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Ultrasound in Medicine and Biology

1215 Fetal brain and spinal cord by 3D/4D neuroimaging technology Pooh RK, Division of Fetal Diagnosis, CRIFM Clinical Research Institute of Fetal Medicine PMC, Japan Antenatal evaluation of the fetal central nervous system (CNS) plays an important role in the field of perinatology. Transvaginal sonography of the fetal brain opened a new field in medicine, neurosonography. Transvaginal approach to the normal fetal brain during the second and third trimester was introduced in the beginning of 1990s. Transvaginal observation of the fetal brain offers sagittal and coronal views of the brain from fetal parietal direction through the fontanelles and/or the sagittal suture as ultrasound windows. Serial oblique sections via the same ultrasound window reveal the intracranial morphology in detail. This method has contributed to the prenatal sonographic assessment of congenital CNS anomalies and acquired brain damage in utero, especially when compared with conventional transabdominal method. Combination of both transvaginal sonography and 3D ultrasound has been a great diagnostic tool for evaluation of 3D structure of fetal CNS. 3D transvaginal sonography demonstrates bony structure such as cranial os and vertebrae, multiplanar analysis of inside morphology from early till late pregnancy, sono-angiography and volume extraction and calculation of target organ, i.e., lateral ventricle and/or choroids plexus. Recent advanced 3D technology produced tomographic ultrasound imaging, which shows tomographic parallel slices of any cutting sections. Because tomographic images are produced from original 3D dataset, slice distance can be changed, and all tomographic images can be rotated around x, y and z axes. Those 3D technologies have contributed to the CNS neuroassessment during pregnancy. 4D ultrasound has furthermore added the information of fetal functional neurobehavior to static neuroimaging data. Fetal MRI has also produced whole CNS information of fetuses and compensated smartly for the weak points of ultrasound, such as detection of gyri and sulci in late pregnancy By the use of update imaging technologies, it has been possible to clarify natural history of normal development of the brain and spine from very early period, natural history and detailed structure of congenital CNS anomalies and rapid morphological changes of in utero brain damage such as intracranial bleeding. In referral cases with CNS abnormalities, main reasons for referral are enlarged ventricles or intracranial cystic area. However, there are many intracranial morphological changes without ventriculomegaly or cystic area, which might cause neurological deficits. New facts produced from advanced neuroimaging of fetal CNS might be clues for explaining the unknown neurological disorders. 1216 Prenatal diagnosis of fetal cerebral malformations Ville Y, Paris V University, France We report on a comprehensive approach of the diagnosis of fetal cerebral malformations with the combined use of ultrasound and MRI. Ultrasound examination of the fetal brain was performed by scrolling through 3-plan views of two volumes acquired from the fetal brain through the lambdatic and bregmatic fontanelles respectively. These two volumes were adequate to thoroughly analyse all malformations seen in three orthogonal axial, sagittal and coronal planes. Abnormal cases were also imaged on a 1.5 T clinical system using a single shot fast spin echo technique. The definitive diagnosis was made either at autopsy in cases that went to termination of pregnancy or by postnatal magnetic resonance imaging in the others. Our results suggest that ultrasound examination is sufficient to diagnose and critically assess most brain abnormalities and that in selected cases detected by ultrasound, antenatal magnetic resonance may provide additional, clinically useful information that may alter management, especially in abnormal-

Volume 32, Number 5S, 2006 ities of the posterior fossa as well as to assess the sulcation and gyration processes. 1217 Fetal facial anomaly Yeo L, UMDNJ-Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, United States of America Fetal facial anomalies are among the more common malformations and can have various etiologies. They may be isolated, due to aneuploidy, seen as part of genetic syndromes or can be due to environmental effects. In many cases, facial anomalies may be easier to identify on prenatal sonography compared to other organ systems, and may often be the first indication that a genetic syndrome is present. Accordingly, the fetal face is a significant component of a prenatal sonographic anatomic survey, and should be examined routinely. Recently, absent/ hypoplastic nasal bone has also been described as an important prenatal sonographic marker for Down syndrome. This fact further emphasizes the importance of examining the fetal face sonographically as part of the full survey. With the advent of three-dimensional (3D) sonography, it has been shown to have increasing importance and value in the prenatal detection and depiction of facial anomalies. 3D sonography can provide benefits and additional information, compared to 2D sonography, in evaluating facial malformations. Therefore, the purpose of this essay is to illustrate the importance of examining the fetal face on prenatal sonographic surveys, and to provide an overview of various facial anomalies and their implications, including discussions regarding the impact of 3D sonography.

GYNECOLOGIC ULTRASOUND 1218 Ultrasound in the diagnosis and treatment of infertility Benson C, Harvard Medical School, Brigham and Women’s Hospital, United States of America Infertility is defined as the failure to conceive despite at least 12 mo of unprotected intercourse. The condition is found in 18 to 20% of married couples, affecting older couples more often than younger ones. This is related in part to decreasing conception rates with increasing age of the female member of the couple and in part to increasing miscarriage rates with increasing maternal age. Ultrasound plays a key role in the diagnosis of the causes of infertility and the treatment of couples with infertility. The causes of infertility may be related to female factors or male factors. Ultrasound is particularly important for diagnosing female factors that affect fertility, including tubal obstruction, uterine abnormalities and ovarian abnormalities. Pelvic ultrasound can be used to assess for causes of tubal obstruction, including ectopic pregnancy, endometriosis and pelvic inflammatory disease. Evaluation of the uterus permits diagnosis of fibroids and uterine duplication anomalies, both of which are associated with decreased conception rates and increased miscarriage rates compared to the normal uterus. Endometrial abnormalities that interfere with successful pregnancy, such as polyps, submucosal fibroids and Asherman syndrome, can be diagnosed with transvaginal ultrasound and with saline infusions sonohysterography. Ovarian lesions, such as masses and cysts, can interfere with ovulation. Likewise, polycystic ovarian syndrome is characterized by infrequent ovulation. Ultrasound is the optimal imaging modality for assessing the ovary. In fact, the diagnosis of polycystic ovarian syndrome now requires the presence of specific sonographic criteria, including ovarian volume ⬎10 ml and/or presence of at least 12 small follicles. Women being treated for infertility with assisted reproductive techniques are monitored with ultrasound. The thickness and appearance of the endo-