Pilar Martinez-Ten

Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimester

To describe a new first‐trimester sonographic landmark, the retronasal triangle, which may be useful in the early screening for cleft palate.

First-trimester diagnosis of cleft lip and palate using three-dimensional ultrasound.

To determine whether systematic examination of primary and secondary palates using three‐dimensional (3D) ultrasound aids in the identification of orofacial clefts in the first trimester.

Intracranial translucency at 11–13 weeks of gestation: prospective evaluation and reproducibility of measurements

This paper aimed to determine the feasibility of identification and measurement reproducibility of intracranial translucency (IT) in our population.

Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations

To investigate the accuracy of three‐dimensional ultrasound (3D‐US) with respect to magnetic resonance imaging (MRI), and compared to clinical examination, in the assessment of cervix and vagina in women with uterine malformations.

Absent mandibular gap in the retronasal triangle view: a clue to the diagnosis of micrognathia in the first trimester

To describe a new ultrasound technique that may be useful for the diagnosis of micrognathia in the first trimester of pregnancy.

Feasibility of 3-dimensional sonographic examination of the fetal secondary palate during the second-trimester anatomy scan.

To determine the feasibility of obtaining adequate 3‐dimensional (3D) data sets to examine the fetal secondary palate during the second‐trimester anatomy scan.

Antenatally Diagnosed Renal Duplex Anomalies Sonographic Features and Long-term Postnatal Outcome

The purpose of this study was to assess the diagnostic accuracy and infant outcomes of antenatally detected renal duplex anomalies.

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View A 3-Dimensional Sonographic Study

Objective. The purpose of this study was to evaluate a new sonographic technique for identifying the nasal bones using the retronasal triangle view, ie, the coronal plane at which the palate and frontal processes of the maxilla are simultaneously visualized. Methods. Three‐dimensional (3D) volumes were acquired from women undergoing first‐trimester sonographic screening for aneuploidy by 2 accredited operators. Those data sets in which the fetal face was clearly identified were selected for offline analysis by 2 other observers who were unaware of the sonographic or clinical findings. The nasal bones were classified as both present, only 1 present (right or left), or absent according to the presence or absence of 2 small paired echogenic linear structures at the upper tip of the retronasal triangle as determined by 3D navigation in the coronal plane and compared to those findings obtained by 3D navigation in the sagittal plane. Additional 3D data sets involving a subset of 4 first‐trimester fetuses with trisomy 21 and absent nasal bones were also analyzed retrospectively and included randomly in the study group. Results. A total of 110 3D data sets were analyzed, of which 86% were obtained transabdominally and 14% transvaginally. The quality of nasal bone identification was classified subjectively by the observers as good in 67% of cases, fair in 29%, and poor in 4%. The nasal bones were classified as at least 1 present in 106 of the cases (96%) and absent in 4 (4%), with complete agreement between observers in both the sagittal and coronal planes (κ = 1). Discrimination between the right and left nasal bones was possible in 89% and 93% for observer A and in 96% and 96% for observer B by assessing the sagittal and coronal views, respectively (right nasal bone: κ = 0.90 [95% confidence interval (CI), 0.79–1]; left nasal bone: κ = 0.85 [95% CI, 0.60–0.99]). The nasal bones were not identified at the level of the retronasal triangle view in any of the fetuses with trisomy 21 and absent nasal bones. Conclusions. This study shows that the nasal bones can be confidently identified as paired echogenic structures located at the upper tip of the retronasal triangle. This coronal view of the fetal face offers the possibility of screening for the presence or absence of the nasal bones in the first trimester, especially when the standard midsagittal views of the fetal face are suboptimal because of fetal or maternal factors. Because both nasal bones can be evaluated simultaneously in the coronal plane, the retronasal triangle view may be advantageous over the conventional midsagittal view assessment, in which only 1 of the 2 nasal bones is evaluated.

First-Trimester Assessment of the Fetal Palate A Novel Application of the Volume NT Algorithm

We describe a new technique that can facilitate the first‐trimester examination of the fetal palate using the Volume NT algorithm (Samsung Medison, Seoul, Korea), a program that automatically detects the exact midsagittal plane of the head and is primarily designed for semiautomatic measurement of the nuchal translucency thickness. Three‐dimensional (3D) data sets from the fetal face were captured with Volume NT and subsequently reformatted with the Oblique View software to obtain orthogonal views of the primary and secondary palate in coronal and axial planes, respectively. By testing this method in selected 3D data sets obtained retrospectively (n = 12) and prospectively (n = 28), we were able to extract clinically acceptable views of the fetal palate in all cases. This preliminary report shows that with this new 3D automation development, early evaluation of the fetal palate is feasible and reproducible and could be easily incorporated into the first‐trimester sonographic protocol once its ability to detect abnormal cases is demonstrated.

Fetal magnetic resonance imaging and three-dimensional ultrasound in clinical practice: General aspects

Ultrasonography is used routinely during pregnancy to screen and diagnose fetal anomalies. Two-dimensional ultrasound is usually adequate in women at low risk for malformations. When technical factors limit optimal evaluation or a malformation is suspected, further imaging with three-dimensional ultrasound and magnetic resonance imaging is becoming increasingly common. Three-dimensional ultrasound allows the manipulation of data acquired from two-dimensional ultrasound to recreate an infinite number of views, thereby enhancing the ability to evaluate the fetal anatomy. When three-dimensional ultrasound is either unavailable or inadequate, fetal magnetic resonance imaging permits detailed evaluation of the suspected anomaly and assesses the presence of associated anomalies. In this chapter, we review the techniques, advantages, limitations, and clinical applications of these two fetal imaging modalities.