Assessment of the fetal thymus by two‐ and three‐dimensional ultrasound during normal human gestation and in fetuses with congenital heart defects

Li, L.; Bahtiyar, Mert O.; Buhimschi, Catalin S.; Zou, Lile; Zhou, Qichang; Copel, Joshua A.

doi:10.1002/uog.8853

Cited by 41 publications

(50 citation statements)

References 24 publications

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“…Visualization of the fetal thymus can be challenging on routine obstetric sonography. Studies looking at the reproducibility of fetal thymus measurements using dedicated research sonographers suggest very high rates of reliable measurements 25 , 29 . However, in our experience, and despite a 3‐month reproducibility trial and continuous quality assurance throughout the study, the study sonographers had lower rates of successfully obtaining thymus measurements.…”

Section: Discussionmentioning

confidence: 61%

“…A potential limitation of our study was the fact that we performed only 2D thymus measurements. Due to the amorphous shape of the fetal thymus, 2D measurements may not adequately reflect its true size, and 3‐dimensional volumetric scanning may better capture subtle changes in thymus size over time 29 . Although using 2D measurements may be considered a potential limitation, we thought that it was important to focus on 2D measurements of the thymus, as these methods are used in other studies focusing on fetal thymus evaluation.…”

Section: Discussionmentioning

confidence: 99%

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Second‐Trimester Sonographic Thymus Measurements Are Not Associated With Preterm Birth and Other Adverse Obstetric Outcomes

Brandt

Bastek

Wang

et al. 2016

J of Ultrasound Medicine

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reterm birth, which is defined as delivery before 37 weeks' gestation, is responsible for 35% of deaths in the first year of life and more than $26 billion in annual health care costs. 1 Current methods for identifying women at increased risk for preterm birth are inadequate. Although universal cervical length screening during the second-trimester anatomic survey may identify patients at risk for spontaneous preterm birth, many patients with normal second-trimester cervical length measurements will still have preterm birth. [2][3][4] Justin S. Brandt, MD, Jamie A. Bastek, MD, MSCE, Eileen Wang, MD, Stephanie Purisch, MD, Nadav Schwartz, MD Received July 2, 2015, ORIGINAL RESEARCHObjectives-Previous studies have demonstrated an association between adverse obstetric outcomes, such as preterm birth, and in utero inflammation. The fetal thymus, which can be visualized in the anterior mediastinum on obstetric sonography, may involute in response to such inflammation and thus may identify pregnancies at increased risk for these outcomes. We therefore sought to determine whether secondtrimester fetal thymus measurements are associated with preterm birth.Methods-Transabdominal fetal thymus measurements were prospectively obtained in singleton pregnancies at gestational ages of 18 weeks to 23 weeks 6 days during a 5-month period. The transverse and anterorposterior thymus diameters and the thymicthoracic ratio were measured. Delivery outcomes were collected from our clinical database. The primary outcome was preterm birth, which we defined as delivery between 24 weeks and 36 weeks 6 days. Small for gestational age (SGA) and pregnancyrelated hypertension, which are adverse obstetric outcomes that may also be associated with in utero inflammation, were included as secondary outcomes.Results-We included 520 patients with thymus measurements and obstetric outcome data. The prevalence of preterm birth was 12.3% (n = 64). None of the thymus measurements were associated with preterm birth. Similarly, there was no association between thymus measurements and SGA or pregnancy-related hypertension.Conclusions-Sonographic assessment of the second-trimester fetal thymus did not identify patients at increased risk for preterm birth, SGA, and pregnancy-related hypertension. Routine thymus measurements during the second-trimester anatomic scan are not clinically useful for prediction of preterm birth and other adverse outcomes.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Second‐Trimester Sonographic Thymus Measurements Are Not Associated With Preterm Birth and Other Adverse Obstetric Outcomes

Brandt

Bastek

Wang

et al. 2016

J of Ultrasound Medicine

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“…Chaoui et al [21] reported a high sensitivity (90%) for prediction of 22q11.2 deletion when thymic aplasia or hypoplasia was detected. Recently Li et al [22] assessed the fetal thymic volume by 3D ultrasound, and concluded that volumetric assessment was a better indicator of normal fetal thymus development than 2D measurement, and may help in deciding when to test for 22q11.2 deletion.…”

Section: Discussionmentioning

confidence: 99%

Variety of prenatally diagnosed congenital heart disease in 22q11.2 deletion syndrome

et al. 2014

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ObjectiveTo analyze the spectrum of prenatally diagnosed congenital heart disease in a Korean population with 22q11.2 deletion syndrome, and to provide guidelines for screening 22q11.2 deletion prenatally.MethodsThis retrospective study evaluated 1,137 consecutive fetuses that had prenatal genetic testing for 22q11.2 deletion because of suspected congenital heart disease between September 2002 and December 2012, at Asan Medical Center, Seoul, Korea.ResultsMain cardiovascular diseases in the 53 fetuses with confirmed 22q11.2 deletions were tetralogy of Fallot (n = 24, 45%), interrupted aortic arch (n = 10, 19%), ventricular septal defect (n = 5, 9%), double outlet right ventricle (n = 4, 8%), and coarctation of the aorta (n = 4, 8%). Other cardiac defects were rarely associated with 22q11.2 deletion. One fetus had persistent truncus arteriosus, one had aortic stenosis, and one had hypoplastic right heart syndrome. Two fetuses had normal intracardiac anatomy with an isolated right aortic arch, and one had an isolated bilateral superior vena cava.ConclusionA variety of congenital heart diseases were seen during the prenatal period. Conotruncal cardiac defects except transposition of great arteries were strongly associated with 22q11.2 deletion. When such anomalies are diagnosed by fetal echocardiography, genetic testing for 22q11.2 deletion should be offered. Even if less frequent deletion-related cardiac defects are detected, other related anomalies, such as thymic hypoplasia or aplasia, should be evaluated to rule out a 22q11.2 deletion.

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“…The fetal thymus can be identified by using several landmarks, including the 3‐vessel edge in the 3‐vessel view, internal mammary arteries, and brachiocephalic veins . Three‐dimensional US and 4‐dimensional spatiotemporal image correlation have been used to calculate the volume of the fetal thymus . Because the fetal thymus grows in size and volume in utero, the thymic‐thoracic ratio was invented to eliminate the influence of gestational age.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between the Thymic‐Thoracic Ratio and Cardiac Axis in Healthy Fetuses

Zhao

Liu

Meng

2017

J of Ultrasound Medicine

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Assessment of the fetal thymus by two‐ and three‐dimensional ultrasound during normal human gestation and in fetuses with congenital heart defects

Cited by 41 publications

References 24 publications

Second‐Trimester Sonographic Thymus Measurements Are Not Associated With Preterm Birth and Other Adverse Obstetric Outcomes

Second‐Trimester Sonographic Thymus Measurements Are Not Associated With Preterm Birth and Other Adverse Obstetric Outcomes

Variety of prenatally diagnosed congenital heart disease in 22q11.2 deletion syndrome

Correlation Between the Thymic‐Thoracic Ratio and Cardiac Axis in Healthy Fetuses

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