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Published on: December 5, 2015
Assessment of pericallosal artery at 11-14 weeks of gestation: Cohort study and meta-analysis
Lorenzo Vasciaveo1, Giuseppe Rizzo2,3, Asma Khalil3
1Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy.
Insights
The pericallosal artery (PCA) is visualized in 98.8% of fetuses during the first trimester. Early detection of the PCA via prenatal ultrasound is highly specific for a normal corpus callosum (CC) later in pregnancy.
Area of Science:
- Fetal Medicine
- Prenatal Diagnostics
- Neurosonography
Background:
- The pericallosal artery (PCA) is a key intracranial landmark.
- Accurate assessment of fetal neuroanatomy in the first trimester is crucial for early diagnosis of anomalies.
- Limited data exists on the early visualization rates of the PCA.
Purpose of the Study:
- To determine the visualization rate of the pericallosal artery (PCA) in the first trimester (11-14 weeks gestation).
- To assess the diagnostic accuracy of early PCA detection for predicting a normal corpus callosum (CC) later in pregnancy.
Main Methods:
- Prospective observational study of 500 fetuses undergoing first-trimester screening.
- High-definition power Color Doppler used to assess PCA in midsagittal view.
- Systematic review and meta-analysis of published literature on PCA visualization.
Main Results:
- The PCA was identified in 98.8% of fetuses trans-abdominally or trans-vaginally at 11-14 weeks.
- In a meta-analysis of 1093 fetuses, PCA was detected in 96.9% by 11-14 weeks.
- No PCA visualization at 11-14 weeks occurred in 20.6% of fetuses with a normal CC at anomaly scan.
Conclusions:
- Prenatal ultrasonography demonstrates high accuracy in detecting the PCA during the first trimester.
- Early visualization of the PCA is a strong indicator of a normal corpus callosum later in gestation.
Objectives:
To report the rate of visualization of the pericallosal artery (PCA) in the first trimester of pregnancy (11-14 weeks).
Methods:
Prospective observational study of consecutive fetuses undergoing first trimester risk assessment for chromosomal anomalies. The presence of PCA was assessed in a midsagittal view of fetal brain using high-definition power Color Doppler. A normal course of the PCA was defined as the visualization of an artery emerging from the anterior cerebral artery running parallel the corpus callosum (CC). The reference standard was the visualization of CC and PCA between the 20 and 22 weeks of gestation. We also performed a systematic review and meta-analysis of the published literature. Multivariate logistic regression and random-effect meta-analyses of proportion were used to analyze the data.
Results:
Cohort study: Five-hundred women were included. PCA was identified trans-abdominally or transvaginally at 11-14 weeks of gestation in 98.8% (95% CI 97.4-99.6: 494/500); of the four cases of PCA not identified one had a diagnosis of complete agenesis of the corpus callosum during the anomaly scan which was confirmed at birth. Systematic review of the published literature: Six studies (1093 fetuses, including the present series) were included. The PCA was detected at the 11-14 weeks scan and confirmed to co-exist with a normal CC at time of the anomaly scan in 96.9% (95% CI 93.8-99.0); 20.6% (95% CI 5.7-41.7) of fetuses with no clear identification of the PCA at the 11-14 weeks scan had a normal appearance of the CC at the time of anomaly scan.
Conclusion:
Prenatal ultrasonography has a high diagnostic accuracy in detecting PCA in the first trimester. Visualization of the PCA at the time of 11-14 scan is highly specific for the presence of a normal CC later in pregnancy.
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