Transcerebellar Diameter Research Articles

A Clinical Approach to Semiautomated Three-Dimensional Fetal Brain Biometry-Comparing the Strengths and Weaknesses of Two Diagnostic Tools: 5DCNS+TM and SonoCNSTM.

(1) Objective: We aimed to evaluate the accuracy and efficacy of AI-assisted biometric measurements of the fetal central nervous system (CNS) by comparing two semiautomatic postprocessing tools. We further aimed to discuss the additional value of semiautomatically generated sagittal and coronal planes of the CNS. (2) Methods: Three-dimensional (3D) volumes were analyzed with two semiautomatic software tools, 5DCNS+™ and SonoCNS™. The application of 5DCNS+™ results in nine planes (axial, coronal and sagittal) displayed in a single template; SonoCNS™ depicts three axial cutting sections. The tools were compared regarding automatic biometric measurement accuracy. (3) Results: A total of 129 fetuses were included for final analysis. Our data indicate that, in terms of the biometric quantification of head circumference (HC), biparietal diameter (BPD), transcerebellar diameter (TCD) and cisterna magna (CM), the accuracy of SonoCNS™ was higher with respect to the manual measurement of an experienced examiner compared to 5DCNS+™, whereas it was the other way around regarding the diameter of the posterior horn of the lateral ventricle (Vp). The inclusion of four orthogonal coronal views in 5DCNS+™ gives valuable information regarding spatial arrangements, particularly of midline structures. (4) Conclusions: Both tools were able to ease assessment of the intracranial anatomy, highlighting the additional value of automated algorithms in clinical use. SonoCNS™ showed a superior accuracy of plane reconstruction and biometry, but volume reconstruction using 5DCNS+™ provided more detailed information, which is needed for an entire neurosonogram as suggested by international guidelines.

Automatic Deep Learning-Based Pipeline for Automatic Delineation and Measurement of Fetal Brain Structures in Routine Mid-Trimester Ultrasound Images

Introduction: The aim of this study was to develop a pipeline using state-of-the-art deep learning methods to automatically delineate and measure several of the most important brain structures in fetal brain ultrasound (US) images. Methods: The dataset was composed of 5,331 images of the fetal brain acquired during the routine mid-trimester US scan. Our proposed pipeline automatically performs the following three steps: brain plane classification (transventricular, transthalamic, or transcerebellar plane); brain structures delineation (9 different structures); and automatic measurement (from the structure delineations). The methods were trained on a subset of 4,331 images and each step was evaluated on the remaining 1,000 images. Results: Plane classification reached 98.6% average class accuracy. Brain structure delineation obtained an average pixel accuracy higher than 96% and a Jaccard index higher than 70%. Automatic measurements get an absolute error below 3.5% for the four standard head biometries (head circumference, biparietal diameter, occipitofrontal diameter, and cephalic index), 9% for transcerebellar diameter, 12% for cavum septi pellucidi ratio, and 26% for Sylvian fissure operculization degree. Conclusions: The proposed pipeline shows the potential of deep learning methods to delineate fetal head and brain structures and obtain automatic measures of each anatomical standard plane acquired during routine fetal US examination.

The Investigation of Cerebroplacental Ratio and Some Cranial Biometric Measurements in Fetuses with Isolated Congenital Heart Disease

Objective: In this study, we aimed to compare the measurements of some fetal cranial structures and Doppler parameters between the groups with congenital heart disease and healthy pregnant women. Materials and Methods: The study included 30 patients with intrauterine congenital heart disease and 30 healthy pregnant women. Fetuses with additional structural and genetic abnormalities were excluded from the study. In both groups, biparietal diameter (BPD), head circumference (HC), transcerebellar diameter (TCD), middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), umbilical artery resistance index (UA-RI), and umbilical artery systole/diastole ratio (UA S/D), as well as superior-inferior diameter of the cavum septum pellucidum (CSP) were measured by ultrasound. The cerebroplacental ratio (CPR), which is an indicator of the protective effect on the brain, was calculated. Data were statistically compared between the two groups, and P < 0.05 was considered statistically significant. Results: A statistically significant difference was found between the groups in UA-RI and UA S/D values. The UA-RI and UA S/D values were significantly higher in the patient group than in the control group (P=0.048; P < 0.001). HC values were lower in the congenital heart disease group, and this result was statistically significant (P=0.047). There was no statistically significant difference between groups in BPD, HC, and TCD Z-scores. There was no statistically significant difference between groups in MCA-PI < 5th percentile, UA-PI > 95th percentile, and CPR < 1 scores. Conclusion: Congenital heart disease may cause chronic fetal hypoxia during the intrauterine process and lead to changes in the fetomaternal circulation. This study suggests that there may be relationships between fetal cranial biometric retardation and cerebral perfusion changes.

Comparison of Transcerebellar Diameter with Biparietal Diameter on Ultrasound for Gestational Age Measurement in Third Trimester of Pregnancy Using First Day of Last Menstrual Period for Actual Period of Gestation

Objective: to evaluate how well biparietal diameter and transcerebellar diameter performed in estimating the gestational age of pregnant women in their third trimester. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of radiology and Imaging, Rawalpindi Pakistan, Feb to Aug 2022. Methodology: There were 120 pregnant women who went to the Obstetrics and Gynecology Departmental walk-in clinic or Emergency room between weeks 28 and 40 of their pregnancies. Ultrasound was done on all patients that had been preselected after a complete history and physical examination had been completed; transcerebellar diameter (TCD) and biparietal diameter (BPD) were measured and compared with LMP. Results: Mean age of the participants recruited in the study was 27.08±1.45 years. There was a significant increase in mean BPD from 28 weeks of gestation (68.01±7.4 mm) to 36 weeks of gestation (89.77±2.35 mm). During 28 weeks of gestation, the mean TCD was 30.3±1.49 mm, whereas at 36 weeks it peaked at 48.1±1.21 mm. By looking at the median gap between real and estimated GA by BPD, we find that when real GA rises, the magnitude of the age estimation error decreases significantly. The error was 3.22±0.17 days for GA at 28 weeks, 2.48±0.09 days at 34 weeks, and 2.18±0.01 days at 36 weeks. A statistically significant (p<0.001) shift in the mean error was observed. .......... Conclusion: Both TCD and BPD were shown to be helpful in this study's context, however statistically speaking, TCD was superior to BPD. ...........

Brain Region Size Differences Associated With Dystonia in People With Cerebral Palsy Born Premature

BackgroundDystonia in cerebral palsy (CP) is classically associated with deep gray matter injury at term gestation, but the patterns of injury associated with dystonia following premature birth are unclear. We examined whether there were brain regional size differences associated with dystonia in people with CP born premature. MethodsIn this retrospective cohort study, we identified subjects with CP born premature (<37 weeks gestational age) seen at a tertiary care CP center between February 1, 2017, to February 1, 2021, who had T1-weighted brain magnetic resonance imaging (MRI) done between ages one and five years available in the clinical record. We measured the following on these brain MRI images per the 2013 Kidokoro criteria: interhemispheric distance, biparietal width, lateral ventricle diameter, transcerebellar diameter, deep gray matter area, and corpus callosum thickness. We then compared the sizes of these structures between those with and without dystonia correcting for gestational age at birth and gross motor functional ability (univariate general linear models). ResultsFifty-five subjects met the inclusion and exclusion criteria. Interhemispheric distance was significantly greater in those with dystonia, suggesting decreased cortical volume (P = 0.005). There was no significant difference in the other measured structures between those with and without dystonia, including deep gray matter area. ConclusionsIncreased interhemispheric distance, not measures of deep gray matter size, correlate with the presence of dystonia in people with CP born premature.

Effect of magnet strength on fetal brain biometry - a single-center retrospective MRI-based cohort study.

Abnormal fetal brain measurements might affect clinical management and parental counseling. The effect of between-field-strength differences was not evaluated in quantitative fetal brain imaging until now. Our study aimed to compare fetal brain biometry measurements in 3.0T with 1.5T scanners. A retrospective cohort of 1150 low-risk fetuses scanned between 2012 and 2021, with apparently normal brain anatomy, were retrospectively evaluated for biometric measurements. The cohort included 1.5T (442 fetuses) and 3.0T scans (708 fetuses) of populations with comparable characteristics in the same tertiary medical center. Manually measured biometry included bi-parietal, fronto-occipital and trans-cerebellar diameters, length of the corpus-callosum, vermis height, and width. Measurements were then converted to centiles based on previously reported biometric reference charts. The 1.5T centiles were compared with the 3.0T centiles. No significant differences between centiles of bi-parietal diameter, trans-cerebellar diameter, or length of the corpus callosum between 1.5T and 3.0T scanners were found. Small absolute differences were found in the vermis height, with higher centiles in the 3.0T, compared to the 1.5T scanner (54.6th-centile, vs. 39.0th-centile, p < 0.001); less significant differences were found in vermis width centiles (46.9th-centile vs. 37.5th-centile, p = 0.03). Fronto-occipital diameter was higher in 1.5T than in the 3.0T scanner (66.0th-centile vs. 61.8th-centile, p = 0.02). The increasing use of 3.0T MRI for fetal imaging poses a potential bias when using 1.5T-based charts. We elucidate those biometric measurements are comparable, with relatively small between-field-strength differences, when using manual biometric measurements. Small inter-magnet differences can be related to higher spatial resolution with 3T scanners and may be substantial when evaluating small brain structures, such as the vermis.

The Association of Dexamethasone and Hydrocortisone with Cerebellar Growth in Premature Infants

Objectives: Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This study aimed to compare cerebellar growth in premature infants who received dexamethasone or hydrocortisone to premature infants who did not receive postnatal corticosteroids. Study Design: Retrospective case-control study in infants born at a gestational age of <29 weeks and admitted to two level 3 neonatal intensive care units. Exclusion criteria were severe congenital anomalies and cerebellar or severe supratentorial lesions. Infants were treated with dexamethasone (unit 1) or hydrocortisone (unit 2) for chronic lung disease. Controls (unit 1) did not receive postnatal corticosteroids. Sequential head circumference (HC) and ultrasound measurements of transcerebellar diameter (TCD), biparietal diameter (BPD), and corpus callosum-fastigium length (CCFL) were performed until 40 weeks’ postmenstrual age (PMA). Growth was assessed using linear mixed models correcting for PMA at measurement, sex, HC z-score at birth, and a propensity score indicating illness severity. Group differences before treatment were assessed using linear regression. Results: 346 infants were included (68 dexamethasone, 37 hydrocortisone, 241 controls). Before starting corticosteroids, TCD, BPD, and HC measurements did not differ between patients and controls at a comparable PMA. After starting treatment, both types of corticosteroid had a negative association with TCD growth. BPD, CCFL, and HC growth were not negatively affected. Conclusion: Administration of dexamethasone and hydrocortisone are both associated with impaired cerebellar growth in premature infants without evident negative associations with cerebral growth.

Transcerebellar Diameter for Determination of Gestational Age In Comparison to Conventional Fetal Biometry in The Second Half of Pregnancy

Transcerebellar Diameter for Determination of Gestational Age In Comparison to Conventional Fetal Biometry in The Second Half of Pregnancy

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Prediction of Fetal Growth Restriction using Transcerebellar Diameter and Abdominal Circumference Ratio

Objective: To predict fetal growth restriction using transcerebellar diameter and abdominal circumference ratio(TCD/AC) in women with clinically diagnosed FGR.Materials and Methods: A prospective observational cohort study was conducted on women &gt;28 weeks of gestationwith clinically diagnosed fetal growth restriction, at the Tertiary care centre. Total 120 women were enrolled ,overa period of 18 months ,from December 2020 to July 2022 .Biometry was performed using ultrasonography andtranscerebellar diameter and abdominal circumference ratio (TCD/AC) and head circumference and abdominalcircumference ratio (HC/AC) were calculated. All women were followed up till delivery and fetomaternaloutcome was recorded. After birth height, weight and ponderal index of the newborn were also noted. TCD/ACratio was correlated with birth weight and ponderal index, for predicting FGR. TCD/AC ratio was also comparedwith routinely used HC/AC ratio for predicting FGR.Statistical Analysis: The final analysis was done with the use of Statistical Package for Social Sciences (SPSS)software, IBM manufacturer, Chicago, USA, version 21.0®.Results: A cut off value of TCD/AC &gt;0.14 was found to have a sensitivity, specificity, PPV and NPV of 87.36%,75.76%, 90.5% and 69.4% respectively with a diagnostic accuracy of 84.17%, in diagnosing FGR. There was a significantnegative correlation between TCD/AC ratio with birth weight and ponderal index, with a correlation coefficientof 0.463 and 0.501 respectively. (p value &lt; 0.001) TCD/AC was better predictor of fetal growth restriction with adiagnostic accuracy of 84.17% versus 40.83% with HC/AC. Significant positive correlation was observed betweenperiod of gestation (weeks) with transcerebellar diameter (mm),with correlation coefficient of 0.497 (p&lt;0.001).Conclusions: TCD/AC ratio is an effective gestational age independent parameter to predict FGR onultrasonography, with better diagnostic accuracy than routinely used HC/AC. Hence it should be performed forall antenatal women clinically suspected to have FGR.

Comparative study between trans cerebellar diameter and head circumference in assessment of gestational age

Comparative study between trans cerebellar diameter and head circumference in assessment of gestational age

Comparative study between transcerebellar diameter with biparietal diameter with femur length for gestational age measurement accuracy in third trimester of pregnancy

Comparative study between transcerebellar diameter with biparietal diameter with femur length for gestational age measurement accuracy in third trimester of pregnancy

Diagnostic accuracy of Trans-cerebellar diameter for estimation of gestational age and prediction of fetal weight in diabetic patients

Diagnostic accuracy of Trans-cerebellar diameter for estimation of gestational age and prediction of fetal weight in diabetic patients

Accuracy of Transcerebellar Diameter to Abdominal circumference ratio in diagnosis of Asymmetric Intrauterine Growth Restriction after 28 weeks of gestation

Accuracy of Transcerebellar Diameter to Abdominal circumference ratio in diagnosis of Asymmetric Intrauterine Growth Restriction after 28 weeks of gestation

Ultrasound Assessment of Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (Tcd/Ac) and to Femur Length Ratio (Tcd/Fl) in Detection of IUGR

Ultrasound Assessment of Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (Tcd/Ac) and to Femur Length Ratio (Tcd/Fl) in Detection of IUGR

The Role of Fetal Transcerebellar Diameter in Determining Gestational Age in the Second Trimester

The Role of Fetal Transcerebellar Diameter in Determining Gestational Age in the Second Trimester

Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study

Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.

Role of transcerebellar diameter in fetal growth assessment and its correlation with conventional biometry-An institutional study

Background: Accurate assessment of gestational age (GA) for fetal development is of paramount importance in management of pregnancy and for favorable perinatal outcome. The estimation of GA by fetal biometry using Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC) and Femoral Length (FL) in estimation of gestational age (GA) is routinely followed. However, these parameters have limitations. BPD and HC are not reliable in third trimester; FL may be reduced in IUGR and skeletal malformations. Thus we evaluated the Transcerebellar diameter (TCD) as an alternate indicator for fetal growth and GA estimation. Aim: To validate the accuracy of TCD with fetal biometry and calculated ultrasound age (CUA) in assessment of fetal growth and GA in between 18 to 40 weeks of pregnancy. Materials and Methods: The prospective study was carried out with 200 pregnant women between 18 to 40 weeks referred to Radiology department ((JJM Medical College), for antenatal scanning. The subjects were divided into two groups (second and third trimesters). TCD was measured along with other routine parameter for growth assessment. Thus, calculated gestational age (GA) using TCD was compared with GA by Last menstrual period (LMP) and calculated ultrasound age (CUA).

Changes in fetal intracranial anatomy during maternal pregestational and gestational diabetes.

To evaluate the changes in fetal intracranial structures in pregnant women with pregestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM). The study was conducted prospectively with patients who were grouped as pregestational DM (n=110), GDM (n=110), and control (n=110). Fetal ultrasonographic measurements of widths of posterior lateral ventricles (PLV), cavum septum pellucidi (CSP), cisterna magna (CM), thalamus and transcerebellar diameter (TCD) were recorded and compared. Fetal PLV, CSP, and CM widths were higher in pregestational DM and GDM groups than in control group, and also higher in pregestational DM group compared to GDM group (p < 0.001). Fetal TCD in the PGDM group was found to be less than both control and GDM groups (p < 0.001). No difference was found between three groups in terms of fetal thalamus size (p=0.801). Fetal PLV, CSP, and CM values were positively correlated with maternal hyperglycemia, fetal abdominal circumference (AC), and deepest vertical pocket of amniotic fluid (DVP) (p < 0.001). Fetal TCD was negatively correlated with HbA1c and DVP (p=0.002, p=0.38, respectively). The optimal cut-off points to identify pregestational DM and GDM were 5.55 and 5.83 mm for PLV, 5.83 and 6.32 mm for CSP, and 7.26 and 6.62 mm for CM. Maternal hyperglycemia was significantly associated with an increase in the widths of fetal PLV, CSP, and CM and a decrease in fetal TCD.

Systemic postnatal corticosteroids and magnetic resonance imaging measurements of corpus callosum and cerebellum of extremely preterm infants.

To compare the size of the corpus callosum (CC) and cerebellum on magnetic resonance imaging (MRI) brain scans conducted at term equivalent age (TEA) in extremely preterm infants who received systemic postnatal corticosteroids (PCS) to extremely preterm infants who did not receive systemic PCS and determine the dose-dependent effects on these outcomes. Single-centre retrospective cohort study including extremely preterm infants (born < 26 weeks' gestation) who had MRI brain scans at TEA. CC and cerebellar measurements were evaluated by two radiologists who were blinded to steroid use and their independent measurements were averaged. Comparative analyses were conducted between exposed (to systemic PCS) and non-exposed groups. Eighty-three extremely preterm infants with mean (SD) 24.9 (0.91) weeks' gestational age, 721.8 (156) g birthweight were included; 38 with systemic PCS exposure and 45 without exposure. After adjustment for birthweight and other significant neonatal morbidities, there was no significant difference noted in corpus callosum length (CCL) between unexposed and exposed groups (adjusted mean (SE) 39.5 (0.57) mm vs. 38.5 (0.62) mm; P= 0.29). Similarly, the ratios of CCL/fronto-occipital diameter (FOD) and CCL/biparietal diameter (BPD) were not significantly different between the groups (CCL/FOD (0.40 (0.01) vs. 0.41 (0.01); P= 0.70) and CCL/BPD (0.51 (0.01) vs. 0.52 (0.01); P= 0.62)). Finally, no significant differences in cerebellar measurements, such as vermian height (adjusted mean (SE) 24.0 (0.46) mm vs. 23.5 (0.51 mm); P= 0.47) and transcerebellar diameter (adjusted mean (SE) 49.3 (0.74) mm vs. 4.78 (0.82) mm; P= 0.22) were found. No dose-dependent effects of systemic PCS on CC and cerebellar measurements were identified. Systemic PCS use in extremely preterm infants was not associated with a change in the CC and cerebellar measurements on MRI brain scan at TEA.