1. 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:
Originally published in Ultrasound Obstet Gynecol ****

2. 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 ****

3. 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 ****

4. Basic principles and terminology of 3D US: the multiplanar mode
Intersection of orthogonal planes A B C
Originally published in Ultrasound Obstet Gynecol ****

5. 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 ****

6. 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 ****

7. midline
A and B rotated on Z plane until midline is aligned with C plane A B C
Originally published in Ultrasound Obstet Gynecol ****

8. A B C Corpus callosum + cavum septi pellucidi Cerebellar vermis
Originally published in Ultrasound Obstet Gynecol ****
Acoustic shadow

9. midline midline Corpus callosum Cavum septi pellucidi
Originally published in Ultrasound Obstet Gynecol ****

10. Angled insonation of posterior fossa to visualize brain stem
Cerebellar vermis
Originally published in Ultrasound Obstet Gynecol ****

11. Originally published in Ultrasound Obstet Gynecol ****
hemisphere
hemisphere
tentorium 4v
vermis
hemisphere
hemisphere
tentorium
vermis
vermian fissures 4v
Originally published in Ultrasound Obstet Gynecol ****

12. Originally published in Ultrasound Obstet Gynecol ****
body
atrium
Occipital horn
Temporal horn
Sylvian fissure
Originally published in Ultrasound Obstet Gynecol ****

13. Originally published in Ultrasound Obstet Gynecol ****
Normal corpus callosum
Absent corpus callosum 3v
Partial agenesis 3v 3v
Originally published in Ultrasound Obstet Gynecol ****

14. Dandy-Walker malformation
Normal
Megacisterna magna
Blake’s pouch cyst
tentorium
Vermian hypoplasia
Dandy-Walker malformation
Originally published in Ultrasound Obstet Gynecol ****

15. 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 ****

16. Originally published in Ultrasound Obstet Gynecol ****

17. Originally published in Ultrasound Obstet Gynecol ****

18. Acoustic shadowing with multiplanar approach
bregmatic
coronal
sagittal
Originally published in Ultrasound Obstet Gynecol ****

19. Posterior fontanel approach
vermis 4v
Brain stem
hemispheres 4v
Originally published in Ultrasound Obstet Gynecol ****

20. Glass body rendering of intracranial arterovenous malformation
Superior sagittal sinus
Falcine sinus
Vein of Galen
Feeding arteries
Originally published in Ultrasound Obstet Gynecol ****

21. 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 ****

22. 3D ultrasound of fetal spine
Posterior ossification centers
body
Multiplanar
Maximum mode
Originally published in Ultrasound Obstet Gynecol ****

23. Vertebral anomalies Hemi-vertebra Partial sacral agenesis
Originally published in Ultrasound Obstet Gynecol ****

24. 3D surface rendering of fetal spina bifida
myelomeningocele
myelocele
Originally published in Ultrasound Obstet Gynecol ****

25. 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 ****

26. Originally published in Ultrasound Obstet Gynecol ****

27. 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 ****

28. 3D ultrasound of the embryonic cerebral vesicles at 9 weeks1
‘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 ****

29. 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 ****

30. 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 ****

31. VCI in coronal plane (VCI-C)
Originally published in Ultrasound Obstet Gynecol ****

32. 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 ****