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Ultrasonographic Nomograms of the Fetal Fourth Ventricle

Additional Tool for Detecting Abnormalities of the Posterior Fossa

Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel (I.G., I.R.M., B.-S.R.); Department of Epidemiology, Technion Faculty of Medicine, Haifa, Israel (A.T.); and Department of Obstetrics and Gynecology, Hospital Dr R. A. Calderon, San Jose, Costa Rica (D.N.).

Address correspondence and reprint requests to Israel Goldstein, MD, Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa 31096, Israel

Objective. To characterize normal growth of the fetal fourth ventricle on ultrasonography throughout pregnancy. Methods. Consecutive biometric measurements and fetal organ scans were obtained from 299 patients undergoing fetal anatomic surveys between 13 and 40 weeks’ gestation. Using 7- and 3.5-MHz transducers for early (13- to 17-week) and late (>17-week) examinations, respectively, we scanned the fetal head in the axial plane with special focus on the posterior fossa of the brain. The fourth ventricle was identified, and its anteroposterior diameter and width were measured. A "triangle" formula was used for calculating its circumference and area. Results. The fourth ventricle was shown as a hypoechoic triangle below the level of the cerebellum. A linear regression line of the fourth ventricle was observed across gestational age, and a first-degree correlation was found between gestational age and anteroposterior diameter of the fourth ventricle (r = 0.894; P < .0001; y = –0.84 + 0.23 x gestational age), its width (r = 0.657; P < .0001; y = 3.82 + 0.14 x gestational age), its circumference (r = 0.843; P < .0001; y = 5.11 + 0.58 x gestational age), and its area (r = 0.844; P < .0001; y = –10.11 + 1.17 x gestational age). Twelve enlarged fourth ventricles were found between 14 and 16 weeks, but results of follow-up scans at 20 weeks were normal. Conclusions. An isolated enlarged fourth ventricle in the early second trimester might represent a normal variant; it should be followed, but decisions about the fate of the pregnancy should not be based solely on this finding.

Abbreviations: AP, anteroposterior • GA, gestational age

Key Words: central nervous system • fetus • fourth ventricle • prenatal diagnosis • ultrasonography