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Objective: Parental counseling for fetal malformations of cortical development (MCD) is based on data from studies in children and adults undergoing imaging investigation for abnormal neurodevelopment. However, such postnatal findings may not be applicable to prenatally diagnosed cases. The aim of this study was to review the existing data on postnatal neurodevelopmental outcome for fetuses diagnosed with MCD. Methods: A literature search was conducted in PubMed, Web of Science and EMBASE for articles published between 2013 and 2023, using standardized keywords to describe fetal cortical malformations. Full‐text articles were accessed for the retrieved citations and data on participant characteristics, imaging findings, and pregnancy and neonatal outcomes were extracted. Fetal MCD was defined as either complex or isolated, according to the presence or absence, respectively, of additional brain or extracranial defects. Results: Overall, 30 articles including 371 cases of fetal MCD were reviewed. The cases were classified as complex (n = 324), isolated (n = 21) or unknown (n = 26). There were 144 terminations and four stillbirths, with pregnancy outcome unreported in 149 cases. A total of 108 cases had postnatal magnetic resonance imaging or postmortem examination data available. In nine of these cases, a diagnosis of complex fetal MCD was changed to isolated MCD after birth, and one case was found not to have MCD. There were 74 live births, for which postnatal neurodevelopment data were available in only 30 cases. Normal neurodevelopmental outcome was reported in seven (23.3% (95% CI, 9.9–42.2%)) infants, with the remaining 23 exhibiting various levels of neurodevelopmental delay (three mild, seven moderate and 13 severe) from 6 months to 7 years of age. Conclusions: Most reviewed cases of fetal MCD were complex in nature and underwent termination of pregnancy. There is a paucity of data on postnatal neurological development in fetuses diagnosed with MCD. The available data suggest antenatal overdiagnosis of case severity in about 5% of cases with known outcome, and either normal neurodevelopment or mild neurodevelopmental delay in approximately one‐third of liveborn cases with neurological follow‐up. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The detailed sonographic assessment of the fetal neuroanatomy plays a crucial role in prenatal diagnosis, providing valuable insights into timely, well-coordinated fetal brain development and detecting even subtle anomalies that may impact neurodevelopmental outcomes. With recent advancements in artificial intelligence (AI) in general and medical imaging in particular, there has been growing interest in leveraging AI techniques to enhance the accuracy, efficiency, and clinical utility of fetal neurosonography. The paramount objective of this focusing review is to discuss the latest developments in AI applications in this field, focusing on image analysis, the automation of measurements, prediction models of neurodevelopmental outcomes, visualization techniques, and their integration into clinical routine. [ABSTRACT FROM AUTHOR]

Background. Currently, therapeutic hypothermia (TH) is the only approved method for treating hypoxic-ischemic encephalopathy (HIE) that helps improve outcomes. However, it also has significant drawbacks, including the necessity for expensive equipment and treatment technologies, poorly understood pathophysiological mechanisms, and, most importantly, not always well-understood long-term results. Numerous scientific studies report the potential benefits of TH, but the actual risk/benefit ratio is still unknown. The results of long-term follow-up of children who underwent TH and did not have serious neuromotor or intellectual disorders are variable. It is believed that the correlation between neonatal neuroimaging and the degree of nervous system impairment remains poorly defined. Chronic brain injuries diagnosed after the neonatal period, such as parenchymal volume loss, appear to be more prognostically significant, which may be reflected by moderate enlargement of the ventricular system of the brain. The method for determining the size of the ventricular system using ultrasound can be accessible for infants of the first year of life who had HIE but do not have direct indications for magne­tic resonance imaging. Therefore, this study aimed to explore the characteristics of the cerebral ventricular system in infants of the first year of life who suffered severe asphyxia at birth, depen­ding on the method of post-resuscitation care (with or without TH). Materials and ­methods. The study examined the results of neurosonographic examinations of 309 infants during their first year of life. Inclusion criteria were gestational age at birth ≥ 36 weeks and birth weight ≥ 2000 g, manifestations of HIE in the early neonatal period without adverse short-term outcomes (at the time of discharge from the neonatal hospital, the children showed no signs of destructive hypoxic-ischemic lesions of the central nervous system (CNS), seizures, or pathological muscle tone, and had full oral feeding). Exclusion criteria were diagnosed congenital CNS abnormalities, neuroinfections, psychomotor development delay of more than 3 months during the first years of life, progressive obstructive ventriculomegaly or ventriculomegaly associated with non-atrophic subarachnomegaly. The children were divided into three groups: hypothermia group — 19 infants who underwent TH after birth; normothermia group — 14 children who conditio­nally had indications for TH but did not undergo it; comparison group — 276 children in their first year of life who did not require TH (Apgar score > 5 at 10 minutes of life, manifestations of mild or moderate HIE (according to the Sarnat scale) during the first days of life). Neurosonographic examinations were conducted at the age of 2–7 months (mean of 2.12 ± 0.07 months). The sizes of the lateral ventricles were assessed in comparison with the results from the control group of infants of the same age (34 healthy children with no recorded factors of complicated perinatal period, no signs of neurological dysfunction during the neonatal period, and the seven-month observation). Enlargement of the lateral ventricles was recorded when the size of the anterior horn or body of the ventricle in the parasagittal projection exceeded the 95th percentile of the corresponding measurements from the control group. Results. Enlargement of the lateral ventricles during the neurosonographic examination was detected in 36.8 % of children in the hypothermia group, 14.3 % in the normothermia group, and 8.0 % of children in the comparison group. Significant differences were registered only when comparing the results of the hypothermia group with the comparison group (p < 0.05, Fisher’s exact test). Significant correlations (p < 0.05) were found between the size of the lateral ventricles and clinical signs such as sleep disturbances, decreased muscle tone in the arms, increased tendon reflexes, delayed motor development, increased muscle tone in a pyramidal pattern, and diffuse muscle hypotonia. Conclusions. Thus, infants who had severe asphyxia at birth and underwent TH significantly more often had enlargement of the cerebral ventri­cular system (versus the comparison group). Therefore, although therapeutic hypothermia improves outcomes for the development of the nervous system in children who have moderate and severe hypoxic-ischemic encephalopathy, brain morphology (particularly the state of the ventricular system) may still be altered in infants during the first year of life. And the presence of significant correlations between the size of the lateral ventricles and clinical signs of neurological dysfunction argues for further clinical monitoring of children after therapeutic hypothermia throughout the first years of life and in the absence of short-term adverse outcomes of HIE or significant delays in psychomotor development during the first year of life.

Entrapment neuropathy of the ulnar nerve at the elbow, the so-called cubital tunnel syndrome, is the second most frequent focal mononeuropathy after carpal tunnel syndrome in adults. Currently, there is a pressing need to identify cost-effective biomarkers and procedures capable of accurately detecting alterations in ulnar nerve structural and functional integrity. Established electrophysiological techniques, such as motor and sensory nerve conduction studies, along with needle electromyography of specific muscles, represent the gold standard for ulnar nerve electrodiagnosis. Concurrently, the introduction of neuromuscular ultrasound and its integration into electromyographic laboratories has significantly impacted structural diagnosis and the precise localization of ulnar nerve pathology over the past two decades. In this review, our objective is to summarize the current knowledge on both classical and advanced diagnostic methods utilized in clinical neurophysiology laboratories. We aim to provide a synthesis of modern electrodiagnostic and neurosonographic techniques, with a particular emphasis on easily attainable, clinically relevant parameters. [ABSTRACT FROM AUTHOR]

Objectives: Fetuses with late‐onset growth restriction (FGR) have a higher risk of suboptimal neurocognitive performance after birth. Previous studies have reported that impaired brain and cortical development can start in utero. The primary aim of this study was to report midline structure growth and cortical development in fetuses with late‐onset FGR according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal Doppler findings, plays a role in affecting brain growth and maturation. Methods: This was a prospective observational study that included fetuses with late‐onset FGR (defined according to the Delphi FGR criteria) undergoing neurosonography between 32 and 34 weeks' gestation. Midline structure (corpus callosum (CC) and cerebellar vermis (CV)) length and cortical development, including the depth of the Sylvian (SF), parieto‐occipital (POF) and calcarine (CF) fissures, were compared between late‐onset FGR, small‐for‐gestational‐age (SGA) and appropriate‐for‐gestational‐age (AGA) fetuses. Subgroup analysis according to the severity of FGR (normal vs abnormal fetal Doppler) was also performed. Univariate analysis was used to analyze the data. Results: A total of 52 late‐onset FGR fetuses with normal Doppler findings, 60 late‐onset FGR fetuses with abnormal Doppler findings, 64 SGA fetuses and 100 AGA fetuses were included in the analysis. When comparing AGA controls with SGA fetuses, late‐onset FGR fetuses with normal Doppler findings and late‐onset FGR fetuses with abnormal Doppler findings, there was a progressive and significant reduction in the absolute values of the following parameters: CC length (median (interquartile range (IQR)), 43.5 (28.9–56.1) mm vs 41.9 (27.8–51.8) mm vs 38.5 (29.1–50.5) mm vs 31.7 (23.8–40.2) mm; K = 26.68; P < 0.0001), SF depth (median (IQR), 14.5 (10.7–16.8) mm vs 12.7 (9.8–15.1) mm vs 11.9 (9.1–13.4) mm vs 8.3 (6.7–10.3) mm; K = 75.82; P < 0.0001), POF depth (median (IQR), 8.6 (6.3–11.1) mm vs 8.1 (5.6–10.4) mm vs 7.8 (6.1–9.3) mm vs 6.6 (4.2–8.0) mm; K = 45.06; P < 0.0001) and CF depth (median (IQR), 9.3 (6.7–11.5) mm vs 8.2 (5.7–10.7) mm vs 7.7 (5.2–9.4) mm vs 6.3 (4.5–7.2) mm; K = 46.14; P < 0.0001). Absolute CV length was significantly higher in AGA fetuses compared with all other groups, although the same progressive pattern was not noted (median (IQR), 24.9 (17.6–29.2) mm vs 21.6 (15.2–26.1) mm vs 19.1 (13.8–25.9) mm vs 21.0 (13.5–25.8) mm; K = 16.72; P = 0.0008). When the neurosonographic variables were corrected for fetal head circumference, a significant difference in the CC length and SF, POF and CF depths, but not CV length, was observed only in late‐onset FGR fetuses with abnormal Doppler findings when compared with AGA and SGA fetuses. Conclusions: Fetuses with late‐onset FGR had shorter CC length and delayed cortical development when compared with AGA fetuses. After controlling for fetal head circumference, these differences remained significant only in late‐onset FGR fetuses with abnormal Doppler. These findings support the existence of a link between brain development and impaired placental function. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate corpus callosum (CC) size in fetuses with malformations of cortical development (MCD) and to explore the diagnostic value of three CC length (CCL) ratios in identifying cortical abnormalities. Methods: This is a single‐center retrospective study in singleton fetuses at 20–37 weeks of gestation between April 2017 and August 2022. The midsagittal plane of the fetal brain was obtained and evaluated for the following variables: length, height, area of the corpus callosum, and relevant markers, including the ratios of corpus callosum length to internal cranial occipitofrontal dimension (CCL/ICOFD), corpus callosum length to femur length (CCL/FL), and corpus callosum length to cerebellar vermian diameter (CCL/VD). Intra‐class correlation coefficient (ICC) was used to evaluate measurement consistency. The accuracy of biometric measurements in prediction of MCD was assessed using the area under the receiver‐operating‐characteristics curves (AUC). Results: Fetuses with MCD had a significantly decreased CCL, height (genu and splenium), and area as compared with those of normal fetuses (P <.05), but there was no significant difference in body height (P =.326). The CCL/ICOFD, CCL/FL, and CCL/VD ratios were significantly decreased in fetuses with MCD when compared with controls (P <.05). The CCL/ICOFD ratio offered the highest predictive accuracy for MCD, yielding an AUC of 0.856 (95% CI: 0.774–0.938, P <.001), followed by CCL/FL ratio (AUC, 0.780 (95% CI: 0.657–0.904), P <.001), CCL/VD ratio (AUC, 0.677 (95% CI: 0.559–0.795), P <.01). Conclusion: The corpus callosum biometric parameters in fetuses with MCD are reduced. The CCL/ICOFD ratio derived from sonographic measurements is considered a promising tool for the prenatal detection of cortical malformations. External validation of these findings and prospective studies are warranted. [ABSTRACT FROM AUTHOR]

The aim of this systematic review is to report the normal cortical development of different fetal cerebral fissures on ultrasound, describe associated anomalies in fetuses with cortical malformations, and evaluate the quality of published charts of cortical fissures. The inclusion criteria were studies reporting development, anomalies, and reference charts of fetal cortical structures on ultrasound. The outcomes observed were the timing of the appearance of different cortical fissures according to different gestational age windows, associated central nervous system (CNS) and extra-CNS anomalies detected at ultrasound in fetuses with cortical malformation, and rate of fetuses with isolated anomaly. Furthermore, we performed a critical evaluation of the published reference charts for cortical development on ultrasound. Random-effect meta-analyses of proportions were used to combine the data. Twenty-seven studies (6875 fetuses) were included. Sylvian fissure was visualized on ultrasound in 97.69% (95% CI 92.0–100) of cases at 18–19, 98.17% (95% CI 94.8–99.8) at 20–21, 98.94% (95% CI 97.0–99.9) at 22–23, and in all cases from 24 weeks of gestation. Parieto-occipital fissure was visualized in 81.56% (95% CI 48.4–99.3) of cases at 18–19, 96.59% (95% CI 83.2–99.8) at 20–21, 96.85% (95% CI 88.8–100) at 22–23, and in all cases from 24 weeks of gestation, while the corresponding figures for calcarine fissure were 37.27% (95% CI 0.5–89.6), 80.42% (95% CI 50.2–98.2), 89.18% (95% CI 74.0–98.2), and 96.02% (95% CI 96.9–100). Malformations of cortical development were diagnosed as an isolated finding at ultrasound in 6.21% (95% CI 2.9–10.9) of cases, while they were associated with additional CNS anomalies in 93.79% (95% CI 89.1–97.2) of cases. These findings highlight the need for large studies specifically looking at the timing of the appearance of the different brain sulci. Standardized algorithms for prenatal assessment of fetuses at high risk of malformations of cortical development are also warranted. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions To describe the sonographic features of the caudothalamic groove in the third trimester of pregnancy in a group of structurally normal fetuses and to report a small series of cases with abnormal appearance of the caudothalamic groove at antenatal cranial ultrasound.This was an observational study conducted at two fetal medicine referral units in Italy. A non‐consecutive cohort of pregnant women with a singleton non‐anomalous pregnancy were recruited prospectively and underwent three‐dimensional (3D) ultrasound assessment of the fetal brain at 28–32 weeks' gestation. At offline analysis, the ultrasound volumes were adjusted in the multiplanar mode, according to a standardized methodology, until the caudothalamic groove was visible in the parasagittal plane. To evaluate interobserver agreement, two operators were asked independently to indicate if the caudothalamic groove was visible unilaterally or bilaterally on each volume and Cohen's kappa (κ) coefficient was calculated. The digital archives of the two centers were also searched retrospectively to retrieve cases with abnormal findings at the level of the caudothalamic groove on antenatal cranial ultrasound that were confirmed postnatally.A total of 180 non‐consecutive cases were included. At offline analysis of the 3D ultrasound volumes, the caudothalamic groove was identified in the parasagittal plane by both operators at least unilaterally in 176 (97.8%) cases and bilaterally in 174 (96.7%) cases. The κ‐coefficient for the agreement between the two independent operators in recognizing the caudothalamic groove was 0.89 and 0.83 for one and both hemispheres, respectively. The retrospective search of our archives yielded five cases with an abnormal appearance of the caudothalamic groove at antenatal cranial ultrasound, including two cases of hemorrhage and three cases of cyst.The caudothalamic groove is consistently seen in normal fetuses on multiplanar neurosonography in the third trimester, and abnormal findings in this region may be detected antenatally. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

To investigate midbrain growth, including corpus callusum (CC) and cerebellar vermis (CV) and cortical development in late fetal growth restricted (FGR) subclassified according to the umbilical vein blood flow (UVBF) values. This was a prospective study on singleton fetuses late FGR with abnormal placental cerebral ratio (PCR). FGR fetuses were further subdivided into normal (≥fifth centile) and abnormal (

Introduction: Growth-restricted fetuses may have changes in their neuroanatomical structures that can be detected in prenatal imaging. We aim to compare corpus callosal length (CCL) and cerebellar vermian height (CVH) measurements between fetal growth restriction (FGR) and control fetuses and to correlate them with cerebral Doppler velocimetry in growth-restricted fetuses. Methods: This was a prospective cohort of FGR after 20 weeks of gestation with ultrasound measurements of CCL and CVH. Control cohort was assembled from fetuses without FGR who had growth ultrasound after 20 weeks of gestation. We compared differences of CCL or CVH between FGR and controls. We also tested for the correlations of CCL and CVH with middle cerebral artery (MCA) pulsatility index (PI) and vertebral artery (VA) PI in the FGR group. CCL and CVH measurements were adjusted by head circumference (HC). Results: CCL and CVH were obtained in 68 and 55 fetuses, respectively. CCL/HC was smaller in FGR fetuses when compared to control fetuses (difference = 0.03, 95% CI: [0.02, 0.04], p < 0.001). CVH/HC was larger in FGR fetuses compared to NG fetuses (difference = 0.1, 95% CI: [−0.01, 0.02], p = < 0.001). VA PI multiples of the median were inversely correlated with CVH/HC (rho = −0.53, p = 0.007), while CCL/HC was not correlated with VA PI. Neither CCL/HC nor CVH/HC was correlated with MCA PI. Conclusions: CCL/HC and CVH/HC measurements show differences in growth-restricted fetuses compared to a control cohort. We also found an inverse relationship between VA PI and CVH/HC. The potential use of neurosonography assessment in FGR assessment requires continued explorations. Plain Language Summary: In this study, we compared ultrasound measurements of several brain structures in fetuses with reduced or normal growth. We also evaluated the correlation of the size/length of these brain structures to blood flow of several blood vessels to the brain. We found that measurements of the small brain (CVH) are larger in pregnancies with growth problems. We also found that the blood flow of the vessel in the back side of the brain (vertebral artery [VA] Doppler) is inversely correlated with the CVH. These findings add to the literature on the use of ultrasound specifically to assess brain structures in pregnancies that are affected by growth problems. Deeper understanding of these associations may help establish which pregnancies with growth problems may need the most help later in life. [ABSTRACT FROM AUTHOR]

This review aims to explore the current application of Cranial Ultrasound Screening (CUS) in the diagnosis and treatment of brain diseases in extremely preterm infants. It also discusses the potential role of emerging ultrasound-derived technologies such as Super Microvascular Structure Imaging (SMI), Shear Wave Elastography (SWE), Ultrafast Doppler Ultrasound (UfD), and 3D ventricular volume assessment and automated segmentation techniques in clinical practice. A systematic search of medical databases was conducted using the keywords ''(preterm OR extremely preterm OR extremely low birth weight) AND (ultrasound OR ultrasound imaging) AND (neurodevelopment OR brain development OR brain diseases OR brain injury OR neuro*)'' to identify relevant literature. The titles, abstracts, and full texts of the identified articles were carefully reviewed to determine their relevance to the research topic. CUS offers unique advantages in early screening and monitoring of brain diseases in extremely preterm infants, as it can be performed at the bedside without the need for anesthesia or special monitoring. This technique facilitates early detection and intervention of conditions such as intraventricular hemorrhage, white matter injury, hydrocephalus, and hypoxic-ischemic injury in critically ill preterm infants. Continuous refinement of the screening and follow-up processes provides reliable clinical decision-making support for healthcare professionals and parents. Emerging ultrasound technologies, such as SWE, SMI, and UfD, are being explored to provide more accurate and in-depth understanding of brain diseases in extremely preterm infants. SWE has demonstrated its effectiveness in assessing the elasticity of neonatal brain tissue, aiding in the localization and quantification of potential brain injuries. SMI can successfully identify microvascular structures in the brain, offering a new perspective on neurologic diseases. UfD provides a high-sensitivity and quantitative imaging method for the prevention and treatment of neonatal brain diseases by detecting subtle changes in red blood cell movement and accurately assessing the status and progression of brain diseases. CUS and its emerging technologies have significant applications in the diagnosis and treatment of brain diseases in extremely preterm infants. Future research aims to address current technical challenges, optimize and enhance the clinical decision-making capabilities related to brain development, and improve the prevention and treatment outcomes of brain diseases in extremely preterm infants.

Background: This study is aimed to compare the accuracy of prenatal standard brain ultrasound (US), neurosonography (NSG), and magnetic resonance imaging (MRI) for diagnosing central nervous system (CNS) anomalies.Methods: In this prospective study pregnant women were consecutively recruited in their second or third trimester of pregnancy, who either had a positive history of fetal brain anomalies in previous pregnancies or were pregnant with fetuses suspected to have brain abnormalities on ultrasound exam. Based on standard US, NSG, and MRI findings concordancy fetuses were subdivided into four groups: the MRI/NSG findings confirmed, supplemented, contradicted, or ruled out the initial US diagnosis. NSG/MRI discordancy was also reported separately. Live births were followed for 18 months to assess the course of postnatal neurodevelopment.Results: Generally, 49.3% of fetuses showed concordancy between US and NSG/MRI; among remaining cases, NSG/MRI showed additional findings to US, changes US diagnosis, and demonstrated a normal brain in 73.2%, 23.9%, and 2.8% of cases, respectively. MRI found additional features to NSG in 22.9% of fetuses, most of whom were diagnosed with intracranial hemorrhage or cortical malformation unseen on NSG or showed a more extensive cortical malformation in MRI. Twenty fetuses underwent postnatal brain MRI and all confirmed prenatal MRI findings with 100% concordancy. Cases with postnatal normal neurodevelopment were more likely to show concordancy between US, NSG, and MRI.Conclusions: Prenatal MRI is the most accurate imaging modality for detecting CNS anomalies antenatal and might supplement the US/NSG findings, and sometimes contradicts or excludes the initial US diagnosis.

Pediatric intracranial arteriovenous shunts are rare vascular malformations that can be diagnosed prenatally or postnatally, as an incidental finding or due to complications. We propose a review of cerebral vascular malformations in newborns and infants with special emphasis on neurosonography and Doppler ultrasound as the first diagnostic method. Sonography can thus contribute in the planning of further studies that are always necessary, and in post-therapy follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To show the development of ganglionic eminence, basal ganglia and thalamus/hypothalamus in week 11 + 3 to 13 + 6 by transvaginal 3D ultrasound. Methods: To visualize the prosencephalic structures surrounding the 3rd ventricle, 285 three-dimensional ultrasound volume blocks from 402 fetuses examined were selected in a prospective transvaginal 3D study to compare ultrasound images of ganglionic eminence, basal ganglia, thalamus/hypothalamus with embryological sections. In addition, measurements of the described structures were made in 104 fetuses to quantify the embryological development. Results: The sonomorphologic characteristics of ganglionic eminence, basal ganglia and thalamus/hypothalamus are described in 71% of the fetuses examined. Measurements of the structures in 57% of the fetuses, show the following results: axGE ap = 0.17 + 0.112*CRL; axGE/I = 0.888 + 0.048*CRL; axGE/BG = 0.569 + 0.041*CRL; coGE/BG = 0.381 + 0.048*CRL; coTh lat = − 0.002 + 0.135*CRL; coTh/HyT = 3.68 + 0.059*CRL; co3.V lat = 0.54 + 0.008*CRL. Conclusion: Transvaginal 3D neurosonography allows visualization and measurement of normal structures in the fetal prosencephalon at 11 + 3 to 13 + 6 weeks of gestation (GW) including details of ganglionic eminence (GE), basal ganglia (BG), and thalamus/hypothalamus (Th/HyT). Further scientific work is needed before using the results to decide on pathological changes in patients. [ABSTRACT FROM AUTHOR]

Objective: Ultrasonographic examination is the first-tier test to detect abnormal development of central nervous system (CNS). In optimal conditions, neurosonography can detect all important hallmarks of CNS development. It is, however, not known how the performance of this modality is in a routine setting. We aimed to evaluate the feasibility of neurosonography in a time-limited routine setting. Study design: We have performed a prospective study in which we have included a group of pregnant women carrying a fetus with an isolated congenital heart defect (CHD), and a control group of fetuses without structural anomalies. We have performed basic neurosonography examination according to the guideline ‘how to perform a basic screening examination of the CNS’, published by the international society of ultrasound in obstetrics and gynecology in both groups. In all these examinations, 9 brain structures were scored in 3 different planes, by researchers that were blinded for group allocation. A sufficient neurosonogram was performed when 7 or more out of 9 CNS structures were clearly visible during the off-line scoring of the examination. Results: A total of 574 neurosonographic examinations were performed in 151 fetuses, 90 in the CHD-group and 61 in the control group. A sufficient neurosonogram could be performed in 79% (234/294) of cases in a clinical setting (CHD cases) and in 90% (253/280) of control pregnancies. Higher maternal BMI (>30), maternal age, fetal cephalic position, fetal gender and placental position did not significantly influence neurosonography scores. Conclusion: In clinical setting, basic fetal neurosonography can be sufficiently performed in the majority of cases. This was not significantly influenced by maternal or fetal factors. The optimal gestational age for neurosonography is between 22 and 34 weeks.

BackgroundUltrasound training is a vital component of maternal-fetal medicine fellowships in the United States. Of the 18 months of core clinical training, the American Board of Obstetrics and Gynecology currently requires a minimum of 3 months to be dedicated to ultrasound to be eligible for board certification. However, the experience and degree of hands-on training differ among the fellowship programs and have not been reassessed for nearly a decade.ObjectiveTo assess regional heterogeneity in the ultrasound training experience during maternal-fetal medicine fellowship in the United States.Study designA survey was distributed to postgraduate year (PGY)-6 maternal-fetal medicine fellows registered to attend an annual ultrasound training course before the conference (n=114). For programs with >1 fellow attending (n=39), only 1 of them completed the survey to represent the program. The questions included demographics of the program, ultrasound training structure, the fellows' self-perception of ultrasound capabilities, research, mentorship, and technical aspects of sonography.ResultsSeventy two postgraduate year 6 fellows with a wide geographic distribution as follows completed the survey (96% response rate): 10 (14%) from the West, 16 (22%) from the Midwest, 17 (24%) from the South, and 29 (40%) from the Northeast. Respondents undergoing training in the South were less likely to report feeling comfortable performing nuchal translucency and detailed anatomic surveys than those from other regions (nuchal translucency: P=.046; anatomy: P=.011). Most of the respondents reported feeling comfortable performing growth (78%) and umbilical artery Doppler (58%) and feeling uncomfortable with three-dimensional ultrasound, neurosonography, and fetal echocardiography. Respondents in the Northeast were more likely to report feeling comfortable performing chorionic villus sampling (P=.001). There was no difference among fellowship programs in the presence or absence of ultrasound curriculum, bedside teaching, ultrasound-focused research mentorship, or months of ultrasound training.ConclusionDespite the standardization of ultrasound training structure across the United States, there remains regional heterogeneity in fellow self-reported comfort with specific ultrasound techniques and chorionic villus sampling at a midpoint in their fellowship training. The maternal-fetal medicine attending involvement at the bedside did not affect the fellow self-reported comfort with ultrasound surveys. This study highlights the need for further optimization of maternal-fetal medicine fellowship ultrasound training, especially in advanced sonography and diagnostic procedures.

The aim of this systematic review is to report the normal cortical development of different fetal cerebral fissures on ultrasound, describe associated anomalies in fetuses with cortical malformations, and evaluate the quality of published charts of cortical fissures. The inclusion criteria were studies reporting development, anomalies, and reference charts of fetal cortical structures on ultrasound. The outcomes observed were the timing of the appearance of different cortical fissures according to different gestational age windows, associated central nervous system (CNS) and extra-CNS anomalies detected at ultrasound in fetuses with cortical malformation, and rate of fetuses with isolated anomaly. Furthermore, we performed a critical evaluation of the published reference charts for cortical development on ultrasound. Random-effect meta-analyses of proportions were used to combine the data. Twenty-seven studies (6875 fetuses) were included. Sylvian fissure was visualized on ultrasound in 97.69% (95% CI 92.0–100) of cases at 18–19, 98.17% (95% CI 94.8–99.8) at 20–21, 98.94% (95% CI 97.0–99.9) at 22–23, and in all cases from 24 weeks of gestation. Parieto-occipital fissure was visualized in 81.56% (95% CI 48.4–99.3) of cases at 18–19, 96.59% (95% CI 83.2–99.8) at 20–21, 96.85% (95% CI 88.8–100) at 22–23, and in all cases from 24 weeks of gestation, while the corresponding figures for calcarine fissure were 37.27% (95% CI 0.5–89.6), 80.42% (95% CI 50.2–98.2), 89.18% (95% CI 74.0–98.2), and 96.02% (95% CI 96.9–100). Malformations of cortical development were diagnosed as an isolated finding at ultrasound in 6.21% (95% CI 2.9–10.9) of cases, while they were associated with additional CNS anomalies in 93.79% (95% CI 89.1–97.2) of cases. These findings highlight the need for large studies specifically looking at the timing of the appearance of the different brain sulci. Standardized algorithms for prenatal assessment of fetuses at high risk of malformations of cortical development are also warranted.

Disorder of the formation of the cavum septum pellucidum (CSP) occurs in a wide range of pathologies of the brain. Its identification from 18 to 37 weeks is a necessary rule of prenatal screening, which must also be performed in postnatal studies of premature infants. Unimaged CSP should be considered as a potential indicator of cerebral dysfunction and such severe malformations as agenesis (dysgenesis) of the corpus callosum, holoprosencephaly (HPE), schizencephaly, Aicardi syndrome, hydrocephalus and septo-optic dysplasia (SOD). A special place in the differential diagnosis of unimaged CSP is represented by SOD, lobar HPE, and its mild subtype - septopreoptic HPE. The literature describes the isolated absence of SP, without finding other signs related to HPE or SOD, as a variant of development. However, the neurological outcome in these children varies from normal to delayed development of the nervous system by different degrees, so this statement remains controversial. The article discusses in detail the anatomy, physiology, pathology of the septal region, the role of echographic studies in the antenatal and postnatal periods, and the correlation of the detected changes with the clinical picture.

To develop charts for fetal brain cortical structures following a proposed standardized methodology and using quantile regression. Prospective cross-sectional study including 344 low-risk singleton pregnancies between 19 and 34 weeks of gestation. The depth of Sylvian (SF), Parieto-occipital (POF) and Calcarine fissures (CF) were measured on ultrasound images using a standardized technique and their changes were evaluated by quantile regression as a function of gestational age (GA) interval or head circumference (HC). The measurements of SF, POF and CF depth significantly increased with gestation. Linear models better described the changes of cortical variables with GA and HC. When the fit of sulci depth with GA and HC were compared, a close relationship was highlighted for the latter variable. We provided prospective charts of fetal cortical development using quantile regression and following a strict standardized methodology These new charts may help in better identifying cases at higher risk of abnormal cortical neurodevelopment. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the impact of pregestational and gestational diabetes mellitus (PGDM and GDM) on the development of fetal intracranial structures and spaces. Methods: This prospective cross‐sectional study involved singleton pregnancies between 20 and 32 weeks of gestation. The study comprised a control group (n = 65) of healthy pregnant women without diabetes mellitus (DM); a PGDM group (n = 43) of pregnant women having type 2 DM in a controlled diabetic state; and a GDM group (n = 26) of pregnant women with GDM diagnosed with 2‐h 75‐g oral glucose tolerance test and received intervention to reduce the diabetic impact on fetus. During neurosonographic evaluation, the simultaneous measurements of corpus callosum (CC) width and depth in the midsagittal image; and lateral craniocortical and posterior craniocortical widths of the subarachnoid space and insular and parieto‐occipital fissure depths in the axial image were performed. Before statistical analysis, these values were carefully adjusted for the occipitofrontal diameter. Results: The DM groups displayed substantially higher frequencies of family history of DM and obstetric history of GDM compared to the control group (p < 0.05). Regarding the neurosonographic parameters, the CC length and insular and parieto‐occipital fissure depths were significantly increased in the GDM group but not in the PGDM group (p < 0.05). No significant difference was found among the study groups regarding other neurosonographic parameters (p > 0.05). Conclusion: The results of neurosonographical evaluation of fetal brain structures and spaces reveal that diabetic impact may not be seen in the presence of PGDM, especially in pregnant women receiving prenatal interventions to reduce or avoid diabetic adverse effects on fetal brain development. The effect of GDM on neurosonographically assessed fetal brain development should be evaluated in further studies with subjects matched for gestational weeks and antenatal care conditions. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the potential utility of dedicated neurosonography for the diagnosis of fetal brain involvement in tuberous sclerosis complex. Methods: This was a multicenter retrospective study of fetuses at high risk for tuberous sclerosis complex. Dedicated neurosonographic, fetal magnetic resonance imaging (MRI) and postnatal reports were reviewed. Data collected included reason for referral, gestational age at which cardiac rhabdomyoma was first suspected and final number of cardiac rhabdomyomas detected on dedicated imaging. We searched for tuberous sclerosis complex‐related brain involvement, defined as the presence of one or more of the following findings: white‐matter lesions; subependymal nodules; cortical/subcortical tubers; and subependymal giant‐cell astrocytoma. Results: We included 20 patients at high risk of tuberous sclerosis complex, of whom 19 were referred for the presence of cardiac rhabdomyomas and one for a deletion in chromosome 16 involving the tuberous sclerosis complex gene locus. Cardiac rhabdomyomas were diagnosed at a mean gestational age of 27 + 2 weeks (range, 16 + 0 to 36 + 3 weeks) and the mean number of cardiac rhabdomyomas per patient was 4 (range, 1–10). Brain involvement was present in 15 fetuses, in 13 of which the disease was confirmed in one or more of the following ways: chromosomal microarray analysis (n = 1), exome sequencing (n = 7), autopsy (n = 4), clinical tuberous sclerosis complex in the newborn (n = 4) and a sibling diagnosed with clinical tuberous sclerosis complex (n = 1). In two cases, the disease could not be confirmed: one was lost to follow‐up and autopsy, following termination of pregnancy, was not performed in the other. Among the five cases without brain findings, tuberous sclerosis complex was confirmed in three by exome sequencing (n = 2) and/or autopsy findings (n = 2). The two remaining cases had normal exome sequencing; one case had five cardiac rhabdomyomas, which was a highly suggestive finding, while in the final case, the autopsy was considered normal, representing the only false‐positive case in our cohort. Conclusions: Contrary to current literature, dedicated neurosonography appears to be effective in the diagnosis of brain involvement in fetuses at risk of tuberous sclerosis complex and should be used as the first‐line approach. Although the number of cases in which MRI was performed was small, it seems that, in the presence of ultrasound findings, the added value of MRI is low. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To describe the appearance and size of the ganglionic eminence (GE) in normal fetuses on midtrimester three‐dimensional (3D) neurosonography and to report on the association between GE alterations (cavitation or enlargement) and malformation of cortical development (MCD). Methods: This was a prospective multicenter cohort study of normal fetuses and a retrospective analysis of pathological cases with MCD. From January 2022 to June 2022, patients attending our tertiary centers for an expert fetal brain scan were recruited for the purpose of the study. A 3D volume of the fetal head, starting from the sagittal plane, was acquired in apparently normal fetuses using a transabdominal or transvaginal approach. Stored volume datasets were then evaluated independently by two expert operators. Two measurements (longitudinal diameter and transverse diameter) of the GE in the coronal view were obtained twice by each operator. Intra‐ and interobserver measurement variation was calculated. Reference ranges for GE measurements were calculated in the normal population. A previously stored volume dataset of 60 cases with MCD was also analyzed independently by the two operators using the same method in order to assess if GE abnormalities (cavitation or enlargement) were present. Postnatal follow‐up was obtained in all cases. Results: In the study period, 160 normal fetuses between 19 and 22 weeks of gestation were included in the study. The GE was visible in the coronal plane on 3D neurosonography in 144 (90%) cases and was not clearly visible in the remaining 16 (10%) cases. The intra‐ and interobserver agreement was almost perfect for the longitudinal diameter, with an intraclass correlation coefficient (ICC) of 0.90 (95% CI, 0.83–0.93) and 0.90 (95% CI, 0.86–0.92), respectively, and substantial for the transverse diameter, with an ICC of 0.80 (95% CI, 0.70–0.87) and 0.64 (95% CI, 0.53–0.72), respectively. A retrospective analysis of 50 cases with MCD in the second trimester showed that GE enlargement was present in 12 cases and GE cavitation was present in four cases. Conclusions: Systematic assessment of the GE in fetuses at 19–22 weeks of gestation is feasible on 3D neurosonography, with good reproducibility in normal cases. Cavitation or enlargement of the GE can be demonstrated in fetuses with MCD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To investigate measurements on neurosonography of midbrain morphology, including corpus callosum–fastigium length and tectal length, in late‐onset small fetuses subclassified as small‐for‐gestational‐age (SGA) or growth‐restricted (FGR). Methods: This was a case–control study of consecutive singleton pregnancies delivered at term at a single center between January 2019 and July 2021, including those with late‐onset smallness (estimated fetal weight (EFW) < 10th centile) and appropriate‐for‐gestational‐age controls matched by age at neurosonography. Small fetuses were further subdivided into SGA (EFW between 3rd and 9th centile and normal fetoplacental Doppler) and FGR (EFW < 3rd centile or EFW < 10th centile with abnormal cerebroplacental ratio and/or uterine artery Doppler). Transvaginal neurosonography was performed at a mean ± SD gestational age of 33 ± 1 weeks in all fetuses to evaluate corpus callosum–fastigium length and tectal length in the midsagittal plane. Intra‐ and interobserver agreement was evaluated using the intraclass correlation coefficient and Bland–Altman plots. Results: A total of 70 fetuses with late‐onset smallness (29 with SGA and 41 with FGR) and 70 controls were included. Compared with controls, small fetuses showed significantly shorter corpus callosum–fastigium length (median (interquartile range), 44.7 (43.3–46.8) mm vs 43.7 (42.4–45.5) mm, P < 0.001) and tectal length (mean ± SD, 10.5 ± 0.9 vs 9.6 ± 1.0 mm, P < 0.001). These changes were more prominent in FGR fetuses, with a linear trend across groups according to severity of smallness. Corpus callosum–fastigium length and tectal length measurements showed excellent intra‐ and interobserver reliability. Conclusions: Small fetuses exhibited shorter corpus callosum–fastigium length and tectal length compared with controls, and these differences were more pronounced in fetuses with more severe smallness. These findings illustrate the potential value of midbrain measurements assessed on neurosonography as biomarkers for brain development in a high‐risk population. However, further studies correlating these parameters with postnatal functional tests and follow‐up are needed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review and meta-analysis was to compare the additional value of fetal neurosonography (NS) and fetal magnetic resonance imaging (MRI) in fetuses at risk for brain anomalies. Materials and Methods: This systematic review article was conducted based on PRISMA guidelines. On January 30, 2021, a systematic search was conducted using Embase, Medline, Web of Science, Scopus, and the Cochrane Library, with no language restrictions. The purpose was to identify all articles comparing NS with fetal MRI, in cases of suspected brain abnormalities. The statistical analysis was performed using STATA-15 and Meta-Disk 1.4 software. Results: Eight articles were included in this review. The overall agreement rate between NS and MRI was 81%. Data from NS changed the management of 6% of patients, and MRI data added data to the results of NS, in 9% of cases. In cases where the fetal MRI was normal, the added value of the postnatal MRI was 4%. Conclusion: When brain abnormalities are suspected, based on NS, MRI can play a significant role in the diagnostic path by clarifying the findings and significantly increasing the detection of abnormalities, especially when abnormalities are suspected in the posterior, midline, or cortical areas of the brain. [ABSTRACT FROM AUTHOR]

Objective: To explore the value of magnetic resonance imaging (MRI) in fetuses with periventricular pseudocysts (PVPC) and the neurodevelopmental outcomes of these fetuses via meta-analysis. Methods: MEDLINE and EMBASE database were searched for studies reporting on the MRI assessment of fetuses diagnosed with PVPC on neurosonography. The neurosonography was conducted according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines or standard axial, coronal and sagittal planes for advanced central nervous system (CNS) assessment. Single-shot fast spin-echo T2-weighted sequences of MRI technique in three orthogonal planes were necessarily performed. The pooled proportion of CNS anomalies missed on neurosonography and detected only at prenatal MRI was calculated. Subanalysis was performed according to the types of intracranial anomalies. The pregnancy outcomes (including normal, abnormal, termination of pregnancy, and perinatal death) of PVPC fetuses were also analyzed. Results: Five studies comprising 136 fetuses were included in this meta-analysis. Mean gestational age was 29.8 weeks (16–38 weeks) at ultrasonography and 31.5 weeks (25–37 weeks) at MRI. Overall, MRI detected exclusively CNS anomalies in 25.2% (95% CI 15.9–35.8%) of cases. Among them, the highest incidence was white matter abnormalities with the pooled proportion of 16.3% (95% CI 9.7–24.2%). When getting rid of white matter abnormalities, the risk of associated CNS anomalies only detected on MRI was reduced to 9.1% (95% CI 1.8–21.4%). Meanwhile, 130 cases were studied to assess the pregnancy outcomes with the scope of 1 month to 10 years. The pooled proportion of normal outcomes in isolated PVPC fetuses was as high as 95.0% (95% CI 83.9–99.8%). When analyzing the neurodevelopmental outcomes in non-isolated PVPC fetuses, the incidence of normal neurodevelopmental outcomes was about 22.1% (95% CI 5.6–45.5%) with mild and single additional abnormalities, the rate of abnormal neurodevelopmental outcomes was 19.5% (95% CI 11.0–29.7%) with apparent and/or multiple abnormalities. Besides, 53.6% (95% CI 35.4–71.3%) of non-isolated PVPC cases were terminated mainly due to infections, genetic anomalies, metabolic disorders and hemorrhage. Conclusions: MRI assessment of PVPC fetuses is recommended to detect associated intracranial anomalies that may be missed on dedicated neurosonography. White matter abnormalities on MRI account for the majority of additional anomalies, which might to be the clue of CMV infection, aminoacidopathy or white matter disease. Moreover, the neurodevelopmental outcome of isolated PVPC fetuses remains favorable, while the neurodevelopmental outcomes of non-isolated PVPC fetuses depend on the accompanying anomaly. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to describe a cohort of fetuses with an ultrasound prenatal diagnosis of obliterated cavum septi pellucidi (oCSP) with the aim to explore the rate of associated malformations, the progression during pregnancy and the role of fetal magnetic resonance imaging (MRI). Material and methods: This was a retrospective multicenter international study of fetuses diagnosed with oCSP in the second trimester with available fetal MRI and subsequent ultrasound and/or fetal MRI follow-up in the third trimester. Where available, postnatal data were collected to obtain information on neurodevelopment. Results: We identified 45 fetuses with oCSP at 20.5 weeks (interquartile range 20.1-21.1). oCSP was apparently isolated at ultrasound in 89% (40/45) and fetal MRI found additional findings in 5% (2/40) of cases, including polymicrogyria and microencephaly. In the remaining 38 fetuses, fetal MRI found a variable amount of fluid in CSP in 74% (28/38) and no fluid in 26% (10/38). Ultrasound follow-up at or after 30 weeks confirmed the diagnosis of oCSP in 32% (12/38) while fluid was visible in 68% (26/38). At follow-up MRI, performed in eight pregnancies, there were periventricular cysts and delayed sulcation with persistent oCSP in one case. Among the remaining cases with normal follow-up ultrasound and fetal MRI findings, the postnatal outcome was normal in 89% of cases (33/37) and abnormal in 11% (4/37): two with isolated speech delay, and two with neurodevelopmental delay secondary to postnatal diagnosis of Noonan syndrome at 5 years in one case and microcephaly with delayed cortical maturation at 5 months in the other. Conclusions: Apparently isolated oCSP at mid-pregnancy is a transient finding with the visualization of the fluid later in pregnancy in up to 70% of cases. At referral, associated defects can be found in around 11% of cases at ultrasound and 8% at fetal MRI indicating the need for a detailed evaluation by expert physicians when oCSP is suspected. [ABSTRACT FROM AUTHOR]

Background: Volume measurements of fetal cisterna magna (CM) by three-dimensional (3D) ultrasonography may have a role in the diagnosis of various posterior fossa abnormalities. Purpose: To evaluate reference intervals and reliability of fetal CM volume values by virtual organ computer-aided analysis (VOCAL) in structurally normal fetuses, considering experience of evaluators. Material and Methods: Three operators with different 3D sonography experience levels measured CM volumes of 100 structurally normal fetuses at 18–27 weeks of gestation. Reference intervals for CM volumes were generated. Intraclass correlation coefficients (ICC) were calculated. Results: Mean fetal CM volume measurements by the three operators did not significantly (P = 0.49, P = 0.22, and P = 0.17, respectively) change through 20–23 weeks of gestation. Moderate degrees of inter-observer reliability were found with an ICC of 0.69 between novice and intermediate-level, ICC of 0.74 between experienced and intermediate-level, and ICC of 0.78 between experienced and novice observer, respectively. The novice sonographer generally overestimated CM measurements. Intra-observer reliability was good (ICC=0.85). Conclusion: A reference chart for fetal CM volume by VOCAL was formed, revealing uniform mean values of 20–23 weeks of gestation. The inter-observer reliability is moderate, and biases seem relatively common for all experience categories. [ABSTRACT FROM AUTHOR]

Introduction: Intracranial abnormalities include hydrocephalus, intracranial haemorrhage and related hypoxic-ischemic damage, for which diagnosis can be confirmed by the transcranial ultrasound. Apart from this, transcranial ultrasound may also be helpful in screening of suspected intracranial infections and tumour. Various studies have demonstrated high sensitivity and specificity of transcranial ultrasound in detecting various intracranial abnormalities. Aim: To evaluate the efficiency of ultrasonography in the diagnosis of intracranial abnormalities in neonates. Materials and Methods: This observational cross-sectional study was conducted in the Department of Radiodiagnosis, SBKS MIRC Sumandeep Vidyapeeth, Piparia, Vadodara from February 2019 to August 2020. Forty neonates with abnormal neurological presentation were included in the study and detailed data regarding prenatal, perinatal and postnatal period was obtained from parents and entered in questionnaire. Length, weight was noted. Further, all the neonates were subjected to relevant blood investigations such as Complete Blood Count (CBC), blood glucose and other investigations depending upon the clinical findings. All the neonates were then subjected to transcranial ultrasonography. Results: In present study, mean gestational age of 40 neonates was 35.38±3.59. Male preponderance was noted in present study with male:female ratio of 2.08:1. Mean birth weight of neonates was 2.11±0.60. Most common mode of delivery was vaginal in 57.5% cases followed by Lower (uterine) Segment Caesarean Section (LSCS) in 27.5% cases. Antenatally, steroids are given in only 25% of the cases in present study. Most common clinical manifestation was seizures and lethargy. Transcranial ultrasound revealed germinal matrix hemorrhage in majority of neonates. Conclusion: Transcranial ultrasound is recommended in every high risk neonate as a first line modality to assess the presence of intracranial abnormalities and for timely referral to higher-centres. It is quick, inexpensive, portable, non invasive and free from ionising radiation.

Christy L Pylypjuk,1 Shiza F Memon,2 Bernard N Chodirker3 1Department of Obstetrics, Gynecology and Reproductive Sciences (Section of Maternal-Fetal Medicine), Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; 2Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada; 3Departments of Pediatrics and Child Health (Section of Genetics and Metabolism) & Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, CanadaCorrespondence: Christy L Pylypjuk, WN5002, HSC Women’s Hospital, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada, Tel +1 204 787-4821, Fax +1 204 787-2920, Email cpylypjuk@hsc.mb.caObjective: To evaluate the utility of measuring fetal cavum septum pellucidum (CSP) width during routine, mid-pregnancy ultrasound for improving diagnosis of 22q11.2 deletion syndrome amongst fetuses with and without conotruncal anomalies.Patients and Methods: This was a retrospective case-control study (2005– 2016). Fetuses and newborns with 22q11.2 deletion and/or conotruncal cardiac anomalies were identified using a regional, clinical database. A control group was assembled in a 2:1 ratio to create three groups for comparison: i) 22q11.2 deletion syndrome; ii) isolated conotruncal anomalies; and iii) controls. Eligibility was restricted to those with stored ultrasound images between 18– 22 weeks’ gestation and a minimum biparietal diameter of 40 mm. Post-processing measurement of CSP width was performed in a standardized fashion by two blinded and independent study personnel. Descriptive and inferential statistics, regression modeling, and receiver operator curves (ROC) were used to compare outcomes between groups and evaluate sensitivity/specificity of CSP width as a marker of 22q11.2 deletion syndrome.Results: Twenty-nine cases of 22q11.2 deletion and 64 cases of isolated conotruncal anomalies were matched to 186 healthy controls. Cases with 22q11.2 deletion syndrome had significantly larger CSP widths (5.36 mm; SD=1.2) compared to those with isolated conotruncal anomalies (3.75 mm; SD=1.11) and healthy controls (2.93 mm; SD=0.57; p< 0.0001). There was no difference in CSP width amongst those with 22q11.2 deletion irrespective of the presence/absence of a conotruncal anomaly (p=0.362), or by type of conotruncal anomaly (p=0.211). Using a CSP width cutoff > 4.3 mm, fetuses with 22q11.2 deletion can be accurately identified with good sensitivity (89.7%) and specificity (84%).Conclusion: Fetuses with 22q11.2 deletion syndrome have dilated CSPs when compared to those with isolated conotruncal anomalies or controls. Because CSP dilation can be evaluated during routine mid-pregnancy ultrasound using standard images of the fetal head, measurement could easily be incorporated to enhance prenatal diagnosis of this phenotypically diverse condition.Keywords: DiGeorge syndrome, 22q11 microdeletion, cavum septum pellucidum, prenatal diagnosis, fetal ultrasound, neurosonography

Introduction: Wallenberg-Zakharchenko syndrome (lateral medullary syndrome) occurs when a cerebral accident in the basin of the PICA (posterior inferior cerebellar artery), leads to infarction of the lateral medulla. In younger patients, infarcts in this area are often associated with variations in cerebral circulation. Objective: To present patients with clinical Wallenberg-Zakharchenko syndrome and variations in cerebral circulation as the only risk factor at a younger age. Materials and methods: Six patients (4 women and 2 men) with an average age of 50 years with brainstem ischemic stroke and clinical symptoms of Wallenberg-Zakharchenko syndrome were analyzed. To establish the causes of the cerebrovascular accidents at a younger age, the following investigations were performed: CTangiography, neurosonography, lipid profile, thrombophilia screening, cardiac evaluation. As the only identified risk factor, variations in cerebral circulation were specified. Vertebral artery hypoplasia was present in 5 patients with stroke-related location, in one of whom a multiple variety was found including also a hypoplastic posterior communicating artery. In one of the patients, hypoplasia of the vertebral artery, contralateral to the accident, and the presence of an anterior trifurcation were visualized. Conclusion: Vascular anomalies of cerebral circulation are among the risk factors for cerebrovascular accidents, especially among younger patients. Neurosonography is a non-invasive, easily applicable, painless and risk-free method for their visualization and follow-up for both diagnosis and prevention. [ABSTRACT FROM AUTHOR]

Introduction: Gómez-López-Hernández syndrome (GLHS), also known as cerebello-trigeminal-dermal dysplasia, is an extremely rare neurocutaneous disease, classically described by the triad of rhombencephalosynapsis (RES), bilateral focal alopecia, and trigeminal anesthesia. The clinical and radiographic spectrum of GLHS is now known to be broader, including craniofacial and supratentorial anomalies, as well as neurodevelopmental issues. Case Presentation: Here, we present a case of antenatally diagnosed GLHS with RES, hydrocephaly, and craniofacial anomalies identified on ultrasound (low-set ears with posterior rotation, hypertelorism, midface hypoplasia, micrognathia, and anteverted nares) which were confirmed by autopsy after termination of pregnancy at 23 weeks of gestation. Discussion: As no known genetic causes have been identified and the classical triad is not applicable to prenatal imaging, prenatal diagnosis of GLHS is based on neuroimaging and the identification of supporting features. In presence of an RES associated with craniofacial abnormalities in prenatal (brachycephaly, turricephaly, low-set ears, midface retrusion, micrognathia), GLHS should be considered as "possible" according to postnatal criteria. [ABSTRACT FROM AUTHOR]

The septum pellucidum is a virtual cavity located at the anterior part of the brain midline, which only in fetal life has a certain amount of fluid inside. The presence of an obliterated cavum septi pellucidi (oCSP) in the prenatal period is poorly described in the literature but, nevertheless, it constitutes an important clinical dilemma for the fetal medicine specialist in terms of significance and prognosis. Moreover, its occurrence is increasing maybe because of the widespread of high-resolution ultrasound machine. The aim of this work is to review the available literature regarding the oCSP along with the description of a case-report of oCSP with an unexpected outcome. A search of the literature through Pubmed was performed up to December 2022 with the aim to identify all cases of oCSP previously described, using as keywords "cavum septi pellucidi," "abnormal cavum septi pellucidi," "fetus," and "septum pellucidum." Along with the narrative review, we describe a case-report of oCSP. A 39 years old woman was diagnosed with a nuchal translucency between the 95° and 99° centile in the first trimester and an oCSP and "hookshaped" gallbladder at 20 weeks. Left polymicrogyria was found at fetal magnetic resonance imaging (MRI). Standard karyotype and chromosomal microarray analysis (CMA) were normal. After birth, the newborn presented signs of severe acidosis, untreatable seizures and multiorgan failure leading to death. A targeted gene analysis of the epilepsy panel revealed the presence of a de novo pathogenic variant involving the PTEN gene. The literature review identified four articles reporting on the oCSP of which three were case report and one was a case-series. The reported rate of associated cerebral findings is around 20% and the rate of adverse neurological outcome is around 6%, which is higher than the background risk of the general population. This case-report and review of the literature shows that oCSP is a clinical entity poorly described so far and that, despite the generally good prognosis, it requires caution in counseling. The diagnostic work-up should include neurosonography while fetal MRI may be always indicated for non-isolated cases only, depending on local facilities. Targeted gene analysis or whole exome sequencing may be indicated for non-isolated cases. [ABSTRACT FROM AUTHOR]

Background: While neonatal brain US is emerging as an imaging modality with greater portability, widespread availability and relative lower cost compared to MRI, it is unknown whether US is being maximized in infants to increase sensitivity in detecting intracranial pathology related to common indications such as hemorrhage, ischemia and ventriculomegaly. Objective: To survey active members of the Society for Pediatric Radiology (SPR) regarding their utilization of various cranial US techniques and reporting practices in neonates. Materials and methods: We distributed an online 10-question survey to SPR members to assess practice patterns of neonatal cranial US including protocol details, use of additional sonographic views, perceived utility of spectral Doppler evaluation, and germinal matrix hemorrhage and ventricular size reporting preferences. Results: Of the 107 institutions represented, 90% of respondents were split evenly between free-standing children's hospitals and pediatric departments attached to a general hospital. We found that most used template reporting (72/107, 67%). The anterior fontanelle approach was standard practice (107/107, 100%). We found that posterior fontanelle views (72% sometimes, rarely or never) and high-frequency linear probes to evaluate far-field structures (52% sometimes, rarely or never) were seldom used. Results revealed a range of ways to report germinal matrix hemorrhage and measure ventricular indices to assess ventricular dilatation. There was substantial intra-institutional protocol and reporting variability as well. Conclusion: Our results demonstrate high variability in neurosonography practice and reporting among active SPR members, aside from the anterior fontanelle views, template reporting and linear high-resolution near-field evaluation. Standardization of reporting germinal matrix hemorrhage and ventricular size would help ensure a more consistent application of neonatal US in research and clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of fetal brain magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses with congenital cytomegalovirus (CMV) infection and normal neurosonography. Methods: This was a multicenter, retrospective cohort study of patients examined between 2012 and 2021 in 11 referral fetal medicine centers in Italy. Inclusion criteria were fetuses with congenital CMV infection diagnosed by polymerase chain reaction analysis of amniotic fluid, pregnancies that underwent detailed multiplanar ultrasound assessment of the fetal brain as recommended by the International Society of Ultrasound in Obstetrics and Gynecology, maternal age ≥ 18 years, normal fetal karyotype and MRI performed within 3 weeks after the last ultrasound examination. The primary outcome was the rate of central nervous system (CNS) anomalies detected exclusively on MRI and confirmed after birth or autopsy in fetuses with a prenatal diagnosis of congenital CMV infection and normal neurosonography at diagnosis. Additional CNS anomalies were classified into anomalies of the ventricular and the periventricular zone, intracranial calcifications in the basal ganglia or germinal matrix, destructive encephalopathy in the white matter, malformations of cortical development, midline anomalies, posterior fossa anomalies and complex brain anomalies. We evaluated the relationship between the incidence of structural CNS malformations diagnosed exclusively on fetal MRI and a number of maternal and gestational characteristics. Univariate and multivariate logistic regression analyses were used to identify and adjust for potential independent predictors of the MRI diagnosis of fetal anomalies. Results: The analysis included 95 fetuses with a prenatal diagnosis of congenital CMV infection and normal neurosonography referred for prenatal MRI. The rate of structural anomalies detected exclusively at fetal MRI was 10.5% (10/95). When considering the type of anomaly, malformations of cortical development were detected on MRI in 40.0% (4/10) of fetuses, destructive encephalopathy in 20.0% (2/10), intracranial calcifications in the germinal matrix in 10.0% (1/10) and complex CNS anomalies in 30.0% (3/10). On multivariate logistic regression analysis, only CMV viral load in the amniotic fluid, expressed as a continuous variable (odds ratio (OR), 1.16 (95% CI, 1.02–1.21); P = 0.02) or categorical variable (> 100 000 copies/mL) (OR, 12.0 (95% CI, 1.2–124.7); P = 0.04), was independently associated with the likelihood of detecting fetal anomalies on MRI. Associated anomalies were detected exclusively at birth and missed by both prenatal neurosonography and fetal MRI in 3.8% (3/80) of fetuses with congenital CMV infection. Conclusions: Fetal brain MRI can detect additional anomalies in a significant proportion of fetuses with congenital CMV infection and negative neurosonography. Viral load in the amniotic fluid was an independent predictor of the risk of associated anomalies in these fetuses. The findings of this study support a longitudinal evaluation using fetal MRI in congenital CMV infection, even in cases with negative neurosonography at diagnosis. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To assess the added value of third trimester fetal brain MRI, performed in one tertiary referral center, in cases of isolated ventriculomegaly as established by a dedicated multiplanar neurosonography. Methods: Fetal brain MRI scans performed in a single tertiary center during a 3-year period were assessed for possible inclusion. Only cases diagnosed with ventriculomegaly without additional findings in a neurosonography preceding the MRI were included. Fetal MRI was performed at a median gestational of 32 weeks (IQR 31–34 weeks). Results: A total of 68 cases met the inclusion criteria. Of them, in four cases MRI identified additional findings including three cases of intraventricular hemorrhage and one case of cortical infarction. The overall rate of MRI-findings in the study population was (5.9%, 95% CI 2.3–14.2%). No additional findings were detected in cases of mild ventriculomegaly, 6.1% in moderate and 25% in severe ventriculomegaly. The combined rate of additional findings in mild to moderate ventriculomegaly was 3.3% (95%CI 0.9–11.4%). Conclusions: MRI was able to detect additional findings in 5.9% of cases with seemingly isolated ventriculomegaly after a dedicated neurosonography. The severity of ventriculomegaly is associated with a higher chance of detecting abnormalities in fetal brain MRI. [ABSTRACT FROM AUTHOR]

Background: Periventricular/intraventricular hemorrhage (PVH/IVH) has a major impact on neurodevelopment due to its complications and sequelae. Objectives: This study aimed to determine the frequency of neurosonographic examination and the length of the monitoring period in children diagnosed with PVH/IVH. Methods: This clinical observational analytical retrospective cohort study was performed on 102 children diagnosed with PVH/IVH. The examinations were done on the third, seventh, fourteenth, and twenty-first days after birth and then in the fourth and sixth weeks and the third and sixth months afterbirth. The results of the examinations performed overtime were subjected to the kappa measure of agreement test, with a significance threshold of 0.05, to determine the period when the most significant changes occur in the patient's condition, as well as to determine the optimum frequency of the examination. Results: There was statistically significant agreement between the results of all the examinations performed in the observed moments (P< 0.0005). However, it is indicative that the agreement was excellent for the fourth week (kappa agreement was more than 0.85), followed by the sixth week that was very good (kappa agreement was 0.79); however, the agreement for the sixth week and the third month was very small (kappa agreement was less than 0.1). Also, there were no major changes (kappa agreement between results from the third and sixth months was 0.88). Conclusions: The first neurosonographic examination should be conducted in the first 7 days after birth, and the control examination should be conducted at the age of 4 - 6 weeks. If a pathological finding is observed, the examination is repeated after the specified period until a stationary finding is observed. After the third month, no new changes in the finding are observed. [ABSTRACT FROM AUTHOR]

Introduction. Pneumonia remains an acute problem not only in pulmonology, but also in pediatrics in general. The prognosis of neonatal pneumonia depends on the perinatal period course. In this case, the predictor of risk is the state of the brain, the main organ that regulates the whole organism’s work. The most available method for brain condition’ assessing in children of the first year of life is neurosonography. The ability of the brain to restore impaired functions is very high during infancy. Early diagnosis and treatment of the correlation relationships’ violations of brain structures in pneumonia of newborns will help prevent an unfavorable outcome of the disease.Aim. Тo study the features of the correlation relationships of structural changes of the brain in pneumonia in infants.Materials and methods. Neurosonographic study was carried out at 57 children: with pneumonia without concomitant diseases (17 children – group 1), against the background of: perinatal lesions of the nervous system (group 17 – 2), jaundice (group 16 – 3), congenital heart defects (group 7 – 4) with SonoScape 1000 apparatus. Neurosonography and echocardiography were performed with a sector transducer with a frequency of 7.5 MHz. All 377 correlations were assessed for 25 studied parameters.Results. The study of correlations revealed the predominant participation of the sections of the right lateral ventricle and the flow system of the brain. The severity of synchronous functional activity (the number of correlations) characterizes the degree of functional tension, stress reaction of the studied structural part and has a relatively greater risk of depletion and, as a consequence, a greater likelihood of destructuring. In the process of adaptation and the formation of compensatory mechanisms, the predominant functional load falls on the right parts of the brain (right lateral ventricle).Conclusions. The most pronounced changes in brain structures during neurosonography were found in infants with pneumonia, which developed against the background of neonatal jaundice and congenital heart defects. In all groups of patients with neonatal pneumonia, correlations were found between the parameters of the structure and flow system of the brain, laboratory parameters indicating the tension of the compensatory mechanisms of organs and systems. The revealed changes characterized the developing of the hydrocephalus in the absence of pathognomonic clinical and neurological symptoms in patients.

Objective: We aimed to explore fetal cortical brain development by neurosonography in fetuses conceived by assisted reproductive technology (ART), including frozen and fresh embryo transfer (ET), compared with those conceived spontaneously (SC), and to investigate its association with infant neurobehavior at 12 months of age.Methods: This was a prospective cohort study of 210 singleton pregnancies, including 70 SC pregnancies, 70 conceived by in-vitro fertilization (IVF) following frozen ET and 70 conceived by IVF after fresh ET. Fetal neurosonography was performed at 32 ± 2 gestational weeks to assess cortical development. Sulci depths were measured offline and normalized by biparietal diameter (BPD). Ages and Stages Questionnaires (ASQ) were completed postnatally, at 12 ± 1 months of corrected age. Neurosonographic findings were adjusted by regression analysis for maternal age, ethnicity, parity, fetal sex and fetal-weight centile and gestational age at scan, and ASQ scores were adjusted for maternal age, ethnicity, parity, educational level and employment status, gestational age at birth, breastfeeding, infant sex and infant age at the ASQ evaluation.Results: Overall, in comparison to the SC fetuses, fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto-occipital sulci depth adjusted for BPD (mean ± SD: fresh ET, 12.5 ± 2.5 vs frozen ET, 13.4 ± 2.6 vs SC, 13.4 ± 2.6, P < 0.001), cingulate sulci depth adjusted for BPD (median (interquartile range (IQR)): fresh ET, 5.8 (4.2-7.4) vs frozen ET, 5.8 (4.1-7.5) vs SC, 6.5 (4.8-7.8), P = 0.001) and calcarine sulci depth adjusted for BPD (median (IQR): fresh ET, 13.5 (10.1-16.1) vs frozen ET, 14.5 (12.1-15.8) vs SC, 16.4 (14.3-17.9), P < 0.001), together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET than in the frozen ET group. ART infants showed lower ASQ scores as compared to SC infants, particularly in the fresh ET group (mean ± SD global ASQ Z-score: fresh ET, -0.3 ± 0.4 vs frozen ET, -0.2 ± 0.4 vs SC, 0 ± 0.4, P < 0.001).Conclusions: Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in those conceived following fresh ET. These findings support the existence of in-utero brain reorganization associated with ART and warrant follow-up studies to assess its long-term persistence. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

(1) Background: Peripheral nerve injuries are severe injuries with potentially devastating impairment of extremity function. Correct and early diagnosis as well as regular regeneration observation is of utmost importance for individualized reconstruction and the best possible results. Currently, diagnoses and follow-up examinations are based on clinical examinations supported with electroneurography, which often causes delays in treatment and can result in impaired healing. However, there is currently no diagnostic device that can reliably correlate the anatomic–pathological parameters with the functional–pathological changes initially and during therapy. With new technologies such as MR neurography (MRN), precise visualization of potential nerve damage and visualization of the reinnervation processes is assumed to accelerate clinical decision making and accompaniment of individualized treatment. (2) Methods/Design: This prospective clinical study will examine 60 patients after peripheral nerve lesion aged 18–65 years from trauma timepoint onward. Patients should be observed over a period of 18–24 months with regular clinical examinations, electroneurography, and ultrasound to compare the potential of MRN to current gold-standard diagnostic tools. Furthermore, 20 patients with the same inclusion criteria stated above, with an internal fixation and osteosyntheses of humerus fractures, will be examined to determine the visibility of peripheral nerve structures in close proximity to metal. (3) Discussion: Peripheral nerve injuries are often accompanied with severe, expensive, and long-lasting impairment of extremity function. An early and precise diagnosis of the nerve lesion, as well as the healing course, is crucial to indicate the right therapy as soon as possible to save valuable time for nerve regeneration. Here, new technologies such as MRN aim to visualize nerve injuries on fascicular level, providing not only early diagnosis and therapy decisions, but also providing a precise tool for monitoring of reinnervation processes. As severe injuries of a nerve are often accompanied with bone fractures and internal fixation, we also aim to evaluate the visualization feasibility of nerves in close proximity to metal, and ultimately improve the outcome and extremity function of patients after a peripheral nerve injury. [ABSTRACT FROM AUTHOR]

Objective: To investigate the adaptation of the anterior cerebral artery (ACA) in fetuses with fetal growth restriction (FGR) and assess if forebrain and midbrain structures are affected by vascular adaptations., Methods: A prospective case-control study involving normally developed fetuses and those with late-onset FGR (estimated fetal weight < 3rd percentile and/or abdominal circumference < 3rd percentile). Doppler indices of the middle cerebral artery (MCA), ACA and umbilical artery (UA) were determined between 32 + 0 and 37 + 0 weeks. Neurosonography assessed the depth of the insula, the sylvian fissure, and the antero-posterior diameter of the frontal lobes (FAPD)., Results: The cerebral-placental ratio (CPR) and cerebro-placental-uterine ratio (CPUR) were lower in FGR cases. ACA PI percentile values were significantly lower in the FGR group (p = 0.020). Sylvian fissure depth was significantly lower in FGR fetuses., Conclusion: The ACA may be the first cranial vascular structure affected in fetuses with FGR. This may be related to the impact on postnatal cognitive functions in FGR patients., Trial Registration: NCT06215690., (© 2024 Wiley Periodicals LLC.)

Background: Neurosonography has been widely used for screening and early detection of Central Nervous System (CNS) defects, such as intraventricular hemorrhage, hydrocephalus, cerebral edema, or any structural anomalies in the neonatal brain in the neonatal intensive care unit (NICU) of a tertiary level hospital. The present study aimed to assess the detection of CNS abnormalities by neurosonography in critically ill neonates.Methods: This prospective cross-sectional study at the Neonatology Unit of the Paediatric Department of Acharya Vinoba Bhave Rural Hospital (AVBRH). A neonate was described as “critically ill” based on detailed maternal history and clinical examination. These neonates were subjected to neurosonography according to the inclusion and exclusion criteria in accordance with the noted protocols and various anomalies. Gestational age, birth weight, clinical examination, investigation, neurosonography finding, and outcomes were evaluated.Results: Neurosonography was performed in 105 critically ill neonates, out of whom 21 cases had abnormal neurosonography findings. Abnormal neurosonography was not significantly correlated with birth weight and gestational age of high-risk neonates (P=0.538 &P=0.130). The most frequent clinical manifestation was respiratory distress syndrome, followed by a neonatal seizure. The mean scores of heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and oxygen saturation were obtained at 140±19.81, 54.08±13.07, 90.96±8.66, 54.13±8.39, and 94.39±6.93, respectively.Conclusion: Neurosonography is a useful tool in NICU. It is an acceptable and reliable modality to screen critically ill neonates, assisting the early detection and management of these ill neonates.

Abstract Fetal growth restriction (FGR) occurswhen the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality. Children born with FGR are at risk of impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood. The purpose of the present revision is to perform a literature search for evidence on the detection and assessment by ultrasound of brain injury linked to FGR during fetal life. Using a systematic approach and quantitative evaluation as study methodology, we reviewed ultrasound studies of the fetal brain structure of growth-restricted fetuses with objective quality measures. A total of eight studies were identified. High quality studies were identified for measurement of brain volumes; corpus callosum; brain fissure depth measurements, and cavum septi pellucidi width measurement. A low-quality study was available for transverse cerebellar diameter measurement in FGR. Further prospective randomized studies are needed to understand the changes that occur in the brain of fetuseswith restricted growth, as well as their correlation with the changes in cognitive development observed.

A case of vertical transmission in a 35-year-old pregnant woman, gravida 4, para 2 with an unknown medical history of carrying primary syphilis is described. A routine 3rd trimester scan was performed at 30 + 5 weeks of pregnancy, which revealed fetal growth restriction (FGR) associated with absent fetal movement, a pathologic neuroscan characterized by cortical calcifications and ominous Doppler waveform analysis of the umbilical artery and ductus venosus. Computerized electronic fetal monitoring (EFM) showed a Class III tracing, according to the American College of Obstetricians and Gynecologists (ACOG) guidelines. An emergency C-section was performed and a female newborn weighing 1470 g was delivered. The Apgar scores were 5 and 8 at the first and fifth min, respectively. Besides the prompted obstetrical and neonatal interventions, the neonate died after 7 days. A histologic examination of the placenta revealed a chorioamnionitis at stage 1/2 and grade 2/3. The parenchyma showed diffuse delayed villous maturation, focal infarcts, and intraparenchymal hemorrhages. The decidua presented with chronic deciduitis with plasma cells. The parents declined the autopsy. Congenital syphilis is an emerging worldwide phenomenon and the multidisciplinary management of the mother and the fetus should be mandatory. [ABSTRACT FROM AUTHOR]

Neurosonography (NSG) is a readily available non-invasive radiological examination technique that assesses brain damage in neonates who experienced perinatal hypoxia. The aim of the study was to determine the relationship between hypoxic-ischemic (HI) brain injuries in full-term neonates detected during ultrasonography and mental and neuromotor development outcomes at an early school age. We evaluated 8--9-yearold children (n = 32) who had experienced hypoxia at birth with mild to moderate hypoxic-ischemic encephalopathy (HIE) and hadn't undergone therapeutic hypothermia. The control group consisted of 8--9-year-old children (n = 16) who were born healthy. During the first five days of life, the newborns underwent cerebral ultrasonography. The HIE stage was evaluated according to the Sarnat and Sarnat scale. Neuromotor and neurological outcomes were assessed using the Gross Motor Function Classification System, the Health Utilities Index (HUI) questionnaire, the Wechsler Intelligence Scale for Children WISC-III, and structured neurological examination. In the case of moderate brain edema and/or thalamus and/or basal ganglion injuries along with cerebellum and brainstem (E/T/BG/C/B) injuries compared to other injuries, the following abnormalities were statistically significantly more common: hearing disorders (100%, p = 0.03), cerebellar dysfunction (60%, p = 0.02), epilepsy (60%, p = 0.01), a lower Working Memory Index (median, 82.0, p = 0.015). In case of moderate brain swelling (edema) and thalamus and/or basal ganglion (E/T/BG) injuries, the sensitivity and specificity of the ultrasound examination when predicting epilepsy, hearing disorders, lower full IQ, and the Perceptual Organization Index were 100%. Neurosonography helps predict the outcomes of mental and neuromotor development at an early school age in fullterm neonates who experienced perinatal asphyxia/hypoxia. Moderate hypoxic-ischemic brain changes detected during ultrasonography were statistically significantly associated with hearing disorders, cerebellar dysfunction, epilepsy, and a lower Working Memory Index in children at an early school age. [ABSTRACT FROM AUTHOR]

Vein of Galen aneurysmal malformation (VGAM) is a rare foetal anomaly associated with neurodevelopment delay, cardiac failure, and even perinatal death. We aimed to assess prenatal features of VGAM and describe postnatal outcomes. This was a retrospective study involving six foetuses diagnosed with VGAM prenatally in two centres. All of the cases underwent foetal neurosonography and echocardiography. The presence of ventriculomegaly, intracranial haemorrhage and cardiac failure was recorded. Pregnancy and neonatal outcome information were obtained from medical records. The mean gestational age at diagnosis was 31.1 ± 5.1 weeks, and the mean size of VGAM was 29.2 ± 5.2 × 26.4 ± 3.3 mm. Ventriculomegaly was detected in five of six (83.3%) cases. Intracranial haemorrhage was present in five (83.3%) cases. Cardiac failure was shown in four (66.6%) foetuses. Three foetuses underwent termination of pregnancy (TOP); in two cases, neonatal death occurred. One patient was treated with endovascular embolisation, and there was no cardiac problem or neurodevelopment delay. Prenatally diagnosed VGAM have a poor prognosis, mainly if a cardiac failure or neurological consequences (intracranial haemorrhage, hydrocephaly) are present in utero. What is already known on this subject? VGAM is the most common cerebral arteriovenous malformation detected prenatally, and it can lead to severe consequences in the perinatal period. What do the results of this study add? The accuracy of foetal neurosonography is excellent for detecting VGAM and associated brain abnormalities. Foetal echocardiography is mandatory for the prediction of prognosis What are the implications of these findings for clinical practice and/or further research? VGAM is associated with severe brain injury, cardiac failure, and the prognosis is generally poor. We need predictors to identify those expected to benefit from postnatal therapy. [ABSTRACT FROM AUTHOR]

Background: Hypoxic--ischemic encephalopathy (HIE) is a devastating condition causing severe neurologic deficits and deaths in children, occurring in about 1.5 out of 1000 live births. The pattern of brain injury depends on the severity and duration of hypoxia as well as the degree of brain maturation at the time of insult. The prognosis can depend largely on diagnosing the early screening of suspected cases, assessment of severity of the injury, and timely intervention. Aims and Objectives: This study is aimed at signifying the importance of neurosonography in neonates with HIE as a diagnostic tool and screening modality in the neonatal intensive care unit (NICU) and at establishing the role of neurosonography and Doppler sonography as an investigatory modality for predicting the neurological damage and influencing their neurodevelopmental outcome. Design: This is a prospective longitudinal-type study. Materials and Methods: A total of 50 neonates admitted in the NICU were included in the study from January 2017 to August 2018 with FUJIFILM SONOSITE (Bothell, Washington, USA) machine using a high-frequency linear probe (6-12 MHz) and convex probe (2-5 MHz). A total of 50 neonates admitted to the NICU were selected and enrolled in the study after fulfilling the selection criteria. The first scans were obtained within 72 h of birth, and subsequent follow-up scans were done between the 8th and 10th day and on the 30th day. The infants were then followed up after 6 to 12 months for a detailed neurological assessment. Statistical Analysis Used: All the statistical analyses were carried out using Fisher's exact test. Results: Out of the eight neurosonographic (NSG) findings analyzed in our study that were found to be associated with hypoxemic brain changes, four of them showed a statistically significant correlation with high positive predictive value (PPV) with poor clinical outcome at 6 to 12 months of age. The PPV of neonates with ventriculomegaly, multicystic leukomalacia, abnormal Doppler indices, and intraventricular hemorrhage (IVH) was found to be 78%, 80%, 82%, and 87%, respectively. Conclusions: Neurosonography was found to be highly significant to predict the clinical outcome in neonates with HIE, and it should be used as the initial screening modality. [ABSTRACT FROM AUTHOR]