Technical Guideline How do we do it Technical Guideline How do we do it? Practical advice on imaging-based techniques and investigations Three dimensional ultrasound examination of the fetal central nervous system Gianluigi Pilu, Tullio Ghi, Angela Carletti, Maria Segata, Antonella Perolo, Nicola Rizzo From the Department of Obstetrics and Gynecology University of Bologna, Italy Address for correspondence: gianluigi.pilu@unibo.it Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
Basic principles and terminology of 3D US: the multiplanar mode Intersection of orthogonal planes A B C Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** 3D volumes of the fetal brain obtained from an axial approach: the ‘start’ scan Cavum septi pellucidi midline Originally published in Ultrasound Obstet Gynecol ****
midline A and B rotated on Z plane until midline is aligned with C plane A B C Originally published in Ultrasound Obstet Gynecol ****
A B C Corpus callosum + cavum septi pellucidi Cerebellar vermis Originally published in Ultrasound Obstet Gynecol **** Acoustic shadow
midline midline Corpus callosum Cavum septi pellucidi Originally published in Ultrasound Obstet Gynecol ****
Angled insonation of posterior fossa to visualize brain stem Cerebellar vermis Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** hemisphere hemisphere tentorium 4v vermis hemisphere hemisphere tentorium vermis vermian fissures 4v Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** body atrium Occipital horn Temporal horn Sylvian fissure Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Normal corpus callosum Absent corpus callosum 3v Partial agenesis 3v 3v Originally published in Ultrasound Obstet Gynecol ****
Dandy-Walker malformation Normal Megacisterna magna Blake’s pouch cyst tentorium Vermian hypoplasia Dandy-Walker malformation Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol ****
Acoustic shadowing with multiplanar approach bregmatic coronal sagittal Originally published in Ultrasound Obstet Gynecol ****
Posterior fontanel approach vermis 4v Brain stem hemispheres 4v Originally published in Ultrasound Obstet Gynecol ****
Glass body rendering of intracranial arterovenous malformation Superior sagittal sinus Falcine sinus Vein of Galen Feeding arteries Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
3D ultrasound of fetal spine Posterior ossification centers body Multiplanar Maximum mode Originally published in Ultrasound Obstet Gynecol ****
Vertebral anomalies Hemi-vertebra Partial sacral agenesis Originally published in Ultrasound Obstet Gynecol ****
3D surface rendering of fetal spina bifida myelomeningocele myelocele Originally published in Ultrasound Obstet Gynecol ****
2D vs 3D ultrasound of fetal spina bifida 2D sagittal 3D multiplanar 3D maximum mode * * * Lateral splaying of neural arches Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
3D ultrasound of the embryonic cerebral vesicles at 9 weeks 1 ‘Start’ scan 4 3 5 4 Cerebral hemispheres Prosencephalic vesicle Acquedut of Sylvius Rhombencephalic vesicle Choriod plexus of 4th ventricle 2 Originally published in Ultrasound Obstet Gynecol ****
Originally published in Ultrasound Obstet Gynecol **** Outline Basic principles and terminology of 3D ultrasound 3D volumes of the fetal brain obtained from an axial approach 3D volumes of the fetal brain obtained from a coronal or sagittal approach The fetal spine Evaluation of fetal brain in the first trimester of gestation Improving the quality of 2D images with three dimensional ultrasound: Volume Contrast Imaging Conclusions Originally published in Ultrasound Obstet Gynecol ****
Principles of Volume Contrast Imaging (VCI) layer 1 layer 2 Noise and speckles Anatomical structures Improved signal to noise ratio Standard multiplanar Static VCI 3 mm thickness Originally published in Ultrasound Obstet Gynecol ****
VCI in coronal plane (VCI-C) Originally published in Ultrasound Obstet Gynecol ****
Conclusions advantages of 3D ultrasound of fetal CNS Allows to obtain scanning planes along different directions from the one of the incident sound beam (within the physical limits of ultrasound) Useful for first trimester neurosonograms Data storage, off-line analysis Originally published in Ultrasound Obstet Gynecol ****