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Updated: May 28, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Prospective detection of open spina bifida at 11-13 weeks by assessing intracranial translucency and posterior brain
R Chaoui1, B Benoit, K S Heling
1Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany. chaoui@feindiagnostik.de
Insights
Early ultrasound screening can detect open spina bifida (OSB) by examining the fetal posterior brain during nuchal translucency (NT) measurement. This method aids in identifying OSB during routine 11-13-week prenatal scans.
Area of Science:
- Prenatal Diagnosis
- Fetal Medicine
- Medical Imaging
Background:
- Routine 11-13 week ultrasound is crucial for fetal anomaly screening.
- Open spina bifida (OSB) is a severe neural tube defect.
- Early detection of OSB improves prenatal management and outcomes.
Observation:
- Six cases of open spina bifida (OSB) were identified in fetuses with crown-rump length 49-78 mm.
- Suspicion of OSB arose during nuchal translucency (NT) measurement in the mid-sagittal plane.
- Abnormal posterior brain structures, including obliterated or abnormal intracranial translucency (IT), were noted in all cases.
Findings:
- An increased brainstem diameter to brainstem-occipital bone distance ratio (≥1) was observed in all six fetuses.
- OSB was confirmed via targeted examination, with five cases detected in the same session.
- Two fetuses presented with multiple anomalies and trisomy 18.
Implications:
- The standard mid-sagittal plane used for NT measurement is feasible for assessing the posterior brain and detecting OSB.
- This technique allows for early identification of OSB during routine first-trimester screening.
- Integrating posterior brain assessment into NT screening can enhance prenatal detection rates for OSB.
Abstract:
We describe a case series of six fetuses with open spina bifida (OSB) from four different prenatal units, where the anomaly was detected at the routine 11-13-week ultrasound examination. Crown-rump length ranged from 49 to 78 mm. All cases were first suspected during nuchal translucency thickness measurement in the mid-sagittal plane of the face. OSB was lumbosacral in five fetuses and cervical in one. The intracranial translucency (IT) was obliterated in two cases, but some fluid was found in the other four cases. However, in all cases the typical landmarks of a normal posterior brain and normal IT were absent. In all six cases the ratio of brainstem diameter to brainstem-occipital bone distance was increased (≥ 1). This detection of an abnormal posterior brain led to a targeted examination and detection of the spinal lesion during the same examination in five cases, whereas in one suspicious case the patient was recalled at 17 weeks, when the abnormality was detected. Two fetuses had both multiple anomalies and trisomy 18. These prospective cases demonstrate the feasibility of using the standard mid-sagittal plane commonly used for NT measurement to assess the IT and the posterior brain and to determine the presence of OSB during NT screening.
