Fetal Neurosonography Research Articles

Cerebral Palsy: State of Art

Abstract Cerebral palsy (CP) is the most common motor disability in childhood. It affects 2 to 2.5 children in 1000 live-births, with 20 to 30 fold increased prevalence in preterm infants. Despite of progress in perinatal care, the prevalence of cerebral palsy did not change in the last 50 years. New knowledge about etiological factors, such as inflammation, elevated level of cytokines, vascular strokes and genetic factors shift the origin of cerebral palsy mostly into antenatal period, making intrapartal damage responsible for less than 10% of cases. CP is becoming increasingly the subject of interdisciplinary research. Fetal neurosonography with a growing number of studies promises better understanding of the normal functional maturation of the human brain which may lead to effective prevention and treatment of cerebral palsy. Advances in 4D ultrasound resulted in development of KANET as tool for detection of abnormal fetal behavior.

Interobserver Reproducibility of Transabdominal 3‐Dimensional Sonography of the Fetal Brain

The purpose of this study was to assess the interobserver reproducibility of transabdominal 3-dimensional (3D) fetal neurosonography. This was a prospective observational study. We studied 23 consecutive singleton pregnancies between 18 and 23 weeks' gestation. All cases had normal fetal neurosonographic examination findings, which were confirmed after birth. A 3D sonographic volume of the fetal head was acquired transabdominally by a single operator using an axial approach. Fetal brain anatomy was later analyzed offline by 2 different operators. Axial, sagittal, and coronal views of the fetal brain were obtained to perform a detailed evaluation of the fetal brain. Each operator defined the scanning planes obtained as adequate or inadequate. Results were evaluated with 2 x 2 tables and the Cohen kappa coefficient to assess interobserver agreement. Good-quality multiplanar images were obtained in 23 of 23 cases. The rate of adequate visualization was 100% for all of the axial planes, with kappa values of 1.00. For sagittal and coronal planes, the rate of visualization ranged between 78% and 91%, with kappa values ranging between 0.61 and 0.83. Transabdominal 3D sonography of the fetal brain at 18 to 23 weeks' gestation has an acceptable degree of interobserver reproducibility.

Prenatal diagnosis of cerebral lesions acquired in utero and with a late appearance

Although no precise figures are available, many congenital brain lesions arise from intrauterine disruption, frequently due to obstetric complications. The most common entities include intracranial hemorrhage, ischemic lesions, thrombosis of venous vessels and infections. Accurate prenatal diagnosis is possible in many of these cases. However, the findings may be subtle, particularly in the early stage of the disruptive process. Identification of these conditions requires therefore specific expertise, the combination of fetal neurosonography and magnetic resonance, and frequently there is a need for serial examinations. Targeted diagnostic imaging should be offered to obstetric patients with conditions predisposing to prenatal cerebral insults.

Thrombosis of an Ectatic Torcular Herophili: Anatomic Localization Using Fetal Neurosonography

Journal of Ultrasound in MedicineVolume 27, Issue 6 p. 989-991 Letter to the Editor Thrombosis of an Ectatic Torcular Herophili: Anatomic Localization Using Fetal Neurosonography First published: 01 June 2008 https://doi.org/10.7863/jum.2008.27.6.989Citations: 9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume27, Issue6June 2008Pages 989-991 RelatedInformation

Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’

Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’

Accurate neurosonographic prediction of brain injury in the surviving fetus after the death of a monochorionic cotwin

To assess the feasibility of the prenatal diagnosis using fetal neurosonography of brain injuries in the surviving fetus after the demise of a monochorionic cotwin. This was a retrospective observational study in the period 1990-2004 of monochorionic twin pregnancies with a single fetal demise. A detailed sonographic evaluation of the intracranial anatomy of the surviving twin had been performed whenever possible using a multiplanar approach and from 1999, fetal magnetic resonance imaging was offered as well. Postnatal follow-up was obtained in all cases. In six of nine cases, abnormal neurosonographic findings were identified including intracranial hemorrhage, brain atrophy, porencephaly and periventricular echogenicities evolving into polymicrogyria. Prenatal diagnosis of brain lesions was confirmed postnatally and all affected infants who survived had severe neurological sequelae. Two fetuses had normal cerebral structures both on the prenatal neurosonogram and on postnatal imaging and were following normal developmental milestones, one at 1 and the other at 5 years of age. In one case the neurosonographic examination was suboptimal and the infant was found at birth to have a porencephalic cyst. Fetal magnetic resonance imaging was performed in two cases and confirmed the ultrasound diagnosis. Prenatal neurosonography is a valuable tool for the prediction of neurological outcome in fetuses surviving after the intrauterine death of a monochorionic cotwin. Although our experience is limited, we suggest that magnetic resonance imaging should also be offered.

OC22.04: Fetal neurosonography and magnetic resonance imaging in the diagnosis of malformations of cortical development

OC22.04: Fetal neurosonography and magnetic resonance imaging in the diagnosis of malformations of cortical development

OC026: Fetal neurosonography in severe RH alloimmunization

The occurrence of abnormal neurodevelopment in survivors after intrauterine transfusion is rare but has been previously documented. We herein describe three fetuses with severe anemia and hydrops in which antenatal neurosonography demonstrated abnormal findings. Three midtrimester fetuses with severe Rh alloimmunization, anemia and hydrops were evaluated with multiplanar neurosonography using a transvaginal approach before and after intravascular transfusion. In all cases, hemoglobin concentration was between 1 and 1.8 g/dL. In all cases, brain edema was noted before the transfusion. In two cases hemorrhage was demonstrated afterwards (one intraventricular grade II and infratentorial, one infratentorial). In the remaining case mild ventriculomegaly developed. The fetus with intraventricular and infratentorial hemorrhage was terminated at the request of the couple and the antenatal diagnosis was confirmed by the postmortem examination. The other two pregnancies continued. The fetus with infratentorial hemorrhage developed hypoplasia of the affected cerebellar hemisphere that was confirmed by both intrauterine and postnatal Magnetic resonance. In the other infant, mild ventriculomegaly resolved in utero and the neonatal neurosonogram was normal. Both infants were delivered after 34 weeks by elective cesarean section and had an uneventful neonatal course. Neurologic examination was within normal limits at one year and two months' of life respectively. The outcome of cases with extreme anemia that are resuscitated by intrauterine transfusion has never been specifically investigated. In published series, brain damage has been although rarely reported. The pathophysiology is uncertain, and is commonly related to preterm birth. We provide evidence that in some cases at least brain injury may occur prenatally. Our experience suggests a role for fetal neurosonography in pregnancies with severe Rh alloimmunization undergoing intrauterine transfusions.

Transvaginal fetal neurosonography: standardization of the planes and sections by anatomic landmarks.

Owing to the limited mobility of the transvaginal probe within the vagina and the introitus, it is virtually impossible to obtain coronal and sagittal sections that are anatomically comparable to those obtained in anatomic sections, computed tomography or magnetic resonance scanning. The aim of this paper is to standardize the neurosonographic images of the fetal brain and develop a nomenclature that more closely reflects the true anatomic sections. A retrospective review of 347 fetal neuroscans was performed. With the use of specific landmarks within the fetal brain, new nomenclature was developed. The scans were divided into the frontal, coronal and sagittal groups. Each group was subsequently further divided into three specific sections. The transvaginal sonographic images of the fetal brain radiate in a fan-like fashion from the anterior fontanelle; therefore the new proposed nomenclature more accurately describes the true anatomic sections.