title: Appearance of the fetal posterior fossa at 11 + 3 to 13 + 6 gestational weeks on transabdominal ultrasound examination.
abstract: OBJECTIVE
  To describe the sonographic appearance of the structures of the posterior cranial fossa in fetuses at 11 + 3 to 13 + 6 weeks of pregnancy and to determine whether abnormal findings of the brain and spine can be detected by sonography at this time.
  
  
  METHODS
  This was a prospective study including 692 fetuses whose mothers attended Innsbruck Medical University Hospital for first-trimester sonography. In 3% (n = 21) of cases, measurement was prevented by fetal position. Of the remaining 671 cases, in 604 there was either a normal anomaly scan at 20 weeks or delivery of a healthy child and in these cases the transcerebellar diameter (TCD) and the anteroposterior diameter of the cisterna magna (CM), measured at 11 + 3 to 13 + 6 weeks, were analyzed. In 502 fetuses, the anteroposterior diameter of the fourth ventricle (4V) was also measured. In 25 fetuses, intra- and interobserver repeatability was calculated.
  
  
  RESULTS
  We observed a linear correlation between crown-rump length (CRL) and CM (CM = 0.0536 × CRL - 1.4701; R2 = 0.688), TCD (TCD = 0.1482 × CRL - 1.2083; R2 = 0.701) and 4V (4V = 0.0181 × CRL + 0.9186; R2 = 0.118). In three patients with posterior fossa cysts, measurements significantly exceeded the reference values. One fetus with spina bifida had an obliterated CM and the posterior border of the 4V could not be visualized.
  
  
  CONCLUSIONS
  Transabdominal sonographic assessment of the posterior fossa is feasible in the first trimester. Measurements of the 4V, the CM and the TCD performed at this time are reliable. The established reference values assist in detecting fetal anomalies. However, findings must be interpreted carefully, as some supposed malformations might be merely delayed development of brain structures.
authors.affiliation: Department of Gynaecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Egle
authors.forename: I
authors.initials: I
authors.lastname: Strobl
authors.forename: V
authors.initials: V
authors.lastname: Weiskopf-Schwendinger
authors.forename: E
authors.initials: E
authors.lastname: Grubinger
authors.forename: F
authors.initials: F
authors.lastname: Kraxner
authors.forename: I S
authors.initials: IS
authors.lastname: Mutz-Dehbalaie
authors.forename: A
authors.initials: A
authors.lastname: Strasak
authors.forename: M
authors.initials: M
authors.lastname: Scheier
mesh_terms: D000005:Abdomen; D001699:Biometry / Q000379:methods*; D002531:Cerebellum / Q000000981:diagnostic imaging* / Q000196:embryology; D002946:Cisterna Magna / Q000000981:diagnostic imaging* / Q000196:embryology; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging* / Q000196:embryology; D018568:Crown-Rump Length; D005240:Feasibility Studies; D005260:Female; D020546:Fourth Ventricle / Q000000981:diagnostic imaging* / Q000196:embryology; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D013131:Spine / Q000000981:diagnostic imaging* / Q000196:embryology; D016216:Ultrasonography, Prenatal / Q000379:methods*