G. Tani

Prenatal diagnosis of open and closed spina bifida

To identify criteria useful for differentiating closed from open spina bifida antenatally.

Prenatal diagnosis and outcome of partial agenesis and hypoplasia of the corpus callosum

To present antenatal sonographic findings and outcome of fetuses with hypoplasia or partial agenesis of the corpus callosum.

Accurate neurosonographic prediction of brain injury in the surviving fetus after the death of a monochorionic cotwin

To assess the feasibility of the prenatal diagnosis using fetal neurosonography of brain injuries in the surviving fetus after the demise of a monochorionic cotwin.

Difficult early sonographic diagnosis of absence of the fetal septum pellucidum.

Standard sonographic views of the brain obtained along the axial planes at mid‐gestation failed to identify absence of the septum pellucidum in two consecutive fetuses. It was presumably the close proximity of the walls of the lateral ventricles that generated an artifact resembling a normal cavum septi pellucidi. In one of these fetuses, septo‐optic dysplasia was confirmed by magnetic resonance demonstration of hypoplastic optic tracts. In the other fetus, isolated absence of the septum pellucidum was the final diagnosis. Standard axial scans are unreliable in predicting absence of the septum pellucidum in the mid‐trimester fetus when the lateral ventricles are normal in size. Copyright

Wernicke's encephalopathy in a child: case report and MR findings.

Abstract We report a child affected by Wernickes encephalopathy (WE), which was unsuspected clinically. MRI suggested the correct diagnosis and prompted appropriate thiamine replacement. WE is a difficult condition to recognise, especially in children, and MRI may be useful in the diagnosis of the disease.

Involvement of the skull base and vault in chronic idiopathic hyperphosphatasia

Abstract Chronic idiopathic hyperphosphatasia (CIH) is a rare generalised skeletal dysplasia in childhood. The clinical, radiographic and cerebral MR findings in a 5-year-old girl with the severe infantile form of CIH are reported. In spite of cranial enlargement, the intracranial space and the skull base were markedly reduced, the whole brain was compressed and a Chiari I malformation was present. Normal flow in the dural venous sinuses was documented. The patient showed no detectable cranial nerve involvement or hydrocephalus. Cranial MR in this patient enabled us to confirm that CIH involves the skull base and vault.

Apparently isolated fetal mesocardia at midtrimester: report of a series.

T. Ghi1*, M. Kuleva1, A. Perolo1, G. Pilu1, D. Prandstraller2, G. Tani3, M. Lima4, E. Contro1, A. Youssef1 and G. Pelusi1 1Department of Obstetrics and Gynecology, University Hospital of Bologna, Bologna, Italy 2Department of Paediatric Cardiology, University Hospital of Bologna, Bologna, Italy 3Department of Paediatric Radiology, University Hospital of Bologna, Bologna, Italy 4Department of Paediatric Surgery, University Hospital of Bologna, Bologna, Italy

OC14.01: Is there a role for magnetic resonance in addition to ultrasound in the prenatal diagnosis of fetal anomalies?

Objective: To assess whether the analysis of cyst content using mean grey value (MGV) discriminate ovarian endometriomas from other unilocular ovarian cysts. Methods: Stored 3D volumes from 54 unilocular ovarian cysts diagnosed in 50 premenopausal women (mean age: 36.9 years, range: 22 to 54 years) were analysed for calculating MGV from cyst content. No cyst with solid component or septations was included. MGV was calculated in all cases with VOCAL technique using 4D View software. B-Mode presumptive diagnosis based on examiner subjective impression was also recorded. Results: In 16 cases the cysts resolved spontaneously and were considered as hemorrhagic functional cysts. 38 cysts were surgically removed (6 simple cysts, 3 hemorrhagic cysts, 20 endometriomas, 6 mucinous cysts and 2 para-ovarian cysts). B-mode diagnosis were as follows: Simple cyst: 8 cases, hemorrhagic cyst: 17 cases, endometrioma: 24 cases, mucinous cyst: 4 cases and paraovarian cyst: one case. MGV was significantly higher in ovarian endometrioma as compared with all other kind of cysts (Table). ROC curve showed that a MGV cut-off > 15.566 had a 85% sensitivity and 76.5& specificity for diagnosing ovarian endometrioma (AUC: 0.831, 95% CI: 0.72 to 0.94). These figures were similar to that for B-mode diagnosis (sensitivity: 90%, specificity: 82.4%) (McNemar test: p = 1.000) Conclusion: MGV of cyst content is higher in ovarian endometrioma than in other unilocular ovarian cysts. Its diagnostic performance is similar than subjective examiner’s diagnosis.

OC58: Clinical significance of fetal posterior fossa malformations

Objective: To define easily identifiable and reproducible measurements and markers of normal anatomical development of the cerebellar vermis in vivo. Methods: Analysis of the midline sagittal views of the cerebellar vermis was performed in over 200 consecutive fetal MR examinations performed for sonographically suspected CNS and non-CNS indications. Analysis included identification of the fastigial point, vermian lobules and fissures, tegmento-vermian angle, and associated abnormalities of the posterior fossa, brainstem, and CNS. Results: Craniocaudal diameter of the cerebellar vermis follows growth approximately predicted by the linear equation: diameter (mm) = 0.74 × gestational age (weeks) −6.11, with an R2 value of 0.89. Average height above and below the fastigial point also followed a linear progression, with average percentages above and below of 47.9% and 52.1% respectively, and no significant change of this ratio with gestational age. The tegmento-vermian angle was always < 2◦ in normal fetuses, but was often increased, and when significantly increased was always associated with vermian hypoplasia. The declive and primary fissure always were visible in normals from 17.5 weeks. The other cerebellar vermian fissures were seen at approximately the following gestational ages: secondary at 20 weeks, prepyramidal at 21 weeks, and preculmenate at 22 weeks. The other lobules became visible from 24 weeks and all were potentially visible by 27 weeks. Alterations of the landmarks were identified in cases of rhombencephalosynapsis, Joubert syndrome, Dandy-Walker continuum, congenital muscular dystrophy, vermian dysgenesis and vermian hypoplasias. Conclusions: Knowledge of normal vermian developmental morphology is essential when assessing for vermian hypoplasia. Specifically, the lobules are not all visible before approximately 27 weeks at the earliest and therefore other morphological features have to be used in addition to simply counting the lobules.

OC44: Expert neurosonography and magnetic resonance to assess the neurologic risk of mild fetal cerebral ventriculomegaly

Objective: The measurement of detrusor wall thickness (DWT) has been used as a screening test for detrusor overactivity in men and women. The aim of this study was to define receiver operator characteristics for DWT as a test for DO and urge incontinence in women. Methods: The notes of 792 women with lower urinary tract symptoms who had undergone a urodynamic study and transperineal ultrasound were reviewed. The urodynamic study included free uroflowmetry and filling and voiding phase cystometry using a fluidfilled system. Transperineal ultrasound was performed after catheter removal and bladder emptying, at a maximum bladder volume of 50 ml. Detrusor wall measurements were taken at the bladder dome as previously described. Results: After exclusion of missing data (largely due to residuals of over 50 ml), 686 datasets remained. The most commonly reported irritable bladder symptom was urge incontinence (503, 73.3%). 36.6% of women had symptoms of frequency, and 46.6% had nocturia. One hundred and eighty-four women (27%) had detrusor overactivity (DO) detected on multichannel urodynamics. The average DWT in the DO group was 4.7 ± 1.9 mm. compared to 4.1 ± 1.6 mm in the non-DO group (p < 0.001). Receiver operator characteristics for DWT as a test for DO were calculated and shown to be very poor, with an area under the curve of 0.606. The published cutoff of 5 mm gave a sensitivity and specificity of 37.0% and 79.3%, respectively. No other potential cutoff performed substantially better. Conclusions: Increased DWT seems to be associated with DO. However, receiver operator characteristics demonstrate that DWT is of little use as a diagnostic test for detrusor overactivity, giving an area under the curve of only 0.606. The sensitivity and specificity of a measurement of > 5 mm for DO was 37.0% and 79.3% respectively. Measurement of Detrusor wall thickness should not be used as a diagnostic parameter for detrusor overactivity in women.