Extending the basic fetal CNS examination at the second and third trimester scan
M.C. Comănescu, E.M. Barbu, N. Cernea, A.C. Comănescu
Rezumat: Introduction. The basic guidelines provide the diagnosis
of most anomalies or at least help the examiner observe
there is something wrong and refer the case to a specialised
unit. Fetal neurosonography is a complex examination
that needs time and making it routinely in a complete form
(with multiple coronal and sagittal sections) may not be
cost-efficient. We analyzed if some elements of advanced
neurosonography, together with color Doppler, would
improve
the examination, increase the diagnostic rate and
decrease
the referred case percentage, but also if they are
feasible or prolong the examination time with minimal
benefits. Materials and method. The new parameters
used in our protocol were: sagittal image with the corpus
callosum and vermis; color Doppler evaluation on a median
approach with the pericallosal artery and Galen’s vein, and
an axial approach with the circle of Willis, targeting the
evaluation of vascular anomalies; acquiring a 3D volume of
the fetal head for diagnostic purposes, but also for storing
in a “3D volumes library”. Result. After the evaluation of 763
cases, we noticed an extension of the examination of about
three minutes, and the target was achieved in over 90% of
the cases, the most difficult being the vascular median view.
The use of new techniques helped us demonstrate more
anomalies or anatomic variants, among which a Galen’s
vein aneurysm, and also offered the possibility of using the
3D volume library and offline examination for retrospective
evaluation of certain cases. Conclusions. We believe that
the new parameters had a good feasibility, they did not
prolong the examination time, and brought new and more
precise diagnosis. The benefits for the pathological cases
were proved by the cases reported. Also, the existence
of an ultrasound volume data base allows retrospective
evaluation of cases and allows for new, sometimes better
images, for later in pregnancy or even postnatally. Cuvinte cheie: neurosonography, color Doppler, 3D ultrasound.