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© 2002 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 21:619-626 • 0278-4297

A Diagnostic Approach for the Evaluation of Spina Bifida by Three-dimensional Ultrasonography

Wesley Lee, MD1,2, Tinnakorn Chaiworapongsa, MD, Roberto Romero, MD, Rosa Williams, RDMS, Beverley McNie, Anthony Johnson, DO, Marjorie Treadwell, MD and Christine H. Comstock, MD

1 Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan (W.L., B.M., C.H.C.); Perinatology Research Branch, National Institute of Child Health and Human Development, Detroit, Michigan (W.L., T.C., R.R., R.W.); and Department of Obstetrics and Gynecology, Hutzel Hospital, Wayne State University, Detroit, Michigan (W.L., T.C., R.R., A.J., M.T., C.H.C.).
2 Wesley Lee, MD, has been a consultant for Medison America and GE Medical Systems, which manufacture some of the three-dimensional ultrasonography equipment used in this project.

Address correspondence and reprint requests to Wesley Lee, MD, Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073-6769.

Objective. To describe a prenatal diagnostic method for evaluating spina bifida by three-dimensional ultrasonography. Methods. Two- and three-dimensional ultrasonography were used to determine the extent of vertebral defects among fetuses with spina bifida. Spinal levels were independently counted from the most caudal thoracic vertebra with a rib (e.g., 12th thoracic rib). A virtual cutting plane was manipulated through a volume-rendered spine to generate optimal multiplanar views for this blinded analysis. Prenatal diagnosis was compared with a postnatal analysis of bony spine defects derived from radiographic films or magnetic resonance imaging. Results. Nine fetuses were examined by two-dimensional ultrasonography (21.8 ± 3.4 menstrual weeks) and three-dimensional ultrasonography (22.8 ± 4.4 menstrual weeks). For two-dimensional ultrasonography, the spinal level agreed to within 1 vertebral segment in 6 of 9 infants. In contrast, three-dimensional ultrasonography agreed to within 1 vertebral segment in 8 of 9 infants. Three fetuses had vertebral defect levels on two-dimensional ultrasonography that were 1.5 to 2 segments away from postnatal findings. The same fetuses had results that were within 1 vertebral segment on three-dimensional ultrasonography. Volume rendering showed splayed vertebral pedicles and disrupted vertebrae. An intact meningeal sac was easily rendered in 5 of 9 subjects. Conclusions. Multiplanar views are generally more informative than rendered views for localizing bony defects of the fetal spine. The level of the defect on three-dimensional ultrasonography correlates well with those on two-dimensional ultrasonography and postnatal imaging studies. This approach may improve characterization of spina bifida by adding diagnostic information that is complementary to the initial assessment by two-dimensional ultrasonography.

Abbreviations: 3D, three-dimensional • 3DUS, three-dimensional ultrasonography • 2DUS, two-dimensional ultrasonography

Key Words: fetus • neural tube defect • prenatal diagnosis • spina bifida • three-dimensional ultrasonography




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