P. S. Oliveira

Fetal cerebral ventricle volumetry: comparison between 3D ultrasound and magnetic resonance imaging in fetuses with ventriculomegaly

Objectives. The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with those obtained by magnetic resonance imaging (MRI). Methods. This cross-sectional study evaluated 30 fetuses with atrial width (AW) between 10 and 30 mm, from 20 to 36 gestational weeks. Fifty-nine ventricles were measured by two observers. Sonographic volumetric measurements using VOCAL 30° were performed with an ACCUVIX XQ machine (Medison, Korea) and MRI assessments with a Sonata system using ARGUS software (Siemens, Germany). Agreement between both techniques was assessed by intraclass correlation coefficient (ICC) calculation, and proportionate Bland–Altman plots were constructed. Results. A high degree of reliability was observed between VOCAL and MRI measurements (ICC 0.928, 95%CI [0.876;0.958]). Bland–Altman plots confirmed the high correlation (mean of differences: 1.62 cm3 and standard deviation: ± 8.41 cm3). Conclusion. Three-dimensional volumetry of fetal LVs by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly and may be used as an additional tool in patient counseling and prognosis prediction.

Fetal lung volume in fetuses with urinary tract malformations: Comparison by 2D-, 3D-sonography and magnetic resonance imaging

Objective. To evaluate the concordance between two-dimensional ultrasonography (2DUS), three-dimensional ultrasonography (3DUS) and magnetic resonance imaging (MRI) in the assessment of lung volume in fetuses with urinary tract malformations (UTM). Methods. This was a cross-sectional study involving 12 pregnancies between 19 and 34 weeks, with various fetal UTM. Pulmonary volume was obtained by 2DUS using the following equation: total lung volume = [right lung antero-posterior diameter (X) × transverse diameter (Y) × cranial-caudal diameter × 0.152 + left lung (X1) × (Y1) × (Z1) × 0.167]. Pulmonary volume by 3DUS was obtained using the virtual organ computer-aided analysis (VOCAL) method with a 30° (VOL30), 18° (VOL18) and 12° (VOL12) rotation. A fast sequence of transverse lung section was also obtained by MRI. The intraclass correlation coefficient was used to evaluate the correlation between the three methods. The paired student t-test was used to compare the means. Results. There was a strong correlation between the three methods, and the highest correlations were between MRI and VOL18 for the right (ICC = 0.913) and left (ICC = 0.947) lungs. A strong correlation was also found between the lung volumes obtained through MRI and VOL12 as well as VOL18 (p = 0.544 and 0.286, respectively). However, for the left lung there was only a correlation between MRI and VOL12 (p = 0.49). Conclusions. There is a good concordance between 3DUS (VOL12) and MRI in the evaluation of lung volume in fetuses with UTM.

Fetal brain tumors: Prenatal diagnosis by ultrasound and magnetic resonance imaging.

Congenital central nervous system tumors diagnosed during pregnancy are rare, and often have a poor prognosis. The most frequent type is the teratoma. Use of ultrasound and magnetic resonance image allows the suspicion of brain tumors during pregnancy. However, the definitive diagnosis is only confirmed after birth by histology. The purpose of this mini-review article is to describe the general clinical aspects of intracranial tumors and describe the main fetal brain tumors.

Reference Ranges for Fetal Brain Fissure Development on 3-Dimensional Sonography in the Multiplanar Mode

To determine reference ranges for measurements of fetal cerebral fissures by 3‐dimensional (3D) sonography in the multiplanar mode and to evaluate the reliability and concordance of these measurements.

OC06.02: Prenatal diagnosis of brainstem anomalies: phenotypic spectrum and neuroimaging features

K.K. Haratz1,2, Z. Leibovitz1,3, P.S. Oliveira4, L. Gindes10,1, N. Raz1, L. Dafna1, M. Tamarkin1, Y. Shalev1,2, G. Malinger5,2, L. Schreiber6, D. Kidron7, A. Arad8, S. Egenburg8, D. Lev1,9, L. Ben-Sira11,2, A.F. Moron12, G. Kasprian13, D. Prayer14, F. Viñals15, A. Fink16, G. McGillivray17, R. Leventer18,19, C. Garel20, A. Poretti21,22, T. Lerman-Sagie23,1 1Fetal Neurology Unit, Ultrasound in Obstetric Gynecology Unit, Wolfson Medical Centre, Holon, Israel; 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Department of Obstetrics and Gynecology, Bnai-Zion Medical Centre, Haifa, Israel; 4DDI – Federal University of São Paulo – UNIFESP, São Paulo, Brazil; 5Obstetric Gynecology Ultrasound Unit, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; 6Department of Pathology, Wolfson Medical Centre, Holon, Israel; 7Pathology, Meir Medical Centre, Kfar Saba, Israel; 8Department of Pathology, Bnai-Zion Medical Centre, Haifa, Israel; 9Institute of Genetics, Wolfson Medical Centre, Holon, Israel; 10Obstetric Gynecology Ultrasound Unit, Wolfson Medical Centre, Ramat-Gan, Israel; 11Radiology, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; 12Fetal Medicine Discipline, Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil; 13Medical University of Vienna, Vienna, Austria; 14Department of Radiology, Medical University of Vienna, Vienna, Austria; 15Clinica Sanatorio Aleman, Centro AGB Ultrasonografia, Concepcion, Chile; 16Medical Imaging, Royal Children’s Hospital, Melbourne, VIC, Australia; 17Murdoch Children’s Research Institute, Royal Women’s Hospital, Mercy Hospital for Women, Melbourne, VIC, Australia; 18Neurology, Royal Children’s Hospital, Murdoch Children’s Research Institute, Melbourne, VIC, Australia; 19Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia; 20Hôpital d’Enfants Armand-Trousseau, Paris, France; 21Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 22Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA; 23Pediatric Neurology Unit, Wolfson Medical Centre, Holon, Israel

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

In order to draw evidence-based recommendations concerning the management of autoimmune diseases of the liver, the Brazilian Society of Hepatology has sponsored a single-topic meeting in October 18th, 2014 at São Paulo. An organizing committee comprised of seven investigators was previously elected by the Governing Board to organize the scientific agenda as well as to select twenty panelists to make a systematic review of the literature and to present topics related to the diagnosis and treatment of autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and their overlap syndromes. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

Desenvolvimento das fissuras cerebrais fetais: avaliação com ultrassonografia tridimensional

OBJETIVO: avaliar a distância das fissuras cerebrais fetais a borda interna da calota craniana por meio da ultrassonografia tridimensional (US3D). METODOS: realizou-se um estudo de corte transversal em 80 gestantes normais entre a 21a e 34a semanas de gestacao. Avaliou-se a distância entre a tabua ossea interna da calota craniana fetal e as fissuras de Sylvius, parieto-occipital, hipocampo e calcarina. Para a obtencao desta distância para as tres primeiras fissuras, realizou-se uma varredura tridimensional atraves do plano axial (nivel dos ventriculos laterais). Para a obtencao da distância da fissura calcarina utilizou-se uma varredura coronal (nivel dos lobos occiptais). Para avaliar a correlacao entre as fissuras e a idade gestacional foram realizadas regressoes de primeiro grau, sendo os ajustes calculados pelo coeficiente de determinacao (R2). Foram determinados percentis 5, 50 e 95 para cada fissura. Avaliou-se ainda a correlacao entre a distância destas fissuras com os diâmetros biparietal (DBP) e circunferencia craniana (CC) utilizando o coeficiente de correlacao de Pearson (r). RESULTADOS: todas as medidas das fissuras apresentaram correlacao linear com a idade gestacional (Sylvius: R2=0,5; parieto-occipital: R2=0,7; hipocampo: R2=0,3 e calcarina: R2=0,3). A media da distância das fissuras variou de 7,0 a 14,0 mm, 15,9 a 28,7 mm, 15,4 a 25,4 mm e 15,7 a 24,8 mm para as fissuras de Sylvius, parieto-occipital, hipocampo e calcarina, respectivamente. As fissuras de Sylvius e parieto-occipital apresentaram as maiores correlacoes com o DBP (r=0,8 e 0,7, respectivamente) e a CC (r=0,7 e 0,8, respectivamente). CONCLUSOES: a distância das fissuras cerebrais fetais a borda interna da calota craniana por meio da US3D apresentou correlacao positiva com a idade gestacional.

P20.07: Interhemisferic variant of holoprosencephaly (MIH) or syntelencephaly: the role of fetal brain MRI in differential diagnosis

postnatal or postmortem examination. The frequency of agreement between the ultrasound modalities was estimated and compared using the McNemar-Bower test. Results: Regarding to the ultrasonographic signs, the local and the remote examiners had high correct rates for 2D US and 3D US (80.0%, 84.0% and 76.0% e 86.0%, respectively). Similarly, the diagnosis for congenital anomalies had a better percentage for 3D US compared for 2D US for the remote examiner (92.3 vs. 84.6%) and equal for the local one (96.2% vs. 96.2%), respectively. Regarding to the ultrasonographic signs and the diagnosis of congenital anomalies, comparing the 2D US vs. 3D US performed by the same examiner the local and remote ones did not find any statistically significant difference. Conclusions: In spite of the slightly increased percentage in the ultrasonographic signs of the 3D US compared to 2D US for congenital anomalies from both examiners and in its diagnosis for the remote examiner, it did not reach any statistically significant difference.

P25.05: Comparison between three-dimensional sonographic method VOCAL and fetal MRI in fetal lateral ventricle volume measurements

karyotype were identified resulting in an incidence of 0.15%. Twenty-nine (46%) represented cases of anencephaly. Seventeen of 29 mothers (58.6%) terminated their pregnancy and 2 were lost to follow up as they delivered in another hospital. Of the 10 women who continued their antenatal care in our hospital, four (40%) had an intrauterine fetal demise at a mean gestational age of 30+4 weeks (range 25+0 to 35+4 weeks) and subsequently delivered vaginally following induction of labour. Three (30%) patients underwent Caesarean section at term. The remaining three patients delivered vaginally at a mean gestational age of 37 weeks, one of whom required induction of labour at term (range 34+5 to 39+2 weeks). The median neonatal survival was 33 minutes. Conclusions: Despite the fact that pregnancy termination is not legally available in Ireland, the majority of women, when faced with a diagnosis of anencephaly, were prepared to travel outside the jurisdiction to avail of pregnancy termination. Nevertheless, over 40% of women in our case series chose to continue their pregnancy and in the absence of intrauterine fetal demise, the majority of pregnancies progressed to term. The above natural history outcome data provides useful information for health professionals charged with prenatal counselling.

OP25.04: Does proximity to the transducer influences accuracy of fetal lateral ventricle volume measurement by transabdominal 3D sonography compared to MRI?

Objectives: The prognosis of infants with open spina bifida depends upon the location and extent of the lesion. This study aimed to determine the effectiveness of the 3D sonography on the prediction of upper pole of spina bifida during second trimester anomaly scan. Methods: Fetuses with spina bifida diagnosed during the second trimester from the October 2009 to the April 2010 were analyzed in two referral centers. Volumes were acquired starting from a midsagittal scan. The upper level of spina bifida was identified in multiplanar mode and maximum mode by comparing axial and sagitttal views, using as reference either the last rib (corresponding to T12) or the sacroiliac joint (S1). The diagnosis made on 3D was confirmed with pathological examination of aborted specimens and postnatal magnetic resonance imaging. Results: Fourteen fetuses were analyzed and the mean gestational age were 20.14 ± 2.11 (17–24). Six fetuses had thoracic spina bifida, six had lumbar defects and two had purely sacral defects. All had cranial signs of Arnold-Chiari malformation including lemon sign, banana sign and ventriculomegaly. Talipes was present in 12/14. Multiplanar mode was superior to the maximum mode in the identification of spina bifida level. This was correctly diagnosed in 10/14 (71, 43%). In the four remaining cases the sonographic estimate was within one vertebral segment (28, 57%). Conclusions: 3D sonography with multiplanar mode is an accurate tool in the diagnosis of open spina bifida level.