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Tavares de Sousa M, Chaoui R, Herrmann J, Hecher K. Intrauterine laser coagulation of rapidly growing epignathus with autonomous cardiac activity. Ultrasound Obstet Gynecol 2024; 63:419-420. [PMID: 37676230 DOI: 10.1002/uog.27477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Affiliation(s)
- M Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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Karl K, Chaoui R. Tela-choroidea-to-anterior-cerebral-artery distance (TACAD): novel marker on color Doppler to identify fetuses with complete or partial agenesis of corpus callosum. Ultrasound Obstet Gynecol 2023; 62:701-706. [PMID: 37265109 DOI: 10.1002/uog.26275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To assess objectively the course of the anterior cerebral artery (ACA) by measuring its distance to the tela choroidea in the midsagittal view, and to compare this distance in normal fetuses with that in those with agenesis of the corpus callosum (ACC), a condition known to be associated with an abnormal course of the ACA. METHODS The tela-choroidea-to-anterior-cerebral-artery distance (TACAD) was measured in the midsagittal view of the brain on color Doppler, between the anterior border of the tela choroidea and the ACA at the level of the callosal genu. Reference ranges in relation to gestational age were established in a prospective, cross-sectional study of 253 normal healthy fetuses between 19 and 36 weeks of gestation. The study group included fetuses with complete ACC (n = 28) or partial ACC (n = 18). RESULTS TACAD of normal fetuses showed an increase during the second half of pregnancy, with a mean value of 10.1 mm and 14.2 mm at 22 and 30 weeks of gestation, respectively. All (28/28) fetuses with complete ACC and 83% (15/18) of those with partial ACC had significantly shorter TACAD, with mean values of 3.9 mm and 6.6 mm, respectively. CONCLUSIONS TACAD is a measurement that is simple to obtain during fetal color Doppler neurosonography, which enables quantification of the course of the ACA and pericallosal artery. TACAD is shorter in fetuses with complete or partial ACC than in normal fetuses and provides an objective, quantifiable value, rather than merely descriptive information. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Karl
- Center for Prenatal Diagnosis Munich, Munich, Germany
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, Germany
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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3
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Carvalho JS, Axt-Fliedner R, Chaoui R, Copel JA, Cuneo BF, Goff D, Gordin Kopylov L, Hecher K, Lee W, Moon-Grady AJ, Mousa HA, Munoz H, Paladini D, Prefumo F, Quarello E, Rychik J, Tutschek B, Wiechec M, Yagel S. ISUOG Practice Guidelines (updated): fetal cardiac screening. Ultrasound Obstet Gynecol 2023; 61:788-803. [PMID: 37267096 DOI: 10.1002/uog.26224] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/04/2023]
Affiliation(s)
- J S Carvalho
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust; and Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - R Axt-Fliedner
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, University Hospital Giessen & Marburg, Giessen, Germany
| | - R Chaoui
- Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Copel
- Departments of Obstetrics, Gynecology & Reproductive Sciences, and Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - B F Cuneo
- Children's Hospital Colorado, The Heart Institute, Aurora, CO, USA
| | - D Goff
- Pediatrix Cardiology of Houston and Loma Linda University School of Medicine, Houston, TX, USA
| | - L Gordin Kopylov
- Obstetrical Unit, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A J Moon-Grady
- Clinical Pediatrics, UC San Francisco, San Francisco, CA, USA
| | - H A Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - H Munoz
- Obstetrics and Gynecology, Universidad de Chile and Clinica Las Condes, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - E Quarello
- Image 2 Center, Obstetrics and Gynecologic Department, St Joseph Hospital, Marseille, France
| | - J Rychik
- Fetal Heart Program at Children's Hospital of Philadelphia, and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - B Tutschek
- Pränatal Zürich, Zürich, Switzerland; and Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - M Wiechec
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Mt. Scopus and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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4
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Lesieur E, Zaffran S, Chaoui R, Quarello E. Prenatal screening and diagnosis of pulmonary artery anomalies. Ultrasound Obstet Gynecol 2023; 61:445-457. [PMID: 36178851 DOI: 10.1002/uog.26078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
Congenital pulmonary artery anomalies are rare. Their antenatal diagnosis requires good knowledge of fetal cardiac anatomy because their clinical presentation varies depending on the type and severity of the underlying lesion. Screening of these vascular anomalies can be straightforward in some cases because of significant associated consequences that are detected easily on ultrasound, while other anomalies have considerably less obvious features. There may be an associated genetic syndrome. The aim of this review was to define anomalies of the main pulmonary artery and its branches and to propose, through the identification of suspicious findings during routine antenatal heart examination, an optimal screening method for the pulmonary artery pathway. We propose that pulmonary artery anomalies can be classified antenatally into four types of disorder. Herein we describe 14 cases subgrouped accordingly as: anomalies of the pulmonary valvular region, with stenosis or atresia of the valve (n = 4); conotruncal abnormalities (n = 4); anomalies associated with abnormal origin or course of the pulmonary artery (n = 4); and anomalies associated with abnormal growth of the pulmonary artery and its branches (n = 2). We highlight the need to differentiate the three-vessel view from the three-vessel-and-trachea view when assessing a fetus with a congenital pulmonary artery anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Lesieur
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, Timone Hospital, Aix-Marseille University, Marseille, France
- UMR 7268 ADES, Aix-Marseille University, CNRS, EFS, Marseille, France
| | - S Zaffran
- Aix-Marseille University, INSERM, MMG, U1251, Marseille, France
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - E Quarello
- Screening and Diagnosis Unit, Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille, France
- IMAGE2 Center, Marseille, France
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5
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Bilardo CM, Chaoui R, Hyett JA, Kagan KO, Karim JN, Papageorghiou AT, Poon LC, Salomon LJ, Syngelaki A, Nicolaides KH. ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan. Ultrasound Obstet Gynecol 2023; 61:127-143. [PMID: 36594739 DOI: 10.1002/uog.26106] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, and Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Hyett
- Western Sydney University, Sydney, Australia
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - J N Karim
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - L C Poon
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Paris Cité University, Assistance Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Agarwal U, Lim J, Pottinger C, Suk EK, Chaoui R. Prenatal diagnosis of KAT6A syndrome in two fetuses with congenital heart disease. Ultrasound Obstet Gynecol 2023; 61:114-116. [PMID: 36070007 DOI: 10.1002/uog.26062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 05/27/2023]
Affiliation(s)
- U Agarwal
- Department of Fetal Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - J Lim
- Alder Hey Children's Hospital, Liverpool, UK
| | - C Pottinger
- All Wales Medical Genetics Service, Wrexham Maelor Hospital, Wrexham, UK
| | - E-K Suk
- Center for Human Genetics, Berlin, Germany
| | - R Chaoui
- Center for Prenatal Diagnosis, Berlin, Germany
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7
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Volpe P, De Robertis R, Fanelli T, Boito S, Volpe G, Votino C, Persico N, Chaoui R. Low torcular Herophili position and large brainstem-tentorium angle in fetuses with open spinal dysraphism at 11-13 weeks' gestation. Ultrasound Obstet Gynecol 2022; 59:49-54. [PMID: 34125985 DOI: 10.1002/uog.23697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To evaluate whether in fetuses with open spina bifida (OSB) the tentorium can be seen to be displaced downwards and vertically oriented by the time of the 11-13-week scan and whether this is reflected in an alteration of the brainstem-tentorium (BST) angle. METHODS The study population was recruited between 2015 and 2020 from three fetal medicine referral centers and comprised a control group and a study group of pregnancies with OSB. The control group was recruited prospectively and included singleton pregnancies with a normal sonographic examination after first-trimester combined screening for chromosomal abnormalities and normal outcome. The study group was selected retrospectively and included all cases with OSB between 2015 and 2020. All cases underwent detailed ultrasound assessment at 11 + 0 to 13 + 6 weeks' gestation. The position of the torcular Herophili (TH) was identified in the midsagittal view of the fetal brain with the use of color Doppler and was considered as a proxy for the insertion of the tentorium on the fetal skull. The BST angle was calculated in the same view and was compared between the two groups. RESULTS Sixty normal fetuses were included in the control group and 22 fetuses with OSB in the study group. In both groups, the BST angle was found to be independent of gestational age or crown-rump length (P = 0.8815, R2 = 0.0003861 in the controls, and P = 0.2665, R2 = 0.00978 in the OSB group). The mean BST angle was 48.7 ± 7.8° in controls and 88.1 ± 1.18°, i.e. close to 90°, in fetuses with OSB. Comparison of BST-angle measurements between the control group and cases with OSB showed a statistically significant difference (P = 0.0153). In all fetuses with OSB, the downward displacement of the TH and tentorium was clearly visible at the 11-13-week scan. CONCLUSIONS In fetuses with OSB, the BST angle is significantly larger than in normal controls, with the tentorium being almost perpendicular to the brainstem. This sign confirms the inferior displacement of the tentorium cerebelli with respect to its normal insertion on the occipital clivus as early as the first trimester of pregnancy and is useful in the diagnosis of Chiari-II malformation at this early stage. In fetuses with OSB, the low position of the tentorium and TH is clearly visible, even subjectively, at the 11-13-week scan. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL, BA, Bari, Italy
| | - R De Robertis
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL, BA, Bari, Italy
| | - T Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL, BA, Bari, Italy
| | - S Boito
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Volpe
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL, BA, Bari, Italy
| | - N Persico
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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8
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Bevilacqua E, Jani JC, Chaoui R, Suk EA, Palma‐Dias R, Ko T, Warsof S, Stokowski R, Jones KJ, Grati FR, Schmid M. Performance of a targeted cell-free DNA prenatal test for 22q11.2 deletion in a large clinical cohort. Ultrasound Obstet Gynecol 2021; 58:597-602. [PMID: 34090308 PMCID: PMC8518527 DOI: 10.1002/uog.23699] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVE 22q11.2 deletion is more common than trisomies 18 and 13 combined, yet no routine approach to prenatal screening for this microdeletion has been established. This study evaluated the clinical sensitivity and specificity of a targeted cell-free DNA (cfDNA) test to screen for fetal 22q11.2 deletion in a large cohort, using blinded analysis of prospectively enrolled pregnancies and stored clinical samples. METHODS In order to ensure that the analysis included a meaningful number of cases with fetal 22q11.2 deletion, maternal plasma samples were obtained by prospective, multicenter enrolment of pregnancies with a fetal cardiac abnormality and from stored clinical samples from a research sample bank. Fetal genetic status, as evaluated by microarray analysis, karyotyping with fluorescence in-situ hybridization or a comparable test, was available for all cases. Samples were processed as described previously for the Harmony prenatal test, with the addition of DANSR (Digital Analysis of Selected Regions) assays targeting the 3.0-Mb region of 22q11.2 associated with 22q11.2 deletion syndrome. Operators were blinded to fetal genetic status. Sensitivity and specificity of the cfDNA test for 22q11.2 deletion were calculated based on concordance between the cfDNA result and fetal genotype. RESULTS The final study group consisted of 735 clinical samples, including 358 from prospectively enrolled pregnancies and 377 stored clinical samples. Of 46 maternal plasma samples from pregnancies with a 22q11.2 deletion, ranging in size from 1.25 to 3.25 Mb, 32 had a cfDNA result indicating a high probability of 22q11.2 deletion (sensitivity, 69.6% (95% CI, 55.2-80.9%)). All 689 maternal plasma samples without a 22q11.2 deletion were classified correctly by the cfDNA test as having no evidence of a 22q11.2 deletion (specificity, 100% (95% CI, 99.5-100%)). CONCLUSIONS The results of this large-scale prospective clinical evaluation of the sensitivity and specificity of a targeted cfDNA test for fetal 22q11.2 deletion demonstrate that this test can detect the common and smaller, nested 22q11.2 deletions with a low (0-0.5%) false-positive rate. Although the positive predictive value (PPV) observed in this study population was 100%, the expected PPV in the general pregnant population is estimated to be 12.2% at 99.5% specificity and 41.1% at 99.9% specificity. The use of this cfDNA test to screen for 22q11.2 deletion could enhance identification of pregnancies at risk for 22q11.2 deletion syndrome without significantly increasing the likelihood of maternal anxiety and unnecessary invasive procedures related to a false-positive result. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - J. C. Jani
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - R. Chaoui
- Prenatal Diagnosis and Human GeneticsBerlinGermany
| | - E.‐K. A. Suk
- Prenatal Diagnosis and Human GeneticsBerlinGermany
| | - R. Palma‐Dias
- The Royal Women's HospitalUniversity of MelbourneParkvilleVICAustralia
| | - T.‐M. Ko
- Genephile Bioscience Laboratory, Ko's Obstetrics & Gynecology ClinicTaipei CityTaiwan
| | - S. Warsof
- Eastern Virginia Medical SchoolNorfolkVAUSA
| | | | - K. J. Jones
- Roche Sequencing Solutions, Inc.San JoseCAUSA
| | - F. R. Grati
- TOMA Advanced Biomedical Assays S.p.A, Impact Lab.Busto ArsizioItaly
| | - M. Schmid
- Roche Sequencing Solutions, Inc.San JoseCAUSA
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Cabet S, Karl K, Garel C, Delius M, Hartung J, Lesca G, Chaoui R, Guibaud L. Two different prenatal imaging cerebral patterns of tubulinopathy. Ultrasound Obstet Gynecol 2021; 57:493-497. [PMID: 32149430 DOI: 10.1002/uog.22010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
To illustrate the prenatal cerebral imaging features associated with tubulinopathy, we report on five affected fetuses from unrelated families, with a de-novo heterozygous variant in a tubulin gene (TUBA1A, TUBB2B or TUBB3). We identified two distinct prenatal imaging patterns related to tubulinopathy: a severe form, characterized by enlarged germinal matrices, microlissencephaly and a kinked brainstem; and a mild form which has not been reported previously in the prenatal literature. The latter form is associated with non-specific features, including an asymmetric brainstem, corpus callosal dysgenesis, a lack of Sylvian fissure operculization and distortion of the anterior part of the interhemispheric fissure with subsequent impacted medial borders of the frontal lobes, the combination of which, in the absence of additional extracerebral anomalies, is highly suggestive of tubulinopathy. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Cabet
- Imagerie Pédiatrique et Fœtale, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France
- Service de Génétique, Groupement Hospitalier Est, Université Claude Bernard Lyon 1, Lyon-Bron, France
| | - K Karl
- Center for Prenatal Diagnosis Munich, Munich, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - C Garel
- Department of Pediatric Imaging, Hôpital d'Enfants Armand-Trousseau APHP, Paris, France
| | - M Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - J Hartung
- Office of Prenatal Diagnosis, Berlin, Germany
| | - G Lesca
- Service de Génétique, Groupement Hospitalier Est, Université Claude Bernard Lyon 1, Lyon-Bron, France
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - L Guibaud
- Imagerie Pédiatrique et Fœtale, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France
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Chaoui R. Evolution of fetal cardiac imaging in 30 years of ISUOG. Ultrasound Obstet Gynecol 2021; 57:38-42. [PMID: 33387411 DOI: 10.1002/uog.23551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
MESH Headings
- Female
- Fetal Heart/diagnostic imaging
- History, 20th Century
- History, 21st Century
- Humans
- Imaging, Three-Dimensional/history
- Imaging, Three-Dimensional/methods
- Periodicals as Topic/history
- Pregnancy
- Ultrasonography, Doppler, Color/history
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Prenatal/history
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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Khalil A, Sotiriadis A, Chaoui R, da Silva Costa F, D'Antonio F, Heath PT, Jones C, Malinger G, Odibo A, Prefumo F, Salomon LJ, Wood S, Ville Y. ISUOG Practice Guidelines: role of ultrasound in congenital infection. Ultrasound Obstet Gynecol 2020; 56:128-151. [PMID: 32400006 DOI: 10.1002/uog.21991] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - P T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's University of London and St George's University Hospitals NHS Trust, London, UK
| | - C Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Malinger
- Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | | | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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12
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Chaoui R, Benoit B, Entezami M, Frenzel W, Heling KS, Ladendorf B, Pietzsch V, Sarut Lopez A, Karl K. Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11-13 weeks' gestation. Ultrasound Obstet Gynecol 2020; 55:81-86. [PMID: 31559662 DOI: 10.1002/uog.20856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To measure the ratio of choroid plexus (CP) size to head size in normal fetuses and to compare it to that in fetuses with open spina bifida (OSB) and quantify the subjective sign of a 'dry brain'. METHODS This was a retrospective study of ultrasound images, obtained during first-trimester screening between 11 and 13 weeks of gestation, from 34 fetuses with OSB and 160 normal fetuses. From the hospital databases, we retrieved images of the fetal head in the transventricular axial plane. We measured the areas of both CPs and the head and calculated the ratio between them. We also measured the longest diameter of each CP and calculated their mean (CP length), and measured the occipitofrontal diameter (OFD) and calculated the ratio of CP length to OFD. Measurements from the OSB fetuses were plotted on crown-rump length (CRL) reference ranges constructed using data from the normal fetuses, and Z-scores were calculated. RESULTS In the normal fetuses, the CP area increased, while the ratios of CP area to head area and CP length to OFD decreased, with increasing CRL. In 30 of the 34 (88%) fetuses with OSB, both ratios were increased significantly and the CPs filled the entirety of the head, giving the impression of a dry brain. In these cases, the borders of the lateral ventricles could not be identified. CONCLUSIONS At 11-13 weeks, the majority of fetuses with OSB have reduced fluid in the lateral ventricles such that the CPs fill the head. The dry brain sign is easily visualized during routine first-trimester ultrasound examination while measuring the biparietal diameter, and can be quantified by comparing the size of the CPs to the head size. Until prospective data confirm the usefulness of this sign in screening for OSB, it should be considered as a hint to prompt the examiner to assess thoroughly the posterior fossa and spine. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - B Benoit
- Department of Obstetrics and Gynecology, Princess Grace Hospital, Monaco
| | - M Entezami
- Center for Prenatal Diagnosis, Berlin, Germany
| | - W Frenzel
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - K S Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - B Ladendorf
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - V Pietzsch
- Prenatal Diagnosis Clinic, Waiblingen, Germany
| | - A Sarut Lopez
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - K Karl
- Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany
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El Kadiri S, Bay Bay H, Chaoui R, Douhi Z, Elloudi S, Mernissi FZ. Mélasma : corrélations clinico-dermoscopiques. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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El Kadiri S, Bay Bay H, Chaoui R, Douhi Z, Elloudi S, Mernissi FZ. Dermoscopie du lichen plan pigmentogène facial : à propos de 30 cas. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Paladini D, Donarini G, Parodi S, Chaoui R. Differentiating features of posterior fossa at 12-13 weeks' gestation in fetuses with Dandy-Walker malformation and Blake's pouch cyst. Ultrasound Obstet Gynecol 2019; 53:850-852. [PMID: 30575134 DOI: 10.1002/uog.20190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G.Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Istituto G.Gaslini, Genoa, Italy
| | - S Parodi
- Biostatistics, Istituto G.Gaslini, Genoa, Italy
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Karl K, Chaoui R. Reply. Ultrasound Obstet Gynecol 2018; 51:419-420. [PMID: 29512271 DOI: 10.1002/uog.19009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- K Karl
- Center for Prenatal Diagnosis Munich, Munich, Germany
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, Germany
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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Karl K, Esser T, Heling KS, Chaoui R. Cavum septi pellucidi (CSP) ratio: a marker for partial agenesis of the fetal corpus callosum. Ultrasound Obstet Gynecol 2017; 50:336-341. [PMID: 28078790 DOI: 10.1002/uog.17409] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/14/2016] [Accepted: 01/08/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE While complete agenesis of the corpus callosum is often suspected on fetal ultrasound due to absence of the cavum septi pellucidi (CSP), suspicion of partial agenesis of the corpus callosum (pACC) is a challenge since the CSP is almost always present. The aim of this study was to measure the length and width of the CSP and calculate the length-to-width ratio (CSP ratio), and compare these between fetuses with pACC and normal fetuses. METHODS In this retrospective case-control study, the length and width of the CSP were measured in the axial plane of the fetal head, and the CSP length-to-width ratio calculated, in 323 normal fetuses and in 20 fetuses with pACC between 20 and 34 weeks' gestation. From the normal population we constructed reference ranges in relation to biparietal diameter (BPD). For all fetuses we calculated Z-scores for the CSP ratio. RESULTS In the normal population, the length and width of the CSP increased with increasing BPD, while the CSP ratio decreased. The CSP was short (< 5th centile) in 85% (17/20) of fetuses with pACC and wide (> 95th centile) in 65% (13/20). The CSP ratio was small (< 5th centile) in 95% (19/20) of pACC fetuses, with 16/20 (80%) having a ratio below an empirical cut-off of 1.5. Analysis of Z-scores showed that fetuses with pACC had a significantly smaller CSP ratio (P < 0.0001) compared with the normal population. CONCLUSIONS Fetuses with a normal-sized corpus callosum have a rectangular-shaped CSP, with a CSP ratio > 1.5 in the second half of gestation. Most fetuses with pACC have an abnormally shaped, wide and short CSP, with a decreased CSP ratio. This simple ratio has the potential to identify fetuses at high risk for pACC. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Karl
- Center for Prenatal Diagnosis Munich, Munich, Germany
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, Germany
| | - T Esser
- Center for Prenatal Diagnosis Munich, Munich, Germany
| | - K S Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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Stampalija T, Arabin B, Wolf H, Bilardo CM, Lees C, Brezinka C, Derks J, Diemert A, Duvekot J, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Kingdom J, Marlow N, Marsal K, Martinelli P, Ostermayer E, Papageorghiou A, Schlembach D, Schneider K, Thilaganathan B, Thornton J, Todros T, Valcamonico A, Valensise H, van Wassenaer-Leemhuis A, Visser G, Aktas A, Borgione S, Chaoui R, Cornette J, Diehl T, van Eyck J, Fratelli N, van Haastert I, Lobmaier S, Lopriore E, Missfelder-Lobos H, Mansi G, Martelli P, Maso G, Maurer-Fellbaum U, Mensing van Charante N, Mulder-de Tollenaer S, Napolitano R, Oberto M, Oepkes D, Ogge G, van der Post J, Prefumo F, Preston L, Raimondi F, Reiss I, Scheepers L, Skabar A, Spaanderman M, Weisglas-Kuperus N, Zimmermann A. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction? Am J Obstet Gynecol 2017; 216:521.e1-521.e13. [PMID: 28087423 DOI: 10.1016/j.ajog.2017.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies. OBJECTIVES The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26+0-31+6 weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use. STUDY DESIGN This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26+0 and 31+6 weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio. RESULTS Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52). Middle cerebral artery pulsatility index Z-score and umbilicocerebral ratio Z-score at inclusion were associated with 2 year survival with normal neurodevelopmental outcome (odds ratio, 1.33; 95% confidence interval, 1.03-1.72, and odds ratio, 0.88; 95% confidence interval, 0.78-0.99, respectively) as were gestation at delivery and birthweight p50 ratio (odds ratio, 1.41; 95% confidence interval, 1.20-1.66, and odds ratio, 1.86; 95% confidence interval, 1.33-2.60, respectively). When comparing cerebroplacental ratio against umbilicocerebral ratio, the incremental range of the cerebroplacental ratio tended toward zero, whereas the umbilicocerebral ratio tended toward infinity as the values became more abnormal. CONCLUSION In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26+0-31+6 weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.
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Rempen A, Chaoui R, Häusler M, Kagan KO, Kozlowski P, von Kaisenberg C, Wisser J. Quality Requirements for Ultrasound Examination in Early Pregnancy (DEGUM Level I) between 4+0 and 13+6 Weeks of Gestation. Ultraschall Med 2016; 37:579-583. [PMID: 27626239 DOI: 10.1055/s-0042-115581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- A Rempen
- Clinic of Gynecology and Obstetrics, Diakonie-Klinikum, Schwaebisch Hall, Germany
| | - R Chaoui
- Practice of Prenatal Medicine, Berlin, Germany
| | - M Häusler
- Department of Obstetrics, University Clinic, Graz, Austria
| | - K-O Kagan
- University Clinic of Obstetrics and Gynecology, Tübingen, Germany
| | - P Kozlowski
- Prenatal Medicine and Genetics, Duesseldorf, Germany
| | - C von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - J Wisser
- Clinic of Obstetrics, University Hospital, Zurich, Switzerland
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Achehboune K, Aqil N, Chaoui R, Baybay H, Gallouj S, Mernissi F. Un érysipèle de la jambe révélant un syndrome de Cooks. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karl K, Sinkovskaya E, Abuhamad A, Chaoui R. Intrathymic and other anomalous courses of the left brachiocephalic vein in the fetus. Ultrasound Obstet Gynecol 2016; 48:464-469. [PMID: 26499470 DOI: 10.1002/uog.15795] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/18/2015] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The left brachiocephalic vein (LBCV), or innominate vein, connects the left jugular vein to the right superior vena cava. Its course is posterior to the thymus and directly anterior and superior to the aortic arch. Pediatric and adult cardiology studies have reported on the subaortic or retrotracheal courses of the LBCV and the presence of double LBCV. We observed recently in the fetus that the LBCV may have a course through the thymus (intrathymic) or be absent in the presence of a left superior vena cava. The aim of this study was to report the prevalence of isolated intrathymic and absent LBCV in normal fetuses undergoing second-trimester ultrasound screening, as well as the prevalence of other courses in association with cardiac anomalies. METHODS In the prospective part of this study, consecutive second-trimester ultrasound examinations were evaluated to assess the presence and course of the fetal LBCV. In the retrospective case-control part of this study, the databases of two fetal medicine centers were reviewed for cardiac anomalies and the pattern and prevalence of anomalous courses of the LBCV were reported. RESULTS One thousand four hundred and eighteen consecutive fetuses were examined prospectively. An intrathymic course of the LBCV with a typical bent shape was found in 1.76% (1 : 57) of cases and the absence of a LBCV in association with a persistent left superior vena cava (LSVC) was found in 0.28% (1 : 350). All fetuses with an isolated intrathymic course or absence of the LBCV had a normal outcome. Over a period of 4.5 years, a total of 1544 fetuses with cardiac malformations were reviewed at two centers. Among these, an anomalous course of the LBCV was noted in eight (0.5%) cases: six subaortic, one retrotracheal and one double LBCV. CONCLUSION An intrathymic LBCV is a common condition and appears to be a normal variant in the fetus. The prevalence of a LSVC in our screening population was similar to that reported in previous studies. Anomalous courses of the LBCV are seen occasionally in cases with cardiac malformation. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Karl
- Center for Prenatal Diagnosis, Munich, Germany.
| | - E Sinkovskaya
- Division of Maternal-Fetal Medicine of the Department of Obstetrics & Gynecology at Eastern Virginia Medical School, Norfolk, VA, USA
| | - A Abuhamad
- Division of Maternal-Fetal Medicine of the Department of Obstetrics & Gynecology at Eastern Virginia Medical School, Norfolk, VA, USA
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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von Kaisenberg C, Chaoui R, Häusler M, Kagan KO, Kozlowski P, Merz E, Rempen A, Steiner H, Tercanli S, Wisser J, Heling KS. Quality Requirements for the early Fetal Ultrasound Assessment at 11-13+6 Weeks of Gestation (DEGUM Levels II and III). Ultraschall Med 2016; 37:297-302. [PMID: 27093520 DOI: 10.1055/s-0042-105514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The early fetal ultrasound assessment at 11 - 13(+6) weeks of gestation remains the cornerstone of care despite the progress in diagnosing fetal chromosomal defects using cell-free fetal DNA (cffDNA) from the maternal circulation. The measurement of nuchal translucency (NT) allows the risk calculation for the fetal trisomies 21, 18 and 13 but also gives information on those fetal chromosomal defects which are at present unable to be detected using cffDNA. Nuchal translucency is the only auditable parameter at 11 - 13(+6) weeks and gives thus information on the quality of the first trimester anomaly scan. In addition it gives indirect information on the risks for fetal defects and for cardiac anomalies. Also the chances for a healthy live baby can be estimated. As experience with first trimester anomaly scanning increases, and the resolution of the ultrasound equipment has increased substantially, more and more details of the fetal anatomy become accessible at the first trimester scan. Therefore fetal anatomical defects and complex anomalies have become amenable to examination in the first trimester. This guideline describes compulsory and optional parameters for investigation at the first trimester scan and outlines a structured method of examining a first trimester fetus at 11 - 13(+6) weeks of gestation.
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Affiliation(s)
- C von Kaisenberg
- Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - R Chaoui
- Praxis für Pränatalmedizin, Berlin, Germany
| | - M Häusler
- Obstetrics and Gynecology, University of Graz, Graz, Austria
| | - K O Kagan
- Obstetrics and Gynecology, University of Tübingen, Germany
| | - P Kozlowski
- Praenatal-Medizin und Genetik, Düsseldorf, Germany
| | - E Merz
- Obstetrics and Gynecology, Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - A Rempen
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Schwäbisch-Hall, Germany
| | - H Steiner
- Ordination Salzburg, Salzburg, Austria
| | - S Tercanli
- Pränatalmedizin, Ultraschallpraxis Freie Straße, Basel, Switzerland
| | - J Wisser
- Obstetrics and Gynecology, University of Zurich, Zurich, Switzerland
| | - K-S Heling
- Praxis für Pränatalmedizin, Berlin, Germany
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Abstract
The study of the intracerebral venous system in the fetus can only be achieved by means of high-resolution ultrasound equipment with sensitive color Doppler. In the past two decades, there has been a growing interest in the ultrasound examination of the fetal brain with few studies reporting on the brain vasculature during various stages of gestation. In comparison to other fetal venous systems, reports on the assessment of the fetal cerebral venous system are still scarce. This article presents a review on the fetal intracranial venous system with detailed discussions on the anatomy of the superficial and deep cerebral veins. Color Doppler of the main fetal cerebral veins to include the superior sagittal sinus, the straight sinus, the vein of Galen, the internal cerebral veins, the transverse sinuses and others is also discussed. Furthermore, this article highlights abnormal clinical conditions such as aneurysm of the vein of Galen, thrombosis of the dural sinus and variation in the course of some veins such as the straight sinus and falcine sinus. The role of pulsed Doppler examination in normal and growth-restricted fetuses is also discussed.
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Affiliation(s)
- K Karl
- Prenatal Diagnosis Center, Munich, Germany
| | - K S Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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Chaoui R, Simon EG. Nuchal translucency and posterior fossa examination. ACTA ACUST UNITED AC 2016; 44:1-2. [PMID: 26792033 DOI: 10.1016/j.gyobfe.2015.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Friedrichstr. 147, 10117 Berlin, Germany.
| | - E-G Simon
- Service de gynécologie-obstétrique et médecine fœtale, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR Inserm U930, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Chaoui R, Orosz G, Heling KS, Sarut-Lopez A, Nicolaides KH. Maxillary gap at 11-13 weeks' gestation: marker of cleft lip and palate. Ultrasound Obstet Gynecol 2015; 46:665-669. [PMID: 26277990 DOI: 10.1002/uog.15675] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe a new sign of cleft lip and palate (CLP), the maxillary gap, which is visible in the mid-sagittal plane of the fetal face used routinely for measurement of nuchal translucency thickness. METHODS This was a retrospective study of stored images of the mid-sagittal view of the fetal face at 11-13 weeks' gestation in 86 cases of CLP and 86 normal controls. The images were examined to determine if a maxillary gap was present, in which case its size was measured. RESULTS In 37 (43.0%) cases of CLP the defect was isolated and in 49 (57.0%) there were additional fetal defects. In the isolated CLP group, the diagnosis of facial cleft was made in the first trimester in nine (24.3%) cases and in the second trimester in 28 (75.7%). In the group with additional defects, the diagnosis of facial cleft was made in the first trimester in 46 (93.9%) cases and in the second trimester in three (6.1%). A maxillary gap was observed in 96% of cases of CLP with additional defects, in 65% of those with isolated CLP and in 7% of normal fetuses. There was a large gap (>1.5 mm) or complete absence of signals from the maxilla in the midline in 69% of cases of CLP with additional defects, in 35% of those with isolated CLP and in none of the normal controls. CONCLUSIONS The maxillary gap is a new simple marker of possible CLP, which could increase the detection rate of CLP, especially in isolated cases.
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - G Orosz
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K S Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - A Sarut-Lopez
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Bahlmann F, Reinhard I, Schramm T, Geipel A, Gembruch U, von Kaisenberg CS, Schmitz R, Stupin J, Chaoui R, Karl K, Kalache K, Faschingbauer F, Ponnath M, Rempen A, Kozlowski P. Cranial and cerebral signs in the diagnosis of spina bifida between 18 and 22 weeks of gestation: a German multicentre study. Prenat Diagn 2015; 35:228-35. [PMID: 25346419 DOI: 10.1002/pd.4524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/21/2014] [Accepted: 10/20/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this article is to study secondary cranial signs in fetuses with spina bifida in a precisely defined screening period between 18 + 0 and 22 + 0 weeks of gestation. METHOD On the basis of retrospective analysis of 627 fetuses with spina bifida, the value of indirect cranial and cerebral markers was assessed by well-trained ultrasonographers in 13 different prenatal centres in accordance with the ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) guidelines on fetal neurosonography. RESULTS Open spina bifida was diagnosed in 98.9% of cases whereas 1.1% was closed spina bifida. Associated chromosomal abnormalities were found in 6.2%. The banana and lemon signs were evident in 97.1% and 88.6% of cases. Obliteration of the cisterna magna was seen in 96.7%. Cerebellar diameter, head circumference and biparietal diameter were below the 5th percentile in chromosomally normal fetuses in 72.5%, 69.7% and 52%, respectively. The width of the posterior horn of the lateral ventricle was above the 95th percentile in 57.7%. The secondary cranial and cerebral signs were dependent on fetal chromosome status and width of the posterior horn. Biparietal diameter was also dependent on the chromosome status with statistical significance p = 0.0068. Pregnancy was terminated in 89.6% of cases. CONCLUSION In standard measuring planes, lemon sign, banana sign and an inability to image the cistern magna are very reliable indirect ultrasound markers of spina bifida. © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- F Bahlmann
- Department of Obstetrics and Gynecology, Bürgerhospital, Frankfurt, Germany
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Adriaanse BME, Bartelings MM, van Vugt JMG, Chaoui R, Gittenberger-de Groot AC, Haak MC. Differential and linear insertion of atrioventricular valves: a useful tool? Ultrasound Obstet Gynecol 2014; 44:568-574. [PMID: 24515626 DOI: 10.1002/uog.13326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/25/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The differential insertion of the atrioventricular valves is the ultrasonographic representation of the more apical attachment of the tricuspid valve to the septum with respect to the mitral valve. A linear insertion is present when both valves form a linear continuum and has been suggested as a marker for atrioventricular septal defects (AVSDs). The objective of this study was to evaluate the anatomical substratum of differential and linear insertions of the atrioventricular valves in normal fetal hearts and fetal hearts with an AVSD. METHODS The extent and position of the fibrous skeleton and attachment of the atrioventricular valves to the septum were studied in histological sections of 17 normal hearts and four hearts with an AVSD from 10 + 0 weeks' gestation to 3 days postpartum with various immunohistochemical tissue markers. In addition, spatiotemporal image correlation (STIC) volumes of 10 normal hearts and STIC volumes of eight hearts with an AVSD at 13 + 6 to 35 + 5 weeks' gestation were examined. RESULTS The differential insertion of the atrioventricular valves was visible in normal hearts in the four-chamber plane immediately beneath the aorta, but nearer the diaphragm a linear insertion was found. In hearts with an AVSD, a linear appearance was observed in the four-chamber plane immediately beneath the aorta. Towards the diaphragm, however, first a differential insertion and, more caudally, a linear insertion was found. CONCLUSIONS Both differential and linear insertions can be found in normal fetal hearts and fetal hearts with AVSD, depending on the plane in which the four-chamber view is visualized. Therefore, measurement of the differential insertion is likely to be useful only in experienced hands.
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Affiliation(s)
- B M E Adriaanse
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
In recent years the advent of high-resolution and color Doppler ultrasound has enabled a more comprehensive examination of the veins at the cardiac level. These veins include both the superior and inferior vena cava, the pulmonary veins, the azygos vein, the coronary sinus, and the brachiocephalic (or innominate) vein. This article gives a review of the normal and abnormal conditions of the cardiac venous system. Normal anatomy and abnormal findings of these veins are demonstrated by grayscale and color Doppler. Three groups of anomalies are presented: 1) the interrupted inferior vena cava with azygos continuity, 2) the left persisting superior vena cava and 3) the total and partial anomalous pulmonary venous connections. Many of these abnormal findings can be detected by a dedicated examination of the veins during fetal echocardiography, but some anomalies are detectable by focusing on indirect signs such as the compensatory dilation of other veins.
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MESH Headings
- Azygos Vein/abnormalities
- Azygos Vein/diagnostic imaging
- Brachiocephalic Veins/abnormalities
- Brachiocephalic Veins/diagnostic imaging
- Cardiology/education
- Coronary Sinus/abnormalities
- Coronary Sinus/diagnostic imaging
- Coronary Vessel Anomalies/diagnostic imaging
- Echocardiography/methods
- Echocardiography, Doppler, Color
- Echocardiography, Three-Dimensional
- Education, Medical, Continuing
- Female
- Heart Defects, Congenital/diagnostic imaging
- Humans
- Infant, Newborn
- Pregnancy
- Pulmonary Veins/abnormalities
- Pulmonary Veins/diagnostic imaging
- Scimitar Syndrome/diagnostic imaging
- Sensitivity and Specificity
- Ultrasonography, Prenatal
- Veins/abnormalities
- Veins/diagnostic imaging
- Vena Cava, Inferior/abnormalities
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Superior/abnormalities
- Vena Cava, Superior/diagnostic imaging
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Affiliation(s)
- R Chaoui
- Praxis, Pränataldiagnostik Friedrichstraße, Berlin
| | - K-S Heling
- Praxis, Pränataldiagnostik Friedrichstraße, Berlin
| | - K Karl
- Praxis, Prenatal Diagnosis Center, Munich
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Abstract
Advances in high-resolution ultrasound combined with color Doppler and three-dimensional (3 D) rendering have contributed to an increasing understanding of the fetal venous circulation in recent years. Still the sonographic evaluation of the venous system in the fetus remains difficult. This article reviews the normal and abnormal intrahepatic venous system. Normal anatomy and abnormal findings of the umbilical vein (UV), the ductus venosus (DV), portal veins, hepatic veins and the inferior vena cava are demonstrated by grayscale, color Doppler and 3D ultrasound and explained by numerous schemes. Typical variants and abnormalities such as agenesis of the DV and portal venous system, persistence of the right UV, UV varix are explained and the clinical value of normal and abnormal Doppler findings in the DV is discussed. Many of these abnormal findings can be detected by a targeted examination of the intrahepatic vasculature with means of color Doppler.
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Friedrichstraße 147, Berlin, Germany
| | - K S Heling
- Center for Prenatal Diagnosis and Human Genetics, Friedrichstraße 147, Berlin, Germany
| | - K Karl
- Prenatal Diagnosis Munich, Tegernseer Landstraße 64, 81541 Munich, Germany
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30
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Carvalho JS, Allan LD, Chaoui R, Copel JA, DeVore GR, Hecher K, Lee W, Munoz H, Paladini D, Tutschek B, Yagel S. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41:348-359. [PMID: 23460196 DOI: 10.1002/uog.12403] [Citation(s) in RCA: 423] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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31
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Sinkovskaya E, Abuhamad A, Horton S, Chaoui R, Karl K. Fetal left brachiocephalic vein in normal and abnormal conditions. Ultrasound Obstet Gynecol 2012; 40:542-548. [PMID: 22461379 DOI: 10.1002/uog.11166] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To establish values of fetal left brachiocephalic vein (LBCV) dimensions during normal pregnancy and determine whether routine assessment of the LBCV may help in identifying fetuses with congenital abnormalities of this vessel. METHODS Fetal LBCV was assessed prospectively during ultrasound examinations in 431 normal singleton pregnancies. The visualization rate of the transverse view of the upper fetal chest at the level of drainage of the LBCV into the superior vena cava (SVC) by two-dimensional (2D) and 2D plus color Doppler ultrasound was evaluated. Reference ranges of LBCV diameter during non-complicated pregnancies were established. Interobserver and intraobserver measurement variability was analyzed. In addition, a retrospective review of the hospital medical records of 91 pregnancies with fetuses diagnosed with LBCV abnormalities was performed. RESULTS Sonographic assessment of the fetal LBCV was consistently achieved in the second and third trimesters and in some fetuses in the first trimester of pregnancy. In normal fetuses LBCV diameter increased significantly throughout pregnancy, with a mean value of 0.7 mm at 11 weeks and 4.9 mm at term. Dilation of the fetal LBCV was noted in five cases of intracranial arteriovenous malformation and six cases of supracardiac type total anomalous pulmonary venous connection. Abnormal course of the LBCV was noted in 12 fetuses. In 63 fetuses with a persistent left SVC and a right SVC the LBCV was absent. CONCLUSION This is the first study describing an effective sonographic approach for the assessment of fetal LBCV dimensions during pregnancy. The normative data may provide an additional means of detecting rare anomalies of systemic and pulmonary veins during pregnancy.
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Affiliation(s)
- E Sinkovskaya
- Division of Maternal-Fetal Medicine of the Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Karl K, Heling KS, Sarut Lopez A, Thiel G, Chaoui R. Thymic-thoracic ratio in fetuses with trisomy 21, 18 or 13. Ultrasound Obstet Gynecol 2012; 40:412-417. [PMID: 22173875 DOI: 10.1002/uog.11068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess thymic size expressed as the thymic-thoracic ratio (TT-ratio) in fetuses with trisomy 21, 18 or 13. METHODS The TT-ratio, the quotient of the anteroposterior thymic and the intrathoracic mediastinal diameter, was measured in 65 trisomic fetuses between 15 and 36 weeks' gestation, including 30 cases with trisomy 21, 19 with trisomy 18 and 16 with trisomy 13. In addition these 65 fetuses were divided into two groups, according to whether they showed growth that was appropriate-for-gestational age (AGA) (n = 39) or intrauterine growth restriction (IUGR) (n = 26). Measurements were compared with reference ranges from 302 normal fetuses. RESULTS The TT-ratio was low in 27.7% (n = 18) of the 65 fetuses with aneuploidy. In comparison to normal fetuses (mean TT-ratio, 0.44), those with trisomy 18 or 21 had a significantly smaller TT-ratio (mean, 0.38 (P < 0.001) and 0.40 (P < 0.05), respectively), while those with trisomy 13 did not (mean, 0.43). These values were not as low as those observed previously in fetuses with del.22q11, suggesting a mechanism involving accelerated thymic involution rather than primary thymic hypoplasia. Furthermore, the TT-ratio was significantly lower than normal in both AGA (P < 0.05) and IUGR (P < 0.001) fetuses. CONCLUSION Fetuses with trisomy 18 or 21, but not trisomy 13, have a small thymus, suggesting accelerated thymic involution in utero. IUGR may contribute to the reduced thymic size in trisomy 18 fetuses. Trisomy 21 fetuses seem to have additional factors leading to a small thymus which could be a possible confirmation of the reduced immune response observed in fetuses and neonates with Down syndrome.
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Affiliation(s)
- K Karl
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, Germany
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33
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Fuchs I, Henrich W, Becker R, Albig M, Chaoui R. Normal intracranial translucency and posterior fossa at 11-13 weeks' gestation in a fetus with closed spina bifida. Ultrasound Obstet Gynecol 2012; 40:238-239. [PMID: 22323342 DOI: 10.1002/uog.11131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Karl K, Benoit B, Entezami M, Heling KS, Chaoui R. Small biparietal diameter in fetuses with spina bifida on 11-13-week and mid-gestation ultrasound. Ultrasound Obstet Gynecol 2012; 40:140-144. [PMID: 22511513 DOI: 10.1002/uog.11175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess whether, at 11-13-week and mid-trimester ultrasound examinations, the biparietal diameter (BPD) in fetuses with open spina bifida is smaller than the reference range. METHODS In a multicenter retrospective analysis of data from 23 fetuses with open spina bifida diagnosed at 16-24 weeks, BPD at diagnosis was compared with that measured at 11-13 weeks, before diagnosis. Z-scores were calculated for comparison of BPD deviations from the reference range within the groups at 11-13 weeks and 16-24 weeks, and between these two time intervals. RESULTS BPD Z-scores at 11-13 weeks and 16-24 weeks were significantly lower (P < 0.0001) in fetuses with open spina bifida when compared to the reference range, with mean values of - 1.29 and - 2.14, respectively, corresponding to the 10(th) and 1.5(th) centiles, respectively. At 11-13 weeks only six of the 23 (26%) fetuses with open spina bifida had BPD below the 5(th) centile, in comparison to 16 (69%) at mid-gestation. This was confirmed by paired t-test comparing the first-trimester with the second-trimester BPD measurements, which showed significantly slower growth of the BPD in fetuses with spina bifida. CONCLUSION In fetuses with open spina bifida, BPD is smaller not only in the second trimester, as previously reported, but also in the first trimester. This is most likely due to loss of cerebrospinal fluid. We suggest that a BPD value < 10(th) centile in an otherwise normally grown fetus at 11-13 weeks' gestation should be considered as a potential subtle early marker for open spina bifida.
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Affiliation(s)
- K Karl
- Department of Obstetrics and Gynecology, Maistrasse, Ludwig-Maximilians-University, Munich, Germany
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35
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Abstract
This review focuses on the examination of the fetal brain, using three-dimensional (3D) ultrasound and the multiplanar rendering mode (MPR). The routine examination of the brain is achieved with axial planes but a dedicated fetal neurosonogram requires additional coronal and sagittal views, in order to provide a complete view of the different brain structures. Because these planes are difficult to obtain under many conditions, the present paper shows how 3D MPR allows one to obtain 1 or multiple reconstructed images from a digital volume. The display can be either as orthogonal planes, tomographic planes with parallel slices or as one single plane of the region of interest, which can be selected by the examiner. This approach allows easily the demonstration of the corpus callosum, the cerebellar vermis, the three-horn view, the foetal hippocampus and other regions. In addition, early neurosonography of the developing brain from the 7th week of pregnancy onwards can be achieved.
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Affiliation(s)
- R Chaoui
- Pränataldiagnostik Friedrichstraße Berlin.
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36
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Chaoui R, Nicolaides KH. Comment on the paper 'Spina bifida in a 13-week fetus with a normal intracranial translucency' published in Prenatal Diagnosis by Arigita et al. 2011. Prenat Diagn 2012; 32:198-9; author reply 202-3. [PMID: 22418967 DOI: 10.1002/pd.2912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Karl K, Kagan KO, Chaoui R. Intra- and interoperator reliability of manual and semi-automated measurements of intracranial translucency. Ultrasound Obstet Gynecol 2012; 39:164-168. [PMID: 22081521 DOI: 10.1002/uog.10137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess the reproducibility of fetal intracranial translucency (IT) measurements performed manually or with SonoNT(®), a semi-automated caliper placement technique recently introduced for nuchal translucency thickness (NT) measurement. METHODS This was a retrospective study using 116 stored images of the head (mid-sagittal plane) from normal fetuses in dorsoposterior position at 11-13 weeks. Two experienced operators each measured the IT separately, twice manually and twice using the semi-automated software. Intraoperator and interoperator repeatability were assessed. The mean of the two manual measurements of the more experienced Operator 2 was considered as the 'gold standard'. RESULTS Seven cases were excluded as the IT could not be recognized by the semi-automated software. In the remaining 109 cases, the interquartile range of the mean IT measurement was 1.9-2.4 mm for Operator 1 and 1.8-2.3 mm for Operator 2 for both the manual and the semi-automated IT measurements. The intraoperator SD for manual measurements was 0.091 mm for Operator 1 and 0.088 mm for Operator 2, and for semi-automated measurements it was 0.054 mm for Operator 1 and 0.067 mm for Operator 2. Concerning interoperator bias of the manual measurements, the mean difference between Operator 1 and Operator 2 was - 0.09 (95% CI, - 0.11 to - 0.07) mm. With respect to the gold standard, the mean bias of the semi-automated measurements was 0.01 (95% CI - 0.01 to 0.03) mm for Operator 1 and - 0.09 (95% CI - 0.11 to - 0.07) mm for Operator 2, indicating good agreement. CONCLUSIONS Manual IT measurements are reproducible. In addition, IT can be assessed reliably using the semi-automated NT algorithm, leading to standardization of the IT assessment process.
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Affiliation(s)
- K Karl
- Department of Obstetrics and Gynecology, Maistrasse, Ludwig-Maximilians-University, Munich, Germany.
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Chaoui R, Benoit B, Heling KS, Kagan KO, Pietzsch V, Sarut Lopez A, Tekesin I, Karl K. Prospective detection of open spina bifida at 11-13 weeks by assessing intracranial translucency and posterior brain. Ultrasound Obstet Gynecol 2011; 38:722-726. [PMID: 21984530 DOI: 10.1002/uog.10111] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2011] [Indexed: 05/31/2023]
Abstract
We describe a case series of six fetuses with open spina bifida (OSB) from four different prenatal units, where the anomaly was detected at the routine 11-13-week ultrasound examination. Crown-rump length ranged from 49 to 78 mm. All cases were first suspected during nuchal translucency thickness measurement in the mid-sagittal plane of the face. OSB was lumbosacral in five fetuses and cervical in one. The intracranial translucency (IT) was obliterated in two cases, but some fluid was found in the other four cases. However, in all cases the typical landmarks of a normal posterior brain and normal IT were absent. In all six cases the ratio of brainstem diameter to brainstem-occipital bone distance was increased (≥ 1). This detection of an abnormal posterior brain led to a targeted examination and detection of the spinal lesion during the same examination in five cases, whereas in one suspicious case the patient was recalled at 17 weeks, when the abnormality was detected. Two fetuses had both multiple anomalies and trisomy 18. These prospective cases demonstrate the feasibility of using the standard mid-sagittal plane commonly used for NT measurement to assess the IT and the posterior brain and to determine the presence of OSB during NT screening.
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Karl K, Kainer F, Knabl J, Chaoui R. Prenatal diagnosis of total anomalous pulmonary venous connection into the coronary sinus. Ultrasound Obstet Gynecol 2011; 38:729-731. [PMID: 21611998 DOI: 10.1002/uog.9063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Chaoui R, Nicolaides KH. Detecting open spina bifida at the 11-13-week scan by assessing intracranial translucency and the posterior brain region: mid-sagittal or axial plane? Ultrasound Obstet Gynecol 2011; 38:609-612. [PMID: 22411445 DOI: 10.1002/uog.10128] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- R Chaoui
- Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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41
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Affiliation(s)
- K Karl
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt, Ludwig-Maximilians-Universität München, Deutschland.
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Karl K, Creton F, Thiel G, Sarioglu N, Heling KS, Chaoui R. Prenatal diagnosis of a nasal cyst in association with deletion 22q11 syndrome: a report of two cases. Prenat Diagn 2011; 31:999-1001. [PMID: 21710588 DOI: 10.1002/pd.2812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/17/2011] [Accepted: 05/17/2011] [Indexed: 11/06/2022]
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Chaoui R, Heling KS, Thiel G, Karl K. Agnathia-otocephaly with holoprosencephaly on prenatal three-dimensional ultrasound. Ultrasound Obstet Gynecol 2011; 37:745-748. [PMID: 21465602 DOI: 10.1002/uog.9009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Chaoui R, Heling KS, Lopez AS, Thiel G, Karl K. The thymic-thoracic ratio in fetal heart defects: a simple way to identify fetuses at high risk for microdeletion 22q11. Ultrasound Obstet Gynecol 2011; 37:397-403. [PMID: 21308838 DOI: 10.1002/uog.8952] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To establish reference ranges for the fetal thymic-thoracic ratio (TT-ratio) and to compare results with those from fetuses with congenital heart defects (CHD) with and without microdeletion 22q11 (del.22q11), a condition known to be associated with a hypoplastic thymus. METHODS TT-ratio was defined as the quotient of the anteroposterior thymic to the intrathoracic mediastinal diameters measured in the three vessels and trachea view. This ratio was measured in a prospective cross-sectional study of 302 normal healthy fetuses between 15 and 39 weeks' gestation. The study group comprised two groups: one group (CHDn) consisted of 90 fetuses with CHD and a normal karyotype with no del.22q11 and the other group (CHD(22)) included 20 fetuses with CHD and a normal karyotype but with proven del.22q11. RESULTS The TT-ratio of the normal fetuses did not show any statistically significant change during gestation, with a mean value of 0.44. The values of all 90 fetuses of the CHDn group were within the normal range and no different from normal fetuses. However, 19 of the 20 (95%) fetuses in the CHD(22) group had a significantly smaller TT-ratio (P < 0.001) compared with both the CHDn group and the normal fetuses, having a mean value of 0.25. CONCLUSIONS The TT-ratio is reliable and easy to obtain during fetal echocardiography. Fetuses with CHD and a low TT-ratio can be considered at high risk of having microdeletion del.22q11.
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Affiliation(s)
- R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Chaoui R, Henrich W. Intrakranielle Transparenz (IT): ein neues Zeichen im Erst-Trimester-Screening. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Chaoui R, Nicolaides KH. From nuchal translucency to intracranial translucency: towards the early detection of spina bifida. Ultrasound Obstet Gynecol 2010; 35:133-138. [PMID: 20101633 DOI: 10.1002/uog.7552] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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47
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Chaoui R, Benoit B, Mitkowska-Wozniak H, Heling KS, Nicolaides KH. Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11-13-week scan. Ultrasound Obstet Gynecol 2009; 34:249-52. [PMID: 19705402 DOI: 10.1002/uog.7329] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Prenatal diagnosis of open spina bifida is carried out by ultrasound examination in the second trimester of pregnancy. The diagnosis is suspected by the presence of a 'lemon-shaped' head and a 'banana-shaped' cerebellum, thought to be consequences of caudal displacement of the hindbrain. The aim of the study was to determine whether in fetuses with spina bifida this displacement of the brain is evident from the first trimester of pregnancy. METHODS In women undergoing routine ultrasound examination at 11-13 weeks' gestation as part of screening for chromosomal abnormalities, a mid-sagittal view of the fetal face was obtained to measure nuchal translucency thickness and assess the nasal bone. In this view the fourth ventricle, which presents as an intracranial translucency (IT) between the brain stem and choroid plexus, is easily visible. We measured the anteroposterior diameter of the fourth ventricle in 200 normal fetuses and in four fetuses with spina bifida. RESULTS In the normal fetuses the fourth ventricle was always visible and the median anteroposterior diameter increased from 1.5 mm at a crown-rump length (CRL) of 45 mm to 2.5 mm at a CRL of 84 mm. In the four fetuses with spina bifida the ventricle was compressed by the caudally displaced hindbrain and no IT could be seen. CONCLUSION The mid-sagittal view of the face as routinely used in screening for chromosomal defects can also be used for early detection of open spina bifida.
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Affiliation(s)
- R Chaoui
- Prenatal Diagnosis and Human Genetics, Berlin, Germany
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Barikbin P, Budde BS, Chaoui R, Bührer C, Berns M. Schwere Verlaufsform einer konnatalen pontozerebellären Hypoplasie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Heling KS, Sarut Lopez A, Bergann A, Chaoui R. Die Anwendung der 3D-Sonografie in der Diagnostik des Corpus callosum im Screeningultraschall in der 22 SSW. – 3D-Sonografie des Gehirn. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Lee W, Allan L, Carvalho JS, Chaoui R, Copel J, Devore G, Hecher K, Munoz H, Nelson T, Paladini D, Yagel S. ISUOG consensus statement: what constitutes a fetal echocardiogram? Ultrasound Obstet Gynecol 2008; 32:239-242. [PMID: 18663769 DOI: 10.1002/uog.6115] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- W Lee
- Division of Fetal Imaging, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, Michigan 48073, USA.
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