Open AccessEnlarged posterior fossa on prenatal imaging: differential diagnosis, associated anomalies and postnatal outcome
Author(s) -
Wüest Anja,
Surbek Daniel,
Wiest Roland,
Weisstanner Christian,
Bonel Harald,
Steinlin Maja,
Raio Luigi,
Tutschek Boris
Publication year - 2017
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13131
Subject(s) - medicine , prenatal diagnosis , cerebellar hypoplasia (non human) , hypoplasia , fetus , cyst , posterior cranial fossa , magnetic resonance imaging , agenesis , radiology , anatomy , pregnancy , cerebellum , genetics , biology
The primary aim of this study was to ascertain the prevalence of the individual conditions and of associated anomalies in fetuses with the prenatal diagnosis of enlarged posterior fossa ( PF ) and to explore the diagnostic accuracy of ultrasound in these anomalies. The secondary aim was to evaluate the postnatal outcome of children affected by PF anomalies. Material and methods All fetuses with enlarged PF detected by prenatal sonography at a referral center from 2001 to 2015 were analyzed retrospectively. Some were also studied by fetal magnetic resonance imaging ( MRI ) or volume ultrasound examinations. Fetal sonographic and MRI were compared using following classification: Dandy–Walker malformation (DWM); megacisterna magna ( MCM ); Blake's pouch cyst; isolated vermian hypoplasia; vermian agenesis; PF arachnoid cyst ( AC ); and cerebellar hypoplasia ( CH ). Results The ultrasound diagnoses of the 69 fetuses were as follows: MCM ( n = 29; of these isolated n = 15), DWM ( n = 28, isolated n = 4), vermian hypoplasia ( n = 5, isolated n = 4), Blake's pouch cyst ( n = 4, isolated n = 1), CH ( n = 2; none isolated) and AC in the PF ( n = 1, isolated). Thirteen of the 41 karyotyped fetuses were aneuploid, including seven with DWM. Associated malformations were found in 37/69 cases. There were 39 live births, including 11 with confirmed DWM, six of whom show a normal development. Twelve infants with isolated MCM show normal development. There were eight false‐positive prenatal diagnoses (or resolution until birth) of “enlarged PF ”: three with Blake's pouch cyst, two with MCM and one with vermian hypoplasia. Conclusions An enlarged PF requires specific diagnoses for the best possible counseling. The term “ Dandy–Walker variant ” should not be used anymore. Isolated MCM and Blake's pouch cyst can either resolve or be normal variants, but may also indicate the presence of a more severe anomaly or associated malformations.