- Ultrasound is the main prenatal imaging modality used to diagnose fetal central nervous system (CNS) anomalies.
- The document provides guidelines for performing both a basic CNS exam and a more detailed fetal neurosonogram.
- The basic exam involves evaluating the fetal head and spine using 2-3 planes to assess brain structures like the ventricles and cerebellum.
- A fetal neurosonogram requires more expertise and provides a more detailed multi-planar evaluation of the brain and spine, useful for high-risk pregnancies.
- Both exams should include standard biometric measurements and qualitative assessments of normal anatomy.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses ultrasound in the first trimester of pregnancy. It defines the first trimester as the first 13 weeks following the last menstrual period. The goals of first trimester ultrasound are listed as assessing for intrauterine/extrauterine pregnancy location, detecting embryonic cardiac activity, identifying blighted ovum, missed abortion, multiple gestation, estimating gestational age, and screening for congenital abnormalities. The document then discusses ultrasound findings expected at different gestational ages from the conceptus period through the embryonic period. Key findings discussed include the intradecidual sign, double decidual sac sign, gestational sac, yolk sac, cardiac activity, and estimation of gestational age. Complications discussed include ectopic pregnancy,
Ultrasound can detect several markers of fetal aneuploidy including increased nuchal translucency, thickened nuchal fold, cystic hygroma, hypoplastic nasal bone, echogenic intracardiac focus, choroid plexus cysts, ventriculomegaly, and hyper echogenic bowel. The presence of these markers increases the risk of aneuploidies like Down syndrome, Trisomy 18, and Monosomy X depending on the specific marker and gestational age. Ultrasound examination between 18-22 weeks provides the best assessment of fetal anatomy and detection of these markers.
This document discusses fetal neurosonography and the sonographic appearance of fetal brain structures throughout gestation. It begins with an overview of embryonic brain development and the division of the brain into sections. It then examines how the appearance of specific structures changes with gestational age, including the posterior fossa, lateral ventricles, and cerebellum. Serial images demonstrate the maturation and relationships between structures over time. The role of 3D imaging in examining the posterior fossa is also mentioned.
- Ultrasound is the main prenatal imaging modality used to diagnose fetal central nervous system (CNS) anomalies.
- The document provides guidelines for performing both a basic CNS exam and a more detailed fetal neurosonogram.
- The basic exam involves evaluating the fetal head and spine using 2-3 planes to assess brain structures like the ventricles and cerebellum.
- A fetal neurosonogram requires more expertise and provides a more detailed multi-planar evaluation of the brain and spine, useful for high-risk pregnancies.
- Both exams should include standard biometric measurements and qualitative assessments of normal anatomy.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses ultrasound in the first trimester of pregnancy. It defines the first trimester as the first 13 weeks following the last menstrual period. The goals of first trimester ultrasound are listed as assessing for intrauterine/extrauterine pregnancy location, detecting embryonic cardiac activity, identifying blighted ovum, missed abortion, multiple gestation, estimating gestational age, and screening for congenital abnormalities. The document then discusses ultrasound findings expected at different gestational ages from the conceptus period through the embryonic period. Key findings discussed include the intradecidual sign, double decidual sac sign, gestational sac, yolk sac, cardiac activity, and estimation of gestational age. Complications discussed include ectopic pregnancy,
Ultrasound can detect several markers of fetal aneuploidy including increased nuchal translucency, thickened nuchal fold, cystic hygroma, hypoplastic nasal bone, echogenic intracardiac focus, choroid plexus cysts, ventriculomegaly, and hyper echogenic bowel. The presence of these markers increases the risk of aneuploidies like Down syndrome, Trisomy 18, and Monosomy X depending on the specific marker and gestational age. Ultrasound examination between 18-22 weeks provides the best assessment of fetal anatomy and detection of these markers.
This document discusses fetal neurosonography and the sonographic appearance of fetal brain structures throughout gestation. It begins with an overview of embryonic brain development and the division of the brain into sections. It then examines how the appearance of specific structures changes with gestational age, including the posterior fossa, lateral ventricles, and cerebellum. Serial images demonstrate the maturation and relationships between structures over time. The role of 3D imaging in examining the posterior fossa is also mentioned.
Fetal brain anomalies were discussed including ventriculomegaly, agenesis of the corpus callosum, and Dandy-Walker malformations. Ventriculomegaly is enlargement of the lateral ventricles and can be mild (10-15mm) or severe (>15mm). It requires ruling out associated anomalies, infections, and chromosomal abnormalities. Agenesis of the corpus callosum is the absence of the connecting structure between hemispheres and may be isolated or complex with other anomalies. Dandy-Walker malformation involves cystic dilation of the 4th ventricle and cerebellar vermis abnormalities. Prognosis depends on associated anomalies and degree of hydrocephalus.
Accompanying slides for the Ultrasound in Obstetrics and Gynecology article 'How to measure cervical length' by K. O. Kagan and J. Sonek
You can find the full article here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.14742/full
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
This document discusses screening for chromosomal defects like Trisomy 21 during pregnancy using ultrasound measurements of fetal nuchal translucency thickness between 11-13+6 weeks. It describes how increased nuchal translucency is associated with chromosomal abnormalities and various markers that can be assessed during the first trimester ultrasound like absent nasal bone, abnormal ductus venosus flow, and certain fetal measurements. The document provides guidelines for managing pregnancies based on nuchal translucency measurements and discusses offering invasive diagnostic tests for higher risk pregnancies.
5 fetal face ultrasound dr ahmed esawy
Fetal face
Skin tag
EAR AND FACE APPENDIX
Beckwith Wiedemann syndrome
HYPOTELERISM
HYPERTELERISM
Facial anomalies with holoprosencephaly
Lacrimal duct cysts.
Macroglossia
Lymphangioma of the tongue
Cleft Palate and Cleft Lip
Cleft lip and palate
Microphthalmia
Micrognathia
Micrognathia associated with a Dandy-Walker variant.
This document discusses various malformations of the posterior fossa, including Chiari malformations, Dandy-Walker malformation, Joubert syndrome, and Rhomboencephalosynapsis. It provides details on the anatomy and development of the posterior fossa. Chiari type 1 malformation is described as the most common, characterized by caudal descent of the cerebellar tonsils through the foramen magnum. Chiari type 2 malformation is associated with myelomeningocele and involves descent of the brainstem into the spinal canal through an abnormally small posterior fossa. Imaging and treatment options are discussed for evaluating and managing these posterior fossa malformations.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
This document discusses ultrasound examination in pregnancy. It provides information on using ultrasound for diagnostic and screening purposes in different trimesters. In the first trimester, ultrasound can be used to date the pregnancy, detect fetal anomalies, confirm intrauterine pregnancy, and detect ectopic pregnancies or nuchal lucency. Structures like the gestational sac, yolk sac, fetal pole, and heartbeat can be visualized on ultrasound as the pregnancy progresses in the first trimester. Crown rump length is an accurate method for measuring and dating the fetus early in the first trimester.
This document provides an overview of fetal biometry measurements used in obstetric ultrasounds to determine gestational age, assess fetal size, and estimate fetal weight. It discusses which measurements should be used at different gestational ages and the correct anatomical views and caliper placements for measurements like crown-rump length, biparietal diameter, head circumference, abdominal circumference, and femur length. The key points emphasized are the importance of obtaining the correct anatomical section and placing calipers accurately according to reference charts in order to provide an accurate assessment of gestational age, fetal size, and weight.
This document describes the fetal anomaly scan, also known as the second trimester targeted scan, which is performed between 18-22 weeks gestation to evaluate fetal anatomy and detect any anomalies. It outlines the "Rule of Three" systematic scanning method to thoroughly examine the head, face, and other structures. Specific anatomical planes and landmarks are identified for different areas, along with common variations and abnormalities that may be seen. The objectives are to determine normalcy, identify severe abnormalities, and raise suspicion of potential issues warranting further evaluation.
Genetic sonogram and soft tissue markersMohit Satodia
This document discusses various soft tissue markers that can be detected on a genetic sonogram to screen for fetal aneuploidies like Down syndrome. It describes markers like nuchal fold thickness, absent nasal bone, echogenic intracardiac focus, choroid plexus cysts, short long bones, pyelectasis, and single umbilical artery. It provides details on the sensitivity and significance of each marker, as well as guidelines on when genetic amniocentesis is recommended based on the number and type of markers present. The document emphasizes that while these markers can help detect aneuploidies, they are often transient and nonspecific findings that also occur commonly in euploid fetuses.
This document provides information about Prof. Narendra Malhotra's qualifications and experience. It lists that he holds positions such as Professor at Dubrovnick International University, Vice President of WAPM, past president of ISAR, president of other organizations. It notes that he has published over 50 papers and given over 100 guest lectures. He is the editor of 18 books and on the editorial board of several journals. The document also provides information about Malhotra Nursing & Maternity Home Pvt. Ltd. and Global Rainbow Health Care in Agra where he practices as an obstetrician gynecologist with interests in areas like high risk obstetrics, ultrasound, and infertility.
This document discusses various techniques for prenatal screening and diagnosis of fetal abnormalities. It describes nuchal translucency screening as a non-invasive tool that is highly sensitive in detecting markers of chromosomal anomalies. It also discusses additional sonographic markers like echogenic foci, shortened long bones, and the measurement of nuchal skin folds to further assess risk. Overall, the document emphasizes the value of ultrasound screening in the first trimester for its ability to provide tangible information to patients and guide decisions about invasive diagnostic procedures.
Presentation1, radiological imaging of tuberous sclerosis.Abdellah Nazeer
Cortical or subependymal tubers and white matter abnormalities, renal angiomyolipomas, and cardiac rhabdomyomas are the most common radiographic manifestations of tuberous sclerosis. Neurological manifestations include calcified cortical/subcortical tubers seen on CT and MRI. Renal angiomyolipomas appear as fat-containing lesions on CT or MRI. Cardiac rhabdomyomas are seen in around half of patients and typically regress by age 4.
Ultrasound examination of the third trimester of pregnancyMohamed Gamal
The document summarizes a third trimester ultrasound examination performed between 28-32 weeks of gestation. A third trimester ultrasound assesses fetal growth and anatomy, amniotic fluid levels, and placental position. It measures fetal size, heart rate, and blood flow. It also checks cervical length and fetal position. The goal is to monitor fetal well-being and check for any issues like placental problems or abnormal growth. The ultrasound is performed transabdominally with a full bladder or transvaginally if needed for a clear view. It provides important information to monitor the health of the mother and fetus late in pregnancy.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
1. The document discusses dilated cerebral ventricles as seen on clinical imaging. It provides 10 figures showing examples of ventricle dilation caused by various conditions, such as congenital hydrocephalus, choroid plexus papilloma, normal aging, Alzheimer's and Huntington's disease.
2. The figures demonstrate examples of generalized and localized ventricular enlargement, obstructive vs communicating hydrocephalus, loss of brain volume from cerebral hemiatrophy and occipital atrophy from intrauterine infection.
3. Imaging is useful for diagnosing the underlying causes of ventricle dilation and assessing treatment needs like ventricular shunting.
This document provides guidelines for performing basic and detailed sonographic examinations of the fetal central nervous system. It outlines the structures that should be evaluated in a basic exam, including head shape, ventricles, cerebellum, cisterna magna and spine. A basic exam can be done transabdominally starting at 20 weeks and should include two standard scan planes. A detailed neurosonogram requires specific expertise and equipment to fully evaluate the brain and spine for anomalies in high risk pregnancies. Biometric measurements of the head and ventricles are also recommended as part of the evaluation.
Hướng dẫn Thực hành ISUOG (cập nhật 2020): Siêu âm đánh giá hệ thần kinh trun...Võ Tá Sơn
This document provides guidelines for performing ultrasound screening examinations of the fetal central nervous system. It recommends that the screening examination include evaluation of the fetal head and spine using transabdominal ultrasound to visualize the lateral ventricles, cerebellum, cisterna magna, and cavum septi pellucidi. It describes the appearance of these structures that should be assessed in the transventricular, transcerebellar, and transthalamic scanning planes between 18-37 weeks gestation. The guidelines also state that a longitudinal section of the fetal spine should be obtained when possible to screen for open and closed spinal dysraphism.
Fetal brain anomalies were discussed including ventriculomegaly, agenesis of the corpus callosum, and Dandy-Walker malformations. Ventriculomegaly is enlargement of the lateral ventricles and can be mild (10-15mm) or severe (>15mm). It requires ruling out associated anomalies, infections, and chromosomal abnormalities. Agenesis of the corpus callosum is the absence of the connecting structure between hemispheres and may be isolated or complex with other anomalies. Dandy-Walker malformation involves cystic dilation of the 4th ventricle and cerebellar vermis abnormalities. Prognosis depends on associated anomalies and degree of hydrocephalus.
Accompanying slides for the Ultrasound in Obstetrics and Gynecology article 'How to measure cervical length' by K. O. Kagan and J. Sonek
You can find the full article here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.14742/full
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
This document discusses screening for chromosomal defects like Trisomy 21 during pregnancy using ultrasound measurements of fetal nuchal translucency thickness between 11-13+6 weeks. It describes how increased nuchal translucency is associated with chromosomal abnormalities and various markers that can be assessed during the first trimester ultrasound like absent nasal bone, abnormal ductus venosus flow, and certain fetal measurements. The document provides guidelines for managing pregnancies based on nuchal translucency measurements and discusses offering invasive diagnostic tests for higher risk pregnancies.
5 fetal face ultrasound dr ahmed esawy
Fetal face
Skin tag
EAR AND FACE APPENDIX
Beckwith Wiedemann syndrome
HYPOTELERISM
HYPERTELERISM
Facial anomalies with holoprosencephaly
Lacrimal duct cysts.
Macroglossia
Lymphangioma of the tongue
Cleft Palate and Cleft Lip
Cleft lip and palate
Microphthalmia
Micrognathia
Micrognathia associated with a Dandy-Walker variant.
This document discusses various malformations of the posterior fossa, including Chiari malformations, Dandy-Walker malformation, Joubert syndrome, and Rhomboencephalosynapsis. It provides details on the anatomy and development of the posterior fossa. Chiari type 1 malformation is described as the most common, characterized by caudal descent of the cerebellar tonsils through the foramen magnum. Chiari type 2 malformation is associated with myelomeningocele and involves descent of the brainstem into the spinal canal through an abnormally small posterior fossa. Imaging and treatment options are discussed for evaluating and managing these posterior fossa malformations.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
This document discusses ultrasound examination in pregnancy. It provides information on using ultrasound for diagnostic and screening purposes in different trimesters. In the first trimester, ultrasound can be used to date the pregnancy, detect fetal anomalies, confirm intrauterine pregnancy, and detect ectopic pregnancies or nuchal lucency. Structures like the gestational sac, yolk sac, fetal pole, and heartbeat can be visualized on ultrasound as the pregnancy progresses in the first trimester. Crown rump length is an accurate method for measuring and dating the fetus early in the first trimester.
This document provides an overview of fetal biometry measurements used in obstetric ultrasounds to determine gestational age, assess fetal size, and estimate fetal weight. It discusses which measurements should be used at different gestational ages and the correct anatomical views and caliper placements for measurements like crown-rump length, biparietal diameter, head circumference, abdominal circumference, and femur length. The key points emphasized are the importance of obtaining the correct anatomical section and placing calipers accurately according to reference charts in order to provide an accurate assessment of gestational age, fetal size, and weight.
This document describes the fetal anomaly scan, also known as the second trimester targeted scan, which is performed between 18-22 weeks gestation to evaluate fetal anatomy and detect any anomalies. It outlines the "Rule of Three" systematic scanning method to thoroughly examine the head, face, and other structures. Specific anatomical planes and landmarks are identified for different areas, along with common variations and abnormalities that may be seen. The objectives are to determine normalcy, identify severe abnormalities, and raise suspicion of potential issues warranting further evaluation.
Genetic sonogram and soft tissue markersMohit Satodia
This document discusses various soft tissue markers that can be detected on a genetic sonogram to screen for fetal aneuploidies like Down syndrome. It describes markers like nuchal fold thickness, absent nasal bone, echogenic intracardiac focus, choroid plexus cysts, short long bones, pyelectasis, and single umbilical artery. It provides details on the sensitivity and significance of each marker, as well as guidelines on when genetic amniocentesis is recommended based on the number and type of markers present. The document emphasizes that while these markers can help detect aneuploidies, they are often transient and nonspecific findings that also occur commonly in euploid fetuses.
This document provides information about Prof. Narendra Malhotra's qualifications and experience. It lists that he holds positions such as Professor at Dubrovnick International University, Vice President of WAPM, past president of ISAR, president of other organizations. It notes that he has published over 50 papers and given over 100 guest lectures. He is the editor of 18 books and on the editorial board of several journals. The document also provides information about Malhotra Nursing & Maternity Home Pvt. Ltd. and Global Rainbow Health Care in Agra where he practices as an obstetrician gynecologist with interests in areas like high risk obstetrics, ultrasound, and infertility.
This document discusses various techniques for prenatal screening and diagnosis of fetal abnormalities. It describes nuchal translucency screening as a non-invasive tool that is highly sensitive in detecting markers of chromosomal anomalies. It also discusses additional sonographic markers like echogenic foci, shortened long bones, and the measurement of nuchal skin folds to further assess risk. Overall, the document emphasizes the value of ultrasound screening in the first trimester for its ability to provide tangible information to patients and guide decisions about invasive diagnostic procedures.
Presentation1, radiological imaging of tuberous sclerosis.Abdellah Nazeer
Cortical or subependymal tubers and white matter abnormalities, renal angiomyolipomas, and cardiac rhabdomyomas are the most common radiographic manifestations of tuberous sclerosis. Neurological manifestations include calcified cortical/subcortical tubers seen on CT and MRI. Renal angiomyolipomas appear as fat-containing lesions on CT or MRI. Cardiac rhabdomyomas are seen in around half of patients and typically regress by age 4.
Ultrasound examination of the third trimester of pregnancyMohamed Gamal
The document summarizes a third trimester ultrasound examination performed between 28-32 weeks of gestation. A third trimester ultrasound assesses fetal growth and anatomy, amniotic fluid levels, and placental position. It measures fetal size, heart rate, and blood flow. It also checks cervical length and fetal position. The goal is to monitor fetal well-being and check for any issues like placental problems or abnormal growth. The ultrasound is performed transabdominally with a full bladder or transvaginally if needed for a clear view. It provides important information to monitor the health of the mother and fetus late in pregnancy.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
1. The document discusses dilated cerebral ventricles as seen on clinical imaging. It provides 10 figures showing examples of ventricle dilation caused by various conditions, such as congenital hydrocephalus, choroid plexus papilloma, normal aging, Alzheimer's and Huntington's disease.
2. The figures demonstrate examples of generalized and localized ventricular enlargement, obstructive vs communicating hydrocephalus, loss of brain volume from cerebral hemiatrophy and occipital atrophy from intrauterine infection.
3. Imaging is useful for diagnosing the underlying causes of ventricle dilation and assessing treatment needs like ventricular shunting.
This document provides guidelines for performing basic and detailed sonographic examinations of the fetal central nervous system. It outlines the structures that should be evaluated in a basic exam, including head shape, ventricles, cerebellum, cisterna magna and spine. A basic exam can be done transabdominally starting at 20 weeks and should include two standard scan planes. A detailed neurosonogram requires specific expertise and equipment to fully evaluate the brain and spine for anomalies in high risk pregnancies. Biometric measurements of the head and ventricles are also recommended as part of the evaluation.
Hướng dẫn Thực hành ISUOG (cập nhật 2020): Siêu âm đánh giá hệ thần kinh trun...Võ Tá Sơn
This document provides guidelines for performing ultrasound screening examinations of the fetal central nervous system. It recommends that the screening examination include evaluation of the fetal head and spine using transabdominal ultrasound to visualize the lateral ventricles, cerebellum, cisterna magna, and cavum septi pellucidi. It describes the appearance of these structures that should be assessed in the transventricular, transcerebellar, and transthalamic scanning planes between 18-37 weeks gestation. The guidelines also state that a longitudinal section of the fetal spine should be obtained when possible to screen for open and closed spinal dysraphism.
This document provides information about performing a fetal neurosonogram. It begins with basic embryology of the developing central nervous system. It then discusses the key features to evaluate in a neurosonogram, including biometric measurements and assessment of brain structures. Different imaging planes and techniques like 3D and tomographic ultrasound are described. Common central nervous system anomalies that can be detected on ultrasound are listed and briefly described. The document emphasizes the importance of understanding fetal brain development and utilizing multiple imaging planes and advanced techniques to thoroughly evaluate the fetal central nervous system.
Presentation1.pptx, ultrasound examination of the neonatal head.Abdellah Nazeer
This document provides an overview of ultrasound examination protocols for evaluating the neonatal head. It describes common indications for neonatal head ultrasound such as prematurity, increased head circumference, craniosynostosis, trauma, hypoxia, and suspected intracranial pathology. The document outlines scanning techniques and normal ultrasound appearances. It also describes various pathologies that may be identified on neonatal head ultrasound such as germinal matrix hemorrhage, periventricular leukomalacia, hydrocephalus, holoprosencephaly, encephaloceles, intracranial hemorrhages, and others. Detailed ultrasound images are provided to illustrate normal and abnormal findings.
By dr Rabab Hashem, MRCPCH, pediatrician at El Nasr hospital Port said.
Cranial sonography is the most widely used neuroimaging procedure in premature infants. US helps in assessing the neurologic status of the child, since clinical examination and symptoms are often nonspecific. It gives information about immediate and long term prognosis.
Neonatal sonography of the brain is an essential part of newborn care, particularly for preterm and unstable infants. It allows for portable, low-cost, and radiation-free evaluation of the brain for hemorrhages, abnormalities, and other issues like hydrocephalus. Standard imaging planes include coronal and sagittal views of the brain and ventricles. Key indications for neurosonography in newborns include detection of intraventricular hemorrhage in preterm infants and evaluation of periventricular leukomalacia, a common ischemic injury. Neurosonography is also used to identify other issues like cystic lesions, tumors, and hydrocephalus.
Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Neonatal spine ultrasound...normal and abnormal findingsAhmed Bahnassy
SUS is an accepted first-line screening test for spinal dysraphism in neonates. It has diagnostic sensitivity equal to MRI but can be performed portably without sedation. The document discusses the advantages of SUS over MRI and appropriate use in neonates. Key points covered include normal spinal anatomy visualized by SUS, common variants seen in neonates, and classifications and features of various spinal dysraphism anomalies detectable by SUS.
Cranial ultrasonography is an important neuroimaging technique for neonates and infants. It provides clinically important information at the bedside in a safe manner. Some key indications include screening for hemorrhage or brain injury in preterm infants, following up known conditions, and assessing sudden deterioration. The technique involves scanning the brain through the anterior fontanelle and other windows using high-frequency transducers. It allows visualization of normal anatomical structures like ventricles and white/gray matter as well as common pathological findings like intraventricular hemorrhage and periventricular leukomalacia. Several normal anatomical variants can mimic pathology but can be distinguished with careful scanning.
The document provides guidance on performing and interpreting a fetal anomaly scan in the second trimester. It outlines key structures to examine in the brain, head, face, thorax, heart, abdomen and gastrointestinal system. Normal anatomy is described along with variants and common anomalies. For the brain, it details the standard thalamic, ventricular and cerebellar views and structures to assess such as ventricle size and cavum septi pellucidi. Common cranial anomalies like holoprosencephaly and Dandy-Walker malformation are also outlined.
This document discusses various imaging modalities and findings related to the skull, brain, and spine. It provides examples of normal anatomy and various pathologies that can be seen on different scans. Some key points include examples of normal skull variations and measurements, common brain tumors like meningioma and astrocytoma, cerebral injuries including epidural and subdural hematomas, and spinal conditions such as spondylolisthesis, disc herniations, and intramedullary tumors. A variety of imaging modalities are also discussed for evaluating the skull, brain, and spine.
Bất sản thể chai - Agenesis of the corpus callosumVõ Tá Sơn
The document discusses agenesis of the corpus callosum (ACC), a condition where the connecting fibers between the brain's hemispheres (the corpus callosum) are completely or partially absent. It summarizes that ACC has a prevalence of 0.3-0.7% in the general population and can be diagnosed on prenatal ultrasound by visualizing the complete or partial absence of the corpus callosum in midsagittal view, with indirect signs like colpocephaly and separation of the frontal horns seen on other views. The risk of chromosomal and other syndromic anomalies is high at 20% and above, and outcome depends on whether additional brain abnormalities are present, with isolated ACC having a generally better
Abnormalities of the corpus callosum are frequently missed on prenatal ultrasound scans. Imaging the entire corpus callosum is not routinely performed, but is important for accurate diagnosis. Indirect markers like the cavum septum pellucidum seen on axial views can indicate abnormalities, but have limitations. A midline sagittal view of the brain is needed to directly visualize the corpus callosum and rule out abnormalities, but this view is often omitted from routine scans. Proper imaging of the corpus callosum is crucial for diagnosing conditions like agenesis of the corpus callosum.
Abnormalities of the corpus callosum are frequently missed on prenatal ultrasound scans. Imaging the entire corpus callosum is not routinely performed, but is important for accurate diagnosis. Indirect markers like the cavum septum pellucidum seen on axial views can indicate abnormalities, but have limitations. A midline sagittal view of the brain is needed to directly visualize the corpus callosum and rule out abnormalities, but this view is often omitted from routine scans. Careful imaging of the corpus callosum is important for evaluating cases of ventriculomegaly or other suspected central nervous system anomalies.
This document provides guidance on performing and interpreting chest x-rays in pediatric patients. It outlines key points to check on the x-ray such as positioning, inspiration, and exposure quality. Common anatomical structures are described such as the heart, lungs, diaphragm, and thymus. Proper positioning of tubes and lines is also discussed. The goal is to obtain high quality images to accurately identify any abnormalities while minimizing radiation exposure in children.
Neonatal cranial sonography is an important tool for evaluating infants with suspected brain abnormalities. It can detect hemorrhages, hydrocephalus, hypoxic ischemic injury, infections, and congenital anomalies. USG is rapid, portable, and avoids radiation, making it well-suited for neonatal intensive care. The summary outlines key findings on USG like germinal matrix hemorrhage, periventricular leukomalacia, hydranencephaly, and how to evaluate features of hydrocephalus. USG is also discussed as the initial study for complications of conditions like TORCH infections and hypoxic ischemic encephalopathy.
Ultrasound guidance for peripheral nerve blockadesxbenavides
This document discusses ultrasound-guided peripheral nerve blocks (PNBs) for pediatric patients. It finds that PNBs are becoming more commonly used in children for postoperative analgesia after orthopedic surgery, as studies have demonstrated their safety, feasibility and efficacy. The document focuses on ultrasound-guided techniques for common upper and lower extremity PNBs, including interscalene, infraclavicular and axillary blocks for the upper extremities, and lumbar plexus, femoral and sciatic nerve blocks for the lower extremities. Ultrasound guidance is presented as improving the success, speed of onset and efficacy of PNBs by allowing clear visualization of anatomy and needle placement.
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Sinh thiết gai rau CVS những điều mẹ bầu nên biếtVõ Tá Sơn
Sinh thiết gai rau là gì?
Sinh thiết gai rau (CVS) là một xét nghiệm trước sinh. Nó được sử dụng để chẩn đoán một số dị tật bẩm sinh và bất thường về di truyền ở con bạn. Bất thường di truyền là những thay đổi trong bộ gen được truyền từ mẹ hoặc bố sang em bé, hoặc có thể là các bất thường mới phát sinh không di truyền từ bố mẹ. Những thay đổi di truyền này có thể gây ra các vấn đề sức khỏe cho em bé. Nhau thai là một cấu trúc trong tử cung cung cấp máu và chất dinh dưỡng từ mẹ sang thai nhi.
Gai rau là những phần nhỏ của mô bánh rau trông giống như ngón tay và chứa vật chất di truyền giống như thai thai nhi. Có thể có xét nghiệm đối với các rối loạn di truyền khác tùy thuộc vào tiền sử gia đình và sự sẵn có của phòng xét nghiệm tại thời điểm tiến hành thủ thuật.
Trong quá trình làm CVS, bác sĩ của bạn sẽ lấy một mẩu mô nhỏ từ nhau thai. Mẫu được sử dụng để kiểm tra sức khỏe của con bạn.
Bạn có thể lấy CVS sớm trong thai kỳ, từ 11 đến 14 tuần tuổi thai. CVS không được cung cấp cho tất cả phụ nữ mang thai một cách thường quy vì có tỷ lệ sảy thai nhỏ sau khi làm xét nghiệm.
CVS khác với một xét nghiệm tiền sản khác gọi là chọc ối. Chọc ối được thực hiện muộn hơn một chút trong thai kỳ, từ sau 15 tuần. Trao đổi với bác sĩ của bạn về việc thực hiện CVS, nước ối hoặc các xét nghiệm tiền sản khác.
Đặt hẹn sinh thiết gai rau với bác sĩ Võ Tá Sơn bệnh viện Vinmec Times City, Hà Nội 0978846100
Chọc ối amniocentesis những điều mẹ bầu cần biếtVõ Tá Sơn
Chọc ối được thực hiện như thế nào?
Chọc ối thường được thực hiện từ tuần thứ 15 đến tuần thứ 20 của thai kỳ, nhưng bạn có thể thực hiện muộn hơn nếu cần thiết.
Nó có thể được thực hiện sớm hơn, nhưng điều này có thể làm tăng nguy cơ biến chứng của chọc ối và thường tránh được.
Trong quá trình thực hiện, một cây kim dài, mảnh sẽ được đưa vào thành bụng của bạn, dưới hướng dẫn bởi hình ảnh siêu âm.
Kim được đưa vào túi ối bao quanh em bé của bạn và một mẫu nhỏ nước ối được lấy ra để phân tích.
Thời gian chọc ối thường mất khoảng 10 phút, mặc dù toàn bộ quá trình tư vấn có thể mất khoảng 30 phút.
Chọc ối thường được mô tả là làm cho bạn không thoải mái hơn là đau đớn.
Một số phụ nữ mô tả cảm giác đau tương tự như đau khi hành kinh hoặc cảm thấy áp lực khi rút kim ra.
Chọc ối với Bác sĩ Võ Tá Sơn bệnh viện Vinmec Hà Nội 0978846100
Prenatal Diagnosis - 2022 - Wu - Prenatal diagnosis of Cornelia de Lange synd...Võ Tá Sơn
This study examined the prenatal diagnosis of Cornelia de Lange syndrome (CdLS) from 12 to 17 weeks' gestation through ultrasound imaging. A patient underwent ultrasounds at 12, 16, and 17 weeks that showed facial features characteristic of CdLS, including a long smooth philtrum, thin upper lip, small upturned nose, low-set ears, and retrognathia. Genetic testing after termination of the pregnancy confirmed the diagnosis of CdLS through detection of mutations in the NIPBL and PIEZO2 genes. The study demonstrated that CdLS can be prenatally diagnosed through ultrasound examination of specific facial features as early as the second trimester before 20 weeks gestation.
Posttest isuog mid trimester ultrasound course 2021Võ Tá Sơn
This document provides information and questions for an assessment on mid-trimester fetal ultrasound. It notes that the assessment contains 7 administrative questions requiring codes from previous sessions, and 30 multiple choice scientific questions. A passing score of 70% is required to receive a certificate of completion if all sessions were also viewed. The assessment then provides sample multiple choice questions covering topics like placenta previa, twin pregnancies, congenital heart defects, and evaluation of fetal brain and other anatomical structures in a mid-trimester ultrasound.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
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Final all-reading-material-neurosonogram isuog 2019
1. Certificate of fetal brain imaging
Suggested reading
1. Chaoui R, Nicolaides KH. Detecting open spina bifida at the 11-13-week scan by
assessing intracranial translucency and the posterior brain region: mid-sagittal or axial
plane? Ultrasound Obstet Gynecol. 2011 Dec;38(6):609-12. doi:10.1002/uog.10128.
PubMed PMID: 22411445.
2. Lerman-Sagie T, Prayer D, Stöcklein S, Malinger G. Fetal cerebellar disorders. Handb
Clin Neurol. 2018;155:3-23. doi:10.1016/B978-0-444-64189-2.00001-9. Review: PubMed
PMID: 29891067.
3. Choudhri AF, Cohen HL, Siddiqui A, Pande V, Blitz AM. Twenty-Five Diagnoses on
Midline Images of the Brain: From Fetus to Child to Adult. Radiographics. 2018 Jan-
Feb;38(1):218-235. doi:10.1148/rg.2018170019. Review. PubMed PMID: 29320328.
4. Davila I, Moscardo I, Yepez M, Sanz Cortes M. Contemporary Modalities to Image the
Fetal Brain. Clin Obstet Gynecol. 2017 Sep;60(3):656-667.
doi:10.1097/GRF.0000000000000307. PubMed PMID: 28742597.
5. Jakab A, Pogledic I, Schwartz E, Gruber G, Mitter C, Brugger PC, Langs G, Schöpf V,
Kasprian G, Prayer D. Fetal Cerebral Magnetic Resonance Imaging Beyond Morphology.
Semin Ultrasound CT MR. 2015 Dec;36(6):465-75. doi:10.1053/j.sult.2015.06.003. Epub
2015 Jun 14. Review. PubMed PMID: 26614130.
2. Ultrasound Obstet Gynecol 2007; 29: 109–116
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.3909
GUIDELINES
Sonographic examination of the fetal central nervous system:
guidelines for performing the ‘basic examination’ and the
‘fetal neurosonogram’
INTRODUCTION
Central nervous system (CNS) malformations are some of
the most common of all congenital abnormalities. Neural
tube defects are the most frequent CNS malformations and
amount to about 1–2 cases per 1000 births. The incidence
of intracranial abnormalities with an intact neural tube is
uncertain as probably most of these escape detection at
birth and only become manifest in later life. Long-term
follow-up studies suggest however that the incidence may
be as high as one in 100 births1
.
Ultrasound has been used for nearly 30 years as the
main modality to help diagnose fetal CNS anomalies. The
scope of these guidelines is to review the technical aspects
of an optimized approach to the evaluation of the fetal
brain in surveys of fetal anatomy, that will be referred
to in this document as a basic examination. Detailed
evaluation of the fetal CNS (fetal neurosonogram) is also
possible but requires specific expertise and sophisticated
ultrasound machines. This type of examination, at
times complemented by three-dimensional ultrasound,
is indicated in pregnancies at increased risk of CNS
anomalies.
In recent years fetal magnetic resonance imaging (MRI)
has emerged as a promising new technique that may add
important information in selected cases and mainly after
20–22 weeks2,3
, although its advantage over ultrasound
remains debated4,5
.
GENERAL CONSIDERATIONS
Gestational age
The appearance of the brain and spine changes throughout
gestation. To avoid diagnostic errors, it is important
to be familiar with normal CNS appearances at
different gestational ages. Most efforts to diagnose
neural anomalies are focused around midgestation. Basic
examinations are usually performed around 20 weeks’
gestation.
Some abnormalities may be visible in the first and early
second trimesters6–11
. Even though these may represent
a minority they usually are severe and deserve therefore
special consideration. It is true that early examination
requires special skills, however, it is always worthwhile to
pay attention to the fetal head and the brain at earlier ages.
The advantage of an early fetal neuroscan at 14–16 weeks
is that the bones are thin and the brain may be evaluated
from almost all angles.
Usually, a satisfying evaluation of the fetal CNS can
always be obtained in the second and third trimesters
of pregnancy. In late gestation, visualization of the
intracranial structures is frequently hampered by the
ossification of the calvarium
Technical factors
Ultrasound transducers
High frequency ultrasound trandsucers increase spatial
resolution but decrease the penetration of the sound
beam. The choice of the optimal transducer and
operating frequency is influenced by a number of
factors including maternal habitus, fetal position and the
approach used. Most basic examinations are satisfactorily
performed with 3–5-MHz transabdominal transducers.
Fetal neurosonography frequently requires transvaginal
examinations that are usually conveniently performed
with transducers between 5 and 10 MHz12,13 Three-
dimensional ultrasound may facilitate the examination
of the fetal brain and spine14,15
.
Imaging parameters
The examination is mostly performed with gray-scale bidi-
mensional ultrasound. Harmonic imaging may enhance
visualization of subtle anatomic details, particularly in
patients who scan poorly. In neurosonographic studies,
Color and power Doppler may be used, mainly to iden-
tify cerebral vessels. Proper adjustment of pulse repetition
frequency (main cerebral arteries have velocities in the
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. ISUOG GUIDELINES
3. 110 Guidelines
range of 20–40 cm/s during intrauterine life)16
and signal
persistence enhances visualization of small vessels.
BASIC EXAMINATION
Qualitative evaluation
Transabdominal sonography is the technique of choice
to investigate the fetal CNS during late first, second and
third trimesters of gestation in low risk pregnancies. The
examination should include the evaluation of the fetal
head and spine.
Two axial planes allow visualization of the cerebral
structures relevant to assess the anatomic integrity of the
brain17
. These planes are commonly referred to as the
transventricular plane and the transcerebellar plane. A
third plane, the so-called transthalamic plane, is frequently
added, mostly for the purpose of biometry (Figure 1).
Structures that should be noted in the routine examination
include the lateral ventricles, the cerebellum and cisterna
magna, and cavum septi pellucidi. Head shape and brain
texture should also be noted on these views (Table 1).
The transventricular plane
This plane demonstrates the anterior and posterior
portion of the lateral ventricles. The anterior portion
of the lateral ventricles (frontal or anterior horns) appears
as two comma-shaped fluid filled structures. They have
Figure 1 Axial views of the fetal head. (a) Transventricular plane;
(b) transthalamic plane; (c) transcerebellar plane.
Table 1 Structures that are usually noted in a basic ultrasound
examination of the fetal central nervous system
Head shape
Lateral ventricles
Cavum septi pellucidi
Thalami
Cerebellum
Cisterna magna
Spine
a well defined lateral wall and medially are separated by
the cavum septi pellucidi (CSP). The CSP is a fluid filled
cavity between two thin membranes. In late gestation
or the early neonatal period these membranes usually
fuse to become the septum pellucidum. The CSP becomes
visible around 16 weeks and undergoes obliteration near
term gestation. With transabdominal ultrasound, it should
always be visualized between 18 and 37 weeks, or with
a biparietal diameter of 44–88 mm18
. Conversely, failure
to demonstrate the CSP prior to 16 weeks or later than
37 weeks is a normal finding. The value of visualizing
the CSP for identifying cerebral anomalies has been
debated17. However, this structure is easy to identify
and is obviously altered with many cerebral lesions such
as holoprosencephaly, agenesis of the corpus callosum,
severe hydrocephaly and septo-optic dysplasia19
.
From about 16 weeks the posterior portion of the
lateral ventricles (also referred to as posterior horns)
is in reality a complex formed by the atrium that
continues posteriorly into the occipital horn. The atrium is
characterized by the presence of the glomus of the choroid
plexus, which is brightly echogenic, while the occipital
horn is fluid filled. Particularly in the second trimester of
gestation both the medial and lateral walls of the ventricle
are parallel to the midline and are therefore well depicted
sonographically as bright lines. Under normal conditions
the glomus of the choroid plexus almost completely fills
the cavity of the ventricle at the level of the atrium being
closely apposed to both the medial or lateral walls, but in
some normal cases a small amount of fluid may be present
between the medial wall and the choroid plexus20–23.
In the standard transventricular plane only the
hemisphere on the far side of the transducer is usually
clearly visualized, as the hemisphere close to the
transducer is frequently obscured by artifacts. However,
most severe cerebral lesions are bilateral or associated
with a significant deviation or distortion of the midline
echo, and it has been suggested that in basic examinations
symmetry of the brain is assumed17
.
The transcerebellar plane
This plane is obtained at a slightly lower level than that
of the transventricular plane and with a slight posterior
tilting and includes visualization of the frontal horns of the
lateral ventricles, CSP, thalami, cerebellum and cisterna
magna. The cerebellum appears as a butterfly shaped
structure formed by the round cerebellar hemispheres
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2007; 29: 109–116.
4. Sonographic examination of the fetal central nervous system 111
joined in the middle by the slightly more echogenic
cerebellar vermis. The cisterna magna or cisterna
cerebello-medullaris is a fluid filled space posterior to the
cerebellum. It contains thin septations, that are normal
structures and should not be confused with vascular
structures or cystic abnormalities. In the second half of
gestation the depth of the cisterna magna is stable and
should be 2–10 mm17
. Early in gestation the cerebellar
vermis has not completely covered the fourth ventricle,
and this may give the false impression of a defect of
the vermis. In later pregnancy such a finding may raise
the suspicion of a cerebellar abnormality but prior to
20 weeks’ gestation this is usually a normal finding24
.
Transthalamic plane
A third scanning plane, obtained at an intermediate level,
is also frequently used in the sonographic assessment
of the fetal head, and is commonly referred to as the
transthalamic plane or biparietal diameter plane. The
anatomic landmarks include, from anterior to posterior,
the frontal horns of the lateral ventricles, the cavum septi
pellucidi, the thalami and the hippocampal gyruses25.
Although this plane does not add significant anatomic
information to that obtained from the transventricular
and transcerebellar planes, it is used for biometry of
the fetal head. It has been proposed that, particularly in
late gestation, this section plane is easier to identify and
allows more reproducible measurements than does the
transventricular plane25
.
The fetal spine
The detailed examination of the fetal spine requires
expertise and meticulous scanning, and the results are
heavily dependent upon the fetal position. Therefore,
a full detailed evaluation of the fetal spine from every
projection is not a part of the basic examination. The most
frequent of the severe spinal abnormalities, open spina
bifida, is usually associated with abnormal intracranial
anatomy. However, a longitudinal section of the fetal
spine should always be obtained because it may reveal, at
least in some cases, other spinal malformations including
vertebral abnormalities and sacral agenesis. Under normal
conditions, a longitudinal section of the spine from about
14 weeks’ gestation demonstrates the three ossification
centers of the vertebrae (one inside the body, and one at
the junction between the lamina and pedicle on each side)
that surround the neural canal, and that appear as either
two or three parallel lines depending upon the orientation
of the sound beam. In addition, attempt should be made
to demonstrate the intactness of the skin overlying the
spine either on transverse or longitudinal views.
Quantitative evaluation
Biometry is an essential part of the sonographic
examination of the fetal head. In the second trimester
and third trimester, a standard examination usually
includes the measurement of the biparietal diameter, head
circumference and internal diameter of the atrium. Some
also advocate measurement of the transverse cerebellar
diameter and cisterna magna depth.
Biparietal diameter and head circumference are com-
monly used for assessing fetal age and growth and may
also be useful to identify some cerebral anomalies. They
may be measured either in the transventricular plane
or in the transthalamic plane. Different techniques can
be used for measuring the biparietal diameter. Most
frequently the calipers are positioned outside the fetal
calvarium (so called outside to outside measurement)26
.
However, some of the available charts have been pro-
duced using an outer to inner technique to avoid artifacts
generated by the distal echo of the calvarium25
. The
two approaches result in a difference of a few millime-
ters that may be clinically relevant in early gestation. It
is important therefore to know the technique that was
used while constructing the reference charts that one
uses. If the ultrasound equipment has ellipse measure-
ment capacity, then head circumference can be measured
directly by placing the ellipse around the outside of
the skull bone echoes. Alternatively, the head circum-
ference (HC) can be calculated from biparietal diameter
(BPD) and occipitiofrontal diameter (OFD) by using the
equation HC = 1.62 × (BPD + OFD). The ratio of the
biparietal diameter over the occipitofrontal diameter is
usually 75–85%. Moulding of the fetal head particu-
larly in early gestation is however frequent, and most
fetuses in breech presentation have some degree of dolic-
ocephaly.
Measurement of the atrium is recommended because
several studies suggest that this is the most effective
approach for assessing the integrity of the ventricular
system22
, and ventriculomegaly is a frequent marker of
abnormal cerebral development. Measurement is obtained
at the level of the glomus of the choroid plexus,
perpendicular to the ventricular cavity, positioning the
calipers inside the echoes generated by the lateral walls
(Figure 2). The measurement is stable in the second
and early third trimesters, with a mean diameter of
6–8 mm20,22,27 and is considered normal when less than
10 mm27–32
. Most of the biometric studies on the size of
the lateral ventricles have used ultrasound equipment that
provided measurements in millimeters33
.
As, with modern equipment, measurements are given
in tenths of millimeters, it is uncertain which is the most
reasonable cut-off value. We believe that particularly at
midgestation a value of 10.0 mm or greater should be
considered suspicious.
The transverse cerebellar diameter increases by about
one millimeter per week of pregnancy between 14 and
21 menstrual weeks. This measurement, along with the
head circumference and the biparietal diameter is helpful
to assess fetal growth. The depth of the cisterna magna
measured between the cerebellar vermis and the internal
side of the occipital bone is usually 2–10 mm34. With
dolicocephaly, measurements slightly larger than 10 mm
may be encountered.
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2007; 29: 109–116.
5. 112 Guidelines
(b)
Figure 2 (a) Measurement of the atrium of the lateral ventricles. The calipers are positioned at the level of the glomus of the choroid plexus,
inside the echoes generated by the ventricular walls; (b) diagram to illustrate correct caliper placement for ventricular measurement. Calipers
are correctly placed touching the inner edge of the ventricle wall at its widest part and aligned perpendicular to the long axis of the ventricle
(YES). Incorrect placements include middle–middle (no1), outer–outer (no2), and placement that is too posterior in the narrower part of the
ventricle or not perpendicular to the ventricle axis (no3).
FETAL NEUROSONOGRAM
It is commonly accepted that dedicated fetal neurosono-
graphy has a much greater diagnostic potential than
that of the standard transabdominal examination, and
is particularly helpful in the evaluation of complex
malformations. However, this examination requires a
grade of expertise that is not available in many
settings and the method is not yet universally used.
Dedicated fetal neurosonography is useful in patients
with an increased risk of CNS anomalies, including
cases in which the basic examination identifies suspicious
findings.
The basis of the neurosonographic examination of
the fetal brain is the multiplanar approach, that is
obtained by aligning the transducer with the sutures
and fontanelles of the fetal head12,13
. When the fetus
is in vertex presentation, a transabdominal/transvaginal
approach can be used. In fetuses in breech presentation,
a transfundal approach is used, positioning the probe
parallel instead of perpendicular to the abdomen. Vaginal
probes have the advantage of operating at a higher
frequency than do abdominal probes and therefore allow
a greater definition of anatomical details. For this reason,
in some breech presenting fetuses an external cephalic
version may be considered in order to use the transvaginal
approach.
Evaluation of the spine is a part of the neurosono-
graphic examination and is performed using a combina-
tion of axial, coronal and sagittal planes.
The neurosonographic examination should include the
same measurements that are commonly obtained in a basic
examination: the biparietal diameter, head circumference
and the atrium of the lateral ventricles. The specific
measurements obtained may vary also depending upon
the gestational age and the clinical setting.
Fetal brain
Whether the exam is performed transvaginally or
transabdominally, proper alignment of the probe along
the correct section planes usually requires gentle
manipulation of the fetus. A variety of scanning planes can
be used, also depending upon the position of the fetus12
.
A systematic evaluation of the brain usually includes the
visualization of four coronal and three sagittal planes.
In the following, a description of the different structures
that can be imaged in the late second and third trimesters
is reported. Apart from the anatomic structures, fetal
neurosonography should also include evaluation of the
convolutions of the fetal brain that change throughout
gestation35–38.
Coronal planes (Figure 3)
The transfrontal plane or Frontal-2 plane. The visual-
ization of this plane is obtained through the anterior
fontanelle and depicts the midline interhemispheric fissure
and the anterior horns of the lateral ventricles on each
side. The plane is rostral to the genu of the corpus cal-
losum and this explains the presence of an uninterrupted
interhemispheric fissure. Other structures observed are the
sphenoidal bone and the ocular orbits.
The transcaudate plane or Mid-coronal-1 plane12. At
the level of the caudate nuclei, the genu or anterior
portion of the corpus callosum interrupts the continuity
of the interhemispheric fissure. Due to the thickness of
the genu in coronal planes it is observed as a more
echogenic structure than the body of the corpus callosum.
The cavum septi pellucidi is depicted as an anechogenic
triangular structure under the corpus callosum. The lateral
ventricles are found at each side surrounded by the brain
cortex. In a more lateral position the Sylvian fissures are
clearly identified.
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2007; 29: 109–116.
6. Sonographic examination of the fetal central nervous system 113
Figure 3 Coronal views of the fetal head. (a) Transfrontal plane; (b) transcaudate plane; (c) transthalamic plane; (d) transcerebellar plane.
CSP, cavum septi pellucidi; IHF, interhemispheric fissure.
Figure 4 Sagittal planes of the fetal head. (a) Midsagittal plane; (b) parasagittal plane. 3v, third ventricle; 4v, fourth ventricle.
The transthalamic plane or Mid-coronal-2 plane12
.
Both thalami are found in close apposition but in some
cases the third ventricle may be observed in the midline
with the interventricular foramina and the atrium of
the lateral ventricles with the choroid plexus slightly
cranial on each side (Mid-coronal-3 plane). Close to
the cranial base and in the midline the basal cistern
contains the vessels of the circle of Willis and the optic
chiasma.
The transcerebellar plane or Occipital-1 and 2 plane.
This plane is obtained through the posterior fontanels
and enables visualization of the occipital horns of the
lateral ventricles and the interhemispheric fissure. Both
cerebellar hemispheres and the vermis are also seen in this
plane.
Sagittal planes (Figure 4)
Three sagittal planes are usually studied: the midsagittal;
and the parasagittal of each side of the brain.
The midsagittal or median plane12
shows the corpus
callosum with all its components; the cavum septi
pellucidi, and in some cases also the cavum vergae and
cavum veli interpositi, the brain stem, pons, vermis and
posterior fossa. Using color Doppler the anterior cerebral
artery, pericallosal artery with their branches and the vein
of Galen may be seen.
The parasagittal or Oblique plane-112
depicts the entire
lateral ventricle, the choroid plexus, the periventricular
tissue and the cortex.
Fetal spine
Three types of scanning planes can be used to evaluate the
integrity of the spine. The choice depends upon the fetal
position. Usually, only two of these scanning planes are
possible in a given case.
In transverse planes or axial planes, the examination
of the spine is a dynamic process performed by sweeping
the transducer along the entire length of the spine and
at the same time keeping in the axial plane of the level
being examined (Figure 5). The vertebrae have different
anatomic configurations at different levels. Fetal thoracic
and lumbar vertebrae have a triangular shape, with the
ossification centers surrounding the neural canal. The first
cervical vertebrae are quadrangular in shape, and sacral
vertebrae are flat.
In sagittal planes the ossification centers of the vertebral
body and posterior arches form two parallel lines that
converge in the sacrum. When the fetus is prone, a
true sagittal section can also be obtained, directing the
ultrasound beam across the unossified spinous process.
This allows imaging of the spinal canal, and of the spinal
cord within it (Figure 6). In the second and third trimesters
of gestation the conus medullaris is usually found at the
level of L2-L339
.
In coronal planes, one, two or three parallel lines are
seen, depending upon the orientation of the sound beam
(Figure 7).
Integrity of the neural canal is inferred by the regular
disposition of the ossification centers of the spine and the
presence of soft tissue covering the spine. If a true sagittal
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2007; 29: 109–116.
7. 114 Guidelines
Figure 5 Axial views of the fetal spine at different levels. (a) Cervical; (b) thoracic; (c) lumbar; (d) sacral. The arrows point to the three
ossification centers of the vertebrae. Note the intact skin overlying the spine. On images a–c the spinal cord is visible as a hypoechoic ovoid
with central white dot.
Figure 6 Sagittal view of the fetal spine at midgestation. Using the
unossified spinous process of the vertebrae as an acoustic window,
the contents of the neural canal are demonstrated. The conus
medullaris is normally positioned at the level of the second lumbar
vertebra (L2).
section can be obtained, visualizing the conus medullaris
in its normal location further strengthens the diagnosis of
normalcy.
EFFECTIVENESS OF ULTRASOUND
EXAMINATION OF THE FETAL NEURAL
AXIS
In a low risk pregnancy around midgestation, if the
transventricular plane and the transcerebellar plane are
satisfactorily obtained, the head measurements (head
circumference in particular) are within normal limits for
gestational age, the atrial width is less than 10.0 mm and
the cisterna magna width is between 2–10 mm, many
cerebral malformations are excluded, the risk of a CNS
anomaly is exceedingly low and further examinations are
not indicated17
.
Figure 7 Coronal views of the fetal spine. These images were obtained with three-dimensional ultrasound from the same sonographic
volume using different angulations and beam-thicknesses. (a) A thin ultrasound beam is oriented through the bodies of the vertebrae; (b) the
same ultrasound beam is oriented more posteriorly to demonstrate the posterior arches of the vertebrae; (c) a thick ultrasound beam is used
to demonstrate simultaneously the three ossification centers.
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2007; 29: 109–116.
8. Sonographic examination of the fetal central nervous system 115
It is beyond the scope of these guidelines to review
the available literature on the sensitivity of antenatal
ultrasound in the prediction of neural anomalies. Some
studies of low risk patients undergoing basic examinations
have reported sensitivities in excess of 80%40,41
.
However, these results probably greatly overestimate
the diagnostic potential of the technique. These surveys
had invariably very short follow-up and almost only
included open neural tube defects, whose recognition
was probably facilitated by systematic screening with
maternal serum alphafetoprotein. Diagnostic limitations
of prenatal ultrasound are well documented and occur for
a number of reasons42
. Some even severe anomalies may
be associated with only subtle findings in early gestation43
.
The brain continues to develop in the second half of
gestation and into the neonatal period thus limiting the
detection of anomalies of neuronal proliferation (such as
microcephaly44, tumors45 and cortical malformations42).
Also, some cerebral lesions are not due to faulty
embryological development but represent the consequence
of acquired prenatal or perinatal insults46–48
. Even in
expert hands some types of anomalies may be difficult or
impossible to diagnose in utero, in a proportion that is
yet impossible to determine with precision.
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ACKNOWLEDGMENTS
These guidelines were developed under the auspices of
the ISUOG Education Committee. Chair, Dario Paladini,
University of Naples, Italy
Appreciation is particularly extended to specialty consul-
tants who contributed to this project:
Gustavo Malinger, MD
Fetal Neurology Clinic, Department of Obstetrics
and Gynecology, Wolfson Medical Center, Tel-Aviv
University, Israel
Ana Monteagudo, MD
Department of Obstetrics and Gynecology, New York
University School of Medicine, New York, USA
Gianluigi Pilu, MD
Department of Obstetrics and Gynecology, University
of Bologna, Italy
Ilan Timor-Tritsch, MD
Department of Obstetrics and Gynecology, New York
University School of Medicine, New York, USA
Ants Toi, MD
Department of Medical Imaging, Mount Sinai Hospital,
University of Toronto, Canada
Copies of this document will be available at:
http://www.isuog.org
ISUOG Secretariat
Unit 4, Blythe Mews
Blythe Road
London W14 0HW, UK
e-mail: info@isuog.org
Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2007; 29: 109–116.