Assessment of the fetal nasal bone at 11–14 weeks of gestation by three‐dimensional ultrasound

Rembouskos, G.; Cicero, S.; Longo, Daniela; Vandecruys, H.; Nicolaides, Kypros H.

doi:10.1002/uog.952

Cited by 47 publications

(32 citation statements)

References 7 publications

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“…Indeed, multiple attempts were required to obtain a satisfactory 3D volume in many cases because about onethird of the initial volumes obtained were considered suboptimal and excluded from further offline analysis. These observations are in keeping with those of Rembouskos et al, 14 who were the first to study 3D data sets for evaluation of the nasal bones in the first trimester. However, in their study, identification of the nasal bones in the coronal plane was achieved in only 5% of the 20 3D data sets, highlighting the importance of optimizing sonographic quality during the time of the 3D volume acquisition and not merely relying on the quality of the 2D images.…”

supporting

confidence: 89%

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

Martínez-Ten¹,

Adiego²,

Pérez-Pedregosa³

et al. 2010

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate a new sonographic technique for identifying the nasal bones using the retronasal triangle view, ie, the coronal plane at which the palate and frontal processes of the maxilla are simultaneously visualized. Methods. Three-dimensional (3D) volumes were acquired from women undergoing first-trimester sonographic screening for aneuploidy by 2 accredited operators. Those data sets in which the fetal face was clearly identified were selected for offline analysis by 2 other observers who were unaware of the sonographic or clinical findings. The nasal bones were classified as both present, only 1 present (right or left), or absent according to the presence or absence of 2 small paired echogenic linear structures at the upper tip of the retronasal triangle as determined by 3D navigation in the coronal plane and compared to those findings obtained by 3D navigation in the sagittal plane. Additional 3D data sets involving a subset of 4 first-trimester fetuses with trisomy 21 and absent nasal bones were also analyzed retrospectively and included randomly in the study group. Results. A total of 110 3D data sets were analyzed, of which 86% were obtained transabdominally and 14% transvaginally. The quality of nasal bone identification was classified subjectively by the observers as good in 67% of cases, fair in 29%, and poor in 4%. The nasal bones were classified as at least 1 present in 106 of the cases (96%) and absent in 4 (4%), with complete agreement between observers in both the sagittal and coronal planes (κ = 1). Discrimination between the right and left nasal bones was possible in 89% and 93% for observer A and in 96% and 96% for observer B by assessing the sagittal and coronal views, respectively (right nasal bone: κ = 0.90 [95% confidence interval (CI), 0.79-1]; left nasal bone: κ = 0.85 [95% CI, 0.60-0.99]). The nasal bones were not identified at the level of the retronasal triangle view in any of the fetuses with trisomy 21 and absent nasal bones. Conclusions. This study shows that the nasal bones can be confidently identified as paired echogenic structures located at the upper tip of the retronasal triangle. This coronal view of the fetal face offers the possibility of screening for the presence or absence of the nasal bones in the first trimester, especially when the standard midsagittal views of the fetal face are suboptimal because of fetal or maternal factors. Because both nasal bones can be evaluated simultaneously in the coronal plane, the retronasal triangle view may be advantageous over the conventional midsagittal view assessment, in which only 1 of the 2 nasal bones is evaluated.

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supporting

confidence: 89%

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

Martínez-Ten¹,

Adiego²,

Pérez-Pedregosa³

et al. 2010

Journal of Ultrasound in Medicine

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“…Good interobserver agreement on nasal bone assessment was achieved when a 3D volume was analyzed by different examiners [109]. Another study [108], however, found that demonstration of the nasal bones at 11-14 weeks of gestation in a reconstructed section is entirely dependent on obtaining a good initial 2D view prior to 3D acquisition.…”

Section: The Nasal Bonementioning

confidence: 97%

Three-dimensional ultrasound in prenatal diagnosis

Chaoui

Heling

2006

Current Opinion in Obstetrics &Amp; Gynecology

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“…Other authors found a signifi cant relation between incidence of NB absence and NT thickness MoM, CRL, and ethnic group [4,7,8,13,[22][23][24][25] . Perhaps the measure of NB was more powerful than only the evaluation of the presence or absence of NB.…”

Section: Discussionmentioning

confidence: 99%

Interest of Foetal Nasal Bone Measurement at First Trimester Trisomy 21 Screening

Weingertner¹,

Köhler²,

Firtion³

et al. 2006

Fetal Diagn Ther

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Objectives: The purpose of this study is to assess the feasibility of foetal nasal bone (NB) measurement during the first trimester of pregnancy, and to examine the contribution of this measurement to the prenatal screening for Down syndrome following the definition of NB threshold using ROC curves in an unselected population. Methods: This prospective study was carried out at our centre SIHCUS-CMCO (reference centre) from January 2002 to December 2004 on a total of 2,044 pregnant outpatients at gestational weeks 11–14. Only 1260 singleton foetuses were used for statistical analysis. In the 784 other patients, we were unable to obtain a correct image allowing a reproducible measurement. NB was measured during the same session as nuchal translucency (NT) measurement. Ten trained sonographers took part in the study. Correlation index was evaluated to shed light on a link between interest variables and NB. Screening values of NB measurement in T 21 were also calculated with NB measurement according to crown-rump length, and expressed as the best threshold of multiple of the median determined by ROC curve. Screening values of genetic ultrasound were then evaluated by adding NB measurement to maternal age and NT measurement. Results: Two thousand and forty-four patients were included. We indexed 30 cases of T 21, 14 cases of Trisomy 18, 10 cases of Trisomy 13 and 25 cases of other karyotype abnormalities. Feasibility of measurement was 62% of all cases. We observed a significant relation between NB and NT (p = 0.001 ), as well as between NB and crown-rump-length (p < 0.0001 ). However, size of NB was not correlated to maternal ethnic group (p = 0.314). At 0.6 multiple of the median thresholds, screening values of NB measurement in T 21 were: sensibility 32%, false positive rate 10%, positive predictive value 13.6%, and negative predictive value 96.9%. The likelihood ratio for T 21 in case of NB ≤ 0.6 multiple of the median was 4.4 (2.0–9.4). Screening values for maternal age and NT measurement were: sensitivity 88%, false positive rate 23%,positive predictive value 9.7%, and negative predictive value 99.6%. Inclusion of NB measurement increased sensitivity to 100%, positive predictive value to 13.6%, and negative predictive value to 100%, and decreased false positive rate to 5%. Conclusion: NB measurement seemed to be a great sonographic marker for T 21. However, its low feasibility made it inadequate for routine settings in first trimester T 21 screening in an unselected population. Statistical independence with NT thickness needed to be further evaluated.

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Assessment of the fetal nasal bone at 11–14 weeks of gestation by three‐dimensional ultrasound

Abstract: Objective To evaluate the benefit of three-dimensional (3D)

Cited by 47 publications

References 7 publications

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

Three-dimensional ultrasound in prenatal diagnosis

Interest of Foetal Nasal Bone Measurement at First Trimester Trisomy 21 Screening

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