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1
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Wu J. Utility of routine mid-trimester fetal ultrasound scan in detecting filar cysts and follow-up outcomes. Arch Gynecol Obstet 2024; 310:2553-2559. [PMID: 39327300 DOI: 10.1007/s00404-024-07750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 09/15/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To assess the value of routine mid-trimester fetal ultrasound scans in detecting FCs, as well as the related ultrasound and clinical follow-up outcomes. METHODS A retrospective analysis was conducted on 1064 fetuses who underwent standardized ultrasound screening during the mid-trimester. During the examination, high-frequency ultrasound was used to examine the fetal spine. Different frequency ultrasound probes were used to compare and analyze the detection rates of FCs. We conducted follow-up ultrasound observations on all FCs and conducted long-term follow-up observations in terms of the motor function of the children after birth. RESULTS Among 1064 fetuses detected by ultrasound, a total of 910 fetuses were completely evaluated using high-frequency and low-frequency ultrasound, and 24 FCs were found. In all 24 cases of FCs, 7 cases were detected using low-frequency ultrasound, while high-frequency ultrasound detected all cases. There was a significant difference in the detection rates between the two groups (χ2 = 26.323, P = 0.000). Of all the 24 FCs, 21 cysts disappeared spontaneously (87.5%); one fetus was induced for abortion due to a concurrent cleft lip; after multiple ultrasound examinations, it was found that the cyst persisted in one fetus; one case was not followed up by ultrasound. There was no statistically significant difference in the start of sitting and crawling time between the control group and the FCs group. CONCLUSION Routine mid-trimester fetal ultrasound scan detect FCs, particularly when high-frequency ultrasound probes were routinely applied. Most FCs detected by prenatal ultrasound spontaneously disappear and have no impact on the motor function of the fetus after birth (with the conus medullaris located at or above the L3 level). The shortest time interval from the detection to the disappearance of the cyst was 11 days.
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Affiliation(s)
- Jingping Wu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, 2 Yinghua East Street, Chaoyang District, Beijing, China.
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2
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Yang X, Sun S, Ji Y, Xu Y, Sun L, Wu Q. Fetal Tethered Spinal Cord: Diagnostic Features and Its Association with Congenital Anomalies. Fetal Pediatr Pathol 2023; 42:557-568. [PMID: 36719707 DOI: 10.1080/15513815.2023.2172632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We assessed the frequency and type of associated congenital anomalies encountered with fetal tethered spinal cord (TSC) determined prenatally. METHOD A retrospective review was conducted based on the associated fetal abnormalities following diagnosis of low-lying fetal conus medullaris during the prenatal ultrasound. RESULTS Of the 26 fetuses with low-lying conus medullaris, four were solitary TSC and 22 had TSC combined with associated congenital malformations, including four cases with spina bifida occulta, four cases with spina bifida aperta, one case with severe hydrocephalus, and 13 cases with multisystem congenital malformations. Among all the 13 cases with combined multisystem congenital malformations, four cases had vertebral defects, anal anomalies, cardiac defects, trachea-esophageal fistula, renal anomalies, and limb anomalies (VACTERL) syndrome, two cases had combined kidney development abnormalities, one case had cloacal exstrophy (OEIS syndrome), and six cases had chromosomal abnormalities (one case of chromosome 7q deletion, two cases of trisomy 13 syndrome, one case of trisomy 18 syndrome, one case of trisomy 9 syndrome, and one case of chromosome 4p deletion). CONCLUSIONS Low-lying conus medullaris found during prenatal ultrasound examination were often associated with neural tube malformations or multi-systemic complex developmental malformations. The frequency of chromosomal abnormalities was 23.1%.
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Affiliation(s)
- Xiaomei Yang
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Shiyu Sun
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Yizheng Ji
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Yasong Xu
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Li Sun
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Qichang Wu
- School of Medicine, Center of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, P.R. China
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Moradi B, Banihashemian M, Radmard AR, Tahmasebpour AR, Gity M, Dadali A, Piri S, Zeinoddini A, Najafi E. A Spectrum of Ultrasound and MR Imaging of Fetal Gastrointestinal Abnormalities: Part 2 Anorectal Malformation, Liver, and Abdominal Wall Anomalies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2615-2627. [PMID: 34962310 DOI: 10.1002/jum.15929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
Ultrasound (US) and magnetic resonance imaging (MRI) are two modalities for diagnosing fetal gastrointestinal (GI) anomalies. Ultrasound (US) is the modality of choice. MRI can be used as a complementary method. Despite its expanding utilization in central nervous system (CNS) fetal malformation, MRI has not yet been established for evaluation of fetal GI abnormalities. Therefore, more attention should be paid to the clinical implications of MRI investigations following screening by US.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Banihashemian
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoumeh Gity
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Dadali
- MBBS Student, St George's University of London, London, United Kingdom
| | - Solmaz Piri
- Department of International Affairs, National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran
| | - Atefeh Zeinoddini
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ehsan Najafi
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Costa Almeida L, de Souza Figueiredo YJ, Pinheiro Zylberman A, Garção DC. Ascent of the conus medullaris in human foetuses: a systematic review and meta-analysis. Sci Rep 2022; 12:12659. [PMID: 35879383 PMCID: PMC9314333 DOI: 10.1038/s41598-022-15130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of the present systematic review and meta-analysis was to identify when the ascent of the conus medullaris occurs in human foetuses considering differences in evaluation methods and sample characteristics. Five databases were searched for relevant articles using different combinations of keywords. Article selection and data extraction were performed independently by two reviewers. Disagreements were resolved by a third reviewer. The variables were distributed into four groups according to the gestational age of the specimens: I (13-18 weeks); II (19-25 weeks); III (26-32 weeks); IV (33 weeks to the probable date of birth). Eighteen articles were included. The majority used imaging exams as the evaluation method. Cadaveric dissections were reported in the remaining articles. Only morphological studies were included in the meta-analysis. Significant ascent occurs between groups I and III as well as groups II and IV. Despite the considerable heterogeneity among the studies included in the present review, the findings enabled the determination that the conus medullaris reaches its normal birth level by the 26th week. Further analyses should be performed based on nationality and ethnicity to diminish the heterogeneity of the data.
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Affiliation(s)
- Lucas Costa Almeida
- Department of Morphology, Center for Biological and Health Sciences, Federal University of Sergipe, Av. Marechal Rondon, s/n - Jardim Rosa Elze, São Cristóvão, SE, 49100-000, Brazil
| | - Yasmin Juliany de Souza Figueiredo
- Department of Morphology, Center for Biological and Health Sciences, Federal University of Sergipe, Av. Marechal Rondon, s/n - Jardim Rosa Elze, São Cristóvão, SE, 49100-000, Brazil
| | - André Pinheiro Zylberman
- Department of Morphology, Center for Biological and Health Sciences, Federal University of Sergipe, Av. Marechal Rondon, s/n - Jardim Rosa Elze, São Cristóvão, SE, 49100-000, Brazil
| | - Diogo Costa Garção
- Department of Morphology, Center for Biological and Health Sciences, Federal University of Sergipe, Av. Marechal Rondon, s/n - Jardim Rosa Elze, São Cristóvão, SE, 49100-000, Brazil.
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Wu J. Spontaneous Disappearance of Filar Cysts Diagnosed by Transabdominal Ultrasonography: A Report of Three Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1009-1012. [PMID: 34156102 DOI: 10.1002/jum.15769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Filar cysts (FCs) can be detected using ultrasound before or after delivery. They usually present as anechoic structures with a clear boundary just caudal to the lower end of the conus medullaris. They are generally considered a physiological variation and do not affect health. Some studies have pointed out that FCs in children can disappear spontaneously, as identified by ultrasound or magnetic resonance imaging. Three cases of FCs diagnosed by prenatal transabdominal ultrasound were reported in this study, and it was observed that FCs could disappear spontaneously in utero. The shortest time of disappearance was 4 weeks.
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Affiliation(s)
- Jingping Wu
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
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6
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Vande Perre S, Guilbaud L, de Saint-Denis T, Maurice P, Lallemant-Dudek P, Maisonneuve E, Dhombres F, Blondiaux E, Ducou le Pointe H, Zerah M, Jouannic JM, Garel C. The Myelic Limited Dorsal Malformation: Prenatal Ultrasonographic Characteristics of an Intermediate Form of Dysraphism. Fetal Diagn Ther 2021; 48:690-700. [PMID: 34814137 DOI: 10.1159/000519060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to report a subtype of dysraphism designated as myelic limited dorsal malformation (MyeLDM) and to describe its characteristics at prenatal ultrasound (US). METHODS It was a retrospective study from 2014 to 2020 based on second-line US evaluation of patients referred to our institution for myelomeningocele (MMC). Magnetic resonance imaging and acetylcholine esterase evaluation in the amniotic fluid were also offered. Major and minor criteria for open and closed dysraphism were defined and recorded for each patient. Patients were included as MyeLDM when both criteria of closed and open dysraphism were observed in the same fetus. Correlations were obtained with the postpartum data. RESULTS Twenty patients fulfilled the inclusion criteria, some of them being very close to MMC, others very close to limited dorsal myeloschisis (LDM), and others lying in between. There were 13 live-born neonates and 7 terminations of pregnancy. Correlations between prenatal and postpartum data were overall very good. CONCLUSION Our series describe the ultrasonographic characteristics of an intermediate type of dysraphism and suggest that there is a continuum between MMC and LDM with numerous possibilities of hybrid forms (MyeLDM) sharing characteristics of both open and closed dysraphisms.
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Affiliation(s)
- Saskia Vande Perre
- Service de Radiopédiatrie, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France,
| | - Lucie Guilbaud
- Service de Médecine Fœtale, Centre de Référence Maladies Rares MAVEM, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Timothée de Saint-Denis
- Service de Neurochirurgie Pédiatrique, Centre de Référence Maladies Rares MAVEM, Hôpital Necker, AP-HP, Université de Paris, Paris, France
| | - Paul Maurice
- Service de Médecine Fœtale, Centre de Référence Maladies Rares MAVEM, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Pauline Lallemant-Dudek
- Service de Médecine Physique et Réadaptation Pédiatrique, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Emeline Maisonneuve
- Service de Médecine Fœtale, Centre de Référence Maladies Rares MAVEM, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Ferdinand Dhombres
- Service de Médecine Fœtale, Centre de Référence Maladies Rares MAVEM, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Eléonore Blondiaux
- Service de Radiopédiatrie, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Hubert Ducou le Pointe
- Service de Radiopédiatrie, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Michel Zerah
- Service de Neurochirurgie Pédiatrique, Centre de Référence Maladies Rares MAVEM, Hôpital Necker, AP-HP, Université de Paris, Paris, France
| | - Jean-Marie Jouannic
- Service de Médecine Fœtale, Centre de Référence Maladies Rares MAVEM, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
| | - Catherine Garel
- Service de Radiopédiatrie, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, Paris, France
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7
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Cyst of the Filum Terminale: Potpourri of 3 Prenatally Diagnosed Cases. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00269-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThe filum terminale (FT) is an extension of pia mater, a fibrous band that connects the conus medullaris and the posterior body of the coccyx.
Current advanced technology in ultrasonography has enabled visualisation of the FT and small structures like a FT cyst can be diagnosed prenatally. Reports pf these cysts are rare. We report three cases of a FT cyst diagnosed prenatally. The objective of reporting these is to make clinicians aware of the importance of the relevance of this clinical entity.
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8
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De Catte L, De Keersmaecker B, Joyeux L, Aertsen M. Sonography of the Fetal Central Nervous System. FETAL MEDICINE 2020:275-304.e5. [DOI: 10.1016/b978-0-7020-6956-7.00028-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Zhai J, Cai A, Wei Q, Xie L, Jing C. A method for quantitative 2-dimensional sonographic analysis of the fetal conus medullaris position. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:929-934. [PMID: 30294797 DOI: 10.1002/jum.14771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/30/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study explored the use of 2-dimensional (2D) ultrasound scans for the quantitative assessment of the fetal conus medullaris (CM) position and its correlation with gestational age (GA). METHODS This was a prospective study. We identified the first sacral vertebra (S1) by intersection of 2 lines in 2D scans, then counted upward from S1 to determine the CM level and recorded the number of ossified sacral vertebral bodies. A quantitative assessment of the CM position was performed by measuring the distance between the CM and the midpoint of the S1 (CM-S1). The correlation between the CM-S1 distance and GA was evaluated. RESULTS We determined the CM level by identifying S1 first in 521 fetuses (GA, 20-38 weeks). The CM position in 70% of cases was at the L2 and L2-3 level, and at the L2 level or above after 37 weeks. The number of ossified sacral veterbral bodies was not consistent. CM-S1 measurements were easy to perform. A significant positive correlation between CM-S1 distance and GA was observed (R2 = .89, P < .05). The best-fit formula was: CM-S1 distance = 1.57 × GA - 16.43. The normal reference range was established and the fifth percentile was calculated for each GA. CONCLUSIONS S1 was easily identified, and the CM position relative to S1 was useful. There was a substantial correlation between CM-S1 and GA. Below the fifth percentile it was suggested that tethered cord may exist.
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Affiliation(s)
- Jing Zhai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Ultrasound, Affiliated Maternity Hospital of Dalian Medical University, Dalian, China
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuju Wei
- Department of Obstetrics and Gynecology, the University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Limei Xie
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunli Jing
- Department of Ultrasound, Affiliated Maternity Hospital of Dalian Medical University, Dalian, China
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10
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Mottet N, Chaussy Y, Auber F, Guimiot F, Arbez-Gindre F, Riethmuller D, Cretolle C, Benachi A. How to Explore Fetal Sacral Agenesis Without Open Dysraphism: Key Prenatal Imaging and Clinical Implications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1807-1820. [PMID: 29377253 DOI: 10.1002/jum.14522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
The estimated prevalence of fetal caudal dysgenesis is 1 per 100,000 births. The functional prognosis of sacral agenesis is dominated by the large spectrum of associated caudal malformations. Except for cases associated with hydrocephalus secondary to open spinal dysraphism or chromosomal anomalies, association with mental deficiency is rare. We propose a systematic prenatal approach to cases of fetal sacral agenesis based on 9 etiologic items: clinical context, type of sacral dysgenesis, associated spinal cord malformations, mobility of lower limbs, investigation of the presacral region, analysis of the gastrointestinal tract, analysis of the genitourinary tract, associated vertebral defects, and cytogenetic analysis.
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Affiliation(s)
- Nicolas Mottet
- Departments of Obstetrics and Gynecology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Yann Chaussy
- Department of Pediatric Surgery, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Frederic Auber
- Department of Pediatric Surgery, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Fabien Guimiot
- Department of Developmental Biology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Denis Diderot University, Paris, France
| | - Francine Arbez-Gindre
- Unit of Fetal Pathology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Didier Riethmuller
- Departments of Obstetrics and Gynecology, Jean Minjoz Besançon University Hospital, Université de Franche Comté, Besançon, France
| | - Célia Cretolle
- National Reference Centre for Rare Diseases on Anorectal Malformations and Rare Pelvic Anomalies, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Paris, France
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11
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Kwon M, Je BK, Hong D, Choi BM. Ultrasonographic features of the normal filum terminale. Ultrasonography 2017; 37:129-133. [PMID: 28736427 PMCID: PMC5885475 DOI: 10.14366/usg.17032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose The filum terminale (FT) is a fibrous band that connects the conus medullaris to the posterior body of the coccyx. Considering the advances of ultrasonography (US) technology and improvements in the resolution of US images, we aimed to re-establish the US features of the normal FT in infants younger than 6 months of age. Methods We retrospectively reviewed 30 spinal US scans, stored as video clips. The internal structure of the FT and the marginal echogenicity of the FT were assessed, and transverse and longitudinal US were compared. Results On US, a central echogenic line was defined in 18 (60%) normal FTs; however, there was no visible internal structure in 12 cases (40%). The marginal echogenicity of the FT was hyperechoic in eight cases (27%) in comparison with the cauda equina and was isoechoic in 22 cases (73%). In differentiating the normal FT from the surrounding nerve roots, transverse US was superior in 18 cases (60%), while longitudinal US was superior in two cases (7%). Conclusion On US, the central canal of the FT was defined in 60% of normal FTs. Hyperechoic marginal echogenicity and the use of transverse US were helpful in distinguishing the normal FT from the nerve roots of the cauda equina.
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Affiliation(s)
- Myoungae Kwon
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo-Kyung Je
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Doran Hong
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Byung Min Choi
- Department of Pediatrics, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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12
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Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F. Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery. Childs Nerv Syst 2017; 33:1083-1099. [PMID: 28593553 DOI: 10.1007/s00381-017-3445-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Accurate and timely prenatal diagnosis of spina bifida (SB) is a major goal of modern antenatal care. Prenatal screening for open SB should be first performed at the time of routine first-trimester ultrasound by examining the posterior fossa for obliteration or non-visualization of the fourth ventricle ("intracranial translucency") and cisterna magna. The second step of screening is the second-trimester anatomy scan, at which time the features of the Chiari type II malformation should be looked for, including ventriculomegaly, scalloping of the frontal bones ("lemon" sign), and backward and caudal displacement of the cerebellar vermis with obliteration of the cisterna magna ("banana" sign). In cases with positive findings, evaluation must include a focused examination of the spine for defects. In cases of closed SB and SB occulta, the cranial and posterior fossa features will not be present as they are not associated with leaking of spinal fluid and resultant hindbrain herniation, highlighting the fact that the spine should be examined thoroughly whenever possible during the second-trimester scan. In tertiary fetal medicine centers, two-dimensional and three-dimensional ultrasound allows an accurate determination of the location, type, extent, and upper level of the spinal defect as well as the presence of associated anomalies. Fetal magnetic resonance imaging should be restricted to candidates for intrauterine surgery as part of the preoperative protocol.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Estoril 50, Suites 203 & 515, Las Condes, 7591047, Santiago, Chile.
| | - Amy E Wong
- Department of Maternal-Fetal Medicine, Palo Alto Medical Foundation, Mountain View, CA, 94040, USA
| | - Francisco Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Estoril 50, Suites 203 & 515, Las Condes, 7591047, Santiago, Chile
| | - Juan L Alcalde
- Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Juan C Devoto
- Department of Anesthesiology, Clinica Las Condes, Santiago, Chile
| | - Felipe Otayza
- Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
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13
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Wei Q, Cai A, Wang X, Wang X, Xie L. The Value of Prenatal Ultrasonographic Diagnosis of Diastematomyelia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1129-1136. [PMID: 28304101 DOI: 10.7863/ultra.16.04054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate the value of prenatal ultrasonographic diagnosis of diastematomyelia, and to provide a basis for the diagnosis and differential diagnosis of fetal diastematomyelia. METHODS Four fetuses with suspected diastematomyelia based on prenatal ultrasonography are presented. Detailed prenatal ultrasonography was performed to examine spinal cord abnormalities. The region of interest-based spine sagittal plane was defined and 3D volumetric scans were performed, as needed. Images were stored and compared with MRI or ultrasonographic images after abortion. RESULTS In the four cases of diastematomyelia diagnosed by prenatal ultrasonography, two were confirmed by MRI after birth, and the other two were confirmed by autopsy and pathologic examination after abortion. Varying degrees of spine or spinal cord deformities were noted. Two pregnancies were terminated, and two newborns underwent surgery. CONCLUSIONS Prenatal ultrasonography contributes to the diagnosis of diastematomyelia and provides a basis for prenatal counseling and prognosis.
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Affiliation(s)
- Qiuju Wei
- Department of Ultrasound, the Second Hospital of Fushun, Liaoning, China
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Xintian Wang
- Department of Ultrasound, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Xiaoguang Wang
- Department of Radiology, the Second Hospital of Fushun, Liaoning, China
| | - Limei Xie
- Department of Ultrasound, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
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Yang SH, Yang ZJ, Li YY, Huang H, Tian XX. Localization of the fetal conus medullaris by oblique view extended imaging. J Med Ultrason (2001) 2017; 44:281-287. [PMID: 28224306 DOI: 10.1007/s10396-017-0773-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/05/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the accuracy of oblique view extended imaging (OVEI) in locating the position of the fetal conus medullaris. METHODS One hundred and twenty-two normal fetuses and five counterparts with spinal bifida received prenatal ultrasound examination. The vertebral body at the terminal of the conus medullaris and the coronal section of over five vertebral bodies were reconstructed using OVEI. Development of the nervous system of normal fetuses was assessed at postnatal day 28. For spinal bifida cases, pathological examination was performed. RESULTS Among 127 fetuses, the conus medullaris was accurately positioned in 120 (94.0%) cases according to OVEI. OVEI failed to locate the conus medullaris in three healthy fetuses due to obesity of the mother and four cases with spinal bifida due to abnormal fetal position. The conus medullaris was located at L3 or above in 115 healthy fetuses. The conus medullaris was positioned below L4 in five fetuses with spinal bifida, including L5 in two, S1 in two, and S3 in one, which was consistent with the findings of pathological examination. CONCLUSIONS OVEI can display the 12th rib, T12, and conus medullaris simultaneously. OVEI is applicable to precisely locate the position of the conus medullaris and useful for prenatal evaluation of spinal bifida.
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Affiliation(s)
- Shui-Hua Yang
- Ultrasonic Department, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 59 Xiangzhu Avenue, Nanning, 530002, Guangxi, China
| | - Zuo-Jian Yang
- Ultrasonic Department, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 59 Xiangzhu Avenue, Nanning, 530002, Guangxi, China
| | - Yuan-Yuan Li
- Ultrasonic Department, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 59 Xiangzhu Avenue, Nanning, 530002, Guangxi, China
| | - Huan Huang
- Ultrasonic Department, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 59 Xiangzhu Avenue, Nanning, 530002, Guangxi, China
| | - Xiao-Xian Tian
- Ultrasonic Department, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 59 Xiangzhu Avenue, Nanning, 530002, Guangxi, China.
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Prenatal Ultrasound Evaluation of the Position of Conus Medullaris for the Diagnosis of Tethered Cord Syndrome. Ultrasound Q 2016; 32:356-360. [DOI: 10.1097/ruq.0000000000000230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sivrikoz TS, Has R, Esmer AC, Kalelioglu I, Yuksel A, Taskin OC. Prenatal diagnosis of tethered spinal cord associated with sacrococcygeal teratoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:506-509. [PMID: 26892808 DOI: 10.1002/jcu.22344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/10/2016] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
Tethered spinal cord is mostly caused by myelomeningocele and lipomyelomeningocele, while dermal sinus tract, diastematomyelia, lipoma, tumor, thickened/tight filum terminale, spinal trauma, and spinal surgery are among the other causes. Prenatal diagnosis of tethered cord has been reported, and it is usually associated with neural tube defects. We present an atypical presentation of a tethered spinal cord, which was associated with a sacrococcygeal teratoma and was diagnosed in the 23rd week of pregnancy by ultrasonography. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:506-509, 2016.
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Affiliation(s)
- Tugba Sarac Sivrikoz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Recep Has
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aytul Corbacioglu Esmer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey.
| | - Ibrahim Kalelioglu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atil Yuksel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Orhun Cig Taskin
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Upasani VV, Ketwaroo PD, Estroff JA, Warf BC, Emans JB, Glotzbecker MP. Prenatal diagnosis and assessment of congenital spinal anomalies: Review for prenatal counseling. World J Orthop 2016; 7:406-417. [PMID: 27458551 PMCID: PMC4945507 DOI: 10.5312/wjo.v7.i7.406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/23/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
The last two decades have seen continuous advances in prenatal ultrasonography and in utero magnetic resonance imaging. These technologies have increasingly enabled the identification of various spinal pathologies during early stages of gestation. The purpose of this paper is to review the range of fetal spine anomalies and their management, with the goal of improving the clinician’s ability to counsel expectant parents prenatally.
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Fayard C, Blondiaux E, Grigorescu R, Garel C. AIRP best cases in radiologic-pathologic correlation: prenatal and postmortem imaging of a complex cloacal malformation. Radiographics 2014; 34:2056-63. [PMID: 25384301 DOI: 10.1148/rg.347140018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Cindy Fayard
- From the Departments of Radiology (C.F., E.B., C.G.) and Pathology (R.G.), Hôpital Armand Trousseau, Hôpitaux Universitaires de l'Est Parisien, Université Pierre et Marie Curie, 26 Avenue du Docteur Arnold Netter, 75012 Paris, France
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Ben-Sira L, Garel C, Malinger G, Constantini S. Prenatal diagnosis of spinal dysraphism. Childs Nerv Syst 2013; 29:1541-52. [PMID: 24013324 DOI: 10.1007/s00381-013-2178-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Since intrauterine repair of open spinal dysraphism have demonstrated promising results, it has become crucial to accurately define the various prenatal pathologies. The embryogenesis of spinal dysraphism according to a clinical neuroradiological classification is reviewed, with special emphasis on the recent advances in prenatal ultrasound (US), such as high-frequency linear transducers and three-dimensional imaging. FUNDINGS The role of magnetic resonance imaging (MRI) of the fetus as a complementary tool for delineating complex fetal spinal anomalies and further defining associated central nervous system (CNS) anomalies is explored. Differentiation between normal appearance of the fetal spine and the wide range of congenital neural tube defects are demonstrated in both modalities with special emphasis on their complementary role in the accurate diagnosis of neural tube defects.
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Affiliation(s)
- Liat Ben-Sira
- Pediatric Radiology Unit, TEL-AVIV Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Youssef A, Bellussi F, Rizzo N, Pilu G, Ghi T. Cyst of the filum terminale: two cases detected on prenatal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:363-364. [PMID: 23733516 DOI: 10.1002/uog.12524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
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Fetal magnetic resonance imaging and three-dimensional ultrasound in clinical practice: Applications in prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2012; 26:593-624. [DOI: 10.1016/j.bpobgyn.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/08/2012] [Indexed: 01/09/2023]
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