The value of quantitatively fetal brainstem-vermis and brainstem-tentorium angles evaluation by three-dimensional ultrasonography

doi:10.3877/cma.j.issn.1672-6448.2015.02.010

Abstract

Abstract:

Objective

To evaluate the role of fetal brainstem-vermis (BV) and brainstem-tentorium (BT) angles in differential diagnosis of fetal cereballar vermis anomalies by three-dimensional ultrasonography.

Methods

A total of 335 normally developed fetuses at 18-34 gestational weeks were examined prospectively in Prenatal Ultrasound Center of Suzhou Municipal Hospital from July 2013 to July 2014 by three-dimensional ultrasonography scanning. The BV angles and BT angles were measured at the mid-sagittal sections of fetal heads which were obtained by three-dimensional ultrasonography. Sixteen fetuses with abnormal cerebellar vermis were selected. The BV angles and BT angles were measured and compared with the measurements of normal group.

Results

In normal fetuses, the mean of BV angles was (3.3±1.7)°, ranging from1.0 to 10.0°; the mean BT angle was (31.5±6.9)°, and ranging from 16.6 to 57.8°. In 16 cases of abnormal cerebellar vermis, 4 cases of Dandy-Walker Malformation (DWM) showed significantly upward rotated cerebellar vermises, the BV angles increased significantly (88.9±18.1)°, the cerebellar tentoriums were superior displaced, the BT angles increased remarkably (89.0±12.8)°; 6 cases of Dandy-Walker variant (DWV) showed upward rotated cerebellar vermises, with increased BV angles (23.7±5.2)°, and slightly increased BT angles (54.5±12.0)°; 6 cases of Blake′s pouch cyst (BPC) showed upward rotated cerebellar vermises were, mildly increased BV angles (16.7±1.8)°, and slightly increased BT angles (50.3±8.2)°. The comparison results showed: BV angles increased with increasing severity of the condition in BPC, DWV and DWM; BT angles increased significantly in DWM.

Conclusions

The measurements of BV angles and BT angles are valuable in the differential diagnosis of fetal cereballar vermis anomalies. From 19 gestational weeks, a BV angle >60° is strongly suggestive of a Dandy-Walker malformation, while a measurement >10.0° and < 20° favors the diagnosis of Blake′s pouch cyst.

Key words: Ultrasonography, three-dimensional, Fetal, Cerebellum, Dandy-Walker complex

Lili Zhang, Xuedong Deng, Zhong Yang, Xiaobing Li, Qin Liang. The value of quantitatively fetal brainstem-vermis and brainstem-tentorium angles evaluation by three-dimensional ultrasonography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(02): 136-141.

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References 15

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孕周	例数	BV角（°）	BT角（°）
18	3	5.8±1.7	24.5±4.8
19	12	5.2±1.9	28.3±5.5
20	11	4.3±2.4	27.0±7.2
21	7	4.3±2.0	27.5±5.5
22	5	3.1±0.9	25.6±5.4
23	21	3.5±1.5	26.7±6.1
24	24	2.7±1.1	28.5±5.6
25	61	3.4±2.0	31.5±5.9
26	62	2.7±1.4	30.6±5.8
27	16	3.6±2.0	30.0±6.7
28	6	2.7±0.9	28.8±9.3
29	6	2.6±1.0	31.1±8.8
30	20	3.5±2.1	34.8±4.4
31	36	3.3±1.6	34.7±5.6
32	36	3.2±1.3	37.1±6.4
33	5	4.1±2.4	41.4±4.0
34	4	3.7±2.2	39.0±3.0

孕周	例数	BV角（°）	BT角（°）
18	3	5.8±1.7	24.5±4.8
19	12	5.2±1.9	28.3±5.5
20	11	4.3±2.4	27.0±7.2
21	7	4.3±2.0	27.5±5.5
22	5	3.1±0.9	25.6±5.4
23	21	3.5±1.5	26.7±6.1
24	24	2.7±1.1	28.5±5.6
25	61	3.4±2.0	31.5±5.9
26	62	2.7±1.4	30.6±5.8
27	16	3.6±2.0	30.0±6.7
28	6	2.7±0.9	28.8±9.3
29	6	2.6±1.0	31.1±8.8
30	20	3.5±2.1	34.8±4.4
31	36	3.3±1.6	34.7±5.6
32	36	3.2±1.3	37.1±6.4
33	5	4.1±2.4	41.4±4.0
34	4	3.7±2.2	39.0±3.0

例序	BV角（°）	BT角（°）	超声诊断
1	62.7	95.0	Dandy-Walker畸形
2	93.9	74.3	Dandy-Walker畸形
3	94.5	103.4	Dandy-Walker畸形
4	104.5	83.4	Dandy-Walker畸形
5	18.8	43.7	Dandy-Walker变异
6	23.3	71.1	Dandy-Walker变异
7	22.0	58.5	Dandy-Walker变异
8	18.4	42.9	Dandy-Walker变异
9	28.7	46.1	Dandy-Walker变异
10	31.1	64.8	Dandy-Walker变异
11	18.5	61.2	Blake囊肿
12	17.5	56.1	Blake囊肿
13	15.6	43.6	Blake囊肿
14	18.5	43.0	Blake囊肿
15	13.9	55.4	Blake囊肿
16	16.4	42.7	Blake囊肿

例序	BV角（°）	BT角（°）	超声诊断
1	62.7	95.0	Dandy-Walker畸形
2	93.9	74.3	Dandy-Walker畸形
3	94.5	103.4	Dandy-Walker畸形
4	104.5	83.4	Dandy-Walker畸形
5	18.8	43.7	Dandy-Walker变异
6	23.3	71.1	Dandy-Walker变异
7	22.0	58.5	Dandy-Walker变异
8	18.4	42.9	Dandy-Walker变异
9	28.7	46.1	Dandy-Walker变异
10	31.1	64.8	Dandy-Walker变异
11	18.5	61.2	Blake囊肿
12	17.5	56.1	Blake囊肿
13	15.6	43.6	Blake囊肿
14	18.5	43.0	Blake囊肿
15	13.9	55.4	Blake囊肿
16	16.4	42.7	Blake囊肿

组别		例数	BV角测值（°）		BT角测值（°）
组别		例数	范围	平均值	范围	平均值
正常组		335	1.0～10.0	3.3±1.7	16.6～57.8	31.5±6.9
异常组		?	?	?	?	?
?	Dandy-Walker畸形	4	62.7～104.5	88.9±18.1	74.3～103.4	89.0±12.8
?	Dandy-Walker变异	6	18.4～31.1	23.7±5.2	42.9～71.7	54.5±12.0
?	Blake囊肿	6	13.9～18.5	16.7±1.8	42.7～61.2	50.3±8.2

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