Transcerebellar Diameter Research Articles

Sexual dimorphism of the fetal brain biometry: an MRI-based study.

Fetal growth assessment is a key component of prenatal care. Sex-specific fetal brain nomograms on ultrasound are available and are clinically used. In recent years, the use of fetal MRI has been increasing; however, there are no sex-specific fetal CNS nomograms on MRI. The study aimed to assess the differences in fetal brain biometry and growth trajectories and to create population-based standards of the fetal brain on MRI. In this cross-sectional study, brain structures of singleton fetuses with normal brain MRI scans were analyzed: biparietal diameter, occipitofrontal diameter, trans-cerebellar diameter, and the corpus callosum were measured and converted into centiles. Sex-specific nomograms were created. A total of 3848 MRI scans were performed in one tertiary medical center between 2011 and 2019; of them, 598 fetuses met the inclusion criteria, 300 males and 298 females between 28- and 37-weeks' gestation. Males had significantly larger occipitofrontal diameter than females (median 75%, IQR 54-88%; median 61%, IQR 40-77%) and biparietal diameter (median 63%, IQR 42-82%; median 50%, IQR 25-73%), respectively (p < 0.001). The cerebellum had the greatest growth rate, with a 1.5-fold increase in diameter between 28 and 37weeks' gestation, with no measurement difference between the sexes (p = 0.239). No significant difference was found in the corpus callosum (p = 0.074). Measuring both sexes on the same nomograms may result in over-estimation of male fetuses and under-estimation of females. We provide fetal sex-specific nomograms on two-dimensional MRI.

The Accuracy of Transcerebellar Diameter in Assessment of Gestational Age in Normal and Growth Restricted Fetuses and Diagnosis of Intrauterine Growth Restriction

The Accuracy of Transcerebellar Diameter in Assessment of Gestational Age in Normal and Growth Restricted Fetuses and Diagnosis of Intrauterine Growth Restriction

Expanding the natural history of CASK-related disorders to the prenatal period.

To assess whether microcephaly with pontine and cerebellar hypoplasia (MICPCH) could manifest in the prenatal period in patients with calcium/calmodulin-dependent serine protein kinase (CASK) gene disorders. In this international multicentre retrospective study, we contacted a CASK parents' social media group and colleagues with expertise in cerebellar malformations and asked them to supply clinical and imaging information. Centiles and standard deviations (SD) were calculated according to age by nomograms. The study consisted of 49 patients (44 females and 5 males). Information regarding prenatal head circumference was available in 19 patients; 11 out of 19 had a fetal head circumference below -2SD (range -4.1SD to -2.02SD, mean gestational age at diagnosis 20 weeks). Progressive prenatal deceleration of head circumference growth rate was observed in 15 out of 19. At birth, 20 out of 42 had a head circumference below -2SD. A total of 6 out of 15fetuses had a TCD z-score below -2 (range -5.88 to -2.02). This study expands the natural history of CASK-related disorders to the prenatal period, showing evidence of progressive deceleration of head circumference growth rate, head circumference below -2SD, or small TCD. Most cases will not be diagnosed according to current recommendations for fetal central nervous system routine assessment. Consecutive measurements and genetic studies are advised in the presence of progressive deceleration of head circumference growth rates or small TCD. Progressive deceleration of fetal head circumference growth rate can be observed. A small transcerebellar diameter is an additional important manifestation. Most cases will not be diagnosed according to current recommendations for fetal central nervous system routine assessment. Consecutive measurements are advised when measurements are within the low range of norm.

Fetal Trans-Cerebellar Diameter and Fetal Trans-Cerebellar Diameter to Abdominal Circumference [tcd/ac] Ratio in Assessment of Gestational Age for the Prediction of Normal Fetal Growth and Intrauterine Growth Restriction

Fetal Trans-Cerebellar Diameter and Fetal Trans-Cerebellar Diameter to Abdominal Circumference [tcd/ac] Ratio in Assessment of Gestational Age for the Prediction of Normal Fetal Growth and Intrauterine Growth Restriction

Accuracy of transcerebellar diameter in comparison with biparietal diameter, femur length, and fetal kidney length in the sonographic assessment of gestational age in the third trimester of pregnancy

Background When gestational age (GA) cannot be calculated by the date of the last menstrual cycle or an early pregnancy ultrasound, the cerebellar diameter acts as an accurate predictor of GA in the fetus and a criterion against which other fetal parameters can be compared. Aim The aim of this work was to evaluate the accuracy of transcerebellar diameter (TCD) in comparison with biparietal diameter (BPD), femur length (FL), and fetal kidney length in the determination of GA in the third trimester of pregnancy. Patients and methods This was a cross-sectional analysis performed at Tanta University Hospital on 200 singleton uncomplicated pregnant women. Fetal biometric measurements were taken using ultrasound, including TCD, BPD, FL, and fetal kidney length. Results The percentages of accurate assessment of GA within 3 days were as follows: of 200 patients, the TCD gave accurate assessment within 3 days in 120 (60%) patients, the BPD gave accurate assessment within 3 days in 90 (45%) patients, the FL gave accurate assessment within 3 days in 100 (50%) patients, and both right and left kidney lengths gave accurate assessment within 3 days in 100 (50%) patients. Conclusion The TCD is a reliable single parameter for the determination of GA in the third trimester of pregnancy. TCD is a most valuable tool in cases where other established biometric indices are difficult to obtain.

Comparison Study between Fetal Kidney Length and Transcerebellar Diameter to Determine Gestational age in the Third Trimester

Introduction and Aim: An accurate determination of gestational age (GA) is crucial to the management of all pregnancies, particularly high-risk pregnancies. This study aimed to comparing between the accuracy of ultrasonographic fetal kidney length and Transcerebellar diameter in GA determination in third trimester.&#x0D; Patients and methods: The study was a cross sectional one, carried out at the department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt. The study had been performed between January 2021 and January 2022. All were submitted to a detailed history, routine antenatal investigations, general and obstetrical examination. Then, measurements of all fetal biometric parameters were recorded using a real- time, grayscale, 3.5–5.0 MHz curvilinear array transducer. Results were compared to the gestational age determined by last menstrual period.&#x0D; Results: The patient age ranged between 18 and 37 years, their weight ranged between 55 and 109 kg, while gravidity ranged between 1 and 5 and parity ranged between 0 and 4. The GA as determined by last menstrual period (LMP) was ranged between 28 and 40 weeks. The calculated GA by different measurements were also included and they were around the same measurements as determined by LMP. This was confirmed by the absent statistically significant difference between GA by LMP and any of calculated gestational age by any method. The mean fetal kidney length is more accurate in determination of gestational age than transcerebellar diameter (96.3% vs 89.8%) and both were significantly correlated with other calculated gestational ages.&#x0D; Conclusion: The length of the fetal kidney length proportionately correlated with fetal gestation age with powerful correlation coefficient. Fetal kidney length is found to be more accurate in GA determination than transcerebellar diameter (TCD).

Ultrasound correlation of transcerebellar diameter with last menstrual period for gestational age in second and third trimester of pregnancy

Background: Foetal biometry is useful modality in assessment of gestational age (GA) for good obstetric outcome. Objectives: To compare ultrasonographic measurement of transverse cerebellar diameter (TCD) with other previously established foetal ultrasound biometric parameters. Methods: An analytical cross-sectional study was conducted from August 2020 to February 2021 in Department of Radiology at Kathmandu Medical College after ethical clearance. Convenience sampling technique was utilised to include all pregnant women in second and third trimester with known last menstrual period (LMP). Written informed consent was taken from those willing to participate. Congenital malformations, multiple pregnancies, irregular menstrual cycle, and maternal illness were excluded. Data were entered and analysed by using SPSS v.22. Descriptive statistics like mean, standard deviation, and percent were used. Inferential statistics (t- test and Pearson correlation) was also used to see the correlation between different variables. Results: Among 100 participants who participated in the study, 63 (63%) were primigravida with singleton pregnancy without any congenital anomalies. The mean foetal heart rate was 144.9 ± 13.6. The mean GA based on LMP, TCD, and other parameters were 30.86 ± 7.76 weeks, 31.07 ± 8.45 weeks, and 29.75 ± 6.61 weeks respectively. In 15-28 weeks, all parameters had nearly equal r-values. Among all, TCD revealed highest correlation (0.888). In 29-40 weeks, there was considerable difference in r-values. The second most accurate correlation was seen with head circumference (r = 0.874). Conclusion: TCD being stable parameter not affected by foetal growth status maybe preferred over other parameters in estimating foetal gestational age.

Study of transcerebellar diameter to abdominal circumference ratio in prediction of foetal growth restriction in high risk pregnancies

Background: The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR. Aims: To study the trans cerebellar diameter / abdominal circumference ratio values in clinically suspected FGR and high-risk cases of pregnant women after 28 weeks. Materials and methods: A prospective study consisting of 100 antenatal women was conducted in pregnant women with clinically suspected FGR and high risk pregnancies after 28 weeks. Results: The most common gestational age group taken for evaluation of TCD/AC ratio was in between 30-36 weeks. Preeclampsia is the major predisposing factor of FGR i.e. 46%, and 30 % of cases were under unknown cause. The mean TCD/AC ratio in FGR cases is 17 .33 +/- 0.23. The cut-off value of TCD/AC ratio was 15.77. TCD/AC ratio has 98% positive predictive value when compared to FL/AC and HC/AC. LSCS rate is high in FGR cases (58 %).

Diagnostic Accuracy of TCD/AC Ratio in Predicting Intrauterine Growth Retardation

Background: Fetal growth assessment is necessary for prediction of fetal health during pregnancy. Aim: To determine the diagnostic accuracy of transcerebellar diameter / abdominal circumference ratio in predicting intrauterine growth retardation after 20 weeks gestation taking birth weight as gold standard. Study design: Cross sectional study. Methodology: Present study was conducted at Department of Obstetrics &amp; Gynecology, Combined Military Hospital Kharian. Patients (n=80) with an age range of 18-40 years with singleton pregnancies at 20 weeks gestation were enrolled. All patients were assessed by ultrasound and TCD/AC ratio was calculated. All patients followed till birth and actual birth weight was obtained. All this information was recorded on Performa. Statistical analysis: Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: The mean age of patients was 28.61±5.72 years. The mean gestational age was 21.96±1.50 weeks. For prediction of IUGR, TCD/AC had sensitivity, specificity, PPV, NPV &amp; diagnostic accuracy of 85.29%, 91.3%, 87.88%, 89.36% &amp; 88.75%, respectively. Conclusion: It was concluded that TCD/AC ratio is an accurate diagnostic tool accuracy for prediction of IUGR during pregnancy. Keywords: Transcerebellar Diameter, Abdominal Circumference, Intrauterine Growth Retardation and Birth Weight.

Second and third trimester estimation of gestational age using ultrasound or maternal symphysis-fundal height measurements: A systematic review.

Tweetable abstractMany vulnerable women seek antenatal care late in pregnancy. How should gestational age be determined? We examine all available studies estimating GA >20 weeks. Ultrasound is much better than fundal height, and using cerebellar measurement appears to be the most accurate. Linked article: This article is commented on by Philip J. Steer, pp. 1459 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17127.

Comparison between Trans-cerebellar diameter, Bi-parietal diameter and Femur length for gestational age measurement accuracy in the third trimester of pregnancy

Comparison between Trans-cerebellar diameter, Bi-parietal diameter and Femur length for gestational age measurement accuracy in the third trimester of pregnancy

Transcerebellar diameter versus biparietal diameter for the measurement of gestational age in third trimester.

AimTo compare the accuracy of biparietal diameter and transcerebellar diameter in measuring the gestational age during the third trimester of pregnancy.Material and methodsIn this prospective observational study, 275 pregnant women with singleton pregnancy between 32 and 37 weeks gestational age were recruited from the outpatient clinics of both Helwan University Hospital and Ain Shams University Maternity Hospital, Cairo, Egypt, during the period from February 2021 to August 2021. Transcerebellar and biparietal diameters of the fetus were measured by a radiologist blinded to the women’s gestational age, and compared to the gestational age acquired from a reliable date of first day of last menstrual period.ResultsThe gestational age calculated by first day of last menstrual period ranged from 32 to 37 weeks (34.35 ± 1.4), while estimated by transcerebellar and biparietal diameters ranged from 31 to 37 weeks (34.31 ± 1.39) and 31 to 39 weeks (34.32 ± 1.44), respectively. There was a strong positive correlation between gestational age and transcerebellar diameter (r = 0.98, p <0.001) as well as biparietal diameter (r = 0.87, p <0.001), yet a stronger correlation was with transcerebellar diameter. 93.6% of gestational age assessment by transcerebellar diameter was correct compared to only 79.9% by biparietal diameter.ConclusionsTranscerebellar diameter is a reliable single sonographic fetal biometric parameter for the assessment of gestational age in third trimester of pregnancy.

Utility of sonographic transcerebellar diameter in the assessment of gestational age in normal and intrauterine growth-retarded fetuses.

The fetal cerebellum has been shown to be least affected by external pressures and molding during pregnancy and therefore might provide more accurate estimation of GA. To study the utility of transcerebellar diameter (TCD) measured by ultrasound for the detection of GA in normal and intrauterine growth-retarded (IUGR) fetuses. This cross-sectional study comprised 500 antenatal patients with a GA between 14 and 39 weeks and who were certain of their last menstrual periods. The TCD was measured ultrasonographically and the corresponding GA was determined. The GA was also determined with other customarily used sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) and compared with TCD. Data of normal pregnancy patients was used to formulate nomograms by taking the 5th, 50th, and 95th percentile measurements. TCD to AC ratio was also calculated in both normal (n = 424) and IUGR pregnancies (n = 76). TCD showed significant correlation with gestational age (GA) measured by last menstrual period (LMP) as well as with GA calculated with other biometric fetal parameters. TCD also showed significant correlation with GA in normal (R2 = 0.979) as well as with IUGR pregnancies (R2 = 0.942). TCD to AC ratio remained fairly constant in normal pregnancies while it was increased in IUGR pregnancies. TCD and TCD/AC ratio can be employed as an objective parameter to establish the GA in normal as well as IUGR pregnancy cases.

Ultrasound Comparative Study between Trans-cerebellar Diameter with Bi-parietal Diameter and Femur Length for Gestational Age Measurement in Second Trimester of Pregnancy

Ultrasound Comparative Study between Trans-cerebellar Diameter with Bi-parietal Diameter and Femur Length for Gestational Age Measurement in Second Trimester of Pregnancy

Evaluation of Correlation and Variability between Transcerebellar Diameter and Gestation age in Normal pregnancies

Background: Transcerebellar diameter is emerging as a promising indicator for assessment of the Gestational age. Present study was done with the objective to evaluate the Correlation and estimate the Variability between Transcerebellar Diameter and Gestation age in Normal pregnancies. Material and Methods: This Prospective Cross-sectional study was conducted on antenatal women of gestational age 15-40 weeks with normal singleton pregnancies cases attending the antenatal clinic and admitted in the Department of Obstetrics and gynecology, and sent to Department of Radiology KNSH MandC and IGMC Shimla for Antenatal USG Scan. In every patient TCD was measured. Data was analysed by appropriate statistical test using EPI INFO Version 7.2 software. Correlation coefficients were then used to compare TCD with Gestational age in normal pregnancies. Results: In this study 100 were normal pregnancies were studied. Mean age of study participants was 24.8±3.25years. Maximum number of patients (54%) was between 21-25 years followed by 26-30 years (32%). Maximum number of patients (44%) was between 30-36 weeks of gestation and least number of patients (5%) was between 12- 18weeks. It was noted that minimum variability was seen during 12-18 weeks i.e±0.34weeks and maximum variability in estimation of gestational age by transcerebellar diameter was seen between 24-30 weeks i.e.±1.38 weeks. It was observed that during second trimester TCD had the highest correlation with gestational age i.e.0.987 .It is also noted that TCD has relatively lesser correlation with gestational age in third trimester. i.e.0.788. Conclusion: Overall it was noted that TCD had a strong correlation with gestational age throughout the pregnancy which was statistically significant.

Assessment of Correlation between Transcerebellar Diameter and Gestation age in IUGR pregnancies

Background: Accurate assessment of the gestational age is very critical in the management of IUGR cases and their associated complications. Present study was done with the objective to evaluate the Correlation between Transcerebellar Diameter and Gestation age in IUGR pregnancies. Material and Methods: This Prospective Cross-sectional study was conducted on antenatal women of gestational age 15-40 weeks with IUGR pregnancies cases attending the antenatal clinic and admitted in the Department of Obstetrics and gynecology, and sent to Department of Radiology KNSH MandC and IGMC Shimla for Antenatal USG Scan. In every patient TCD was measured. Data was analysed by appropriate statistical test using EPI INFO Version 7.2 software. Correlation coefficients were then used to compare TCD with Gestational age in IUGR pregnancies. Results: In this study 120 cases were studied out of which 20 were pregnancies with IUGR. Age distribution of IUGR pregnancies was 20 to 27years with mean age of 22.6±2.14 years. Maximum number of patients 13(65%) was between 21-25 years followed by 16-20 years 4(20%). Youngest patient was 20 years old and the eldest was 27 years. Maximum number of patients 8(40%) was between 30-36 weeks and 36-42 weeks of gestation and least number of patients 1 (5%) were between 24- 30weeks. In third trimester of pregnancy it was observed that TCD shows strongest correlation with gestational age and shows a statistically significant correlation (P is less than 0.001).It was noted that there is a correlation between gestational age and TCD in second trimester of IUGR pregnancies however the correlation was statistically insignificant(P&gt;0.05). Conclusion: TCD is better predictor of gestational age in IUGR pregnancies as it remains nearly unaffected and correlates more closely with gestational age both in second and third trimester of pregnancy.

Determination of Gestational Age by Fetal Kidney Length Measurement After the 20th Week in Healthy Women With Uncomplicated Pregnancy in Tertiary Care Centre

Introduction: Various organs are measured to estimate the gestational age of fetus. Sonographically derived parameters used to date pregnancy include crown rump length, biparietal diameter, head circumference, femoral length and abdominal circumference. Fetal kidney length, transcerebellar diameter and placental thickness are emerging as new parameters and are claiming to be more accurate in certain situations. In Nepalese context fetal kidney length has not been studied yet so this study was done to fill this need. Methods: Obstetric sonography was performed in 108 pregnant women with uncomplicated pregnancy to evaluate the efficacy of FKL as a measure to calculate the predicted gestational age. Gestational age ranged from 20 weeks to term. Only patient with known LMP and previous history of normal menstrual cycle were included in the study. Results: The study showed mean fetal kidney length at 20 - 24, 25 - 29, 30 - 34 and 35 - 37 weeks gestation as 22.5 ± 0.5, 26.9 ± 0.7, 32.32 ± 0.7 and 36.3 ± 0.6 respectively. Overall in combined second and third trimester, fetal kidney length showed strong linear correlation with gestation age with highest significant Pearson correlation coefficient of 0.989 as compared to other parameters (BPD = 0.986, HC = 0.976, AC = 0.971, FL = 0.984). Conclusions: Fetal kidney showed strongest linear correlation with clinical gestational age and it also demonstrated positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length. Therefore fetal kidney length can be used as a reliable parameter for determination of gestational age.

Accuracy of Fetal Transcerebellar diameter in evaluation of Fetal gestational age in Egyptian pregnant women

Accuracy of Fetal Transcerebellar diameter in evaluation of Fetal gestational age in Egyptian pregnant women

Relationships between early postnatal cranial ultrasonography linear measures and neurobehaviour at term-equivalent age in infants born

BackgroundThe relationship between early postnatal brain development and neurobehaviour at term-equivalent age (TEA) remains uncertain. AimWe aimed to explore relationships between early postnatal cranial ultrasonography (cUS) linear measures of brain size and brain growth with neurobehaviour at TEA in infants born <30 weeks' gestational age (GA). Study designProspective observational cohort study. Subjects137 infants born <30 weeks' GA without major brain injury on neonatal cUS. Outcome measuresNeurobehaviour at TEA assessed using the General Movements Assessment (GMA) and Hammersmith Neonatal Neurological Examination (HNNE). ResultsThe GMA was administered in 115/137 (84%) infants; 80 (70%) presented with abnormal general movements (GMs) (79 poor repertoire, 1 cramped synchronised). The HNNE was assessed in 106/137 (77%) infants; 52 (49%) had a suboptimal total score. With respect to brain size, larger measures of the corpus callosum length (CCL) and right anterior horn width (AHW) at 1-month were related to lower risk of abnormal GMs, and larger measures of the biparietal diameter at 1-week and 2-months were related to lower risk of a suboptimal HNNE. As for brain growth, increases of the CCL and transcerebellar diameter between birth and 1-month, and left and right AHWs between 1- and 2-months, were related to lower risk of abnormal GMs. ConclusionEarly postnatal brain size and brain growth were related to neurobehaviour at TEA in infants born <30 weeks' GA. This study provides preliminary evidence for the prognostic utility of early postnatal cUS linear measures as potential markers of neurodevelopment in later childhood.

Fetal Transverse Cerebellar Diameter (TCD) Measurement for Gestational Age Prediction in the Second and Third Trimesters of Pregnancy

Background: The purpose of this study was to see how accurate transverse cerebellar diameter (TCD) measurement is at predicting gestational age in normal fetuses. In the 2 nd &amp; 3 rd trimesters of pregnancy a range of sonographics fetal biometric characteristics can be utilized to determine gestational age. Other parameters, such as bi-parietal diameter and fetal length, are used to determine transcerebellar diameter. Objective(s): To determine the predictability of GA estimated from fetal TCD assessed on ultrasonography in the 2 nd and 3 rd trimesters of pregnancy. Methodology: This was a cross-sectional study conducted at the Ch. Mohammad Akram teaching and research hospital on 84 pregnant healthy ladies with fetuses ranging in age from 18 to 45 years old. During the 2 nd and 3 rd trimesters of pregnancy a routine ultrasound scan was done. In additions to the standard biometric parameter the transcerebellar diameter was estimated. Results: The TCD of 84 patients as a measure of gestational age in weeks. These were generated from data collected during the study and include mean and standard deviation TCD measurements of 84 participants ranging in gestational age from 14 to 40 weeks. The current research found a significant link between the GA of TCD and the GA of BPD and fetal length. The TCD(mm) mean and standard deviations were 33.74 ± 11.762 respectively. The TCD gestational age mean and standard deviations were 28.160 ± 6.7942 respectively. Bi-parietal diameter (mm) has a mean and standard deviation of 68.24 ± 18.503. Bi-parietal diameter had a mean and standard deviation of 27.996 ± 6.9099 gestational age. The standard deviation and mean 50.32 ± 16.265 mm Fetal length The mean and standard deviation of fetal length gestational age are 27.423 ± 6.7625. Different criteria such as transcerebellar diameter, biparietal diameter, and femur length, are used to establish the gestational age of the fetus in this cross-sectional analysis. Conclusion(s): The TCD is a set of accurate variables for assessing GA in pregnant women in the 2 nd and 3 rd trimesters. Key words: Transcerebellar diameter; Gestational age; Fetal length ; Bi-parietal diameter. DOI: 10.7176/JHMN/93-08 Publication date: September 30 th 2021