Bermejo C, Martínez-Ten P, Recio M, Ruiz-López L, Díaz D, Illescas T. Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations. Ultrasound Obstet Gynecol. 2014 Mar;43(3):336-45.
ABSTRACT
OBJECTIVES: 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.
METHODS: In this prospective study, 16 patients diagnosed with uterine
malformation with cervical involvement underwent 3D-US examination. The
acquisition of cervical volumes was transvaginal, with four cases repeated in the
peri-ovulation period, while vaginal volumes were acquired by transperineal
imaging following filling of the vagina with gel. MRI was performed in 13
patients using endovaginal gel. All cases underwent clinical examination,
comprising bimanual gynecological examination and speculoscopy. Diagnostic
concordance of each of the methods with the gold standard was calculated.
RESULTS: 3D-US cervical examinations revealed 12 cases of duplicate cervix, two
of complete septate cervix and two of incomplete septate cervix. Images of the
cervical canal in the peri-ovulation period were judged subjectively to be better
in quality, but did not lead us to change any diagnosis. 3D-US vaginal
examinations revealed four cases with a vaginal dividing wall and two with a
blind hemivagina. None of the 3D-US findings contradicted the clinical findings
of the cervix; however, clinically we observed two cases with vaginal dividing
wall that had not been diagnosed with 3D-US. MRI diagnosed nine cases of
duplicate cervix, three of complete septate cervix, one of incomplete septate
cervix, five of vaginal dividing wall and two of blind hemivagina. One case
diagnosed as complete septate cervix was in fact a duplicate cervix on 3D-US and
on clinical examination. Compared with the gold standard, both 3D-US and MRI were
highly efficient in the diagnosis of anomalies of the cervix and vagina. The
overall diagnostic concordance of 3D-US with clinical examination (kappa, 0.84;
95% CI, 0.62-1) was slightly inferior to that of MRI with clinical examination
(kappa, 0.9; 95% CI, 0.72-1), but this difference was not statistically
significant.
CONCLUSIONS: The acquisition of isolated cervical volumes, without including the
uterus, defines the extent of the ectocervix and the limits of the cervical canal
in uterine malformations. The use of endovaginal gel makes possible the diagnosis
of associated vaginal anomalies with 3D-US.
Adiego B, Martinez-Ten P, Illescas T, Bermejo C, Sepulveda W. First-trimester assessment of nasal bone using retronasal triangle view: a prospective study. Ultrasound Obstet Gynecol. 2014 Mar;43(3):272-6.
ABSTRACT
OBJECTIVE: To examine the feasibility and accuracy of fetal nasal bone (NB)
assessment in the retronasal triangle (RNT) view for aneuploidy screening in the
first trimester of pregnancy.
METHODS: Consecutive women with singleton pregnancies undergoing sonographic
screening at 11-13 weeks' gestation were prospectively evaluated. In all cases,
assessment of the NB by using the RNT view was attempted and classified as
present (if one or both of the NBs were clearly seen) or absent/hypoplastic (if
the NB was not visualized or if it was small and less echogenic than the
surrounding bones). The detection rate of fetal karyotypic abnormalities by the
assessment of the NB in the RNT view was calculated.
RESULTS: In total, 1977 women were scanned. The RNT was successfully examined in
1970 fetuses (99.6%). Fetal outcome was available in 1767 (89.7%) of evaluated
cases, and of these, 39 (2.2%) cases of aneuploidy were documented (trisomy 21,
n=17; trisomy 18, n=8; trisomy 13, n=5; Turner syndrome, n=5; and triploidy,
n=4). The prevalence of absent/hypoplastic NB was 12/1728 (0.7%) in chromosomally
normal fetuses and 12/17 (70.6%) in trisomy 21 fetuses. Sensitivity, specificity
and positive and negative predictive values of absent/hypoplastic NB for trisomy
21 were 70.6%, 99.3%, 50.0% and 99.7%, respectively. The positive and negative
likelihood ratios of NB assessment were 101 (95% CI, 53-193) and 0.3 (95% CI,
0.14-0.62), respectively.
CONCLUSIONS: The RNT view is a useful technique for assessing the NB during the
first trimester of pregnancy. With this new approach, performance of
absent/hypoplastic NB as a marker of aneuploidy, mainly trisomy 21, appears to be
similar to that previously reported by using the mid-sagittal plane.
Sepulveda W, Wong AE, Andreeva E, Odegova N, Martinez-Ten P, Meagher S (2014) 'Biparietal diameter-to-crown-rump length disproportion in first-trimester fetuses with holoprosencephaly', J Ultrasound Med. Jul;33(7):1165-9
OBJECTIVES: To determine whether the biparietal diameter measurement is altered
in first-trimester fetuses with holoprosencephaly.
METHODS: Cases of holoprosencephaly were collected retrospectively from 4 fetal
medicine centers, and first-trimester biparietal diameter measurements were
reviewed. The diagnosis of holoprosencephaly was established sonographically by
the detection of abnormal choroid plexus morphologic characteristics (absent
"butterfly" sign) and the identification of a monoventricular cerebral cavity on
axial views of the fetal brain. The proportion of fetuses with biparietal
diameter measurements below the 5th percentile for crown-rump length was
determined.
RESULTS: Among 45 cases of holoprosencephaly reviewed, 43 had information on both
biparietal diameter and crown-rump length measurements. The biparietal diameter
was below the 5th percentile for crown-rump length in 14 (32.6%) fetuses.
Chromosomal analysis was available in 41; no statistically significant difference
in biparietal diameter measurement between those with associated chromosomal
anomalies and those without anomalies was noted. A supplementary analysis using
head circumference measurement showed an even greater proportion of fetuses with
holoprosencephaly with measurements below the 5th percentile for crown-rump
length (18 of 42 [42.9%]).
CONCLUSIONS: One-third of first-trimester fetuses with a sonographic diagnosis of
holoprosencephaly had a biparietal diameter that was smaller than expected for
crown-rump length. In this subset of fetuses, the evaluation of intracranial
anatomy for signs of holoprosencephaly may be more difficult to perform due to
the smaller size of the brain. Therefore, the detection of a biparietal diameter
below the 5th percentile as expected from crown-rump length on the
first-trimester scan may be a warning sign of holoprosencephaly and should prompt
a detailed examination of the intracranial anatomy.
Illescas T, Ibba RM, Zoppi MA, Iuculano A, Contu R, Monni G. Prenatal ultrasound diagnosis of a fetal testis granulosa cell tumour. J Obstet Gynaecol. 2014 Jan;34(1):96-7.