Multiplanar Approach Research Articles

Ulnar peripheral tears of the triangular fibrocartilage complex: multiplanar approach of injury patterns with a focus on CT arthrography

Ulnar peripheral tears of the triangular fibrocartilage complex: multiplanar approach of injury patterns with a focus on CT arthrography

Early second-trimester three-dimensional transvaginal neurosonography of fetal midbrain and hindbrain: normative data and technical aspects.

To provide a detailed description of the sonographic appearance and development of various fetal structures of the midbrain and hindbrain (MBHB) during the early second trimester, and to evaluate the impact of the frequency of the transvaginal sonography (TVS) transducer on the early recognition of these structures. This was a retrospective analysis of three-dimensional volumetric datasets of the MBHB from apparently normal fetuses at 14-19 gestational weeks, acquired by TVS in the midsagittal view through the posterior fontanelle. Using a multiplanar approach, we measured the tectal thickness and length, aqueductal thickness, tegmental thickness and width and height of the Blake's pouch (BP) neck. In addition, we assessed the existence of early vermian fissures, the linear shape of the brainstem and the components of the fastigium. The correlation between gestational age according to last menstrual period and sonographic measurements of MBHB structures was evaluated using Pearson's correlation (r). A subanalysis was performed to assess the performance of a 5-9-MHz vs a 6-12-MHz TVS transducer in visualizing the MBHB structures in the early second trimester. Sixty brain volumes were included in the study, obtained at a mean gestational age of 16.2 weeks (range, 14.1-19.0 weeks), with a transverse cerebellar diameter range of 13.0-19.8 mm. We found a strong correlation between gestational age and all MBHB measurements, with the exception of the tectal, tegmental and aqueductal thicknesses, for which the correlation was moderate. There was good-to-excellent intraobserver and moderate-to-good interobserver correlation for most MBHB measurements. We observed that the BP neck was patent in all fetuses between 14 and 18 weeks with decreasing diameter, and that the aqueductal thickness was significantly smaller at ≥ 18 weeks compared with at < 16 weeks. The early vermian fissures and the linear shape of the brainstem were present in all fetuses from 14 weeks. We found that, in the early second trimester, the horizontal arm of the presumed 'fastigium' evolves from the fourth ventricular choroid plexus and not the posterior vermis, indicating that this is not the fastigium. Standard- and high-resolution TVS transducers performed similarly in the assessment of MBHB anatomy. Detailed early second-trimester assessment of the MBHB is feasible by transvaginal neurosonography and provides reference data which may help in the early detection of brain pathology involving the MBHB. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

Role of prenatal magnetic resonance imaging in fetuses with isolated mild or moderate ventriculomegaly in the era of neurosonography: international multicenter study.

To assess the role of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses presenting with mild or moderate isolated ventriculomegaly (VM) undergoing multiplanar ultrasound evaluation of the fetal brain. This was a multicenter, retrospective, cohort study involving 15 referral fetal medicine centers in Italy, the UK and Spain. Inclusion criteria were fetuses affected by isolated mild (ventricular atrial diameter, 10.0-11.9 mm) or moderate (ventricular atrial diameter, 12.0-14.9 mm) VM on ultrasound, defined as VM with normal karyotype and no other additional central nervous system (CNS) or extra-CNS anomalies on ultrasound, undergoing detailed assessment of the fetal brain using a multiplanar approach as suggested by the International Society of Ultrasound in Obstetrics and Gynecology guidelines for the fetal neurosonogram, followed by fetal MRI. The primary outcome of the study was to report the incidence of additional CNS anomalies detected exclusively on prenatal MRI and missed on ultrasound, while the secondary aim was to estimate the incidence of additional anomalies detected exclusively after birth and missed on prenatal imaging (ultrasound and MRI). Subgroup analysis according to gestational age at MRI (< 24 vs ≥ 24 weeks), laterality of VM (unilateral vs bilateral) and severity of dilatation (mild vs moderate VM) were also performed. Five hundred and fifty-six fetuses with a prenatal diagnosis of isolated mild or moderate VM on ultrasound were included in the analysis. Additional structural anomalies were detected on prenatal MRI and missed on ultrasound in 5.4% (95% CI, 3.8-7.6%) of cases. When considering the type of anomaly, supratentorial intracranial hemorrhage was detected on MRI in 26.7% of fetuses, while polymicrogyria and lissencephaly were detected in 20.0% and 13.3% of cases, respectively. Hypoplasia of the corpus callosum was detected on MRI in 6.7% of cases, while dysgenesis was detected in 3.3%. Fetuses with an associated anomaly detected only on MRI were more likely to have moderate than mild VM (60.0% vs 17.7%; P < 0.001), while there was no significant difference in the proportion of cases with bilateral VM between the two groups (P = 0.2). Logistic regression analysis showed that lower maternal body mass index (adjusted odds ratio (aOR), 0.85 (95% CI, 0.7-0.99); P = 0.030), the presence of moderate VM (aOR, 5.8 (95% CI, 2.6-13.4); P < 0.001) and gestational age at MRI ≥ 24 weeks (aOR, 4.1 (95% CI, 1.1-15.3); P = 0.038) were associated independently with the probability of detecting an associated anomaly on MRI. Associated anomalies were detected exclusively at birth and missed on prenatal imaging in 3.8% of cases. The incidence of an associated fetal anomaly missed on ultrasound and detected only on fetal MRI in fetuses with isolated mild or moderate VM undergoing neurosonography is lower than that reported previously. The large majority of these anomalies are difficult to detect on ultrasound. The findings from this study support the practice of MRI assessment in every fetus with a prenatal diagnosis of VM, although parents can be reassured of the low risk of an associated anomaly when VM is isolated on neurosonography. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing.

Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing. Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded. Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up (P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy. Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction. Level IV, retrospective case series.

Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study

BackgroundConnective tissue mobility alters motor unit recruitment, but the restoration of fascial mobility allows for optimal motor function. The Fascial Manipulation® (FM®) method is a multiplanar approach that assesses and treats the mobility of deep fascia in specific anatomical locations where motor units converge. ObjectivesTo assess the effects of FM® vs. standard physical therapy treatment (SPT) in patients with low back pain (LBP). DesignSix-months controlled clinical trial. Method102 participants with LBP received SPT or FM®. Numeric Pain Rating Scale (NPRS), 15- point Global Rating of Change (GROC), and Oswestry Disability Index (ODI) were used to monitor progress. ResultsThe FM® group had a significantly lower ODI (p < 0.009) and NPS scores (p < 0.0001) and significantly higher GROC scores (p < 0.003) once their means were adjusted for initial scores. When comparing the SPT to FM®, the final ODI decreased by at least 1 category in 48.9% of the SPT cases, while in 36.2% of the cases was no change. ODI minimal clinical importance difference (MCID) change of 10% decrease in scores occurred in 70.2% of the SPT group compared to 96% of the FM® group (p = 0.003). ODI MCID change of 50% decrease in scores occurred in 40% of the SPT group compared to 64.6% of the FM® group (p = 0.02) 44.7% of the participants in the SPT group had final GROC values above +5 at discharge, compared to 92% of the participants from the FM® group (p = 0.0001). The FM® subjects had almost three times the change in NPRS compared to SPT counterparts (-4.3 ± 2.2 to -1.5 ± 2.4, p=0.0001). ConclusionsFM® appears to improve NPRS, GROC, and ODI more than SPT. FM® may provide an effective treatment technique for LBP.

Multicenter Early Radiographic Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight-Bearing

Category: Bunion Introduction/Purpose: Hallux valgus is a complex positional deformity of the first ray. Traditional correction methods for hallux valgus prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. However, only addressing the transverse plane component of hallux valgus is a potential factor resulting in poor outcomes and high long-term recurrence rates ranging from 8%-78%. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. The triplanar tarsometatarsal arthrodesis (modified Lapidus, Figure 1) uses a multi-planar approach to evaluate and correct the deformity associated with hallux valgus in all three anatomical planes. The purpose of this study is to investigate early radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, radiographs and charts were retrospectively reviewed for 101 patients (age 41.9 ± 17.9 years) undergoing triplanar tarsometatarsal arthrodesis (modified Lapidus) for hallux valgus deformity correction at four institutions between June 2016 and June 2017. Patients were allowed immediate weight-bearing as tolerated after the procedure. Radiographic imaging at 4 months and 12 months was reviewed and compared to pre-operative imaging. Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), metatarsus adductus angle, evidence of metatarsal pronation, and radiographic first TMT union. Demographics included age, gender, body mass index, medical comorbidities, and smoking status. Time (days) to weight-bearing, wearing athletic shoes, and return to full activity were also noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Radiographic results demonstrated significant improvements in IMA, HVA, and TSP at final follow-up. IMA was 5.9 ± 3.2 degrees at final follow-up compared to 15.0 ± 3.1 degrees pre-operatively (p &lt; 0.001). At final follow-up, HVA was 8.3 ± 5.5 degrees compared to 23.7 ± 10.1 degrees pre-operatively (p &lt; 0.001). TSP was also significantly improved at final follow-up (2.0 ± 0.9) compared to pre-operatively (5.1 ± 1.2; p &lt; 0.001). Lateral round sign was present in 5 patients (4.9%) at final follow-up compared to 88 patients (87.1%) prior to corrective surgery. Four patients (4.0%) demonstrated evidence of radiographic non-union at final follow-up. Regarding complications, there were four cases (3.9%) of hardware removal for either soft-tissue irritation or hardware failure. Conclusion: In this study, early radiographic outcomes of triplanar tarsometatarsal arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. These results demonstrate that this procedure is able to reliably achieve anatomic correction in all three planes for hallux valgus deformity. The triplanar tarsometatarsal arthrodesis technique also demonstrated high union rates and low recurrence rates at final follow-up. Longer follow-up is necessary to determine the long-term survivorship, outcomes, and complications of this new technique to correct hallux valgus deformity.

Early Endocarditis and Delayed Left Ventricular Pseudoaneurysm Complicating a Transapical Transcatheter Mitral Valve-in-Valve Implantation: Percutaneous Closure Under Local Anesthesia and Echocardiographic Guidance.

A 72-year-old man was referred because of suspected infective endocarditis. Fifteen years earlier, he had undergone mitral valve replacement with a 33-mm Hancock valve for severe mitral regurgitation. Three months ago, he presented with a first episode of congestive heart failure caused by severe mitral regurgitation reflecting degeneration of the bioprosthetic valve without sign of endocarditis. Because of a high surgical risk based on an estimated Euroscore I of 42.96% and The Society of Thoracic Surgeons (STS) score of 29% (main comorbidity is an advanced Parkinson disease), valve-in-valve implantation was planned. A 29-mm Edwards Sapien 3 (S3) balloon-expandable valve was successfully implanted through transapical puncture of the left ventricle (LV) after direct surgical exposure by mini thoracotomy. Patient was discharged 10 days after the procedure without complications. On his admission, the patient was febrile and examination revealed a purulent discharge at the site of thoracotomy. Transthoracic echocardiography (TTE) and transesophageal echocardiography showed a 15-mm mobile vegetation on the leaflet of the S3 (Movie I in the Data Supplement) and a pseudoaneurysm at the apex of the left ventricle (LVPA) flowing by a large apical defect (Figure 1; Movie II in the Data Supplement). Computed tomographic (CT) scanning confirmed the LVPA free from any thrombus and identified the surgical suture tip in its deep (Figures 1 and 2; Movie III in the Data Supplement). 18F positron-emission tomography demonstrated an uptake on the S3 and LVPA (Figure 2). Blood cultures were positive for Staphylococcus aureus . Antibiotherapy with co-trimoxazole for 6 weeks and clindamycin for 1 week was started, and a quick clinical and biological …

The Multiplanar Nature of Frequency

AbstractAs reflected by the distinction between types and tokens, frequency is standardly conceived of in a two-dimensional fashion. This conception draws on the linguistic hierarchy in that token frequency is calculated at a higher structural level than type frequency. The fact that the linguistic hierarchy consists of more than two levels raises the possibility of investigating frequency from a multiplanar angle. This approach is illustrated with a three-level analysis of derivational affixes in English, German, and Dutch. The lowest level represents the number of affix types, the intermediate level the number of words of which these affixes are a part, and the highest level the textual frequency of these affixed words. The three languages exhibit significant variation. While English shows a consistent increase, German shows a consistent decrease in the suffix-to-prefix ratios from the lower to the higher levels. Dutch is inconsistent in displaying an increase from the lowest to the intermediate level but a decrease from the intermediate to the highest level. A good part of the explanation for this difference lies in the disparate role of prefixing in the three languages. The multiplanar approach provides novel perspectives on a number of issues such as the locus of linguistic change. Preliminary evidence suggests that the loss of a lower-level unit may be accompanied by “collateral damage” at the higher level.

Dynamic Multiplanar Real Time Ultrasound Guided Infraclavicular Subclavian Vein Catheterization

Ultrasound guided vascular access has been well-characterized as a safe and effective technique for internal jugular and femoral vein catheterization. However, there is limited experience with the use of ultrasound to access the infraclavicular subclavian vein. Multiple ultrasound techniques do exist to identify the subclavian vein, but real time access is limited by vessel identification in a single planar view. To overcome this limitation, a novel technique of ultrasound guided infraclavicular subclavian vein catheterization using a real time multiplanar approach has been developed. The initial experience with this approach is described. A single surgeon used combined oblique, transverse, and longitudinal views along with Doppler color flow images to both define the infraclavicular anatomy and to obtain subclavian vein access in 42 adult patients (20 M/22 F and 22 L/20 R) with a mean body mass index of 29.2 (range = 18.9-55.4). Chest x-ray was obtained to confirm position and to rule out pneumothorax. Subclavian vein cannulation was achieved in 100 per cent of patients; subsequent catheterization was successful in 92.9 per cent. The number of attempts required for cannulation averaged 1.3 (range = 1-5), and decreased after a five patient learning curve. No patient developed a pneumothorax, hematoma, or cannula malposition. Ultrasound guided multiplanar infraclavicular subclavian vein access appears to be a safe and effective adjunct for central line placement.

Ultrasound vs Magnetic Resonance in the Assessment of CNS Anomalies

ABSTRACT Central nervous system (CNS) malformations are some of the most comon congenital abnormalities. Long-term follow-up studies suggest that the incidence may be as high as 1 in 100 births. Imaging technologies have been remarkably improved and contributed to prenatal evaluation of fetal CNS development and assessment of CNS abnormalities. The routine examination of the fetal brain can be achieved with axial planes by conventional transabdominal ultrasonography. In order to provide a complete view of the different brain structures a detailed fetal neurosonogram requires additional coronal and sagittal views. Three-dimensional (3D) sonography should be performed transvaginally using the multiplanar approach. Transvaginal high-resolution 3D ultrasound can demonstrate cerebral fine vascular anatomy such as medullary vessels, intracranial calcification, vascular abnormalities. Parallel slicing provides a tomographic visualization of internal morphology similar to magnetic resonance imaging (MRI). Fetal MRI appears to be a useful adjunct to ultrasound to confirm or exclude certain abnormalities. MRI is a valuable complementary tool to detailed neurosonography which allows an evaluation of the normal brain maturation from the second trimester. It also offers a higher diagnostic performance for some congenital abnormalities such as cortical development or posterior fossa assessment. How to cite this article Crnogorac S, JuriÓiƒ A, Grdiniƒ A. Ultrasound vs Magnetic Resonance in the Assessment of CNS Anomalies. Donald School J Ultrasound Obstet Gynecol 2013;7(4):496-499.

Fetal uvula: navigating and lightening the soft palate using HDlive

Cleft lip and palate (CLP) have an incidence of 1.82 in 1,000 live births [1], thus representing one of the most common congenital anomalies. In a series by Cash et al. [2], 67 % of the cases involved isolated cleft lip, 93 % involved CLP, and only 22 % involved isolated cleft palate. The prenatal detection of 553 cleft lips with or without cleft palate and 198 cleft palates by 2D ultrasound from 20 European registries was reported by Clementi et al. [3]. Prenatal diagnosis of CLP was made in 65/366 cases with an isolated malformation, 32/62 cases with chromosomal anomaly, 30/89 cases with multiple malformations, and 21/36 syndromic cases. Prenatal diagnosis of isolated cleft palate was made in only 13/198 cases. Prenatal ultrasound diagnosis of CLP in a low-risk population has proved to have a low detection rate that ranged from 9 to 100 % for cleft lip with or without cleft palate, 0–22 % for isolated cleft palate only, and 0–73 % for all types of cleft. 3Dultrasound in high-risk women (women whose fetuses were suspected or confirmed to have facial cleft by 2D ultrasound examination or who had a family history of facial cleft) yielded a detection rate of 100 % for cleft lip, 86–90 % for cleft lip with palate, and 0–88.9 % for cleft primary palate only [4]. In a recent series, Maarse et al. [5] studied 35,924 low-risk and 2,836 high-risk pregnant women undergoing ultrasound screening. Orofacial clefts were present in 62 cases, an incidence of 1:624. The distribution of clefts was as follows: 18 (29 %) cleft lips, 25 (40 %) cleft lips with cleft palate, 17 (27 %) cleft palates only, one median cleft and one atypical cleft. Cleft lip with or without cleft palate was detected prenatally in 38/43 cases, a sensitivity of 88 %, but no case of cleft palate only was detected prenatally. Offerdal et al. [6] evaluated prenatal detection by ultrasound on 101 fetuses with facial clefts in a large nonselected population (49,314 deliveries) and showed a significant statistical increase in detection rates (from 34 to 58 %) over the two 9-year periods. Isolated cleft palates amounted to 24 %, and none were detected prenatally. Different 3D ultrasound techniques have been developed to image the fetal palate. Campbell et al. [7] were first to develop the ‘‘reverse face’’ view using 3D ultrasound. The fetal lips and alveolar ridge were examined in the frontal plane, and the face was then rotated 180 on the vertical axis to examine the secondary palate. Eight cases of suspected orofacial clefting were examined. In one case with a left-sided cleft in the lips and the alveolar ridge, and with an intact hard palate, the correct diagnosis was made, but a cleft in the soft palate was missed. Platt et al. [8] have described the ‘‘flipped face’’ view that is based on the multiplanar approach and which requires specific technical expertise. After volume acquisition, the image is rotated 90 so that the cut plane is directed along a plane extending from chin to nose. The volume cut plane is then scrolled from chin to nose to examine sequentially the lower lip, mandible, and alveolar ridge; the tongue; the upper lip, maxilla, and alveolar ridge; and the hard and soft palates. In the ‘‘angle insonation’’ technique developed by Pilu and Segata [9], in order to avoid acoustic shadowing from G. Tonni (&) Department of Obstetrics and Gynecology, Prenatal Diagnostic Center, Guastalla Civil Hospital, ASL Reggio Emilia, Via Donatori di Sangue,1, 42016 Guastalla, RE, Italy e-mail: tonni.gabriele@ausl.re.it; tonnig@ausl.re.it

Ultrasonography: The Main Diagnostic Tool in Subfertile Women

ABSTRACT The diagnostic assisted reproductive technology (ART) workup includes ultrasonography, hysteroscopy, hysterosalpingography, magnetic resonance imaging (MRI) and laparoscopy where appropriate. Ultrasound represents the mainly used imaging modality for assessing the female genital tract. Recent developments, i.e. the introduction in the daily praxis of hydrosonography, elastography and the use of contrast media, enhanced by the application of three-dimensional (3D) and fourdimensional (4D) software produce images of high resolution. All these offer the possibility of multiplanar approach and create fast techniques that result in specific and detailed reports. The comparably short period of training for the medical doctors could transform the ultrasonography in the leading diagnostic tool even in nonexperienced hands. It is noteworthy, that in suspicion of malignancy, patients should be referred to more experienced teams. How to cite this article Domali E, Kyriakopoulos K, Antsaklis A. Ultrasonography: The Main Diagnostic Tool in Subfertile Women. Donald School J Ultrasound Obstet Gynecol 2012;6(3):270-285.

MRI in Neurosciences

MRI in Neurosciences

Case Report Highlighting How Wound Path Identification on CT Can Help Identify Organ Damage in Abdominal Blast Injuries

Penetrating trauma is frequently encountered in forward deployed military combat hospitals. Abdominal blast injuries represent nearly 11% of combat injuries, and multiplanar computed tomography imaging is optimal for injury assessment and surgical planning. We describe a multiplanar approach to assessment of blast and ballistic injuries, which allows for more expeditious detection of missile tracts and damage caused along the path. Precise delineation of the trajectory path and localization of retained fragments enables time-saving and detailed evaluation of associated tissue and vascular injury. For consistent and reproducible documentation of fragment locations in the body, we propose a localization scheme based on Cartesian coordinates to report 3-dimensional locations of fragments and demonstrating the application in three cases of abdominal blast injury.

Imaging Diagnosis of Colorectal Cancer

Recently, treatment strategy of rectal cancer has undergone a dramatic change. Application of total mesorectal excision and preoperative chemoradiation therapy (PCRT) has become standard procedure for locoregional and locally advanced rectal cancer, respectively. Functional and morphological radiologic evaluation as well as multidisciplinary approach is both essential for planning patient-specific therapy. In other words, the needs for more accurate T-and N-staging and assessment of circumferential resection margin, both before and after PCRT, are increasing rapidly. Although there is no consensus on the role of diagnostic imaging such as endorectal ultrasonography, computed tomography and magnetic resonance imaging (MRI), in evaluation of rectal cancer patient so far, MRI is emerging as an essential imaging modality with superior trssue contrast and multiplanar approach.

Normal sonographic development of the central nervous system from the second trimester onwards using 2D, 3D and transvaginal sonography

The developmental changes of the fetal central nervous system (CNS) during the second and third trimesters, specifically the brain, relate mostly to changes in size. However, other changes do occur in the fetal brain during the second and third trimester such as: the union of the cerebellar hemispheres, development of the corpus callosum (CC), and increasing complexity of the cerebral cortex. These changes follow a well-defined developmental timeline recognizable by sonography. The fetal neuroscan can be divided into a 'basic scan' which is performed transabdominally and a 'targeted Exam or neurosonogram' which uses a multiplanar approach, which preferably should be performed transvaginally. During the 'basic scan', several brain structures are imaged in addition to obtaining important biometric measurements. The 'neurosonogram' is a more extensive or detailed fetal study during which the emphasis is on the addition of coronal and sagittal planes. The easiest way to obtain these planes, if the fetus is in a cephalic presentation, is the transvaginal route. Three-dimensional (3D) sonography should, if possible, be performed transvaginally using the multiplanar approach. An added benefit of 3D sonography is the ability to display and render the volume in a variety of ways which may enhance the detection of pathology.

Examination of the Fetal Heart by Four-Dimensional Ultrasound with Spatiotemporal Image Correlation during Routine Second-Trimester Examination: The ‘Three-Steps Technique’

Objective: To prospectively analyze theaccuracy and rapidity of four-dimensional (4D) ultrasonography with spatiotemporal image correlation (STIC) in the assessment of four-chamber view and outflow tracts in unselected fetuses and in fetuses with congenital heart defects (CHD) at 19–23 weeksof gestation. Materials and Methods: 112 consecutive pregnancies undergoing routine second-trimester ultrasonographic scan and 10 pregnancies with fetuses with CHD affecting the great arteries formed the study group. From the four-chamber view, volumes of the fetal heart were acquired by the STIC technique and stored for a later offline analysis that was performed by two examiners blinded to the characteristics of the fetuses. Offline analysis was performed using a simplified multiplanar approach based on 3 different steps and one rotation finalized to visualize the four-chamber view and the left and right outflow tracts. Results: Adequate recognition of four-chamber view and outflow tracts was obtained in more than 80% of the volumes. There were no false-positives and only one observer had a false-negative (interrupted aortic arch classified as normal). The mean time required to interpret 4D volumes was 3.7 min. Conclusions: The standard fetal cardiac anatomy survey can be performed in the second-trimester fetus by 4D STIC in both normal and abnormal hearts. This approach may reduce the operator’s dependency in diagnosis of CHD.

‘Ceci n’est pas une échographie': a plea for quality assessment in prenatal ultrasound

‘Ceci n’est pas une échographie': a plea for quality assessment in prenatal ultrasound

The fetal corpus callosum. ‘The truth is out there’

The fetal corpus callosum. ‘The truth is out there’