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Fetal Brain Imaging
S132
Ultrasound in Medicine and Biology
T11-16-IN01 Fetal Brain Imaging Ritsuko K. Pooh, MD, PhD, LL.B CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity Clinic, Osaka, Japan Fetal CNS is remarkably developing in the first trimester and changing its appearance from premature tubal structure to the bilateral cerebri, cerebellum and brainstem. Neuro-sonoembryology has been improved with great advances of 3D ultrasound technology such as HDlive silhouette technology and studio-live technology. However, detectable CNS abnormalities are limited in the first trimester because neuronal migration and proliferation will take place from 3rd or 4th months of gestation. Phenotype of migration disorders in the cortex conspicuously appears after 28 weeks of gestation when cortical gyration is clearly visualized. It has been believed that it is quite hard to detect migration disorder before 28 weeks. However, ‘‘early detection of migration disorder before gyration’’ has been recently possible by observation of Sylvian fissure development, abnormal sulcation and ganglionic eminence during the second trimester. Close observation of those brain structure in detail is not generally performed however it might help to establish a new field of fetal neuroscience. T11-16-IN02 Prenatal US Findings of Musculoskeletal Anomalies Jeong Yeon Cho Department of Radiology, Seoul National University Hospital, Seoul, Korea Fetal musculoskeletal malformations take a number of pathologic forms, among which a variety of lethal dysplasias and several anomalies have a poor perinatal and postnatal outcome. Precise antenatal ultrasonographic diagnosis of bone dysplasia may be very difficult, but differentiation between a lethal and a nonlethal variety is very important in terms of antenatal care and the prediction of fetal outcome. Variety of lethal skeletal dysplasias commonly show very short long bones and narrow thorax. For the differential diagnosis of fetal skeletal dysplasia, comprehensive evaluation of fetal bones including cranium, face, ribs, and spine is very important. Genetic counseling is critical and individualized multidisplinary prenatal and postnatal care is important for the management of fetal skeletal dysplasias. Several anomalies leading to limb loss or contracture as the expression of other pathologic entities have a poor outcome, and their early detection is also very important for the management of a pregnancy. Focal musculoskeletal anomalies can occur in isolation or in association with a large variety of syndromes, malformations and disorders. Thus, the early and accurate prenatal diagnosis of anomalies is important not only for detecting the anomaly itself, but is also helpful with regard to these other, associated, anomalies. T11-16-IN03 The Applications of 3D/4D Ultrasound in Prenatal Diagnosis and Fetal Surgery in Open Spina Bifida S. W. Steven Shaw Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan Prenatal diagnosis of open spina bifida (OSB) by ultrasound examination during the second trimester of pregnancy was greatly improved in the mid 1980s by the description of the lemon and banana signs. More recently the researchers mentioned about the intracranial translucency is lower in the fetus with OSB during first trimester scanning. In this talk, we would like to share the experience of using 3D/4D ultrasound in prenatal diagnosis of OSB either in first trimester Down syndrome screening or second
Volume 43, Number S1, 2017 trimester routine scanning. The 3D/4D have advantages in helping the detection rate in spina bifida and more clearly to follow up the later on examination. Alone with this technique, the open fetal surgery or fetoscopic repair of the defect in OSB are reliable during whole surgery. In the end of talk, we will also update the current trend of fetal surgery in OSB and compare the different approach with different clinical outcomes. T11-16-IN04 Diagnostic Roles of Color Doppler Mapping of Fetal Circulation Tuangsit Wataganara Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, BKK, Thailand Prenatal assessment of primitive circulation in the human fetus with color Doppler flow mapping has added a new dimension to fetal assessment. Normal values generated from pulse-wave Doppler studies have been generated for fetal vessels. Early development of placental circulation can be evaluated with color Doppler studies, and it appears to be promising for elucidation of placental pathology as is found in a number of fetal and placental diseases Doppler color-flow mapping appears to be promising for elucidation of abnormal flow in fetuses suspected of having structural and/or functional cardiovascular disease. Certain congenital anomalies can be detected early on in gestation using color Doppler mapping, and hence provide a unique opportunity for in utero intervention. Fetal exposure to Doppler ultrasound should be as low as reasonably achievable (ALARA) because of the potential for tissue heating when the thermal index is exceeding. T11-16-IN05 Fetal MR Neuroimging: Practical Issues Alex Mun-Ching Wong, M.D. Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelong, Linkou Medical Center and Chang Gung University, Taiwan Fetal magnetic resonance (MR) imaging, initially introduced in the 1980s, has become a widespread and valuable imaging modality in prenatal evaluation of the fetal nervous system. Advances in fetal diagnosis and management throughout the years have urged a need for precise depiction of structural abnormalities. Although obstetric ultrasonography (US) remains the screening modality of choice in evaluation, MR imaging, having multiplanar imaging ability and superior tissue differentiation, is now an important complementary imaging modality in the evaluation of the fetal nervous system. This presentation will focus on the practical issues of fetal MR neuroimaging, including technical aspects, clinical utility with examples, advanced imaging technigues, and limitations. T11-16-IN06 Cervical Examination by US for Cervical Insufficiency Keun-Young Lee, MD Department of OB & GYN Hallym University, Seoul, Korea Although numerous investigators have tried to find accurate means of cervical insufficiency diagnosis, there is no reliable and objective standard as of yet. Transvaginal ultrasonography (TVU) is the most powerful diagnostic tool for the assessment of cervical competence. TVU is superior to transabdominal or translabial ultrasound for the assessment of the cervix. It is an accurate, reliable, and reproducible method for the measurement of cervical length (CL) and funneling. I has been well documented that a short CL (,25mm) preferentially increases the risk of midtrimester birth. The risk of preterm birth is inversely associated
Ultrasound in Medicine and Biology
T11-16-IN01 Fetal Brain Imaging Ritsuko K. Pooh, MD, PhD, LL.B CRIFM Clinical Research Institute of Fetal Medicine Pooh Maternity Clinic, Osaka, Japan Fetal CNS is remarkably developing in the first trimester and changing its appearance from premature tubal structure to the bilateral cerebri, cerebellum and brainstem. Neuro-sonoembryology has been improved with great advances of 3D ultrasound technology such as HDlive silhouette technology and studio-live technology. However, detectable CNS abnormalities are limited in the first trimester because neuronal migration and proliferation will take place from 3rd or 4th months of gestation. Phenotype of migration disorders in the cortex conspicuously appears after 28 weeks of gestation when cortical gyration is clearly visualized. It has been believed that it is quite hard to detect migration disorder before 28 weeks. However, ‘‘early detection of migration disorder before gyration’’ has been recently possible by observation of Sylvian fissure development, abnormal sulcation and ganglionic eminence during the second trimester. Close observation of those brain structure in detail is not generally performed however it might help to establish a new field of fetal neuroscience. T11-16-IN02 Prenatal US Findings of Musculoskeletal Anomalies Jeong Yeon Cho Department of Radiology, Seoul National University Hospital, Seoul, Korea Fetal musculoskeletal malformations take a number of pathologic forms, among which a variety of lethal dysplasias and several anomalies have a poor perinatal and postnatal outcome. Precise antenatal ultrasonographic diagnosis of bone dysplasia may be very difficult, but differentiation between a lethal and a nonlethal variety is very important in terms of antenatal care and the prediction of fetal outcome. Variety of lethal skeletal dysplasias commonly show very short long bones and narrow thorax. For the differential diagnosis of fetal skeletal dysplasia, comprehensive evaluation of fetal bones including cranium, face, ribs, and spine is very important. Genetic counseling is critical and individualized multidisplinary prenatal and postnatal care is important for the management of fetal skeletal dysplasias. Several anomalies leading to limb loss or contracture as the expression of other pathologic entities have a poor outcome, and their early detection is also very important for the management of a pregnancy. Focal musculoskeletal anomalies can occur in isolation or in association with a large variety of syndromes, malformations and disorders. Thus, the early and accurate prenatal diagnosis of anomalies is important not only for detecting the anomaly itself, but is also helpful with regard to these other, associated, anomalies. T11-16-IN03 The Applications of 3D/4D Ultrasound in Prenatal Diagnosis and Fetal Surgery in Open Spina Bifida S. W. Steven Shaw Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan Prenatal diagnosis of open spina bifida (OSB) by ultrasound examination during the second trimester of pregnancy was greatly improved in the mid 1980s by the description of the lemon and banana signs. More recently the researchers mentioned about the intracranial translucency is lower in the fetus with OSB during first trimester scanning. In this talk, we would like to share the experience of using 3D/4D ultrasound in prenatal diagnosis of OSB either in first trimester Down syndrome screening or second
Volume 43, Number S1, 2017 trimester routine scanning. The 3D/4D have advantages in helping the detection rate in spina bifida and more clearly to follow up the later on examination. Alone with this technique, the open fetal surgery or fetoscopic repair of the defect in OSB are reliable during whole surgery. In the end of talk, we will also update the current trend of fetal surgery in OSB and compare the different approach with different clinical outcomes. T11-16-IN04 Diagnostic Roles of Color Doppler Mapping of Fetal Circulation Tuangsit Wataganara Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, BKK, Thailand Prenatal assessment of primitive circulation in the human fetus with color Doppler flow mapping has added a new dimension to fetal assessment. Normal values generated from pulse-wave Doppler studies have been generated for fetal vessels. Early development of placental circulation can be evaluated with color Doppler studies, and it appears to be promising for elucidation of placental pathology as is found in a number of fetal and placental diseases Doppler color-flow mapping appears to be promising for elucidation of abnormal flow in fetuses suspected of having structural and/or functional cardiovascular disease. Certain congenital anomalies can be detected early on in gestation using color Doppler mapping, and hence provide a unique opportunity for in utero intervention. Fetal exposure to Doppler ultrasound should be as low as reasonably achievable (ALARA) because of the potential for tissue heating when the thermal index is exceeding. T11-16-IN05 Fetal MR Neuroimging: Practical Issues Alex Mun-Ching Wong, M.D. Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelong, Linkou Medical Center and Chang Gung University, Taiwan Fetal magnetic resonance (MR) imaging, initially introduced in the 1980s, has become a widespread and valuable imaging modality in prenatal evaluation of the fetal nervous system. Advances in fetal diagnosis and management throughout the years have urged a need for precise depiction of structural abnormalities. Although obstetric ultrasonography (US) remains the screening modality of choice in evaluation, MR imaging, having multiplanar imaging ability and superior tissue differentiation, is now an important complementary imaging modality in the evaluation of the fetal nervous system. This presentation will focus on the practical issues of fetal MR neuroimaging, including technical aspects, clinical utility with examples, advanced imaging technigues, and limitations. T11-16-IN06 Cervical Examination by US for Cervical Insufficiency Keun-Young Lee, MD Department of OB & GYN Hallym University, Seoul, Korea Although numerous investigators have tried to find accurate means of cervical insufficiency diagnosis, there is no reliable and objective standard as of yet. Transvaginal ultrasonography (TVU) is the most powerful diagnostic tool for the assessment of cervical competence. TVU is superior to transabdominal or translabial ultrasound for the assessment of the cervix. It is an accurate, reliable, and reproducible method for the measurement of cervical length (CL) and funneling. I has been well documented that a short CL (,25mm) preferentially increases the risk of midtrimester birth. The risk of preterm birth is inversely associated