A prenatal ultrasound study of cerebral sulci and gyrus development in fetuses with tetralogy of Fallot / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the development of the cerebral sulci and gyrus and cerebral blood flow in fetuses with tetralogy of Fallot (ToF) in the second and third trimesters using ultrasound imaging.</p><p><b>METHODS</b>Forty fetuses (23-33weeks) with ToF diagnosed using ultrasound imaging between December, 2015 and September, 2016 were analyzed in this study. The development of the cerebral sulci and gyrus was evaluated by measuring the parietal-occipital fissure (POF) depth, POF angle, sylvian fissure (SF) depth, SF width, uncovered insular width, calcarine fissure (CF) depth, hemisphere depth on the views of POF, SF and CF, uncovered insular ratio, biparietal diameter (BPD), and head circumference (HC). Cerebral hemodynamics were assessed by measuring the umbilical artery resistance index, umbilical artery pulsation index, middle cerebral artery pulsation index (MCA-PI), middle cerebral artery resistance index, the cerebral-to-placental resistance ratio, and the cerebroplacental ratio.</p><p><b>RESULTS</b>In ToF fetuses, the POF depth, SF depth, CF depth, BPD, HC and hemisphere depth on the views of parietal-occipital sulcus and calcarine sulcus were significantly smaller than those in the control group (P<0.05). The middle cerebral artery resistance index, middle cerebral artery pulsation index, the cerebral-to-placental resistance ratio and the cerebroplacental ratio were also significantly lower in ToF fetuses than in the control group (P<0.05).</p><p><b>CONCLUSION</b>The cerebral sulci and gyrus in ToF fetuses in second and third trimesters show underdevelopment compared with those in normal fetuses, and the changes in hemodynamics caused by abnormal cardiac structure might be one of the reasons for cerebral sulci and gyrus underdevelopment in fetuses with ToF.</p>

Ultrasonographic Characteristics of Cortical Sulcus Development in the Human Fetus between 18 and 41 Weeks of Gestation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Fetal brain development is a complicated process that continues throughout pregnancy. Fetal sulcus development has typical morphological features. Assessment of fetal sulcus development to understand the cortical maturation and development by prenatal ultrasound has become widespread. This study aimed to explore a reliable method to assess cortical sulcus and to describe the normal sonographic features of cortical sulcus development in the human fetus between 18 and 41 weeks of gestation.</p><p><b>METHODS</b>A cross-sectional study was designed to examine the fetal cortical sulcus development at 18-41 weeks of gestation. Ultrasound was used to examine the insula, sylvian fissure (SF), parieto-occipital fissure (POF), and calcarine fissure (CF). Bland-Altman plots were used for assessing the concordance, and the intraclass correlation coefficient was used for assessing the reliability.</p><p><b>RESULTS</b>SF images were successfully obtained in 100% of participants at 22 weeks of gestation, while the POF images and CF images could be obtained in 100% at 23 weeks of gestation and 24 weeks of gestation, respectively. The SF width, temporal lobe depth, POF depth, and the CF depth increased with the developed gestation. The width of uncovered insula and the POF angle decreased with the developed gestation. By 23 weeks of gestation, the insula was beginning to be covered. Moreover, it completed at 35 weeks of gestation. The intra- and inter-observer agreements showed consistent reproducibility.</p><p><b>CONCLUSIONS</b>This study defined standard views of the fetal sulcus as well as the normal reference ranges of these sulcus measurements between 18 and 41 weeks of gestation. Such ultrasonographic measurements could be used to identify fetuses at risk of fetal neurological structural disorders.</p>

Ultrasound measurement of fetal posterior fossa at 11 to 13⁺⁶ gestational weeks for screening open spina bifida / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish the normal reference ranges of transabdominal ultrasound measurements of the posterior fossa structure in fetuses at 11 to 13⁺⁶ gestational weeks and explore their clinical value in screening open spina bifida (OSB).</p><p><b>METHODS</b>Between January, 2013 and September, 541 randomly selected normal fetuses underwent nuchal translucency at the gestational age 11 to 13⁺⁶ weeks. The parameters of the posterior fossa were measured in mid-sagittal view of the fetal face and the axial view of the transverse cerebellum insonated through the anterior fontanel by transabdominal ultrasound to establish the normal reference ranges. The measurements were obtained from 3 fetuses with OSB for comparison with the reference ranges.</p><p><b>RESULTS</b>In normal fetuses, the parameters of the posterior fossa measured in the two views showed no significant differences (P>0.05). Two high echogenic lines were observed in normal fetuses, as compared with one in fetuses with OSB representing the posterior border of the brain stem and the anterior border of the fourth ventricle. The line between the posterior border of the fourth ventricle and the anterior border of the cisterna magna was not displayed in fetuses with OSB. The anteroposterior diameters of the brain stem, the fourth ventricle, and cisterna magna all increased in positive correlation with the crown-lump length in normal fetuses. In the 3 OSB fetuses, the anteroposterior diameter of the brain stem exceeded the 95th percentile and the anteroposterior diameter of fourth ventrical-cisterner magena was below the 5th percentile of the reference range for CRL; the brain stem to fourth ventrical-cisterner magena anteroposterior diameter ratio was increased to above 1.</p><p><b>CONCLUSION</b>The established normal reference ranges of the parameters of fetal posterior fossa may provide assistance in early OSB detection. The absence of the posterior border of the fourth ventricle and the anterior border of the cisterna magna and a brainstem to fourth ventrical-cisterner magena anteroposterior diameter ratio greater than 1 can be indicative of OSB at 11 to 13⁺⁶ gestational weeks.</p>

Prenatal diagnosis of dural sinus malformation by ultrasound / 中华医学超声杂志（电子版）

Objective To assess the prenatal features of dural sinus malformation (DSM) by ultrasound. Methods The prenatal ultrasonography and MRI examination were applied in three fetuses who were suspected as brain abnormalities and transferred to Shenzhen Maternity and Child Healthcare Hospital for detailed antenatal ultrasound examination. Comparative analysis was performed on MRI, autopsy and prenatal ultrasonography. The prenatal characteristics were summarized. Results In the sonograms of all three cases, the torcular Herophili and superior sagittal sinus were dilated. No blood lfow was detected within or around lesions by color Doppler imaging. Posterior intracranial dual sinus thrombosis was detected in one case. MRI examinations were applied in two fetuses. The results of prenatal ultrasonography were consisted with those of MRI, MRI imaging showed dilated torcular Herophili and superior sagittal sinus with short T1 and short T2 signal. The thrombosis was presented as iso-hypointense with focal eccentric hyperintense. One case was undertook autopsy and the result was consisted with the prenatal sonographic findings. Conclusions The typical sonographic features of DSM is dilated torcular Herophili and superior sagittal sinus with no blood lfow in color Doppler imaging. DSM should be excluded when anechoic area was detected at the rear part of midline.

Sonographic lenticulostriate vasculopathy in fetus / 中华医学超声杂志（电子版）

Objective To explore the value of prenatal diagnosis and sonographic features of lenticulostriate vasculopathy (LSV). Methods Prenatal ultrasonographic features of three cases of fetal lenticulostriate vasculopathy were retrospectively analysed associated with maternal TORCH screen, fetal magnetic resonance imaging, neonatal physical examination and TORCH screen. Results Prenatal sonographic diagnosis of case 1 demonstrated fetal LSV as well as fetal growth restriction (FGR), periventricular hemorrhage, mitral and tricuspid regurgitation, hydropericardium and catatact. Prenatal sonographic diagnosis of case 2 demonstrated fetal LSV, FGR, periventricular hemorrhage, mitral and tricuspid regurgitation. Prenatal sonographic diagnosis of case 3 showed fetal LSV and intraventricular hemorrhage. Maternal TORCH screens of case 1 and case 3 was negative, while in case 2 was positive. Neonatal examinations of case 1 showed cataract, hearing impairment and congenital infection. Case 3 showed prompted retinal hemorrhage, sinus bradycardia, hyperbilirubinemia and congenital infection. In case 2, maternal teratogenic pathogen screen was positive and the baby did not survive because the mother decided to stop pregnancy in 34 weeks. Conclusions Fetal LSV could be imaged by prenatal ultrasonography. Fetal LSV might indicate intrauterine infection when other abnormalities were accompanied. Ultrasound might be useful for the cases with negative maternal TORCH screen results.

Ultrasonographic features of cornual pregnancy and analysis of misdiagnosed cases / 中华医学超声杂志（电子版）

Objective To summarize the ultrasonographic features and differential diagnosis of uterine cornual pregnancy.Methods Trans-abdominal and trans-vaginal ultrasound were performed in 93 uterine cornual pregnancy patients before surgery,ultrasonographic findings of uterine cornual pregnancy through different two approaches were analyzed and compared with surgical and pathologic findings.ResultsIn contrast with surgical and pathological diagnosis,66 cases(82.5%,66/80) of uterine cornual pregnancy were accurately diagnosed by ultrasonography before surgery,these cases were divided into gestational sac pattern (55 cases) and mixed mass pattern(11 cases); 11 cases were misdiagnosed as interstitial tubal pregnancy,2 cases were misdiagnosed as pregnancy in rudimentary horn,1 case was misdiagnosed as choriocarcinoma,misdiagnosed rate were 17.5%(14/80); uterine cornual pregnancy presented as adnexal mass in ultrasound in 13 cases,while ruptured uterine cornual mass were found in surgery,in which location and type of the masses couldn't be accurately diagnosed by ultrasound.Ultrasonographic features of uterine cornual pregnancy presented as a gestational sac located in extended cornual of uterus,surrounded by thin myometrium,and connected with endometrium.The misdiagnosed causes were: (1) Uterine cornual mass was not connected with endometrium or surrounded by thin myometrium,which were misdiagnosed as interstitial tubal pregnancy.(2) Uterine cornual pregnancy with thick lateral myometrium were misdiagnosed as pregnancy in rudimentary horn.(3)Uterine cornual pregnancy presented as cornual mass with abundant blood flow was misdiagnosed as choriocarcinoma.Conclusions Uterine cornual pregnancy can be accurately diagnosed by trans-abdominal and trans-vaginal ultrasound.Ultrasonographic features are helpful in differential diagnosis of uterine cornual pregnancy.

Perinatal management and outcome of different types of fetal arrhythmia / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the perinatal management and outcome of different types of fetal arrhythmia.</p><p><b>METHODS</b>A retrospective analysis was conducted among the fetuses with arrhythmia identified by M-mode and pulsed Doppler echocardiography in a single institution between October 2003 and December 2010.</p><p><b>RESULTS</b>A total of 130 fetuses were found to have fetal arrhythmia. The most common arrhythmia during pregnancy was extrasystole (n=59), followed by bradycardia (n=23), tachycardia (n=16), atrial flutter (AF, n=3), atrioventricular block (AVB, n=12) and other arrhythmia (n=17). The overall incidence of cardiac anomalies (commonly fetal bradycardia) was 9.2% in these cases. The prognosis of arrhythmia differed significantly between cases of different classifications. The type of fetal arrhythmia (P=0.024), presence of congenital heart defect (CHD, P=0.000) and fetal hydrops (P=0.008) were significant risk factors associated with termination of pregnancy.</p><p><b>CONCLUSION</b>Fetal arrhythmias without CHD or hydrops under close monitoring often have good clinical outcome, while fetal bradycardia is associated with a high mortality rate. CHD and the presence of fetal hydrops are significant risk factors for pregnancy termination.</p>

Methodology of measuring induced postnatal fetal long bones / 中华医学超声杂志（电子版）

Objective To investigate the effects of different standard cross sections and angles on the measurement accuracy of induced postnatal fetal long bones. Methods Fetal long bones (femori and humeri) in 30 cases with induced abortion were measured utilizing ultrasound from different angles and /or at different directions. The values measured from different sections and angles with vernier calipers were compared prenatally and postnatally. Results There was no apparent difference between the pre-induced abortion and those of the post-induced abortion. The results in the 30 cases showed that: (1) the values measured from anterior 90 degree, the long bone length would best match with the bare long bone length up to 96.7%, the match rate of other angles and/or directions was up to 80%; (2) no apparent statistical difference was between the length of left and right bone and no difference was found using 4 different directions and 3 different angles; (3)there was no difference between the left and right femuri and humeri.Conclusions Though the measured value from anterior 90 degree direction was the most accurate one, the statistical analtical results showed no difference among 12 values measured from 3 different angles and/or 4 different directions.