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Three-Dimensional Ultrasound Study of Fetal Craniofacial Anatomy

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Three-Dimensional Ultrasound Study of Fetal Craniofacial Anatomy Three-dimensional ultrasound study of fetal craniofacial anatomy N.M. Roelfsema The work presented in this thesis was financially supported by the Netherlands Organization for Scientific Research, grand no: 902-37-116. It was conducted at the department of Obstet- rics and Gynecology and in collaberation with the department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands J.E. Jurriaanse Stichting and GE Healthcare financially supported the printing of this thesis The following parts of this publication have been published previously and have been repro- duced with permission from the publishers: Elsevier Ltd.(Roelfsema et al. Three-dimensional sonographic measurement of normal fetal brain volume during the second half of pregnancy. Am J Obstet Gynecol 2004;190:275-80) and the International Society of Ultrasound in Obstet- rics and Gynecology (Roelfsema et al. Three-dimensional ultrasonography of prenatal skull base development. Ultrasound Obstet Gynecol 2007:29:372-7; Roelfsema et al. Craniofacial variability index determined by three-dimensional ultrasound in isolated versus syndromal cleft lip/palate. Ultrasound Obstet Gynecol 2007;29:265-70; Roelfsema et al. Craniofacial variability index in utero; a three-dimensional ultrasound study. Ultrasound Obstet Gynecol 2007;29:258-64; Roelfsema et al. Three-dimensional sonographic determination of normal fetal mandibular and maxillary development during the second half of pregnancy. Ultrasound Obstet Gynecol 2006;28:950-7; Dikkeboom et al. The role of three-dimensional ultrasound in visualizing the fetal cranial sutures and fontanels during the second half of pregnancy. Ultra- sound Obstet Gynecol 2004;24:412-6). Front cover: © N.M. Roelfsema © 2007, N.M. Roelfsema. All rights reserved. No part of this publication may be reproduced, stored in retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission from the propietor © 2007, N.M. Roelfsema. Alle rechten voorbehouden. Niets uit deze uitgave mag worden verveelvoudigd, opgeslagen in een geautomatiseerd gegevensbestand, of openbaar ge- maakt, in enige vorm of op enige wijze, hetzij elektronisch, mechanisch, door fotokopieën, opnamen, of op enig andere manier, zonder voorafgaande schriftelijke toestemming van de rechthebbende. Three-Dimensional Ultrasound Study of Fetal Craniofacial Anatomy Drie-dimensionaal ultrageluidsonderzoek van de foetale craniofaciale anatomie PROEFSCHRIFT TER VERKRIJGING VAN DE GRAAD VAN DOCTOR AAN DE ERASMUS UNIVERSITEIT ROTTERDAM OP GEZAG VAN DE RECTOR MAGNIFICUS PROF.DR. S.W.J. LAMBERTS EN VOLGENS BESLUIT VAN HET COLLEGE VOOR PROMOTIES DE OPENBARE VERDEDIGING ZAL PLAATSVINDEN OP WOENSDAG 31 OKTOBER 2007 OM 15.45 UUR DOOR Nanette Marianne Roelfsema GEBOREN TE NORG Promotiecommissie: Promotoren: Prof.jhr.dr. J.W. Wladimiroff Prof.dr. S.E.R. Hovius Overige leden: Prof.dr.ir. N. Bom Prof.dr. E.A.P. Steegers Prof.dr. M.H. Breuning Copromotor: Dr. L.N.A. van Adrichem Voor Mam Contents 1: Literature overview and research objectives 1.1: Literature overview 13 1.1.1: Three-dimensional ultrasound in general 13 1.1.2: Three-dimensional ultrasound in prenatal diagnosis 13 1.1.3: Prenatal diagnosis of craniofacial abnormalities 17 Two-dimensional ultrasound 18 Three-dimensional ultrasound 19 1.1.4: Assessment of craniofacial development 20 1.2: Research objectives 22 1.3: References 23 2: Methodology for 2D and 3D fetal craniofacial biometry assessment 2.1: Methodology 33 2.1.1: Study subjects 33 Population of normal pregnancies 33 Population with a fetal anomaly 33 2.1.2: Recording technique 34 2.1.3: Craniofacial measurements 35 Measurements derived from the sagittal scan mode of 3D acquisition 35 Measurements derived from the transverse scan mode of 3D acquisition 43 Measurements derived from the coronal scan mode of 3D acquisition 45 2.2: Statistical analysis 49 2.3: References 50 3: Normal fetal craniofacial development 3.1: Normal fetal craniofacial biometry 53 3.1.1: Skull height, total facial height, upper facial height, lower facial height and 55 bizygomatic breadth (facial width). 3.1.2: Length of the back of the nose, nasal protrusion, philtrum length, nasal 58 width and mouth width. 3.1.3: Palatal length, outer palate width, inner palate width and bigonial breadth. 60 3.1.4: Anterior skull base/ palatal plane angle and anterior skull base/ mandibular 61 plane angle. 3.1.5: Biparietal distance (BPD), fronto-occipital distance (FOD), head 62 circumference (HC), inter ocular distance (IOD) and outer ocular distance (OOD). 7 Contents 3.1.6: Sella- nasion, gonion- sella, bitragal breadth and upper facial depth. 68 3.1.7: Ear length, ear breadth, ear rotation and ear position 70 3.1.8: Conclusions 71 3.1.9: References 71 Appendix to Chapter 3.1: Regression equations 74 3.2: Three-dimensional sonographic measurement of normal fetal brain volume 75 during the second half of pregnancy. Am J obstet Gynecol 2004;190:275-280 3.3: Three-dimensional sonography of prenatal skull base development. Ultrasound 85 Obstet Gynecol 2007;29:372-377 3.4: Three-dimensional sonographic determination of normal fetal mandibular 97 and maxillary size during the second half of pregnancy. Ultrasound Obstet Gynecol 2006;28:950-957 3.5: Comparison of prenatal and postnatal development 109 3.5.1: Height of the head and face 109 3.5.2: Facial width 109 3.5.3: Facial depth 111 3.5.4: References 112 4: Craniofacial Variability Index Introductory remarks 115 4.1: Craniofacial Variability Index in utero; a three-dimensional ultrasound study. 116 Ultrasound Obstet Gynecol 2007;29:258-264 4.2: Craniofacial Variability Index determined by three-dimensional ultrasound 129 in isolated versus syndromal fetal cleft lip/ palate. Ultrasound Obstet Gynecol : 2007;29:265-270 5: Fetal cranial sutures and fontanels Introductory remarks 143 5.1: The role of three-dimensional ultrasound in visualizing the fetal cranial 144 sutures and fontanels during the second half of pregnancy. Ultrasound Obstet Gynecol 2004;24:412-416 6: General discussion and conclusions 6.1: Introduction 155 6.2: Methodology 155 6.3: Normal fetal craniofacial measurement 156 6.4: Craniofacial Variability Index 157 6.5: Fetal cranial sutures and fontanels 159 6.6: Final remarks 159 6.7: References 160 8 Contents 163 Summary Samenvatting 167 Dankwoord 173 Publication List 175 Curriculum Vitae 177 List of syndromes mentioned in thesis 179 Appendix 181 Contents 9 Chapter 1 Literature overview and research objectives Literature overview and research objectives 1.1 LiterATUre overvieW 1.1.1 Three-dimensional ultrasound in general Ultrasound has placed itself in a strong position as an imaging technique in day to day obstetric 1 Chapter care. This is the result of many advantages over techniques such as MRI (magnetic resonance imaging) and CT (computer tomography), in particular the flexibility of the technique, the moderate costs, the possibility of real-time imaging and the use of non-ionizing radiation.1 In the Netherlands, ultrasound is used on a regular basis in all obstetric units and by most regional midwifery services. During the last decades the image quality has strongly improved, partially due to the development of new ultrasound techniques. When using the technique of conventional two-dimensional ultrasound (2DUS) the ultra- sonographer tries to form a mental three-dimensional (3D) picture of the fetal anatomy from two-dimensional (2D) planes. This process tends to become more difficult and time-consum- ing when the structure itself and the circumstances are more complicated, thus enhancing the risk of misinterpretation.2 This shortcoming of conventional ultrasound techniques opened up the way for three-dimensional ultrasound (3DUS) in fetal imaging at the beginning of the 90s.3-5 1.1.2 Three-dimensional ultrasound in prenatal diagnosis Different methods in obtaining a three-dimensional ultrasound image have been developed: the defocusing lens method, free hand scanning with or without electromagnetic sensing, and mechanical devices to move the transducer. These devices may be external or integrated within the probe along with a position sensor (automatic volume scanning).6,7 In commonly used (2D) ultrasound probes an acoustic lens is used converging the ul- trasonic beam in the direction of the slice width. The ultrasonic beam is best kept small to optimize the resolution of the 2D image. In the defocusing lens (3D) method, however, a lens is used which diverges the beam and produces a thick slice width. From the returning echoes a volume image is displayed. This allows real-time volume scanning, but as a result of the thick slice width the resolution is poor.6 Moreover, the size of the displayed volume image is restricted to the thickness of the ultrasonic beam. This technique is therefore not commonly used in prenatal diagnosis. The other techniques use computer processing for 3D reconstruction. With movement of the ultrasound probe (free hand or mechanically) a consecutive set of 2D planes is acquired and constructed into a 3D data set by a computer. By using a position sensor or electromag- netic sensing device the position of every pixel of the 2D images within the volume is deter- mined and a 3D reconstruction can be built. The 3D-ultrasound machine used in the present study (Voluson 530D; Kretztechnik AG, Zipf, Austria), is equipped with an automatic volume scanning method. The ultrasound probe has a built-in mechanical device to move the transducer along with a position sensor. The 13 Chapter 1 patient setting of a 3DUS examination is identical to that of a conventional two-dimensional (2D) ultrasound examination. Before 3D acquisition can take place, orientation with real-time 2DUS and optimization of the B-mode image (the normal 2DUS mode) is necessary. The ab- dominal as well as the vaginal 3DUS probe offers a mechanical fan-like rotating device, which can obtain a large number of adjoining section planes. Acquisition takes place automatically after the examiner defines a region of interest (‘volume-box’).
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