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López Soto Á, Bueno González M, Urbano Reyes M, Carlos Moya Jiménez L, Beltrán Sánchez A, Garví Morcillo J, Velasco Martínez M, Luis Meseguer González J, Martínez Rivero I, García Izquierdo O. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol 2023; 283:13-24. [PMID: 36750003 DOI: 10.1016/j.ejogrb.2023.01.035] [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: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Genital anomalies are a heterogeneous group of congenital pathologies that have become increasingly relevant since the Chicago Consensus of 2005. Their postnatal diagnosis has developed significantly in the last two decades, while prenatal diagnosis seems to be underdeveloped, with few protocols available, fragmented scientific literature, and low diagnostic rates. This review aims to examine the current status of this subspecialty from the perspective of prenatal imaging. Indications for the evaluation of fetal genitalia can be divided into medical and non-medical reasons. Medical reasons include sex-linked disorders, detection of other anomalies, relevant family history, or multiple pregnancy. Non-medical reasons include parental request for sex disclosure. Disclosure of fetal sex may be associated with ethical, legal, and medical issues. The main imaging technology used is 2D ultrasound, although there are other complementary techniques such as 3D, MRI, or Color Doppler. Regarding working methodology, several authors have drawn attention to the lack of standardized protocols and guidelines. Most guidelines tend to limit their recommendations to study indications and ethical issues. Technical proposals, measurements, or working methods have not yet been standardized. Fetal sex determination is usually divided into early and late gestation. Early gestation is based on the sagittal sign. Late gestation is based on direct visualization. There are several measurements to describe male and female genitalia, such as penile length, bilabial diameter, or scrotal diameter. Prenatal diagnosis of genital pathologies presents some particularities such as the wide spectrum of phenotypes, the high frequency of associated deformities, or the time of diagnosis. Some of the most frequent pathologies are ambiguous genitalia, fetal sex discordance, hypospadias, micropenis, clitoromegaly, ovarian cysts, hydro(metro)colpos, and cloacal anomalies. Higher-quality studies and direction from scientific societies through the implementation of clinical guidelines are needed.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain.
| | | | - Maribel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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Pinson K, Melber DJ, Nguyen NH, Montaney L, Basu R, Mims J, Pretorius D, Lamale-Smith L. The Development of Normal Fetal External Genitalia Throughout Gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:293-307. [PMID: 35975397 DOI: 10.1002/jum.16080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
In this review, we describe normal development of fetal genitalia throughout gestation as well as the identification of normal male and female genitalia on ultrasound. We use abnormal and ambiguous genitalia as illustrative tools to assist with the identification of normal genitalia and recognition of some of the most common abnormalities in external genitalia development.
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Affiliation(s)
- Kelsey Pinson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
- Maternal Fetal Care and Genetics, La Jolla, California, USA
| | - Dora J Melber
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
- Maternal Fetal Care and Genetics, La Jolla, California, USA
| | - Ngoc-Hieu Nguyen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
- Maternal Fetal Care and Genetics, La Jolla, California, USA
| | - Laura Montaney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
- Maternal Fetal Care and Genetics, La Jolla, California, USA
| | - Reshmi Basu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
- Maternal Fetal Care and Genetics, La Jolla, California, USA
| | - Joseph Mims
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
| | - Dolores Pretorius
- Maternal Fetal Care and Genetics, La Jolla, California, USA
- Department of Radiology, University of California, San Diego, California, USA
| | - Leah Lamale-Smith
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
- Maternal Fetal Care and Genetics, La Jolla, California, USA
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PFP-LHCINCA: Pyramidal Fixed-Size Patch-Based Feature Extraction and Chi-Square Iterative Neighborhood Component Analysis for Automated Fetal Sex Classification on Ultrasound Images. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6034971. [PMID: 35655731 PMCID: PMC9132621 DOI: 10.1155/2022/6034971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
Abstract
Objectives Fetal sex determination with ultrasound (US) examination is indicated in pregnancies at risk of X-linked genetic disorders or ambiguous genitalia. However, misdiagnoses often arise due to operator inexperience and technical difficulties while acquiring diagnostic images. We aimed to develop an efficient automated US-based fetal sex classification model that can facilitate efficient screening and reduce misclassification. Methods We have developed a novel feature engineering model termed PFP-LHCINCA that employs pyramidal fixed-size patch generation with average pooling-based image decomposition, handcrafted feature extraction based on local phase quantization (LPQ), and histogram of oriented gradients (HOG) to extract directional and textural features and used Chi-square iterative neighborhood component analysis feature selection (CINCA), which iteratively selects the most informative feature vector for each image that minimizes calculated feature parameter-derived k-nearest neighbor-based misclassification rates. The model was trained and tested on a sizeable expert-labeled dataset comprising 339 males' and 332 females' fetal US images. One transverse fetal US image per subject zoomed to the genital area and standardized to 256 × 256 size was used for analysis. Fetal sex was annotated by experts on US images and confirmed postnatally. Results Standard model performance metrics were compared using five shallow classifiers-k-nearest neighbor (kNN), decision tree, naïve Bayes, linear discriminant, and support vector machine (SVM)-with the hyperparameters tuned using a Bayesian optimizer. The PFP-LHCINCA model achieved a sex classification accuracy of ≥88% with all five classifiers and the best accuracy rates (>98%) with kNN and SVM classifiers. Conclusions US-based fetal sex classification is feasible and accurate using the presented PFP-LHCINCA model. The salutary results support its clinical use for fetal US image screening for sex classification. The model architecture can be modified into deep learning models for training larger datasets.
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AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3093-3100. [PMID: 31736130 DOI: 10.1002/jum.15163] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Najdi N, Safi F, Hashemi-Dizaji S, Sahraian G, Jand Y. First trimester determination of fetal gender by ultrasonographic measurement of anogenital distance: A cross-sectional study. Int J Reprod Biomed 2019; 17. [PMID: 31435579 PMCID: PMC6652156 DOI: 10.18502/ijrm.v17i1.3820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 05/03/2018] [Accepted: 07/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background In some patients with a family history of the gender-linked disease, determination of the fetal gender in the first trimester of pregnancy is of importance. In X-linked recessive inherited diseases, only the male embryos are involved, while in some conditions, such as congenital adrenal hyperplasia, female embryos are affected; hence early determination of fetal gender is important. Objective The aim of the current study was to predict the gender of the fetus based on the accurate measurement of the fetal anogenital distance (AGD) by ultrasound in the first trimester. Materials and Methods To determine the AGD and crown-rump length in this cross-sectional study, 316 women with singleton pregnancies were exposed to ultrasonography. The results were then compared with definitive gender of the embryos after birth. Results The best cut-off for 11 wk to 11 wk, 6 days of pregnancy was 4.5 mm, for 12 wk to 12 wk, 6 days was 4.9 mm, and for 13 wk to 13 wk, 6 days was 4.8 mm. Conclusion AGD is helpful as an ultrasonographic marker that can determine fetal gender in the first trimester, especially after 12 wks.
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Affiliation(s)
- Nazila Najdi
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Safi
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Shahrzad Hashemi-Dizaji
- Department of Gynecology and Obstetrics, Shahid Akbarabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazal Sahraian
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Yahya Jand
- Departement of Pharmacology, School of Medicine, Tehran University of Medical Science, Tehran, Iran
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Wax J, Minkoff H, Johnson A, Coleman B, Levine D, Helfgott A, O’Keefe D, Henningsen C, Benson C. Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314532221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Beverly Coleman
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Andrew Helfgott
- University of South Carolina School of Medicine, Columbia, SC, USA
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Wax J, Minkoff H, Johnson A, Coleman B, Levine D, Helfgott A, O'Keeffe D, Henningsen C, Benson C. Consensus report on the detailed fetal anatomic ultrasound examination: indications, components, and qualifications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:189-195. [PMID: 24449720 DOI: 10.7863/ultra.33.2.189] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Joseph Wax
- MMC Ob/Gyn Associates, 887 Congress St, Suite 200, Portland, ME 04102 USA.
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Abstract
Background: Pregnant women have been curious about the sex of their unborn child. The advent of ultrasound, its application into medicine, and the revolutionary changes in its resolution and function has led to the ability to assign a sex to these unborn children, thereby allaying the anxiety of these women but with consequent emergent ethical, moral, psycho-social, and medico-legal issues. The objectives were to determine the accuracy of sonographic prenatal sex determination, perform binary classification test, and the impact it has, including mis-diagnosis. Materials and Methods: A prospective prenatal sonographic sex determination study on 205 consecutive consenting pregnant women aged 20-40 years in a private hospital in Benin between August 2010 and October 2011. Questionnaires were administered to these women before and after the scan and the women were told the sex of the fetuses and their feelings on the determined sex recorded. The sex at birth was confirmed and compared to the scan determined gender by their case note and telephone. Relevant discussions during the scan and later on were recorded on the questionnaires. The statistical package used was SPSS version 17 and binary classification tests were performed. Results: The sensitivity (98.2%) and binary classification components values of prenatal sex determination were high with the sensitivity of detecting a female higher than that of males. Two males were misdiagnosed as females. Most of the women were happy even when the sex differed from that which they desired. Conclusion: Prenatal sonographic sex determination has a high sensitivity index. Consequently we advocate its use prior to more invasive sex tests.
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Utility of Multiplanar and Three-Dimensional Reconstructions From Computed Tomography Performed for Maternal Indications for Visualizing Fetal Anatomy and Estimating Gestational Age. J Comput Assist Tomogr 2011; 35:446-53. [DOI: 10.1097/rct.0b013e3182206f40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Youssef A, Arcangeli T, Radico D, Contro E, Guasina F, Bellussi F, Maroni E, Morselli-Labate AM, Farina A, Pilu G, Pelusi G, Ghi T. Accuracy of fetal gender determination in the first trimester using three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:557-61. [PMID: 20814877 DOI: 10.1002/uog.8812] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2010] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To evaluate the accuracy of three-dimensional (3D) ultrasound in fetal gender assignment in the first trimester. METHODS A series of pregnant women attending at 11 to 13 + 6 weeks for the nuchal translucency (NT) scan were enrolled into the study. An ultrasound volume of each fetus was obtained and stored for offline analysis. On the reconstructed mid-sagittal plane, the angle between the genital tubercle and an imaginary line passing tangentially through the fetal back (genital angle) was estimated and a receiver-operating characteristics (ROC) curve was constructed to determine the best cut-off for genital angle in fetal male gender determination. Fetal gender was subsequently ascertained in all cases. To calculate the interobserver variability, a second operator repeated the measurements. RESULTS There were 85 cases included in the study. The genital angle in males was significantly higher than that in females (51.2 ± 11.3° (n = 36) vs. 18.9 ± 4.1 (n = 49), P < 0.001). The ROC curve revealed the estimated genital angle to have a high degree of accuracy in fetal gender determination (area under the curve ± SE = 1.000 ± 0.001). The best cut-off for male gender determination was found to be between 27° and 29° (sensitivity, 100%; specificity, 98.0%). There was a high degree of correlation between the two operators (r(2) = 0.998; coefficient of variation = 5.4%). CONCLUSIONS 3D ultrasound is a highly accurate and reproducible tool for fetal gender assignment prior to 14 weeks of gestation.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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Eze C, Ezugwu F, Agbo J. Sonographic determination of fetal gender in the second and third trimesters in a private hospital in Enugu, southeast Nigeria. Radiography (Lond) 2010. [DOI: 10.1016/j.radi.2010.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hackett LK, Tarsa M, Wolfson TJ, Kaplan G, Vaux KK, Pretorius DH. Use of multiplanar 3-dimensional ultrasonography for prenatal sex identification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:195-202. [PMID: 20103789 DOI: 10.7863/jum.2010.29.2.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Determination of fetal sex is an important part of detailed second-trimester ultrasonography. This task can be hindered by the fetal position, a low amniotic fluid volume, and advanced gestational age. Identification of fetal sex is further important in multiple gestations and prior histories of indeterminate-sex pregnancies. The goal of the study was to compare the effectiveness of 2-dimensional ultrasonography (2DUS) versus 3-dimensional ultrasonography (3DUS) at sex identification and to determine how genitalia measurements taken with 3DUS technology compare with measurements taken with 2DUS. METHODS A total of 111 patients at or beyond 16 weeks' gestation were recruited. Assignments of fetal sex using 2DUS and 3DUS were compared by the test of proportions. The actual neonatal sex was obtained after delivery. Given such small number of misdiagnoses by either 2DUS or 3DUS, the accuracies of the two modalities were not found to be statistically distinguishable from one another (P = .5585). The penile length, scrotal width, and bilabial diameter according to gestational age were measured and compared with previously published 2DUS data by t tests. RESULTS Sexes were assigned and interpreted in 65 cases. Ranges of genitalia measurements were plotted against gestational age and were found to be comparable with published data. There was a dramatic difference between the bilabial diameter and scrotal width with advancing gestational age that made sex determination much easier in the third trimester. CONCLUSIONS Although 3DUS did not have better prediction of fetal sex when compared with 2DUS, it may be a useful tool in conjunction with traditional imaging techniques in assigning fetal sex.
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Affiliation(s)
- Lauren K Hackett
- Department of Radiology, University of California, San Diego, 9300 Campus Point Dr, 7756, La Jolla, CA 92037 USA
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Chelli D, Methni A, Dimassi K, Boudaya F, Sfar E, Zouaoui B, Chelli H, Chennoufi MB. Fetal sex assignment by first trimester ultrasound: a Tunisian experience. Prenat Diagn 2009; 29:1145-8. [DOI: 10.1002/pd.2374] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Verwoerd-Dikkeboom CM, Koning AHJ, Groenenberg IAL, Smit BJ, Brezinka C, Van Der Spek PJ, Steegers EAP. Using virtual reality for evaluation of fetal ambiguous genitalia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:510-514. [PMID: 18666092 DOI: 10.1002/uog.5343] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The utility of a virtual reality system was examined in the visualization of three-dimensional (3D) ultrasound images of fetal ambiguous genitalia. METHODS In 2005, fetal ambiguous genitalia were diagnosed in four patients referred to our department for prenatal ultrasound assessment. The patients were examined by two-dimensional (2D) and 3D ultrasound and, subsequently, the volumes obtained on 3D ultrasound were visualized in the BARCO I-Space virtual reality system. This system projects stereoscopic images on three walls and the floor of a small 'room', allowing several viewers to see a 3D 'hologram' of the data being visualized. The results of 2D and 3D ultrasound examination and the virtual reality images of the I-Space were compared with diagnoses made postpartum. RESULTS In all cases, prenatal diagnosis was unclear based on 2D ultrasound alone. Surface rendering of 3D data provided an impression of ambiguity, but diagnosis based on these data proved incorrect at birth in three cases. Conclusions based on the evaluation of 3D volumes in virtual reality best fitted the postpartum diagnosis in all cases. CONCLUSIONS This study suggests that by evaluation of the genitals in the I-Space, a better impression of genital ambiguity can be established. Binocular depth perception appeared particularly useful in distinguishing either a micropenis or enlarged clitoris from labia minora, since it helps in the estimation of size and position. Therefore, we see potential for the application of virtual reality not only for the evaluation of fetal ambiguous genitalia, but in all those cases where depth perception would improve the visualization of anatomical structures.
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Affiliation(s)
- C M Verwoerd-Dikkeboom
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, University Medical Center, Rotterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW Several technological advances have greatly improved three-dimensional sonography, which have improved acquisition and display capabilities. This review describes these technical changes as well as current applications of 3D sonography in prenatal diagnosis. RECENT FINDINGS Recently published papers have emphasized the potential of getting a precise 'any plane of choice' from a three-dimensional volume, as a new way of scanning, based on the off-line analysis of a volume dataset. Surface mode has been used to demonstrate malformations and genetic diseases. The maximum rendering mode, which highlights bones, has great potential for imaging the nasal bones and the frontal bones with the metopic suture. Organ volume can be measured, but the utility of this in clinical practice remains to be determined. Three-dimensional ultrasound needs to be standardized. SUMMARY Three-dimensional ultrasonography is the most rapidly developing technique in fetal imaging. New features will permit the transition from the era of 'sonography in two-dimensional planes' to 'volume ultrasound'.
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Affiliation(s)
- Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Glanc P, Umranikar S, Koff D, Tomlinson G, Chitayat D. Fetal sex assignment by sonographic evaluation of the pelvic organs in the second and third trimesters of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:563-9; quiz 570-1. [PMID: 17459997 DOI: 10.7863/jum.2007.26.5.563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the feasibility and reliability of fetal sex assignment by prenatal sonography of the pelvic organs in the second and third trimesters. METHODS A prospective study, on an axial pelvic image with the umbilical arteries in cross section at the midpoint of the bladder, measured the distance between the posterior wall of the bladder and the anterior wall of the rectum. The bladder interface was scored as concave, flat, or convex. Endometrium visualization was recorded. A video loop of the pelvis was obtained. Each case was read by a second reader aware of only the gestational age. RESULTS The study population included 205 fetuses. The primary reader was 98.8% accurate in identifying true female fetuses and 100% accurate in identifying true male fetuses. The intraclass correlation coefficient for axial measurement was 0.99. Video loop analysis achieved 96% inter-reader concordance. In the second trimester, measurements in 100% of male fetuses were less than 3.3 mm, and those in 94% of female fetuses were greater than 3.3 mm. In the third trimester, measurements in 96% of male fetuses were less than 4.7 mm, and those in 100% of female fetuses were greater than 4.7 mm. Ninety-eight percent of all fetuses with concave interfaces were female. The endometrium was visualized in 74%. The additional time per examination was less than 5 minutes in 87.7%. CONCLUSIONS Internal pelvic fetal sex assignment is a reliable additional method for fetal sex determination. A numerical discriminatory level can be used to distinguish between male and female internal genitalia. Larger numbers will be required to further refine these values.
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Affiliation(s)
- Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Women's College Hospital, University of Toronto, Toronto, ON M5S 1B2, Canada.
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Timor-Tritsch IE, Monteagudo A. Three and four-dimensional ultrasound in obstetrics and gynecology. Curr Opin Obstet Gynecol 2007; 19:157-75. [PMID: 17353685 DOI: 10.1097/gco.0b013e328099b067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Developments in ultrasound in general, but even more so in three-dimensional ultrasound, parallel the growth in computing power and speed of computer technology. It is not surprising, therefore, that three-dimensional ultrasound technology is constantly evolving at a fast pace. The purpose of this article is to provide enhanced diagnostic capabilities for the obstetrical and gynecologic provider. RECENT FINDINGS The most recent advances in three-dimensional ultrasound have to do with two main features. First, an increasingly fast acquisition speed, enabling quick sequences of fast moving organs such as the heart to be captured. Second, the increasing number of different display modalities, making understanding and analysis of normal anatomy and pathology easier for clinicians. SUMMARY This article highlights a selected number of clinical situations in which three-dimensional ultrasound meaningfully enhances the contribution of this fast evolving diagnostic imaging tool.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA.
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Benacerraf BR, Benson CB, Abuhamad AZ, Copel JA, Abramowicz JS, Devore GR, Doubilet PM, Lee W, Lev-Toaff AS, Merz E, Nelson TR, O'Neill MJ, Parsons AK, Platt LD, Pretorius DH, Timor-Tritsch IE. Three- and 4-dimensional ultrasound in obstetrics and gynecology: proceedings of the American Institute of Ultrasound in Medicine Consensus Conference. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1587-97. [PMID: 16301716 DOI: 10.7863/jum.2005.24.12.1587] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The American Institute of Ultrasound in Medicine convened a panel of physicians and scientists with interest and expertise in 3-dimensional (3D) ultrasound in obstetrics and gynecology to discuss the current diagnostic benefits and technical limitations in obstetrics and gynecology and consider the utility and role of this type of imaging in clinical practice now and in the future. This conference was held in Orlando, Florida, June 16 and 17, 2005. Discussions considered state-of-the-art applications of 3D ultrasound, specific clinical situations in which it has been found to be helpful, the role of 3D volume acquisition for improving diagnostic efficiency and patient throughput, and recommendations for future investigations related to the utility of volume sonography in obstetrics and gynecology.
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Abstract
This article provides clinicians with an overview of current methods for prenatal genetic screening and diagnosis. Topics include developments in prenatal screening procedures such as ethnicity-based carrier testing, maternal serum screening, and ultrasonography. Diagnostic alternatives to amniocentesis include chorionic villus sampling and preimplantation diagnosis. Future endeavors such as three-dimensional ultrasonography and fetal cell sorting are discussed.
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Affiliation(s)
- Jennifer A Bubb
- Center for Human Genetics, University Hospitals of Cleveland, 11100 Euclid Avenue, LKS 1500, Cleveland, OH 44106, USA.
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Michailidis GD, Papageorgiou P, Morris RW, Economides DL. The use of three-dimensional ultrasound for fetal gender determination in the first trimester. Br J Radiol 2003; 76:448-51. [PMID: 12857703 DOI: 10.1259/bjr/13479830] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to examine the accuracy of fetal gender prediction at a routine first trimester scan using three-dimensional (3D) ultrasound. 200 women were recruited for this study and they agreed to have a transvaginal scan for their routine first trimester scan for fetal anatomy and nuchal thickness measurement. 3D volumes were obtained and stored. Two examiners independently reviewed all the volumes and recorded their diagnosis of fetal gender and measured the angle between the genital tubercle and the skin overlying the sacrum. After studying the 3D volumes both examiners recorded a diagnosis of male or female in 150 cases (81.5%). In 34 cases (18.5%) either both (n=21) or one of them (n=13) could not comment on fetal gender by studying the saved volume. From these 150 cases correct prediction of fetal gender by both examiners was achieved in 85.3% of cases. In 6.7% of cases both examiners predicted the wrong gender while for the rest 8% of cases each examiner assigned different gender to the fetus (k=0.84; standard error 0.045). Angle measurements performed from the saved 3D volumes were highly reproducible. Gestational age did not affect the accuracy of gender identification. This study demonstrates that 3D ultrasound can be an effective and fast way of identifying fetal gender in the first trimester. The advantages of 3D ultrasound stem from its ability to virtually reproduce all required views.
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Affiliation(s)
- G D Michailidis
- Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Abstract
PURPOSE OF REVIEW Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided. RECENT FINDINGS The advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers. The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multilinear arrays. SUMMARY 3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA
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Horn LC, Faber R, Meiner A, Piskazeck U, Spranger J. Current awareness in prenatal diagnosis. Prenat Diagn 2001; 21:427-33. [PMID: 11360293 DOI: 10.1002/pd.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Platt LD. Three-dimensional ultrasound, 2000. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 16:295-298. [PMID: 11169302 DOI: 10.1046/j.1469-0705.2000.00318.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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