title: What is the clinical importance of echogenic material in the fetal frontal horns?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the importance of echogenic material in the fetal frontal horns.
  
  
  METHODS
  This was a Health Insurance Portability and Accountability Act-compliant, Institutional Review Board-approved retrospective study. In part 1 of the study, prenatal sonography, prenatal magnetic resonance imaging (MRI), and birth outcomes of 17 fetuses (mean gestational age, 19 weeks; range, 15-34 weeks) with prospective echogenic material in the frontal horns were assessed. In part 2, 400 consecutive sonographic fetal surveys (mean gestational age, 19 weeks; range, 15-38 weeks) were reviewed to determine the incidence. In part 3, 2 independent reviewers assessed the appearance of the frontal horns in 40 fetuses (20 with suspected intraventricular hemorrhage from parts 1 and 2 and 20 who were interpreted to have normal findings in part 2).
  
  
  RESULTS
  Part 1 of the study showed that suspected hemorrhage was unilateral in 13 fetuses and bilateral in 4. Additional findings by sonography were grade 4 intraventricular hemorrhage (n = 2), ventriculomegaly (n = 2), and porencephaly (n = 1). An additional finding by MRI was porencephaly in 1 fetus. In part 2, echogenic material in the frontal horns was identified in 3 of 400 fetuses (0.8%). In part 3, hemorrhage was probably or definitely present in 11 of the 20 fetuses with abnormalities; material looked like a cyst in 6; and normal choroid was in an abnormal position in 2 and a normal position 1. Of 19 fetuses with abnormalities, 14 had a posteriorly symmetric choroid; 9 had material of different echogenicity compared with the choroid; and 17 had an expanded frontal horn. Birth outcomes were abnormal in 7, including platelet abnormalities (n = 2), hemorrhage on imaging or pathologic examination (n = 2), extraventricular hemorrhage (n = 3), and ventriculomegaly (n = 3).
  
  
  CONCLUSIONS
  The incidence of echogenic material in the frontal horns is less than 1%. This does not represent the normal location of the choroid plexus and may represent hemorrhage, which may resolve without sequelae or result in ventriculomegaly and porencephaly.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Neely
authors.initials: N
authors.lastname: Hines
authors.forename: Tejas
authors.initials: T
authors.lastname: Mehta
authors.forename: Janneth
authors.initials: J
authors.lastname: Romero
authors.forename: Deborah
authors.initials: D
authors.lastname: Levine
mesh_terms: D002552:Cerebral Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000196:embryology*; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*