M. Vassallo

The role of spatio‐temporal image correlation (STIC) with tomographic ultrasound imaging (TUI) in the sequential analysis of fetal congenital heart disease

Spatio‐temporal image correlation associated with the tomographic ultrasound imaging mode (TUI‐STIC) is a new modality that allows a complete sequential analysis of cardiac structures to be displayed on a single panel by showing all echocardiographic transverse views at the same time. The aims of this study were to identify the best settings for displaying the classic echocardiographic views at different gestational ages and to investigate the role of TUI‐STIC in the sequential segmental analysis of complex congenital heart disease (CHD).

Diagnosis, characterization and outcome of congenitally corrected transposition of the great arteries in the fetus: A multicenter series of 30 cases

To describe the anatomy, associated anomalies and outcome of 30 cases of congenitally corrected transposition of the great arteries (ccTGA) detected prenatally.

The role of tissue harmonic imaging in fetal echocardiography

To define the role of tissue harmonic imaging (THI) in fetal echocardiography.

Cavernous lymphangioma of the face and neck: prenatal diagnosis by three-dimensional ultrasound.

Cavernous lymphangiomas are characterized by penetration through the subcutaneous areas between the muscular septa and represent rare variants of the more common superficial lymphangioma. Although frequently described in the fetus when involving the posterior aspect of the neck (i.e. cystic hygroma), involvement of the craniofacial region is rare. We describe the prenatal findings in a case of cavernous lymphangioma of the fetal face and neck, which extended caudally to envelop the larynx and the trachea. The anomaly was assessed by two‐ and three‐dimensional (3D) ultrasound. The latter approach was used thoroughly both during counseling with the couple and during consultation with the pediatric surgeon. This case report confirms the usefulness of the 3D approach in the management of rare fetal anomalies. In particular, the possibility of navigating the volume facilitated consultation with the pediatric surgeon and counseling of the parents. Copyright

Cardiac troponin T and amino-terminal pro-natriuretic peptide concentrations in fetuses in the second trimester and in healthy neonates.

Abstract We measured the concentrations of cardiac troponin T (cTnT) and amino-terminal pro-natriuretic peptide (NT-proBNP) in umbilical cord blood during the second trimester (20–25weeks of gestation) and at delivery in 109 uncomplicated pregnancies to define reference values. Using the 97.5th percentile, the upper reference limits for cTnT and NT-proBNP were 0.308ng/mL and 5402pg/mL in fetuses in the second trimester, and 0.038ng/mL and 1690pg/mL in healthy neonates, respectively. We also evaluated whether labor and delivery mode affected the concentrations of the two analytes. We found significantly higher (p<0.001) umbilical blood NT-proBNP and cTnT levels at 20–25weeks of gestation than at term. In addition, within the term group, NT-proBNP concentrations were significantly higher in women delivering by elective cesarean section than in women delivering spontaneously (p<0.001), and higher than in women delivering by cesarean section during active labor. This indicates that the decrease in NT-proBNP levels is probably due to labor rather than delivery mode. Finally, we confirmed the at-birth reference values previously established for cTnT and NT-proBNP. Clin Chem Lab Med 2006;44:834–6.

Struma ovarii associated with hyperthyroidism, elevated CA 125 and pseudo‐Meigs syndrome may mimic advanced ovarian cancer

T. Wataganara*†, A. Sutanthaviboon†, S. Ngerncham‡ and C. Vantanasiri† †Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital and ‡Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, Thailand 10700 *Correspondence. (e-mail: sitwg@mahidol.ac.th) DOI: 10.1002/uog.5326 Published online 11 June 2008

Normal and abnormal development of the fetal anterior fontanelle: a three-dimensional ultrasound study.

To describe the methodology for correct visualization of the anterior fontanelle using three‐dimensional ultrasound, to report its normal development during gestation, and to compare this with abnormal development.

OC23.02: Assessment of cardiac function impairment by four‐dimensional echocardiography with inversion mode rendering in fetal congenital heart disease

Background: Fetoscopic laser coagulation of the vascular anastomoses is currently the best available treatment method for severe twin–twin-transfusion syndrome (TTTS) diagnosed < 26 weeks. However, postoperative single intrauterine fetal death (sIUFD) commonly occurs, in which unequal placental distribution may play an important role. Objectives: To evaluate the use of preoperative Magnetic Resonance Imaging (MRI) to determine placental volume distribution and to correlate unequal placental distribution with the occurrence of postoperative sIUFD. Material and methods: Preoperative MRI (T1-T2-Diffusion) of the monochorionic placenta was performed in 28 cases of TTTS to determine the placental volume ratios. Placental distribution was considered to be unequal when the placental volume ratios were less than 30/70. An ultrasound scan was performed 24 and 48 hours after the procedure to check fetal viability. Postoperative sIUFD was defined as demise of 1 twin within 48 hours. After birth, volumetric CT angiography was performed of 9 placentas with double survivors. The placental volume ratios measured on postnatal CT angiography were compared with the predicted values on preoperative MRI. Results: Determination of the placental volume ratios was possible in 22/28 (79%) of cases on T2-weighted MRI as well as on ADC maps. In 8/9 placentas examined after birth, preoperative MRI had accurately predicted the placental distribution. In 3/4 cases with predicted unequal placental distribution, sIUFD occurred, of which 2 fetuses had the largest placental part and 1 had the smallest part. In contrast, sIUFD occurred in only 3/18 cases (17%) with equal placental distribution (P < 0.05). Conclusion: Preoperative MRI seems to accurately predict placental volume distribution in most cases with TTTS. Also, unequal placental distribution appears to be a risk factor for sIUFD after laser treatment. However, sIUFD was not restricted to the fetus with the smallest placental part.

OC158: Multimodal diagnostic flow chart for prenatal characterization of CNS abnormalities in a tertiary referral center: the role of MRI

phase Ib was to collect a new dataset for prospective testing of all of the previously developed models. Methods: Prospective model performance was assessed from the area under the ROC curve (AUC), accuracy, sensitivity, specificity, PPV and NPV. Results: Some 507 patients from three IOTA centers were included; 28% (142) masses were malignant. The AUC of the logistic regression model was 0.942 on the test set of IOTA 1 (n = 312), 0.950 on the new dataset, and 0.954, 0.908 and 0.992 in each of the individual centers. For the least squares support vector machine model with linear kernel the AUC on the IOTA 1 test set was 0.946, 0.950 on the new dataset, and 0.950, 0.894 and 0.986 for each center individually. For the relevance vector machine with linear kernel the AUC was 0.949 on the test set of IOTA 1, 0.947 on the new dataset, and 0.947, 0.896 and 0.984 for each center individually. A multilayer perceptron neural network, finally, had an AUC of 0.942 on the test set of IOTA 1, 0.948 on the new dataset, and 0.947, 0.917 and 0.985 for each center individually. Conclusions: The analysis shows that all models performed well when tested prospectively on the whole dataset and in each center individually. The next step will be to test the models prospectively in new centers with different levels of ultrasound experience and population characteristics.

OP04.02: Partial atrioventricular septal defect (pAVSD) in the fetus. Diagnostic features and associations in a multicentre series of 17 cases

Objective: Rhomboencephalosynapsis (RES) is a rare, but increasingly recognized malformation consisting of fused cerebellar hemispheres, dentate nuclei and superior cerebellar peduncles and absent vermis. RES is associated with significant neurocognitive delay, seizures, and movement disorder. Associated central nervous system abnormalities are common. We report five fetal cases and discuss the fetal ultrasound and magnetic resonance imaging (MR) findings. All cases presented with hydrocephalus. Methods: Institutional ethics approval was obtained. Prenatal ultrasound is available in five cases, prenatal MR imaging in two, postnatal ultrasound and MR in two and autopsy confirmation in three. Images were evaluated for presence and degree of vermian fusion, presence of primary fissure and fastigial point and associated central nervous system anomalies. Results: Fetal and postnatal MR readily identified the classic features of hypoplastic single lobed cerebellum with transverse folia and associated intracranial malformations, specifically within the realm of holoprosencephaly. Both also identified diamond shaped 4th ventricle on axial views, rounded ‘fastigial point’ and lack of primary fissure. Postnatal MR more readily identified fusion of the dentate nuclei. Fetal and postnatal ultrasound documented the transverse folia and narrow transverse diameter of the cerebellum. Conclusion: Rhomboencephalosynapsis is a rare lesion that is best imaged prenatally with fetal MR. Suspicious ultrasound features are cerebellar hypoplasia and absence of the vermis. The presence of these ultrasound findings should raise the clinical suspicion of RES, and be an indication for fetal MR if available.