Sonography of fetal choroid plexus cysts: detection depends on cyst size and gestational age

Natural History and Clinical Significance of Multiple Cysts in a Single Choroid Plexus

Different types and locations of choroid plexus cysts (CPCs) have been described, including oversized and bilateral. It appears that the type, size, and number of CPCs are correlated with various degrees of aneuploidy risk. This report deals with the natural history and significance of CPCs filling only one choroid plexus. Multiple CPCs filling the entire choroid plexus were detected in 9 of 4211 consecutive second-trimester sonographic examinations. Karyotyping via amniocentesis or neonatal blood analysis was performed in all cases. CPCs in a single choroid plexus were associated with transient ventriculomegaly in five of nine fetuses. Resolution of CPCs took place between 25 and 33 weeks of pregnancy, with most resolving after the 30th week. Karyotyping revealed normal results in all cases. Favorable prognosis of newly described multiple CPCs in a single choroid plexus should be mentioned during patient counseling.

Single-Shot Version of FLAIR Sequence in the Detection of Intraventricular Anomalies: Preliminary Experience in Fetal MR Imaging

OBJECTIVE

To evaluate single-shot (ss) FLAIR sequence in the detection of intraventricular anomalies in a series of fetuses showing mild-moderate ventriculomegaly at ultrasound.

SUBJECTS AND METHODS

Fetuses with mild-moderate isolated ventriculomegaly, which underwent MR imaging between 2003 and 2014 were considered eligible. Fetuses were examined by standard MR protocol and ss-FLAIR sequence, tailored for snapshot imaging. Two paediatric neuroradiologists evaluated MR images.

RESULTS

542 cases were selected. MR imaging was performed at mean 26 weeks of gestation. ss-FLAIR sequence detected intraventricular findings, consistent with cysts in 10 cases. In 3/10 intraventricular cysts were also evident on ss-FSE T2 and FSE T1-weighted images. In no case diffusion weighted imaging was able to detect cyst. No cyst was highlighted on ss-FSE-T2 and FSE-T1-weighted images, without being visible also on ss-FLAIR.

CONCLUSION

ss-FLAIR sequence may be useful to detect intraventricular anomalies especially when fetal position or maternal obesity prevents adequate visualization by ultrasound.

Learning to segment key clinical anatomical structures in fetal neurosonography informed by a region-based descriptor

We present a general framework for automatic segmentation of fetal brain structures in ultrasound images inspired by recent advances in machine learning. The approach is based on a region descriptor that characterizes the shape and local intensity context of different neurological structures without explicit models. To validate our framework, we present experiments to segment two fetal brain structures of clinical importance that have quite different ultrasonic appearances-the corpus callosum (CC) and the choroid plexus (CP). Results demonstrate that our approach achieves high region segmentation accuracy (dice coefficient: [Formula: see text] CC, [Formula: see text] CP) relative to human delineation, whereas the derived automated biometry measurement deviations are within human intra/interobserver variations. The use of our proposed method may help to standardize intracranial anatomy measurements for both the routine examination and the detection of congenital conditions in the future.

Isolated choroid plexus cyst or echogenic cardiac focus on prenatal ultrasound: is genetic amniocentesis indicated?

OBJECTIVE

The purpose of this study was to determine whether or not genetic amniocentesis is warranted when isolated choroid plexus cysts (CPC) or echogenic cardiac foci (EF) are noted on prenatal ultrasound.

STUDY DESIGN

We performed a retrospective analysis on patients from our perinatal database. All obstetric patients with CPC or EF noted on second-trimester perinatology ultrasound from April, 1998 to November, 2004 were included. Information regarding ultrasound findings and neonatal outcome were analyzed.

RESULTS

During the study period, 515 patients with CPC or EF were evaluated. Of these, 429 (83.3%) had isolated CPC or EF and 86 (16.7%) had additional risk factors. The incidence of abnormal karyotype was 0 versus 2.3%, respectively (P = .03). The additional risk factors considered were: advanced maternal age, abnormal serum triple marker screening, and/or other abnormal ultrasound findings. Furthermore, during the study period there were 20,122 live births and 27 (0.1%) cases of aneuploidy diagnosed postnatally. Of these, none had isolated CPC or EF on prenatal ultrasound.

CONCLUSION

CPC or EF noted on prenatal ultrasound warrants referral for careful consultative ultrasound evaluation. In the absence of other risk factors, however, genetic amniocentesis for isolated CPC or EF does not appear to be necessary.

Digital mammography: effects of reduced radiation dose on diagnostic performance

PURPOSE

To experimentally determine the relationship between radiation dose and observer accuracy in the detection and discrimination of simulated lesions for digital mammography.

MATERIALS AND METHODS

This HIPAA-compliant study received institutional review board approval; the informed consent requirement was waived. Three hundred normal craniocaudal images were selected from an existing database of digital mammograms. Simulated mammographic lesions that mimicked benign and malignant masses and clusters of microcalcifications (3.3-7.4 cm in diameter) were then superimposed on images. Images were rendered without and with added radiographic noise to simulate effects of reducing the radiation dose to one half and one quarter of the clinical dose. Images were read by five experienced breast imaging radiologists. Results were analyzed to determine effects of reduced dose on overall interpretation accuracy, detection of microcalcifications and masses, discrimination between benign and malignant masses, and interpretation time.

RESULTS

Overall accuracy decreased from 0.83 with full dose to 0.78 and 0.62 with half and quarter doses, respectively. The decrease associated with transition from full dose to quarter dose was significant (P < .01), primarily because of an effect on detection of microcalcifications (P < .01) and discrimination of masses (P < .05). The level of dose reduction did not significantly affect detection of malignant masses (P > .5). However, reduced dose resulted in an increased mean interpretation time per image by 28% (P < .0001).

CONCLUSION

These findings suggest that dose reduction in digital mammography has a measurable but modest effect on diagnostic accuracy. The small magnitude of the effect in response to the drastic reduction of dose suggests potential for modest dose reductions in digital mammography.