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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:317-320 • 0278-4297

Fetal Cerebral Ventricular Pointing as a Marker of Spina Bifida

Incidence and Observational Agreement

Joseph R. Wax, MD, Michael G. Pinette, MD, Angelina Cartin, Janet Michaud, RDMS and Jacquelyn Blackstone, DO

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.

Address correspondence to Joseph R. Wax, MD, MMC Ob/Gyn Associates, 887 Congress St, Suite 200, Portland, ME 04102 USA., E-mail: waxj{at}mmc.org

Objective. Occipital cerebral ventricular pointing is a promising intracranial marker for spina bifida. We sought to determine (1) the incidence of pointing in fetuses with and without spina bifida and (2) inter-observer and intraobserver agreement for visualizing pointing. Methods. Second-trimester transverse axial images of the lateral cerebral ventricles from an equal number of affected and unaffected fetuses were independently reviewed in a blinded fashion by 2 examiners. Results. Sixty-two fetuses (31 with isolated spina bifida and 31 without) had sonographic examinations at 19.2 ± 1.3 weeks (mean ± SD). Pointing was present in 77.3% of fetuses with spina bifida and 15% of those without by the first examiner and in 78.3% of fetuses with spina bifida and 10% of those without by the second examiner. Interobserver and intraobserver agreement were substantial ({kappa} = 0.69 and 0.78, respectively). Conclusions. Ventricular pointing is a highly agreed-on finding that is substantially associated with but not pathognomonic for fetal spina bifida.

Key Words: cerebral ventricles • open neural tube defect • prenatal diagnosis • spina bifida

Abbreviations: CI, confidence interval • MRI, magnetic resonance imaging

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