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The Neural Tube, image, image, image, image, image, image, image, image,…

- - - - Forebrain (Corpus callosum, Septum pellucidum, CSP, Fornix)
      - Midbrain (Peduncles)
      - Hindbrain (Cerebellum)
    - - Arachnoid
        
        Subarachnoid Space > Cisterna Magna
        
        Arachnoid villi >> Absorbs CSF
      - Pia
        
        Lines the ventricles and brain surface
        
        Forms Choroid plexus >> makes CSF
      - Dura
        
        Falxcerebri
        
        Tentoriumcerebelli
  - - - Intro
        
        Assess both lateral ventricles for [consistency]
        
        Measured Far field one at the Trigone
        
        Inner to Inner
        
        ≤ 10 mm is normal
        
        Subjectively normal = Choroid plexus mostly fills ventricle
      - MVM
        
        Mild ventriculomegaly
        
        Soft marker (>10mm- <=15mm)
        
        “Dangling Choroid” Sign
      - CPC
        
        Choroid Plexus Cysts
        
        True CPC soft marker ≥3mm
        
        ↑Risk for Trisomy 18 & 21 (Check fetal hands)
        
        Documentation
        
        Measure in 3 orthogonal planes
        
        Specify Rt or Lt
        
        VS Vasc. channels <3mm
        
        Isolated CPC(’s)
        
        Single or Multiple CPC’s are considered isolated if:
        
        Biometry is consistent
        
        Amniotic fluid is normal
        
        No structural abnormalities seen
        
        No other markers for aneuploidy are seen
        
        Usually resolve, often absent on subsequent scans
        
        No need to follow up with ultrasound!!!
        
        Rather…..Genetics Referral / Serum Screening Correlation
      - Required Images (Choroid plexus, Falx)
    - - Intro
        
        Slide inferior from Ventricular Level
        
        CSP and Thalamus are landmarks
      - Measurements
        
        HC
        
        Outside skull
        
        Do NOT include skin –bone only
        
        CI
        
        Assesses head shape
        
        CI= BPD/OFD x 100
        
        Brachycephalic (round) CI > 83
        
        Normal CI = 74 –83
        
        Dolichocephalic (flat)CI < 74
        
        OFD (occipito frontal diameter)
        
        Perform when:-subjectively variant head shape
        -BPD and HC measurements are inconsistent
        
        BPD
        
        Leading –leading
        
        Widest part of head
        
        Criteria:
        
        Head is oval, Midline is horizontal, Midline in middle ,Landmarks visible
        
        Measure x 2, Re-scan in between
      - Landmarks
        
        CSP
        
        Anterior to thalamus
        
        Between anterior horns of lateral ventricles
        
        Note if present or absent
        
        Thalamus
        
        Fornix & peduncles
        
        Slightly inferior to Level of BPD
        
        CSP 2 lines, Fornix 3 lines
      - Required Images (CSP, Thalamus or Fornices, peduncles)
    - - Cerebellum
        
        Some labs measure
        
        Measure TR width (Include hyperechoic outer layer)
        
        Size ≈Age (20mm = 20wks) 2nd trimester
      - Cisterna Magna (CM)
        
        Posterior to cerebellum
        
        Normal 2 –10 mm (Enlarged = soft marker - in setting of Dandy Walker Malformation)
        
        Measure in midline posterior to vermis
      - Nuchal Thickness (NT)
        
        Fetal Soft Marker
        
        30 degrees off horizontal
        
        Structures:
        
        Solid occipital bone
        
        CSP visible
        
        Normal if:
        
        <5 mm (16-18wks)
        
        <6 mm (18-24wks)
        
        Outer bone -outer skin
        
        Thickness vs Translucency
        
        Thickness
        
        2nd trimester
        
        Routine
        
        Axial scan plane
        
        Outer to outer
        
        Translucency
        
        1st trimester
        
        Certification required
        
        Sagittal scan plane
        
        Inner to inner
      - Required Images (CSP, Cerebellum, Cisterna magna, Nuchal thickness)
- - - - Forebrain (Telecephalon >> Hemispheres) (Diencephalon> Thalamus
      - Midbrain (Peduncles)
      - Hindbrain (Cerebellum)
    - - Cervical 7, Thoracic 12, Lumbar 5, Sacrum fused5, Coccyx fused4 tailbone.
      - Body, Arch(pedicles, lamina) Transverse processes, Spinous process, Articular process/facets
    - - Ectoderm
        
        Skin, Nervous
      - Mesoderm
        
        MSK, CVS, Urogenital
      - Endoderm
        
        GIT, RS
    - - Cranial end (closes at day 24)
      - Caudal end (closes at day 26)
      - Forms from mesoderm
      - Forms from 2 rows of somites
      - Zips closed from middle to envelop neural tube
      - Lower spine closes last
    - - Forms from mesoderm
      - Fibrous joints between bones = sutures
      - Fontanelles(“soft spots”)
        
        Moldingduring birth
        
        Growth of brain thru adolescence