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Objectives: First arch syndromes are congenital defects caused by failure of neural crest cells to migrate into the first branchial arch. First arch syndrome is classified into 2 main clinical manifestations: Treacher Collins syndrome, characterized by bilateral underdevelopment of the zygomatic bones; and Pierre Robin sequence. The aim of this study was to describe the feasibility of visualization of the fetal zygomatic bone and assess its application in cases referred for features suggestive of first arch syndrome., Methods: A prospective cohort study was conducted. The feasibility of visualization of the zygomatic bone was performed in 50 sequential fetuses with a normal anatomic scan between 12 and 24 weeks' gestation using 3-dimensional sonography. Following this, cases referred for targeted scans for suspected first branchial arch syndrome were assessed for the presence or absence of the zygomatic bones., Results: Visualization of the fetal zygomatic bone was feasible in all low-risk cases. Cases referred for targeted scans included 11 isolated cases of micrognathia or retrognathia, 3 cases of microtia, and 3 cases of auricular or facial vestiges. Within this group, the zygomatic bones were visualized in all but 2 cases. No associated extrafacial malformations were detected; therefore, this phenotype was consistent with Treacher Collins syndrome., Conclusions: Prenatal imaging of the zygomatic bones offers a clinically based sonographic approach to cases referred for features suggestive of first arch syndrome and enables differentiation between the 2 main clinical manifestations: Treacher Collins syndrome and Pierre Robin sequence., (© 2020 by the American Institute of Ultrasound in Medicine.)

Objectives: The purposes of this study were to assess the feasibility of fetal thymus measurement between 13 and 16 weeks' gestation, to evaluate the potential difference using color Doppler sonography with the thy-box technique, and to construct normal percentile ranges., Methods: This retrospective study included 287 healthy singleton pregnancies. The fetal thymus was shown in an axial plane of the upper mediastinum. Color Doppler imaging was applied to outline the thy-box: ie, the area between the brachiocephalic artery posteriorly and internal mammary arteries laterally. Measurements of the lateral and anteroposterior diameters of the thymus with and without color Doppler imaging were compared., Results: The thymus was shown in 95% of the cases (273 of 287) between 13 and 16 weeks' gestation. The mean lateral thymus diameter ± SD with color Doppler imaging (5.30 ± 0.7 mm) was significantly longer in comparison to the measurement without color Doppler imaging (5.06 ± 0.8 mm; P < .001), whereas the anteroposterior diameter was significantly shorter (3.19 ± 0.9 versus 3.26 ± 0.8 mm; P = .044). Normal percentiles of thymus measurements for gestational age were constructed., Conclusions: The fetal thymus can be clearly and accurately shown as early as 13 weeks' gestation by using the thy-box. Measurements with color Doppler imaging were significantly different from those without and hence are preferable, as color Doppler imaging can delineate the thymus borders more accurately., (© 2015 by the American Institute of Ultrasound in Medicine.)

This series describes the sonographic characteristics and pregnancy outcomes of fetuses with abnormal insertion of the umbilical vein (UV) into the inferior vena cava (IVC). We conducted a retrospective study that described the sonographic features of 6 patients who underwent a routine anatomic scan during early pregnancy. Six patients had a diagnosis of abnormal insertion of the UV to the IVC; in 3, the diagnosis was made at 12 weeks' gestation. Cardiac anomalies were detected in 3 patients, including ventricular septal defects, pericardial effusion, tricuspid and mitral regurgitation, and an aberrant right subclavian artery. Four had noncardiac anomalies, including cystic hygroma and skeletal, brain, and abdominal anomalies. Only 1 fetus who presented with UV insertion into the IVC as an isolated finding had a normal karyotype, resulting in term vaginal delivery. Four other patients had chromosomal abnormalities, including trisomies 13 and 21, Turner mosaicism of 45,XO/46,XY, and Robertsonian translocation, and 1 patient terminated the pregnancy without a karyotype evaluation. Abnormal insertion of the UV into the IVC with agenesis of the ductus venosus can be seen as early as the first trimester. When detected, a detailed anatomic examination should be performed, as well as a fetal karyotype evaluation. Isolated cases of insertion of the UV into the IVC at a position lower than usual may have a good prognosis., (© 2013 by the American Institute of Ultrasound in Medicine.)

Prenatal imaging of the fetal cerebellar vermis is challenging even for experienced examiners. We found that by aiming the ultrasound beam through the mastoid fontanel and then rotating the data set in a multiplanar reconstruction and applying volume contrast imaging in the C plane, we were consistently able to obtain images of the vermis in the standard midsagittal plane. Images of the fetal vermis suitable for morphologic evaluation were obtained in 408 of 414 cases (98.5%) at gestational ages of 18 weeks to 31 weeks 6 days; the examination time was only minimally increased.

Objective: The purpose of this study was to establish the normality of the fetal vermis, ie, the time of appearance of the primary fissure, as well as its measurements between 18 and 26 weeks' gestation, using 3-dimensional (3D) ultrasonography., Methods: A prospective cross-sectional study of normal singleton pregnancies was conducted. Examinations were performed with high-resolution transabdominal ultrasonography using the axial plane in 173 fetuses between 18 and 26 weeks' gestation. Postprocessing measurements of the fetal vermis were done with 4-dimensional software using static volume contrast imaging and tomographic ultrasound imaging in the C-plane. Detection of the primary fissure was evaluated in all cases, and the time of appearance was documented., Results: Adequate vermis measurements were obtained in 173 fetuses. Vermian length as a function of gestational age was expressed by regression equations, and the correlation coefficients were found to be highly statistically significant (P < .001). The normal mean +/- 2 SD for each gestational week was defined. The primary fissure was observed at 24 weeks' gestation in all cases, at 22 weeks in 94% of cases, and as early as 18 weeks in 40%., Conclusions: This 3D study documents the appearance of the primary fissure and presents the normal range of vermian measurements, confirming normal development of the fetal vermis starting as early as 18 weeks' gestation. It also shows an easy method for visualizing the vermis with 3D ultrasonography at every gestational week regardless of fetal presentation.

Objective: The purpose of this study was to perform high-resolution sonographic examinations to determine the normal anatomic relationship of the conus medullaris (CM) of the spinal cord with the vertebral column during different stages of gestation., Methods: In this prospective study, fetal sonographic evaluations were performed between 13 and 40 weeks' gestation. Transvaginal probes (7.5-8 MHz) or abdominal probes (5-8 MHz) were used, depending on gestational age and position of the fetus. The CM was located in coronal longitudinal sections. The positions of the kidneys and lumbosacral junction and the origin of the ribs determined the location of the vertebrae. The locations of the CM were divided into 5 groups according to their positions relative to the vertebrae., Results: A total of 110 fetuses between 13 and 40 weeks' gestation were studied. Between 13 and 18 weeks' gestation, the CM was situated at the level of the L4 vertebra, or more caudally, in 100% of the fetuses. At term, all fetuses showed the CM above L2. A distinct ascent of the CM was detected between 13 and 40 weeks' gestation. The results were statistically significant (P < .0001)., Conclusions: A distinguishable ascent of the CM in relation to the vertebral column during fetal life was detected.

Objective: To describe our experience in prenatal diagnosis of hemivertebra., Methods: This is a case series of patients referred to our tertiary medical center over a 3-year period. All fetuses were scanned by high-resolution real-time scanners. The apparent vertebral anomaly was assessed in a real-time manner by a joint team of obstetricians, sonographers, and pediatric orthopedic surgeons. A complete anomaly survey of other fetal organs was performed on each fetus. All patients were given proper counseling by the same joint team. All patients had detailed obstetric and neonatal follow-up. Prenatal sonograms, neonatal medical records, and clinical courses were evaluated retrospectively., Results: During the 3 years, 6 cases of hemivertebra were identified in our department. Gestational age at diagnosis was 14 to 23 weeks. Two patients had conception by assisted reproductive technology. Associated anomalies included VATER syndrome (vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia), gastroschisis, and pyelectasis. Outcomes in fetuses without major associated anomalies were fair., Conclusions: Diagnosis of isolated hemivertebra might be associated with a favorable outcome. The 3 key factors in achieving an optimal spine at maturity, early diagnosis, anticipation, and prevention of deterioration, might be enhanced by our joint multidisciplinary approach to the diagnosis of skeletal anomalies.

Objective: The upper limit of the fetal atrial width in normal fetuses is debated. This was a prospective cohort evaluation of the lateral ventricular width with special regard to the upper limit of its size., Methods: Measurements of fetal atrial ventricular size were obtained by abdominal ultrasonography in 427 male and female fetuses between 20 and 40 weeks' gestation of normal singleton pregnancies. In addition, reanalysis of previous data (8 studies) and the current data was performed to produce a pooled mean and SD., Results: The mean ventricular width +/- SD was 6.2 +/- 1.2 mm. The ventricular width did not show significant modification throughout gestation. Reanalysis of the current and previous studies (8216 cases) yielded a pooled mean of 6.4 +/- 1.2., Conclusions: According to the current and previous studies, the upper cutoff of fetal ventricular atrium width should be 10 mm. This cutoff represents a range of approximately 3 SDs above the pooled mean, corresponding to a 99.74% confidence interval.

Objective: To evaluate our experience with sonography and color Doppler blood flow in the diagnosis and management of chorioangiomas of the placenta., Methods: All cases with placental chorioangiomas diagnosed in our sonography unit between 1992 and 2001 were included in the study. Sonographic and color Doppler flow characteristics were evaluated in all cases. Our cases were compared with all cases of placental chorioangiomas diagnosed antenatally by sonography published in the English literature between 1978 and 2001., Results: Six cases of placental chorioangioma were identified antenatally, with a mean size of 6.5 cm (range, 4-13 cm). With the use of color Doppler flow, all cases of chorioangioma were shown to have either abundant blood flow or a large feeding vessel within the tumor. During follow-up, 2 cases had reduction of the intratumoral blood flow, and the outcomes were favorable. Three of our cases had delivery before 33 weeks' gestation (1 with intrauterine fetal death and 1 with termination of pregnancy). Review of the literature revealed 72 cases of antenatally diagnosed placental chorioangioma. Two thirds of the cases had dismal outcomes., Conclusions: The sonographic diagnosis of chorioangiomas of the placenta is feasible and necessitates close surveillance of these pregnancies because of the dismal prognosis in more than half. The addition of color Doppler flow is important in the diagnosis and antenatal follow-up of these pregnancies.

Objective: To assess the efficacy, safety, and associated complications of sonohysterography for the diagnosis of residual trophoblastic tissue., Methods: We conducted a prospective study of 23 consecutive patients admitted to our ultrasonography unit with clinical and ultrasonographic signs of retained intrauterine tissue., Results: Twelve patients had hydrosonographic features suggestive of residual trophoblastic tissue (i.e., an intrauterine lesion not detachable from the uterine wall after instillation of saline), whereas in 11 cases the hydrosonographic findings were negative for retained tissue. Blood flow was detected within abnormal intrauterine masses in 4 of 12 patients with trophoblastic tissue, whereas it was not detected in any patient without retained tissue (P = .093). No complications were encountered during the procedure or the postprocedure period. None of the patients had anesthetic complications, perforation of the uterus, fluid overload, or any other surgical complication. All 12 patients underwent hysteroscopic removal of the suspected residual trophoblastic tissue, and histologic confirmation of residual trophoblastic tissue was obtained in all cases., Conclusions: Sonohysterography for detection and diagnosis of residual trophoblastic tissue is an accurate and safe procedure. Further studies comparing the efficacy of sonohysterography with that of diagnostic hysteroscopy are warranted.

Our objective was to evaluate the preoperative clinical, laboratory, and sonographic characteristics of struma ovarii in comparison to ovarian dermoid cysts. A retrospective review of gynecologic patients operated on for mature cystic teratoma over a 10 year period identified 12 cases of struma ovarii. These cases, combined with 4 additional cases from an earlier report, were the subject of this study. Results were compared to 32 cases of ovarian dermoid cysts. Ovarian struma ovarii occurred in 12 (4.8%) of 251 cases of ovarian dermoid cysts. Most patients were premenopausal, and the mean lesion diameter was 57.3 mm (range, 30-95 mm). Struma ovarii occurred more frequently (68.8%) in the right adnexa and was seen with a normal CA-125 level. Blood flow, assessed by Doppler ultrasonography, was located in the center of the lesion in all cases of struma ovarii. Rare cases were seen with elevated tumor markers and low resistance blood flow. With regard to dermoid cysts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echoic lesion in dermoid cysts (P < 0.0001). In summary, it is difficult to distinguish between struma ovarii and dermoid cysts on the basis of their sonographic appearance. Nevertheless, Doppler flow may aid in the preoperative diagnosis of struma ovarii. Blood flow signals, detected from the center of the echoic lesion, and low resistance to flow may be more common in struma ovarii.

Our objective was to characterize tubal abnormalities with color Doppler ultrasonography. We evaluated 25 women with adnexal masses suggestive of tubal masses using gray scale sonography. Color Doppler flow was added to further characterize the adnexal lesion. Of 18 women diagnosed as having hydrosalpinx, in 6 cases the diagnosis was tuboovarian abscess and in 1 case the diagnosis was tubal torsion. In the periphery of the hydrosalpinx, color Doppler flow revealed a mean resistive index of 0.752 +/- 0.04. In the periphery of the tuboovarian abscess, an abundant flow with reduced resistance to flow (mean resistive index = 0.448 +/- 0.04) was seen. The difference was statistically significant (P < 0.0001). In the case of adnexal torsion, no blood flow was detected in the lesion. All cases but one were confirmed in either laparoscopy or laparotomy or during colpotomy and drainage of the abscess. For adnexal masses suggestive of tubal lesions, color Doppler flow can further characterize the masses by detecting a significantly richer and low resistant blood flow in cases of tuboovarian abscess in comparison to hydrosalpinx.

The purpose of our study was to evaluate the Doppler flow characteristics of ovarian dermoid cysts. In 70 women (mean age, 38.7 +/- 14.6 years), 78 ovarian lesions with mean diameter of 48.9 +/- 28.4 mm and preoperative sonographic diagnosis of dermoid cyst of the ovary were evaluated prospectively by Doppler flow sonography; these cysts were eventually removed surgically. The findings were compared to the postoperative histologic results. In 74 lesions (eight cases were bilateral), when blood flow patterns were detected (detection rate of 24.3%) they were obtained only from the ovarian tissue surrounding the dermoid cavity, with a mean resistive index of 0.6 +/- 0.1 (range, 0.4 to 0.76). In four cases, which were proved postoperatively to be struma ovarii, blood flow was detected not only from the cyst capsule but also from the centrally positioned solid area (dermoid tissue), with a mean RI of 0.565 +/- 0.08 (range, 0.509 to 0.667). Dermoid cysts of the ovary are devoid of blood flow, with flow detection rate being only 24.3% from the cyst capsule. When apparently vascularized solid tissue is detected in the central part of a sonographically suspected benign cystic teratoma, struma ovary is highly suspected.

Routine vaginal ultrasonographic evaluation of pelvic organs was performed in asymptomatic postmenopausal women to evaluate the diagnostic significance of sonographic findings of endometrial fluid collections in the presence of a thin endometrium in postmenopausal women. The study included nine women aged 61 to 79 years who had been postmenopausal for 7 to 30 years, and in whom endometrial fluid collections were incidently demonstrated. Endometrial samplings followed the ultrasonographic examinations in all nine patients, and the correlation between the histologic report and the endometrial ultrasonographic thickness was evaluated. The diameter of the endometrial fluid collections varied from 3 to 12 mm. The thickness of the endometrium surrounding the fluid ranged from 1 to 3 mm. Of the nine endometrial samples examined, five revealed atrophic endometrium, three had insufficient material for histologic evaluation, and one specimen revealed well-differentiated adenocarcinoma. The woman in whom endometrial carcinoma was diagnosed underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymph node sampling. The pathologic examination confirmed the previous histologic finding, and deep penetration into the myometrium was noticed with intact lymph nodes. Endometrial fluid collections found in asymptomatic postmenopausal patients still may be associated with endometrial malignancy, even in the presence of thin endometrium.

The objective of this study was to evaluate the role of sonographically guided aspiration of simple ovarian cysts. During the period from 1985 through 1992, 107 ultrasonographically guided punctures of apparently simple ovarian cysts were performed. The group included 76 premenopausal and 31 postmenopausal women who were followed for 1 to 6 years (mean, 2.7 years) after initial cyst puncture. In 42 cases, cyst aspiration constituted the definitive therapy. In 65 cases the cyst recurred and in this group, 38 women (with complete recurrence) were operated on whereas 27 women with a cyst less than 5 cm (incomplete recurrence) were allocated to a follow-up group. Overall, in 69 cases (65%) surgery was avoided. No major complications were encountered. In our experience, aspiration of simple ovarian cysts is a suitable alternative in the management of this problem. Close follow-up is necessary to detect recurrence and perform surgical intervention when indicated.