Fetal Imaging Committee Page

Our intent is to provide a central resource for SPR members who seek additional information to help establish or grow their involvement with fetal imaging in their communities. Content is offered in a downloadable format for your use and modification. To offer suggestions on ways to improve the page or add other useful components, please contact the Fetal Imaging Committee chair through the link on the committee roster. 

More Information

An example of an Obstetrical Ultrasound checklist for technologists or reporting physicians

There are many superb fetal ultrasound resources developed over many decades by smart and dedicated medical professionals from multiple disciplines; it is not our intention to assemble them all here. You are encouraged to review the following documents for detailed information on suggested components of thorough ultrasound evaluation of a fetus:

Selected resources used by the Fetal Imaging Committee members follow, including

Examples of reporting template for the ultrasound examination can be found on the Guidelines Reporting Templates on the right hand side of this page. 

  • Commonly-used tables
  • Commonly-used reference materials

Educational  Resources

Websites

Recommended Texts

  • Benacerraf BR. Ultrasound of Fetal Syndromes. Second Edition. Churchill Livingstone, 2008.
  • Callen PC.  Ultrasonography in Obstetrics and Gynecology. Fifth Edition. WB Saunders and Co, 2008.
  • Sanders RC.  Structural Fetal Abnormalities: The Total Picture. Second Edition. Elsevier Health Sciences, 2002.
  • Woodward PJ.  Diagnostic Imaging: Obstetrics. Amirsys, 2005.
  • Woodward PJ. Expertddx: Obstetrics. Amirsys, 2009.

Fetal CT

by Teresa Victoria MD, Children’s Hospital of Philadelphia

Congenital skeletal abnormalities are a group of rare abnormalities of the fetus that affect bone growth and development. The prenatal diagnosis of these entities is challenging because of the relative rarity of each skeletal dysplasia, the multitude of differential diagnoses encountered when the bony abnormalities are identified, lack of precise molecular diagnosis and the fact that many of these disorders have overlapping features and marked phenotypic variability. In addition, our main imaging modality in the obstetric world, ultrasound, only has 40-60% sensitivity in the diagnosis of such malformations, and prenatal MR has not been show to shed significant light in the evaluation of these abnormalities.

Prenatal low-dose CT is an imaging modality that emerged to better evaluate these entities. This imaging study is ONLY done during the second and third trimester of gestation, in the fetus with severe skeletal abnormalities, when the diagnosis is still in question after performing an ultrasound. It is also done at low dose such that the fetal skeleton is well seen, but the fetal body is not.

The main risk to this examination is the radiation dose. We aim to keep it as low as reasonably achievable. Our mean radiation dose is <5 mSv. To put things in context, the American College of Radiologists describes the suspected in-utero deterministic radiation dose of <50 mSv as negligible. Note that this study is only done in a highly selective group of fetuses with severe skeletal abnormalities, as discussed above.

Technique

Once the patient is on the CT table, the top and bottom of the uterus are sonographically marked with radiopaque markers. The topogram, which only includes the maternal abdomen between the markers, confirms fetal position. Our protocol for this unenhanced CT is: 80-100 kVp, modulated mAs, pitch 1.2 mm, slice thickness 1.5 mm on a 1.2 mm detector, rotation time 0.5 sec. Images are then evaluated in a 3D console, where the maternal abdomen can be selectively excluded and the fetal skeleton can be reconstructed in 3D for complete evaluation.

Image Interpretation

Although this is a radiology exam, we usually do our image interpretation in conjunction with the obstetricians, geneticists, and when appropriate, orthopedic colleagues, and then reach a team-approach diagnosis.

Evaluation of bone mineralization requires a learning curve. We found the fetal atlas of Schumacher et al. [1], which shows postmorten radiographs of normal fetuses up to a gestational age of 23 weeks, valuable. The reconstructed fetal skeleton is then evaluated as expected for these group of diseases, including description of shape of skull, ribs, vertebral bodies, and pelvis, and full evaluation for the presence of fractures, bone bowing and segmentation anomalies. Referral to the always helpful Taybi and Lachmans’s “Radiology of Syndromes, Metabolic Disorders and Skeletal Dysplasias” [2] is strongly encouraged.

In summary, low-dose fetal CT affords exquisite detail of the fetal bones, allowing improved prenatal diagnosis, parental counseling and predelivery planning in a selective group of fetuses.

References

  1. Schumacher R, Spranger JW, Seaver LH. Fetal radiology: a diagnostic atlas. Berlin; New York: Springer, 2004: viii, 194 p.
  2. Lachman RS, Taybi H. Taybi and Lachman's radiology of syndromes, metabolic disorders, and skeletal dysplasias, 5th ed. Philadelphia: Mosby Elsevier, 2007: xxiii, 1365 p.

Resources

Guidelines Reporting Templates

Fetal Imaging Experts

Institutions who self-report offering prenatal imaging (in alpha order by US – States , then Canadian Provinces)
SPR Members: To be added to this resource, please click here.  

 

ARKANSAS
Little Rock

Arkansas Children's Hospital
Leann Linam, MD

 CALIFORNIA
Los Angeles

Institute for Maternal Fetal Health at Hollywood Presbyterian Medical Center
Hollie A. Jackson, MD

 San Francisco/Stanford  

 Packard Children’s Hospital
Dr. Beverley Newman
 
San Diego 
UCSD Medical Center 
Rosalind Brown Dietrich, MD 

COLORADO
Denver

University of Colorado Hospital 
Kimberly Dannull, MD
Laura Fenton, MD  
Mariana Meyers, MD
Carol Rumack, MD

DISTRICT OF COLUMBIA
Washington
 
Children's National Medical Center 
Dorothy Bulas, MD
Eva Rubio, MD 

FLORIDA
Jacksonville

Wolfson Children’s Hospital 
Chetan C. Shah, MD 

GEORGIA 
Atlanta
 
Children's Healthcare of Atlanta- Egleston Hospital
Adina Alazraki, MD 
Nilesh Desai,MD
Jonathan Loewen, MD
Sarah Milla, MD

 INDIANA 
Indianapolis
 
Riley Hospital for Children 
Kimberly Applegate, MD

 IOWA 
Iowa City
 
Children's Hospital of Iowa 
Michael D'Alessandro, MD 
Simon Kao, MD

 MASSACHUSETTS
Boston
 
Boston Children's Advanced Fetal Care Center
Carol Barnewolt, MD 
Stephen Brown, MD 
Susan Connolly, MD 
Judy Estroff, MD 
 

MICHIGAN

 Ann Arbor
C.S. Mott Center Children's Hospital
Maria Fernanda Ladino Torres, MD

Detroit
Children's Hospital of Michigan
Aparna Joshi, MD
Swati Mody, MD 

Royal Oak
Beaumont Children's Hospital 
David Bloom, MD
Luis F. Goncalves, MD

NEW HAMPSHIRE 

Lebanon
Darthmouth-Hitchcock Medical Center 
Steven Sargent, MD 

NEW YORK
New York
 
Benjamin Taragin, MD
Children's Hospital at Montefiore

OHIO 
Cincinnati

Cincinnati Children's Hospital Medical Center 
Beth Kline-Fath, MD
Maria Calvo-Garcia, MD
Carl Merrow, MD 
Usha Nagaraj, MD

PENNSYLVANIA
Philadelphia
 
Children's Hospital of Philadelphia 
Anne Hubbard, MD
Erin Simon, MD 

TENNESSEE
Memphis

Le Bonheur Children's Hospital
Harris Cohen, MD 

Nashville 
Vanderbilt Children's Hospital 
Marta Hernanz-Schulman, MD

TEXAS 
Houston
 
Texas Children's Hospital 
Chris Cassady, MD 
Amy R Mehollin-Ray, MD
Jennifer L Williams, MD  
 
CANADA

 NOVA SCOTIA
Halifax
 
Izaak Walton Killam Grace Health Centre 
Dr. Marian Macken 

ONTARIO

 Toronto 
Hospital for Sick Children 
Dr. Susan Blazer
Dr. Suzanne Laughlin

Ottawa
Children’s Hospital of Eastern Ontario
Dr. Julie Hurteau-Miller
Dr. Elka Miller

  QUEBEC

 Montreal 
Hopital Ste-Justine 
Dr. Josée Dubois
Dr. Laurent Garel
Dr. Andrée Grignon
Dr. Françoise Rypens

Montreal Children's Hospital - McGill University Health Center
Dr. Lucia Carpineta

 


Educational Posters

Resident and Fellow Training

Useful Links

References

Meetings

  • 2015

Fetal Imaging Committee

Beth M Kline-Fath, MD, Chair
Dorothy Isabella Bulas, MD, FACR
Lucia Carpineta, MD, CM
Kimberly A Dannull, MD
Nilesh Desai, MD
Judy Ann Estroff, MD
Katrina S Hughes, MD
Sabiha Pinar Karakas, MD
Mariana L Meyers, MD
Erika Rubesova, MD
Gaurav Saigal, MD
Chetan C Shah, MD
Gayathri Sreedher, MD
Laura J Varich, MD
Teresa Victoria, MD

Fetal Unknown Cases

Unknown Case #74

Potter's Syndrome

Unknown Case #68

Walker-Warburg Syndrome

Unknown Case #64

Omphalocele

 

Unknown Case #61

 pericardial teratoma

Unknown Case #55

Posterior Urethral Valves on Fetal MRI

Unknown Case #50

Epignathus teratoma

 

Unknown Case #48

 

CHAOS