title: A diagnostic approach for the evaluation of spina bifida by three-dimensional ultrasonography.
abstract: OBJECTIVE
  To describe a prenatal diagnostic method for evaluating spina bifida by three-dimensional ultrasonography.
  
  
  METHODS
  Two- and three-dimensional ultrasonography were used to determine the extent of vertebral defects among fetuses with spina bifida. Spinal levels were independently counted from the most caudal thoracic vertebra with a rib (e.g., 12th thoracic rib). A virtual cutting plane was manipulated through a volume-rendered spine to generate optimal multiplanar views for this blinded analysis. Prenatal diagnosis was compared with a postnatal analysis of bony spine defects derived from radiographic films or magnetic resonance imaging.
  
  
  RESULTS
  Nine fetuses were examined by two-dimensional ultrasonography (21.8 +/- 3.4 menstrual weeks) and three-dimensional ultrasonography (22.8 +/- 4.4 menstrual weeks). For two-dimensional ultrasonography, the spinal level agreed to within 1 vertebral segment in 6 of 9 infants. In contrast, three-dimensional ultrasonography agreed to within 1 vertebral segment in 8 of 9 infants. Three fetuses had vertebral defect levels on two-dimensional ultrasonography that were 1.5 to 2 segments away from postnatal findings. The same fetuses had results that were within 1 vertebral segment on three-dimensional ultrasonography. Volume rendering showed splayed vertebral pedicles and disrupted vertebrae. An intact meningeal sac was easily rendered in 5 of 9 subjects.
  
  
  CONCLUSIONS
  Multiplanar views are generally more informative than rendered views for localizing bony defects of the fetal spine. The level of the defect on three-dimensional ultrasonography correlates well with those on two-dimensional ultrasonography and postnatal imaging studies. This approach may improve characterization of spina bifida by adding diagnostic information that is complementary to the initial assessment by two-dimensional ultrasonography.
authors.affiliation: Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan 48073-6769, USA.
authors.forename: Wesley
authors.initials: W
authors.lastname: Lee
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Rosa
authors.initials: R
authors.lastname: Williams
authors.forename: Beverley
authors.initials: B
authors.lastname: McNie
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Marjorie
authors.initials: M
authors.lastname: Treadwell
authors.forename: Christine H
authors.initials: CH
authors.lastname: Comstock
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D011247:Pregnancy; D016135:Spinal Dysraphism / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal / Q000379:methods*