Appearance of fetal posterior fossa at 11-14 weeks in fetuses with Dandy-Walker malformation or chromosomal anomalies.
OBJECTIVE
To describe the sonographic appearance of fetal posterior fossa anatomy at 11-14 weeks of pregnancy and to assess the outcome of fetuses with increased intracranial translucency (IT) and/or brainstem-to-occipital bone (BSOB) diameter.


METHODS
Reference ranges for brainstem (BS), IT and cisterna magna (CM) measurements, BSOB diameter and the BS : BSOB ratio were obtained from the first-trimester ultrasound examination of 233 fetuses with normal postnatal outcome (control group). The intraobserver and interobserver variability of measurements were investigated using 73 stored ultrasound images. In addition, a study group of 17 fetuses with increased IT and/or BSOB diameter was selected to assess outcome.


RESULTS
No significant intraobserver or interobserver variability was found for any measurement in the control group. In the study group, IT was increased in all cases and BSOB diameter was above the 95(th) centile of the calculated normal range in all but two (88%) cases. In 13/17 study cases, only two of the three posterior brain spaces were recognized on ultrasound. These 13 fetuses had a larger BSOB diameter than did the four cases that showed all three posterior brain spaces, and had severe associated anomalies including Dandy-Walker malformation (DWM) and/or chromosomal anomalies.


CONCLUSIONS
Visualization of the fetal posterior fossa anatomy at 11-14 weeks' gestation is feasible. Increased fluid in the posterior brain at 11-14 weeks, particularly in the case of non-visibility of the septation that divides the future fourth ventricle from the CM, is an important risk factor for cystic posterior fossa malformations, in particular DWM, and/or chromosomal aberrations. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy.
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P
Volpe
Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
E
E
Contro
Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy.
T
T
Fanelli
Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy.
B
B
Muto
Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
G
G
Pilu
Medical Genetics Unit, Di Venere Hospital, ASL BA, Bari, Italy.
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M
Gentile
D016022:Case-Control Studies; D002869:Chromosome Aberrations; D025063:Chromosome Disorders / Q000000981:diagnostic imaging*; D003388:Cranial Fossa, Posterior / Q000002:abnormalities / Q000000981:diagnostic imaging*; D003616:Dandy-Walker Syndrome / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D015588:Observer Variation; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016216:Ultrasonography, Prenatal / Q000379:methods*
Dandy-Walker complex; chromosomal anomalies; first trimester; intracranial translucency; posterior fossa; prenatal diagnosis; ultrasound