Qualitative and Quantitative Study of Fetal Posterior Fossa During the First Trimester in a Chinese Population

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2022 Oct 10

PMID 36217104

Authors

Li Feng

Lijuan Sun

Jingjing Wang

Congxin Sun

Lijuan Lu

Zhikun Zhang

Yu Hu

QingQing Wu

Affiliations

Soon will be listed here.

Abstract

Background: To establish the normal reference ranges for parameters related to the fetal posterior fossa in the first trimester (11 ~ 13+6 weeks of gestation) and to analyze the relationship between them and crown-rump length (CRL) among the Chinese population.

Methods: Singleton pregnancies of 11 ~ 13 weeks (CRL:45 ~ 84 mm) with both parents from China were randomly selected from January 2021 to November 2021. The related parameters of the posterior fossa including cisterna magna (CM), intracranial translucency (IT), brain stem (BS), brain stem to the occipital bone (BSOB), and brain stem/brain stem to occipital bone (BS/BSOB) were evaluated and measured in nuchal translucency (NT) mid-sagittal section clearly by an experienced sonographer (operator 1). To assess the reproducibility of the measurements, we randomly selected 50 pregnant women. According to the blind method, operators 1 and 2 respectively screened and measured relevant parameters. In addition, operator 1 examined and measured relevant parameters again 2 h after the first.

Results: This study included 1663 fetuses. All fetuses can clearly show the three spaces of the fetal posterior fossa. The ICCs (95% CI) of intra-operator reproducibility of CM, IT, BS, BSOB, BS/BSOB were 0.981 (0.952 ~ 0.991, P < 0.001), 0.929 (0.866 ~ 0.961, P < 0.001), 0.970 (0.946 ~ 0.983, P < 0.001), 0.991 (0.974 ~ 0.996, P < 0.001), 0.939 (0.892 ~ 0.965, P < 0.001), respectively; The ICCs (95% CI) of inter-operator reproducibility 0.926 (0.860 ~ 0.960, P < 0.001), 0.810 (-0.083 ~ 0.940, P < 0.001), 0.820 (0.645 ~ 0.904, P < 0.001), 0.804 (0.656 ~ 0.888, P < 0.001), 0.772 (0.599 ~ 0.871, P < 0.001), respectively. There was a linear correlation between CRL and the parameters related to the posterior fossa (CM, IT, BS, BSOB, BS/BSOB). CM (mm) = -1.698 + 0.532 × CRL (cm) (r = 0.829, P < 0.001); IT (mm) = 0.701 + 0.179 × CRL (cm) (r = 0.548, P < 0.001); BS (mm) = 0.403 + 0.349 × CRL (cm) (r = 0.716, P < 0.001); BSOB (mm) = -0.277 + 0.719 × CRL (cm) (r = 0.829, P < 0.001); BS/BSOB = 0.747-0.021 × CRL (cm) (r = 0.196, P < 0.001).

Conclusions: Qualitative and quantitative assessment of the fetal posterior fossa structure was feasible in the first trimester. We constructed the normal reference ranges of CM, IT, BS, BSOB, and BS/BSOB. Furthermore, CM, IT, BS, and BSOB were positively correlated with CRL, but BS/BSOB was negatively correlated with CRL.

References

Engels A, Joyeux L, Brantner C, De Keersmaecker B, De Catte L, Baud D . Sonographic detection of central nervous system defects in the first trimester of pregnancy. Prenat Diagn. 2016; 36(3):266-73. DOI: 10.1002/pd.4770. View

Garcia-Rodriguez R, Garcia-Delgado R, Romero-Requejo A, Medina-Castellano M, Garcia-Hernandez J, Gonzalez-Martin J . First-trimester cystic posterior fossa: reference ranges, associated findings, and pregnancy outcomes. J Matern Fetal Neonatal Med. 2019; 34(6):933-942. DOI: 10.1080/14767058.2019.1622673. View

Sepulveda W, Wong A, Sepulveda F, Alcalde J, Devoto J, Otayza F . Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery. Childs Nerv Syst. 2017; 33(7):1083-1099. DOI: 10.1007/s00381-017-3445-7. View

Martinez-Ten P, Illescas T, Adiego B, Estevez M, Bermejo C, Wong A . Non-visualization of choroid plexus of fourth ventricle as first-trimester predictor of posterior fossa anomalies and chromosomal defects. Ultrasound Obstet Gynecol. 2017; 51(2):199-207. DOI: 10.1002/uog.17445. View

Zvanca M, Munteanu A, Bot M, Petca A, Nemescu D . Posterior fossa assessment in the axial view of the head at 11-14 weeks of gestation in normal and aneuploid fetuses. Exp Ther Med. 2020; 20(3):2470-2474. PMC: 7401706. DOI: 10.3892/etm.2020.8793. View

Wertaschnigg D, Ramkrishna J, Ganesan S, Tse C, Scheier M, Volpe N . Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation. Prenat Diagn. 2019; 40(3):365-372. DOI: 10.1002/pd.5614. View

Iuculano A, Zoppi M, Ibba R, Monni G . A Case of Enlarged Intracranial Translucency in a Fetus with Blake's Pouch Cyst. Case Rep Obstet Gynecol. 2014; 2014:968089. PMC: 3912764. DOI: 10.1155/2014/968089. View

Chaoui R, Benoit B, Mitkowska-Wozniak H, Heling K, Nicolaides K . Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11-13-week scan. Ultrasound Obstet Gynecol. 2009; 34(3):249-52. DOI: 10.1002/uog.7329. View

Pertl B, Eder S, Stern C, Verheyen S . The Fetal Posterior Fossa on Prenatal Ultrasound Imaging: Normal Longitudinal Development and Posterior Fossa Anomalies. Ultraschall Med. 2019; 40(6):692-721. DOI: 10.1055/a-1015-0157. View

10.

Salomon L, Alfirevic Z, Bilardo C, Chalouhi G, Ghi T, Kagan K . ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013; 41(1):102-13. DOI: 10.1002/uog.12342. View

11.

Volpe P, Contro E, Fanelli T, Muto B, Pilu G, Gentile M . Appearance of fetal posterior fossa at 11-14 weeks in fetuses with Dandy-Walker malformation or chromosomal anomalies. Ultrasound Obstet Gynecol. 2015; 47(6):720-5. DOI: 10.1002/uog.14883. View

12.

Eric Ozdemir M, Demirci O, Ayvaci Tasan H, Ohanoglu K, Akalin M . The importance of first trimester screening of cranial posterior fossa in predicting posterior fossa malformations which may be identified in the following weeks of gestation. J Clin Ultrasound. 2021; 49(9):958-962. DOI: 10.1002/jcu.23057. View

13.

. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. J Ultrasound Med. 2020; 40(5):E1-E16. DOI: 10.1002/jum.15477. View

14.

Jansen A, Keymolen K . Fetal and neonatal neurogenetics. Handb Clin Neurol. 2019; 162:105-132. DOI: 10.1016/B978-0-444-64029-1.00005-9. View

15.

Lachmann R, Chaoui R, Moratalla J, Picciarelli G, Nicolaides K . Posterior brain in fetuses with open spina bifida at 11 to 13 weeks. Prenat Diagn. 2010; 31(1):103-6. DOI: 10.1002/pd.2632. View

16.

Chaoui R, Benoit B, Heling K, Kagan K, Pietzsch V, Sarut Lopez A . Prospective detection of open spina bifida at 11-13 weeks by assessing intracranial translucency and posterior brain. Ultrasound Obstet Gynecol. 2011; 38(6):722-6. DOI: 10.1002/uog.10111. View

17.

Volpe P, Persico N, Fanelli T, de Robertis V, DAlessandro J, Boito S . Prospective detection and differential diagnosis of cystic posterior fossa anomalies by assessing posterior brain at 11-14 weeks. Am J Obstet Gynecol MFM. 2020; 1(2):173-181. DOI: 10.1016/j.ajogmf.2019.06.004. View

18.

Rossi A, Prefumo F . Correlation between fetal autopsy and prenatal diagnosis by ultrasound: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2017; 210:201-206. DOI: 10.1016/j.ejogrb.2016.12.024. View

19.

Pauta M, Grande M, Borobio V, Illanes C, Soler A, Nogue L . Is Cisterna Magna Width a Useful First-Trimester Marker of Aneuploidy?. Fetal Diagn Ther. 2019; 47(6):457-463. DOI: 10.1159/000503386. View

20.

Struksnaes C, Blaas H, Vogt C . Autopsy Findings of Central Nervous System Anomalies in Intact Fetuses Following Termination of Pregnancy After Prenatal Ultrasound Diagnosis. Pediatr Dev Pathol. 2019; 22(6):546-557. DOI: 10.1177/1093526619860385. View