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The Predictive Value of Dry Brain Sign for Open Spina Bifida at First Trimester Anomaly Scan: A Case-Control study
Hesham Kamal El Din Abd El Fatah El Emam1, Hend Galal Eldeen Mohamed Ali Hassan2, Sahar Mohamed El Feky1
1Department of Diagnostic, Interventional Radiology and molecular imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt (H.K.E.D.A.E.F.E.E., H.G.E.M.A.H., S.M.E.F., A.M.O.).
Insights
The dry brain sign, characterized by enlarged choroid plexuses, shows promise as an early ultrasound marker for detecting open spina bifida (OSB) in the first trimester.
Area of Science:
- Medical Imaging
- Prenatal Diagnosis
- Fetal Abnormalities
Background:
- Spina bifida is a common neural tube defect.
- Early detection of spina bifida is crucial for prenatal management.
- First-trimester sonographic screening is vital for identifying fetal anomalies.
Purpose of the Study:
- To evaluate the diagnostic utility of the "dry brain sign" in first-trimester screening for open spina bifida (OSB).
- To assess specific sonographic measurements for OSB detection.
Main Methods:
- A prospective case-control study involving 50 pregnant women.
- Divided into 25 controls and 25 cases with the "dry brain sign" (enlarged choroid plexuses without surrounding CSF).
- Confirmed OSB diagnoses using second and third-trimester ultrasounds.
Main Results:
- Cases with the dry brain sign showed significantly higher mean choroid plexus (CP) length, CP to occipitofrontal diameter (CP/OFD), and CP to biparietal diameter (CP/BPD) ratios (p=0.001).
- Biparietal diameter (BPD) and occipitofrontal diameter (OFD) were significantly lower in cases (p=0.001).
- CP/BPD and CP/OFD ratios demonstrated 100% diagnostic accuracy, sensitivity, and specificity for OSB.
Conclusions:
- The dry brain sign, particularly the mean CP/BPD and CP/OFD ratios, can serve as reliable sonographic markers for early first-trimester screening of OSB.
- These ratios offer high diagnostic accuracy for identifying open spina bifida prenatally.
Rationale And Objectives:
Spina bifida is a common neural tube defect resulting from incomplete closure of the spinal column, with early detection crucial for prenatal management. This work aimed to assess the diagnostic utility of the dry brain sign in first-trimester sonographic screening for open spina bifida (OSB).
Materials And Methods:
This prospective case-control study included 50 pregnant women (aged 18-40 years) who underwent first-trimester ultrasound screening for singleton pregnancies. Participants were divided into two equal groups: 25 controls with normal ultrasound findings and 25 cases exhibiting a positive "dry brain sign," defined by enlarged choroid plexuses without surrounding cerebrospinal fluid. Second and third-trimester ultrasound findings were used to confirm OSB diagnoses.
Results:
The case group exhibited significantly higher mean choroid plexus (CP) length, CP to occipitofrontal diameter (CP/OFD), and CP to biparietal diameter (CP/BPD) ratio (p= 0.001). BPD and OFD were significantly lower in the case group compared with the controls (p= 0.001). CP/BPD and CP/OFD demonstrated the highest diagnostic accuracy (100%) with optimal sensitivity and specificity. CP/BPD (cutoff ≥0.65, p < 0.001) and mean BPD (cutoff ≤20.5 mm, p < 0.001) were reliable markers for OSB.
Conclusion:
Dry brain sign could be used as sonographic markers for early screening in the first trimester for OSB by using mean CP/BPD ratio and mean CP/OFD ratios.
