OC8.01: Ultrasound measurement of the transverse diameter of the fetal thymus
15thWorld Congress on Ultrasound in Obstetrics and GynecologyOral communication abstracts
of GTD Follow-up (months)
Profuse vaginal bleeding
Prolonged vaginal spotting
Prolonged vaginal spotting
GTS-resistant to chemotherapy
GTS-resistant to chemotherapy
Pregnancy, Recurrent AVM (40 m)
AVM not identified in follow-up scans (26 m)
Persistent AVM despite negative beta-HCG (30 m)
Cure (24 m)
AVM not identified in follow-up scans (22 m)
AVM not identified in follow-up scans (18 m)
GTD–Gestational Trophoblastic Disease.
in our center in 2002–2003. The different clinical presentations
and their diagnosis are described and a prospective follow-up for a
minimum period of eighteen months is included (see Table).
After reviewing current experience and prior reports, we conclude
that sonography is the preferred imaging modality for diagnosis and
for future fertility. The sonographic characteristics for diagnosing
uterine AVM’s are detailed and a clinical algorithm for management
Uterine artery Doppler flow velocity following uterine fibroid
Z. Novacovik, U. Kirste, E. Dorenberg, H. Husby, G. Haugen
Rikshospitalet University Hospital, Norway
Objective: To evaluate the relation of uterine artery (UA) Doppler
flow velocity indices with volume reduction of uterine fibroids
Methods: Seventeen women underwent embolization due to one or
more of the following symptoms and signs: menorrhagia (n = 13),
frequency of voiding (n = 9) and sensation of pressure (n = 14).
Median age was 47 years (range 30–52). Bilateral Doppler flow
velocity measurements were performed before and within four days
after embolization. The size and localization of the fibroids were
assessed on MRI examinations before, at 3 months and at one
year after the procedure. After selective catheterization of both
UAs through a unilateral femoral access, bilateral embolization
was obtained by injection of polyvinyl alcohol particles under
intermittent fluoroscopic guidance until complete cessation of flow.
Evaluation of the pulsatility index (PI) was separate for the right and
left UAs and for the dominant UA dependent on fibroid localization
(right, n = 10; left, n = 4). The mean PI value of both arteries was
used if none was judged to be dominant (n = 3). Nonparametric
statistical tests were used.
Results: The PI values increased from before to after embolization
with median values (25th – 75th centiles) of 1.37 (1.06–2.46) vs.
2.49 (1.30–3.04) on the right side (p = 0.08), 1.86 (1.43–2.63) vs.
2.29 (1.15–3.47) on the left side (p = 0.33) and 1.39 (1.16–2.54)
vs. 2.49 (1.18–3.28) in the dominant UA (p = 0.01). The individual
change in PI values (PI after–PI before) was highly correlated to
the percentage decrease in fibroid size at 3 months (n = 12) for the
dominant (r = 0.73, p = 0.01) and right UA (r = 0.75, p = 0.01),
but not for the left side. No significant correlations were observed
between the PI changes and fibroid size at one year (n = 13).
Conclusions: This pilot study showed that the changes in the PI
values of the UAs at the time of embolization was related to short
term but not long term reduction in fibroid size.
Saline infusion for endometrial abnormalities: technique and
findings in a small town
R. Sanders, C. Carlos, P. Combs
Los Alamos Womens Health Center, USA
To determine the most painfree and satisfactory technique for saline
infusion studies and to see the spectrum of pathology in a non-
referral population submitted to a saline infusion study.
The Los Alamos womens health center provides gynecological
care for most patients in Los Alamos and some from the
surrounding area. All patients in the study were examined by
a single radiologist/sonologist. Patients were selected for saline
infusion studies if they had abnormal uterine bleeding, an apparent
endometrial mass, amenorrhea, or were infertile. Studies were
performed in the proliferative phase unless there was constant
vaginal bleeding or irregular menstruation. All studies were
commenced with a straight 5 Fr. catheter (the Tampa catheter). If
cavity distension was inadequate a 5 Fr. balloon catheter was used.
455 saline infusion studies were performed over a four year period.
370 (81%) studies were performed satisfactorily with a Tampa
catheter. 34 (7.5%) required a balloon catheter, an os finder was
essential in 7(1.5%), 22 (4.8% required a tenaculum and 21(4.6%
The following pathology was diagnosed.
Conclusion: Most saline infusion studies do not require balloon
insertion for a satisfactory image. There was one cancer of the
endometrium amongst the 159 diagnosed polyps most of whom
were referred for abnormal bleeding.
Ultrasound measurement of the transverse diameter of the
J. Y. Cho1, S. I. Jung1, M. H. Moon1, J. Y. Min1, S.-.J. Yoo2
1Samsung Cheil Hospital, Sungkyunkwan University School
of Medicine, Korea, Republic of,2The Hospital for Sick
Children, University of Toronto, Canada
Purpose: The purposes of this study are to present the reference
value of the transverse diameter of the fetal thymus and to assess its
usefulness to predict the fetal thymic development.
Ultrasound in Obstetrics & Gynecology 2005; 26: 309–375
25–29 September 2005, Vancouver, CanadaOral communication abstracts
Materials and methods: The maximum transverse diameter of the
thymus was measured in 376 normal fetuses from 19 to 38 weeks of
gestation. Mean diameter and standard deviation at each gestational
week was calculated. We assessed the relationship of the thymic
diameterwithgestational age(GA),biparietal diameter(BPD),femur
length (FL), and abdominal circumference (AC). Linear regression
of transverse diameter on GA, BPD, FL, and AC was calculated.
Results: Measurements of the transverse diameter were possible in
352 of 376 fetuses (93.6%). The transverse diameter of the fetal
thymus increased according to the fetal GA and size. The regression
equations for transverse diameter of the thymus as a function of GA,
BPD, FL, and AC was: thymic diameter (cm) = −1.58 + 0.15 × GA
(weeks), −1.038 + 0.51 × BPD (cm), −0.63 + 0.63 × FL (cm), and
−0.74 + 0.14 × AC (cm).
Conclusion: We could get the reference value of the transverse
measurement of transverse diameter is useful method to assess the
development of the fetal thymus.
Sonographic evaluation of the fetal hard palate and maxillary
L. F. Mok, S. L. Lee, S. Fook-Chong, D. Kanagalingam,
H. K. Tan
Singapore General Hospital, Singapore
Introduction: Fetal facial clefts are often associated with maxillary
hypoplasia, secondary to cleft palate. Sonographic evaluation of the
hard palate is presently in thecheck-list ofthescreening scan in many
ultrasound departments, but only a comprehensive examination will
detect these defects. It has been shown in recent years that the
demonstration of fetal tooth buds will also aid in excluding the
presence of clefts. Ulm MR(1999) reported using 3-dimensional(3D)
ultrasound of fetal tooth buds for characterisation of facial clefts.
Objective: To determine the potential and accuracy of hard palate
measurements and maxillary tooth buds visualisation in the prenatal
diagnosis of facial clefts.
Method: 350 patients from 18.1–40 weeks gestation were recruited
into the study. The imaging of the hard palate and maxillary tooth
buds were successful in 90% of patients. 3-dimensional ultrasound
was also performed. Hard palate measurements included maximum
length, maximum width and calculated area. A nomogram of fetal
hard palate area versus gestational age was constructed.
Results: Incisors and canines were visualised at 18.1 weeks,
premolars at 18.3 weeks, and molars at 26.3 weeks. A nomogram of
hard palate measurements with fitted 2.5th, 50th and 97.5th centiles
Conclusion: Fetal hard palate and tooth buds were visualised on 2D
and 3D sonography. Examination with the 3D technique is simpler
and is less time-consuming. Our nomogram showed that fetal hard
palate area correlate strongly with gestational age. It may be used
for the evaluation of maxillary hypoplasia.
Orbital measurements at 11–14 weeks of gestation
N. Greene1, J. Hyett2, L. Platt1
1Center for Fetal Medicine and Women’s Ultrasound, USA,
2Fetal Medicine Foundation, UK
Introduction: Studies have demonstrated the value of assessing
facial features during first trimester ultrasound. The orbits are well
defined at 11–14 weeks. Previous studies have shown differences in
orbital proportions between chromosomally normal and abnormal
children. This pilot study aimed to establish normal ranges for
orbital measurements at 11–14 weeks and to compare these with
those of aneuploid fetuses and a fetus that was subsequently found
to have absent corpus callosum.
Methods: Orbital (OD) and intraorbital (IOD) diameters were
measured in women presenting to our practice for first trimester
aneuploidy screening or diagnosis. Measurements were made in the
coronal view where the orbits were largest. These measurements
were used to calculate the orbital width index (OD/IOD). Pregnancy
outcome was established by fetal karyotype or phenotype at birth.
Statistical analysis was performed to develop normal ranges using
polynomial linear regression (Excel, Microsoft, USA). Data from
abnormal pregnancies were plotted against normal ranges.
Results: The OD and IOD measurements were made in 301
normal and 5 abnormal pregnancies. The OD and IOD increase
linearly between 11 and 14 weeks (R2= 0.52 and 0.40 respectively;
p < 0.01). The orbital width index (OWI) was constant through this
period (R2= 0.00, p < 0.01). No trisomic fetus (2 Trisomy 21, 1
Trisomy 18) had an OWI outside of the normal ranges. The OWI
was reduced in a fetus later found to have agenesis of the corpus
Conclusions: At 11–14 weeks’ gestation, orbital and intraorbital
diameters increase linearly with gestational age. The orbital width
index is constant and can be used independently of gestation. This
small pilot study suggests that OWI may not be useful in screening
for trisomies; it may be of use screening for abnormalities of midline
brain and facial structures.
Prenatal diagnosis of an isolated cleft palate with 2D
ultrasound – a case report
Queen Charlotte’s & Chelsea Hospital, London, UK
Facial clefts are one of the most frequently occurring types of
congenital malformation with a reported incidence of approximately
1:1000. Clefts are characterized by their location and extent i.e.
cleft lip and palate, isolated cleft palate and isolated cleft lip. Of
these, isolated cleft palate is the most common accounting for
approximately 40%. The defect is thought to be a result of failure
of the lateral palatine processes to fuse with each other. Despite its
relatively common incidence, few cases of isolated cleft palate have
been diagnosed prenatally.
This case report is of a 30-year old primigravida woman who
presented for routine anomaly screening at 20 weeks’ gestation.
Fetal biometry was at the 3rd centile for gestational age as was the
amniotic fluid index. Morphologic appearance was normal except
for suspicion of a cleft in the fetal palate. A rescan at 22 weeks’
gestational age was undertaken to assess fetal growth and confirmed
the presence of cleft palate.
Postnatal diagnosis confirmed a unilateral cleft of the hard and
soft palate. Ultrasound examination of the fetal face is assessed in
sagittal, coronal and transverse views. Whereas the diagnosis of cleft
lip is best made in all three views, the view required for detection of
cleft palate is the transverse view.
Sonographic findings in this case were an abnormal transverse view
of the hard palate with intact alveolus.
Although an isolated palatal cleft can be extremely difficult to detect
on ultrasound, this case demonstrates the importance of careful
examination of the fetal posterior palate in transverse view even
when intact lips and alveolus are noted.
Ultrasound in Obstetrics & Gynecology 2005; 26: 309–375