Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11–13 weeks' gestation

• Published in: Ultrasound in obstetrics & gynecology Vol. 55; no. 1; pp. 81 - 86
• Main Authors: Chaoui, R., Benoit, B., Entezami, M., Frenzel, W., Heling, K. S., Ladendorf, B., Pietzsch, V., Sarut Lopez, A., Karl, K.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-01-2020; Wiley Subscription Services, Inc
• Subjects: biparietal diameter; Brain; Choroid plexus; Diameters; dry brain; Fetuses; first‐trimester screening; Gestation; Head; Mathematical analysis; Screening; Spina bifida; Spine; Ultrasonic imaging; Ultrasound; Ventricle (lateral); first-trimester screening; biparietal diameter; dry brain; spina bifida; choroid plexus
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.20856

ABSTRACT
Objectives
To measure the ratio of choroid plexus (CP) size to head size in normal fetuses and to compare it to that in fetuses with open spina bifida (OSB) and quantify the subjective sign of a ‘dry brain’.
Methods
This was a retrospective study of ultrasound images, obtained during first‐trimester screening between 11 and 13 weeks of gestation, from 34 fetuses with OSB and 160 normal fetuses. From the hospital databases, we retrieved images of the fetal head in the transventricular axial plane. We measured the areas of both CPs and the head and calculated the ratio between them. We also measured the longest diameter of each CP and calculated their mean (CP length), and measured the occipitofrontal diameter (OFD) and calculated the ratio of CP length to OFD. Measurements from the OSB fetuses were plotted on crown–rump length (CRL) reference ranges constructed using data from the normal fetuses, and Z‐scores were calculated.
Results
In the normal fetuses, the CP area increased, while the ratios of CP area to head area and CP length to OFD decreased, with increasing CRL. In 30 of the 34 (88%) fetuses with OSB, both ratios were increased significantly and the CPs filled the entirety of the head, giving the impression of a dry brain. In these cases, the borders of the lateral ventricles could not be identified.
Conclusions
At 11–13 weeks, the majority of fetuses with OSB have reduced fluid in the lateral ventricles such that the CPs fill the head. The dry brain sign is easily visualized during routine first‐trimester ultrasound examination while measuring the biparietal diameter, and can be quantified by comparing the size of the CPs to the head size. Until prospective data confirm the usefulness of this sign in screening for OSB, it should be considered as a hint to prompt the examiner to assess thoroughly the posterior fossa and spine. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.