultrasound: A scoping review.

The objective is to summarize the current use of artificial intelligence (AI) in obstetric ultrasound. PubMed, Cochrane Library, and ClinicalTrials.gov databases were searched using the following keywords "neural networks", OR "artificial intelligence", OR "machine learning", OR "deep learning", AND "obstetrics", OR "obstetrical", OR "fetus", OR "foetus", OR "fetal", OR "foetal", OR "pregnancy", or "pregnant", AND "ultrasound" from inception through May 2022. The search was limited to the English language. Studies were eligible for inclusion if they described the use of AI in obstetric ultrasound. Obstetric ultrasound was defined as the process of obtaining ultrasound images of a fetus, amniotic fluid, or placenta. AI was defined as the use of neural networks, machine learning, or deep learning methods. The authors' search identified a total of 127 papers that fulfilled our inclusion criteria. The current uses of AI in obstetric ultrasound include first trimester pregnancy ultrasound, assessment of placenta, fetal biometry, fetal echocardiography, fetal neurosonography, assessment of fetal anatomy, and other uses including assessment of fetal lung maturity and screening for risk of adverse pregnancy outcomes. AI holds the potential to improve the ultrasound efficiency, pregnancy outcomes in low resource settings, detection of congenital malformations and prediction of adverse pregnancy outcomes.

Use of artificial intelligence and deep learning in fetal ultrasound imaging.

Deep learning is considered the leading artificial intelligence tool in image analysis in general. Deep-learning algorithms excel at image recognition, which makes them valuable in medical imaging. Obstetric ultrasound has become the gold standard imaging modality for detection and diagnosis of fetal malformations. However, ultrasound relies heavily on the operator's experience, making it unreliable in inexperienced hands. Several studies have proposed the use of deep-learning models as a tool to support sonographers, in an attempt to overcome these problems inherent to ultrasound. Deep learning has many clinical applications in the field of fetal imaging, including identification of normal and abnormal fetal anatomy and measurement of fetal biometry. In this Review, we provide a comprehensive explanation of the fundamentals of deep learning in fetal imaging, with particular focus on its clinical applicability. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

The Morphometry of the Foot in Fetal Human Cadavers

Foot and associated formations have important functions in the musculoskeletal system. Recognition of normal parameter values related to the fetus in fetal development is important for the derivation of fetal growth curves, as each society determines its own normal values for its own population. There are limited number of studies on foot morphology in particular. Therefore, the aim of our study was to determine the measurements of morphological characteristics in human fetuses depending on gestational age, gender and side. Our study was carried out on 30 fetuses. Bilateral acropodian-pternion measurement (AP), the pternion measurement of 2nd, 3rd, 4th, 5th fingers (2P, 3P, 4P, 5P), metatarsaltibia-metatarsalfibula measurement (MT-MF), lengths of the 1., 2., 3rd, 4th, 5th toes (1TL, 2TL, 3TL, 4TL, 5TL), malleolus width (MW), proximal metatarsal width (PMW), distal metatarsal width (DMW), lateral forefoot length ( LFL), the length of the sole of the foot with the medial malleol (MMFL), the length of the sole of the foot (LMFL) with the lateral malleol, and the length of the lower leg (LLL) were measured on all fetuses. Furthermore, the foot index (FI), lower limb length (LL), and leg index (LI) values were also calculated. The difference between trimesters was found statistically significant for all parameters measured except bilateral AI, and right BI measurements. All parameters except left LMFL at 2nd trimester and PMW at 3rd trimester were higher in female fetuses. However, the difference between genders was not statistically significant (p&gt;0.05). The difference between trimesters was significant for all measurements. Furthermore, a correlation was detected between many parameters. In our study, it was found that foot measurements in fetal cadavers did not change with gender, but increased as the week of gestation increased. It was concluded that the data obtained from our study would be useful for further studies as well as recognition of fetal foot anatomy in obstetrics, perinatology, fetopathology, and pediatric surgery.

Normal umbilical artery doppler values in 18–22 week old fetuses with single umbilical artery

Umbilical cord with a single umbilical artery (SUA) can carry twice the blood volume of a three-vessel cord (TVC). So, the normal hemodynamics of the fetuses with SUA was different from those with TVC. Furthermore, structural abnormalities, fetal aneuploidy, and intrinsic growth retardation may be associated with the presence of a SUA. In order to evaluate these patients, intermittent doppler measurements have been suggested. From this point, we aimed to determine the CDUS flow parameters in SUA cases and to demonstrate that these flow parameters are different from the TVC parameters. Ultrasound (US) examinations were performed in the 18–22 weeks of gestation during routine fetal anatomy screening. Resistance index (RI), Pulsatility index (PI), and S/D: systole to diastole ratio values were measured. The samples were taken from the proximal, mid-portion, and distal of the umbilical cord. In addition to Doppler Ultrasound values, AC and estimated fetal weight (EFW) values were also recorded. The study included 167 pregnant women, 86 of whom were study group with SUA and 81 were control group with TVC. The measurements of RI, PI, and S/D at all three levels were significantly lower in the SUA group compared to the TVC group. The resistance in the UA of fetuses with SUA is lower than in fetuses with TVC. The resistance in the UA of fetuses with SUA decreases from the fetal end to the placental end. Knowing the normal values for fetuses with SUA might provide a better and more reliable Doppler Ultrasoundassessment.

A LITHOPEDION – AN UNUSUAL CALCIFIED ABDOMINAL PREGNANCY: A CASE REPORT

Introduction: Lithopedion is an ectopic pregnancy that progresses to fetal mortality and calcification, as described in the introduction. It is uncommon, with a reported incidence of 1.5% to 2% of all ectopic pregnancies. The fetus expires and is not absorbed by the mother's body, but it evades maternal immunity by surrounding itself with a calcified shell. Lithopedion can be diagnosed through abdominal X-rays, ultrasonography, and CT imaging. Case presentation: A 73-year-old female complaining of abdominal mass for over three decades and radiating pain to the right hip for a month. The patient is multipara with a history of habitual abortion. There was an immobile abdominopelvic mass in palpation. The ultrasound showed a large calcified mass in the pelvic cavity. Abdominal and pelvic CT revealed a mummified fetus, depicting great detail of the fetal anatomy surrounded by a calcified membrane. The uterus was normal. Our case is suitable with lithokelyphopedion. Conclusion: Lithopedion is a seroius condition associated with high maternal and perinatal mortality rates. The condition was not identified during prenatal visits. A thorough history and physical examination are as important as imaging investigations in this setting. Keywords: lithopedion, lithokelyphopedion, calcified abdominal mass

Physiological assessment of the fetal body using MRI: current uses and potential directions.

MRI assessment of the fetus using fast T2-weighted sequences is well established in defining alterations in fetal anatomy and structure, as a biomarker for disease, and in some cases prognostication. To date, the physiological assessment of the fetus using advanced sequences to characterise tissue perfusion and microarchitecture has largely been unused. Current methods of assessing fetal organ function are invasive and carry inherent risk. Therefore, the identification of imaging biomarkers of altered fetal physiology, and correlation with postnatal outcome, is attractive. This review describes the techniques which show promise for such a task and potential future directions.

Ultra-high-field MRI of postmortem human fetal wrist joints: initial experience

BackgroundThis study aimed to assess the feasibility of postmortem ultra-high-field magnetic resonance imaging (UHF-MRI) to study fetal musculoskeletal anatomy and explore the contribution of variation in iodine and formaldehyde (paraformaldehyde, PFA) treatment of tissue.MethodsSeven upper extremities from human fetuses with gestational ages of 19 to 24 weeks were included in this experimental study, approved by the Medical Research Ethics Committee. The specimens were treated with various storage (0.2–4% PFA) and staining (Lugol’s solution) protocols and the wrist joint was subsequently imaged with 7.0 T UHF-MRI. Soft-tissue contrast was quantified by determining regions of interest within a chondrified carpal bone (CCB) from the proximal row, the triangular fibrocartilage (TFC), and the pronator quadratus muscle (PQM) and calculating the contrast ratios (CRs) between mean signal intensities of CCB to TFC and CCB to PQM.ResultsUHF-MRI showed excellent soft-tissue contrast in different musculoskeletal tissues. Increasing storage time in 4% PFA, CRs decreased, resulting in a shift from relatively hyperintense to hypointense identification of the CCB. Storage in 0.2% PFA barely influenced the CRs over time. Lugol’s solution caused an increase in CRs and might have even contributed to the inversion of the CRs.ConclusionsUHF-MRI is a feasible technique to image musculoskeletal structures in fetal upper extremities and most successful after short storage in 4% PFA or prolonged storage in 0.2% PFA. The use of Lugol’s solution is not detrimental on soft-tissue MRI contrast and therefore enables effectively combining UHF-MRI with contrast-enhanced micro-computed tomography using a single preparation of the specimen.Relevance statementUHF-MRI can be performed after CE-micro-CT to take advantage of both techniques.Key points• UHF-MRI is feasible to study human fetal cartilaginous and ligamentous anatomy.• Storage in low PFA concentrations (i.e., 0.2%) improves soft-tissue contrast in UHF-MRI.• Limited preservation time in high concentrations of PFA improves soft-tissue contrast in UHF-MRI.• Prior staining with Lugol’s solution does not reduce soft-tissue contrast in UHF-MRI.Graphical

Evaluation fetal heart in the first and second trimester: Results and limitations.

Cardiac heart defects affect nearly 6-12 per 1000 live births in the general population and are more frequent than common trisomies. To assess the efficacy and technical limitations of first-trimester fetal heart evaluation in the 11-14th-weeks' scan and comparison with the second-trimester anatomical exam by ultrasound. Between April 2015 and July 2020, medical records and ultrasound data of 3295 pregnancies who underwent first-trimester fetal anatomy exams by ultrasound were reviewed retrospectively. All ultrasound exams were performed by the same two operators (TUKD, OP) with transabdominal transducers. Fetal situs, four-chamber view, outflow tracts, and three-vessel trachea view are the cornerstones of first-trimester fetal heart examination. Conventional grayscale mode and high-definition power Doppler mode were utilized. The same operators re-examined all cases between the 18 and 23 weeks of gestation by ISUOG guidelines. We performed a combined transvaginal and transabdominal approach for only 101 cases (3.06%). The mean maternal age was 31.28 ± 4.43, the median gestational age at the first-trimester ultrasound exam was 12.4 weeks, and the median CRL was 61.87 mm (range was 45.1-84 mm). Even combined approach situs, cardiac axis, and four-chamber view could not be visualized optimally in 28 cases (0.7%). Outflow tracts were visualized separately in 80% (2636 in 3295) cases. Three vessel-trachea views were obtained in 85.4% (2814 in 3295) cases by high-definition Doppler mode. There were 47 fetuses with cardiac defects in 3295 pregnancies with the known pregnancy outcome. Ten cases had abnormal karyotype results. Thirty-two fetuses with cardiac anomalies (9.7 in 1000 pregnancies) were detected in the first-trimester examination, and the remaining 15 (4.55 in 1000 pregnancies) cases were diagnosed in the second-trimester examination. The prevalence of congenital cardiac anomalies was 14.25 in 1000 pregnancies. Fifteen cases were missed in the first-trimester exam. Also, ten fetuses which had abnormal cardiac findings in the first-trimester exam were not confirmed in the second-trimester exam. Sensitivity, specificity, positive, and negative predictive values were calculated as 65.3%, 99.7%, 66.8%, and 99.67%, respectively. Late first-trimester examination of the fetus is feasible and allows earlier detection of many structural abnormalities of the fetus, including congenital heart defects. Suspicious and isolated cardiac abnormal findings should be re-examined and confirmed in the second-trimester exam. Previous abdominal surgery, high BMI, and subtle cardiac defects can cause missed cardiac abnormalities.

The clinical impact of the first trimester nuchal translucency between the 95th -99th percentile.

To evaluate the clinical significance of nuchal translucency (NT) between the 95th -99th percentile, in terms of typical and atypical chromosomal abnormalities (ACA), associated fetal congenital defects and postnatal outcome. Retrospective cohort study of fetuses with NT between the 95th -99th percentile. Data regarding rate of associated fetal defects, genetic abnormalities and postnatal outcome were collected. A total number of 306 cases of fetuses with a NT between the 95th -99th percentile were included. The overall rate of genetic abnormalities was 12.1% (37/306). Chromosomal abnormalities were found in 10.1% (31/306) of cases and 2% were ACA (6/306). Within this group, two were pathogenic Copy Number Variants (CNVs) and four were single gene disorders. The overall rate of fetal congenital defects was 13.7% (42/306). All ACA were found in fetuses with congenital defects. Postnatally, a new diagnosis of a single gene disorder was made in 0.85% of cases (2/236). The presence of a NT between the 95th -99th percentile carries a 10-fold increased risk of fetal defects, representing an indication for referral for a detailed fetal anatomy evaluation. The risk of ACA is mainly related to the presence of fetal defects, irrespective of the combined test risk. This article is protected by copyright. All rights reserved.