Calipers, CRL measurement. /Filter /FlateDecode At this early stage, the gestational age is being estimated by determination of the mean sac diameter (MSD): the average of the sac length, width, and depth. Cortical maturation continues throughout pregnancy, as the brain develops gyri and loses its smooth appearance (Fig. Premature closure of multiple cranial sutures restricts expansion of the skull, particularly with advancing gestation, resulting in a cloverleaf appearance. Note the difference in echogenicities between the various organs. As the U.S. National Library of Medicine explains, "The long-term consequences of dolichocephaly are not fully known, but it has been correlated with delayed reaching skills, tightness in the spinal extensors and scapular retractors, and development of motor asymmetries.". Using 3D ultrasound (Figs. /BitsPerComponent 8 1 0 obj In these conditions, the skull is also easily compressible, which can be demonstrated by applying gentle pressure with the ultrasound transducer. Estimating fetal age: effect of head shape on BPD. The CM is a CSF-filled structure that is located behind the cerebellum. B: Axial view of the same fetus. The shape of the ventricles is best assessed using the combination of longitudinal and coronal views (Figs. Coronal sections add very little information to the axial ones, but depending on the position of the fetus, this approach may provide the clearest view. At the time the article was last revised Munyi Ambrose Ithiga had Scaphocephaly, or sagittal craniosynostosis, is a type of cephalic disorder which occurs when there is a premature fusion of the sagittal suture.Premature closure results in limited lateral expansion of the skull resulting in a characteristic long, narrow head. If it appears to be exceptionally large, it can be objectively assessed by measurement of its anteroposterior diameter in an axial section of the posterior fossa (Fig. Dolichocephaly has two primary causes: craniosynostosis or positioning. Ultrasound is a noninvasive imaging test that shows structures inside your body using high-intensity sound waves. 1.6). In an axial section at the superior aspect of the thorax, clavicles can be seen even early in gestation (Fig. American Academy of Pediatrics. Please note the difference in the texture of the surface of the cortex, with absent sulci and gyri at 22 weeks gestation (A) and well-developed pattern of sulci and gyri at term (B). When three or more of these characteristics are present, 1 point is added to the systemic score. Scaphocephaly(also known as dolichocephaly) is the most common form of craniosynostosis, where premature closure of the sagittal suture results in an impediment to the lateral growth of the skull while anteroposterior growth continues, producing a classic elongated, yet narrow, skull. Employing the transvaginal route to image a fetus that is cephalic in presentation can facilitate a detailed examination of the intracranial anatomy. CI nh hn 75. Fusion of all sutures produces a tall pointed skull known as acro- or oxy-cephaly. Note that this is a neonatal image to show the anatomy in its entirety. Notched arrow, falx cerebri; cp, choroid plexus. Con transductor linear de 7,5 Mhz se visualiza imagen nodular con eco-patrn mixto ( contenido solido-liquido ), se localiza en lbulo derecho . FIGURE 1.49: Sagittal view of the lumbar spinal cord (solid arrow) ending in the conus medullaris (notched arrow) in late second trimester. /Type /ExtGState FIGURE 1.43: A: Axial section of a fetal head in the mid-second trimester weeks demonstrating the fourth ventricle (arrow). Since the cerebellar vermis is not yet fused, a large midline communication is seen between the developing fourth ventricle and the cisterna magna (CM) (Fig. Dhnert W. Radiology Review Manual. Color Doppler may be used to help define the cord insertion and the number of arteries in the cord (Fig. If you are concerned that your baby may have a severe case of dolichocephaly that may result in any developmental, health, or psychological issues, you should speak to your pediatrician. 1989;74 (4): 600-3. 7 0 obj Sometimes it is called dolichocephaly, as 'dolicho' means long. In this rare case, surgery is very successful after birth to correct the problem. . After a quick Google search, I've found it means the head is long and narrow in shape. The exact timing of the examination may also depend on maternal habitus. Images Scaphocephaly: The head has a short laterolateral and a long anteroposterior diameter. An axial view of the inferior aspect of the cerebellum at this point in pregnancy may reveal a fluid-filled space between the tonsils, which may lead to the erroneous diagnosis of a defect in the vermis. The fetus is in a neutral position and occupies the majority of the image. From Fowlkes JB; Bioeffects Committee of the American Institute of Ultrasound in Medicine. B: Sagittal section of a fetal head in the early third trimester. Because sutures are fluid, they allow the brain to grow and develop. Fetal feet can also be identified, though evaluating the number of toes may be difficult because of their small size (Fig. According to the AAP, most cases of misshapen infant heads or skull deformities are not serious and do not affect the health or well-being of an infant. By Wendy Wisner In the early first trimester, the transvaginal approach is ideal to detect any adnexal pathology or free fluid. A: Arrow, developing aqueduct of Sylvius; bs, brain stem. (2012) American Journal of Roentgenology. Dolichocephaly is a mild cranial deformity in which the head has become disproportionately long and narrow, due to mechanical forces associated with breech positioning in utero. The falx cerebri is seen as an echogenic line running in the anteroposterior direction. The genital tubercle (open arrow) points in a direction parallel to the longitudinal axis of the fetus, indicating a female gender. Using axial planes, the mid-second trimester cerebellum is seen as a dumbbell-shaped structure consisting of two hemispheres connected by the vermis. This is normally done at the level of the posterior margin of the choroid plexus using a magnified image so that calipers can be accurately placed on the inner margins of the ventricular walls (Fig. In the coronal view, the two lateral points of ossification can be visualized cleanly, and by moving the probe anteriorly, ossification of the vertebral body can be brought into view. However, the presence of multiple vertebral ossification centers does obscure it to a variable degree, especially later in gestation. The cephalic index (CI) is a ratio/value calculated using two fetal biometric parameters which are the occipitofrontal diameter (OFD) and the biparietal diameter (BPD). The occipital horns project posteriorly. Trong nhng trng hp nh vy, u hp v di ra. Our data suggest that craniosynostosis could be diagnosed antenatally in a significant number of cases. 1.30 to 1.33). In the axial section, the three ossification centers are in a triangular arrangement. The half of the brain that is closest to the transducer is much more difficult to image clearly when compared with the distal half. Pediatric radiology, the requisites. It provides the same information as the early first trimester scan with a number of additional benefits. /Subtype /Image Babies' skull bones contain spaces in between them that are filled with a flexible substance called sutures. Usually, this misshapen look is minimal and resolves on its own. Care should be taken with caliper placement as the authors of some charts measure from the outer aspect of the calvarium in the near field to the inner aspect of the calvarium in the far field, while others use an outerouter approach. /CreationDate (D:20180611143312+03'00') 2. It can also be used to localize the DV in a right parasagittal section, allowing pulse wave assessment of this vessel for aneuploidy and cardiac screening. Calipers, BPD measurement; chevron, lateral ventricle (occipital horn); open arrow, lateral ventricle (atrium containing echogenic choroid plexus); thin solid arrows, lateral ventricle (frontal horns); notched arrow, lateral ventricle (occipital horn); thick solid arrow, third ventricle; t, thalamus; asterisk, cavum septi pellucidi. Dolichocephaly = CI <76%; 5. At 20 weeks gestation, the upper limit of normal is considered to be 10 mm, although recently some authors have suggested that even measurements up to 12 mm are very unlikely to be associated with significant pathology.8790 The ventricles become less prominent with advancing gestation although a threshold of measurement <10 mm is typically also used in the third trimester. Both hands are commonly held in front of the chest or fetal face, and the legs are generally flexed at the hip at this gestation. So worried The accuracy of CRL measurement decreases with gestational age. 8 0 obj 4) The sacral portion of the spine usually has a more persistent curvature, with the tip of the spine pointing posteriorly (Fig. %PDF-1.4 Compare with Figure 1.7. bs, brainstem; asterisks, cerebellar hemispheres; arrow, cisterna magna. Synonyms for dolichocephaly in Free Thesaurus. FIGURE 1.7: Transverse views of a fetal head at 12 weeks gestation demonstrating hindbrain appearance at various levels in descending order. This dolichocephalic preterm infant enjoys time in the upright seated position, promoting midline positioning and head reshaping. By the completion of the process at the beginning of the third trimester, it remains as only a slit-like structure, representing the Sylvian fissure (Fig. The case was diagnosed to be a variant of Miller-Dieker syndrome (MDS). It has an incidence of 1 in every 4,200 babies." - Does this mean it ex Continue Reading More answers below Is ABVS ultrasound better at detecting abnormal tissues in breasts than conventional ultrasound? FIGURE 1.41: Axial view of a fetal head in the third trimester after the completion of insular operculization. Typical facial characteristics include dolichocephaly, downslanting palpebral fissures, enophthalmos, retrognathia, and malar hypoplasia. However, fetal position, reduction in amniotic fluid volume, and increased bony ossification often make the third trimester examination more challenging. National Council on Radiation Protection and Measurements. The length of the skull is the distance from the glabella (the midpoint between the brows) and the most projecting point at the back of the head. Remember that any concerns you may have are valid. << endstream Absence of the nasal bone is associated with an increased risk of trisomy 21.55 Similarly, the intracranial anatomy of the posterior fossa can be examined and used to screen for spina bifida in this view.12 The methodology for assessment of these features as well as the overall utility of the 11 to 13+6 week scan is discussed in detail in Chapter 8. /Length 7 0 R Prior to the completion of the 7th gestational week, the anatomy of the embryonic pole is difficult to clearly delineate. FIGURE 1.37: A: Axial section of a fetal head at 22 weeks gestation at the level of the cavum septi pellucidi (solid arrow). ASSESSING FETAL ANATOMY DURING THE SECOND AND THIRD TRIMESTERS. We evaluated dolichocephaly, the name associated with a no Objective: Cephalic index less than 76% Subjective: Apparently increased antero-posterior length of the head compared to width Comments: Cephalic index is the ratio of head width expressed as a percentage of head length. ; C]pb If one or more sutures close early, it will cause the skull to expand in the direction of the sutures that remain open, which can result in an abnormal head shape. In cases of moderate or severe skull deformity, therapies and other interventions may be necessary. As a normal variant, the CSV can be unusually large and visible in this section. If your babys skull looks elongated, they may be diagnosed with a condition called dolichocephaly (also known as scaphocephaly). 1.18 and 1.19). FIGURE 1.40: A: Axial section of a fetal head at 20 weeks gestation demonstrating the insula at an early stage of operculization (open arrow) with the middle cerebral artery (color Doppler) at its base (solid arrow). Open arrow, vertebral body ossification center. My 20 week ultrasound also recvealed abnormal head dimensions and cephalic index of 69. Z@N 30 - N. 4 - Quarterly - ISSN 2385 - 0868 Prediction of Fetal Lung Maturity by Ultrasonic Thalamic Echogenicity The approach to the anatomical survey is essentially the same in both the second and the third trimesters. Examination of the cerebral cortex focuses on ruling out any space occupying lesions, either cystic or solid in nature. It can also be seen in conditions where the skull is poorly ossified such as certain types of osteogenesis imperfecta and hypophosphatasia. Exposure Criteria for Medical Ultrasound, II: Criteria Based on All Known Mechanisms. endobj The vertebral column should be evaluated in at least two of the three planes: coronal, axial, and longitudinal (midsagittal). 1.5). CVA is the difference between 2 diagonal measurements (frontozygomaticus to opposite eurion). The ultrasound appearance of the spinal cord is fairly uniform with slightly decreasing size moving cranial to caudal. Head length is measured between the glabella (the most prominent point on the . cp, choroid plexus; arrow, third ventricle. FIGURE 1.23: Fetal hand with all phalangeal ossification centers visible (13 to 14 weeks gestation). Confirm that the fetal heart is beating. Isolated enlargement of the fourth ventricle is unlikely to occur and is of limited clinical significance. ultrasound scans throughout the pregnancy and all neonates were found to be normal. 1.12 to 1.14). A complete examination of the uterine contents in pregnancy includes much more than evaluation of the fetal anatomy; the remaining issues will be discussed in later chapters. Cranial vault asymmetry (CVA): also referred to as diagonal difference, oblique diagonal difference, or transcranial difference. And will have appointment with my private Obstertric , he will do ultrasound to check head . You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. It is seen as a hypoechoic structure between the cerebral peduncles and the cerebellum (Fig. Even though this view is primarily designed to evaluate the posterior fossa and the back of the fetal head, it also offers a good view of the CSP, thalami, and the midbrain as well as their anatomic relationship (Fig. There is a tendency of the ankles to turn inward, making the diagnosis of clubfoot in the first trimester challenging. a, atria. The uterus should then be scanned in cross section, from left to right and from top to bottom, determining the number of fetuses that are present and defining the lie of the fetus. 1.4).49,50. xYr6z9 >$II4 R_? IQP]HU>aJ[iJ*UFeuVk~T. Y\4r$9I 3^nvlZ6|=!ss2%+u*W'Z9 Solid arrow, medulla oblongata; open arrow, pons; asterisk, cisterna magna; c, cerebellum. The temporomandibular joint (TMJ) conducts and restrains masticatory movements between the mammalian cranium and the mandible.Through this functional integration, TMJ morphology in wild mammals is strongly correlated with diet, resulting in a wide range of TMJ variations. Here are some the AAP recommends you try at home: Caring for a baby with any sort of abnormality can be stressful. It is commonly, though not exclusively, a result of an extended stay in neonatal intensive care unit (NICU). /BitsPerComponent 8 FIGURE 1.25: Both lower extremities visible at 13 to 14 weeks gestation. Appointments & Locations. Beginning with the 8th week of gestation, the embryonic head and torso become identifiable. Dolichocephaly is a long keel-shaped skull with prominent forehead and occiput. FIGURE 1.4: Sagittal view of an 11- to 12-week fetus. Solid arrows, clavicles. 1.37).96 In the sagittal view, visualization of the pericallosal artery helps to confirm the presence of the corpus callosum (Fig. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Bell D, Zivic L, et al. The fetus usually presents itself in a better axis for examination. But most of the time, these occur after birthwithin the first 4 to 12 weeks, when babies spend a lot of time lying flat and are less mobile. The midsagittal section of the fetus is very important, as this allows accurate measurement of CRL and, when adequately magnified, nuchal translucency (Fig. FIGURE 1.3: Sagittal view of an 8-week gestation. Anyone had this and how did it turn out? Since the CSPV is arched in shape, may appear to be separate from the cavum septi pellucid, simulating a cyst (Fig. It is best to develop a systematic approach to the examination. Cephalic index: a gestational age-dependent biometric parameter. A more significant deformity can also impact a person's self-esteem and confidence as they grow into adulthood. Dolichocephaly seems a Materials and methods Ultrasound examinations were performed prospectively at the Department of Obstetrics and Gynecology and at the Department of Medical Genetics and Fetal Medicine at Palack University Teaching Hospital in Olomouc. Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses sound waves to produce images of structures within your body. Using this method, the accuracy of sex determination is only 70% at 11 weeks gestation but increases to nearly 100% at 13 to 14 weeks gestation.59. c, cerebellar hemispheres. The stomach should be visible in the upper abdomen, and the integrity of the diaphragm can be assessed in sagittal or coronal sections (Figs. Increased BMI can significantly compromise the ultrasound examination and may require a change in the usual strategy. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-2020, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2020,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/scaphocephaly/questions/1916?lang=us"}, View Frank Gaillard's current disclosures, see full revision history and disclosures. Retrospective analysis showed a prenatal scan reporting dolichocephaly. << The process of cortical maturation can be most easily observed in the insula. 2023 Dotdash Media, Inc. All rights reserved, Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. -. The BPD is assessed using an axial image of the head at a level where standard anatomic landmarks are visible: The globular and slightly hypoechoic paired structures representing the thalami in the midportion of the head with a slit-like hypoechoic structure representing the third ventricle located between them, the cavum septi pellucidi (CSP) in front of the thalami, and the lateral ventricles, with the frontal horns seen anteriorly and the atria (trigones) seen posteriorly. The shape of the skull may be abnormal in association with a number of specific fetal anomalies. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Both the femur and the humerus can be identified and measured (Figs. /ColorSpace /DeviceRGB Its common for babies heads to look slightly misshapen after birth and even in the first few weeks that follow. The CSP and its posterior extension, the cavum septi vergae (CSV), are seen as a continuous hypoechoic structure located in the midline. Dolichocephaly refers to an elongation of an infants head caused most often by positioning after birth. Another axial section routinely employed to evaluate the intracranial anatomy is the suboccipitobregmatic view: Starting with the BPD view, the posterior aspect of the probe is rotated caudally until the posterior fossa becomes visible. Examination of the CSPV in the sagittal section will help to elucidate the diagnosis (see Fig. Neuroimaging and molecular cytogenetics were used to ascertain the cause of disability in a case. h, fetal head. After 11 weeks gestation, the calvarium should be ossified and is seen as an echogenic ring around the intracranial structures (see Fig. ic d-li-k-s-fa-lik : having a relatively long head with cephalic index of less than 75 dolichocephaly d-li-k-se-f-l noun Word History Etymology New Latin dolichocephalus long-headed, from Greek dolichos long + -kephalos, from kephal head more at cephalic First Known Use 19, 20) can help differentiate closed from open sutures [22]. You may have fears about the future, and you may not know how to handle what is happening in the here and now. This can lead to a false impression that the CSP is present, consequently missing the diagnosis of anomalies that can be associated with absent CSPV such as agenesis of corpus callosum, septo-optic dysplasia, lobar holoprosencephaly, and neuronal migration defects. This scan can be done anytime between 18-22 weeks of your pregnancy but ideally around the 20 week mark. In longitudinal section, the line of ossification of vertebral bodies is seen anteriorly and, if there is a slight oblique cut, one set of posterior ossification sites will be visualized. Serial examinations may be needed to reach a diagnosis. 1.34). Even though operculization of the insula begins at approximately 14 weeks gestation, on ultrasound, this process does not become evident until approximately 19 weeks gestation. Arrow, cavum veli interpositi; cp, choroid plexus. Table 1.2 Selected Safety Recommendations for Diagnostic Ultrasound Ultrasound exposures that elevate fetal temperature by 4C above normal for 5 min or more have the potential to induce severe developmental defects Apply the ALARA principle if the tissues to be exposed contain stabilized gas bodies (lung) and the MI exceeds 0.4 Returning to an axial section, the anterior abdominal wall and cord insertion are evaluated (Fig. Dolichocephalic head shapes are relatively rare in cultures where infants sleep supine. This ratio is valuable in describing the shape of the head. The sagittal suture permits growth in the width of the skull; premature closure results in a cranium that is high, long, and narrow (dolichocephaly). She has worked with breastfeeding parents for over a decade, and is a mom to two boys. In order to assess the symmetry of the two halves of the brain, regardless of the level of the axial view, care should be taken to keep the falx cerebri truly in the midline. Some mild cases of dolichocephaly and other instances of misshapen skulls will not require treatment, as they will generally just resolve as your baby grows. B: Axial view of the same fetus in slightly more caudal section. FIGURE 1.44: A, B: Suboccipitobregmatic views of the head demonstrating a variety of normal septations within the cisterna magna (cm). The spinal cord can be delineated within the spinal canal using ultrasound on most exams (Fig. Fetal anatomy is best assessed at 20 to 24 weeks gestation. American Institute of Ultrasound in Medicine consensus report on potential bioeffects of diagnostic ultrasound. Paciente femenina de 48 aos de edad con historia de hipertension arterial. FIGURE 1.31: Anterior coronal view of the brain at 24 weeks gestation. These diagnoses can be difficult to tease out and depend on findings in axial, midsagittal, and coronal sections. What is Dolichocephalic? Dolichocephaly can develop in an otherwise normal developing skull when a baby spends too much time in certain positions. Assessment of the central nervous system is not complete without detailed examination of the fetal spine. Thieme Medical Publishers. Early Hum Dev. The structures that are easiest to identify because of their well-delineated boundaries and greatest differences in echogenicity from the surrounding cortex are the lateral ventricles and the CSP. Note that CVA will be symmetric in symmetric brachy-, and dolichocephaly. It begins as infolding of the cerebral cortex at the lateral edge of the cerebrum located initially in the anterior half of the distance between the occiput and the forehead. Dolichocephaly. Routine examination of the intracranial anatomy should always include identification of these structures. Mosby Inc. (2009) ISBN:0323031250. /Length 9 0 R 1.35). FIGURE 1.8: Transverse views of a fetal head at 13.5 weeks gestation demonstrating progressive development of the cerebellum. An abnormal skull shape can also lead to difficulties with chewing, swallowing, vision, and breathing. FIGURE 1.2: Embryo at 6.5 weeks gestation. It is normally small (<3 mm diameter) and may be difficult to visualize. A cloverleaf shape of the skull is more specific of various fetal abnormalities including Pfeiffer syndrome 23, 24. The third ventricle is located inferiorly to the CSP, between the paired thalami. CARTA, Human Uniqueness Compared to "Great Apes": Absolute Difference /Width 38 The HC is measured by tracing around the outside of the calvarium in the same axial section as the BPD. During surgery, the affected suture is removed to correct the baby's head shape. Thickened (>6 mm) nuchal fold is associated with an increased risk of trisomy 21. The abnormal shape of the skull can also result in difficulties to chew and swallow, as well as issues with vision and breathing. Note the formation of a cyst-like structure in B. Calipers, cisterna magna measurement; c, cerebellar hemispheres. 1.38). We evaluated dolichocephaly, the name associated with a nonsynostotic cause to be a physiological variant having no prognostic value, to that of a similar synostotic or secondary to a. 4 0 obj Gestational age is 20 weeks, 1 day, with EDD of 09/01/2023 by the clinical dates given. FIGURE 1.6: Axial view of the fetal head at 12 weeks gestation. /Height 60 1.8). Ultrasound findings are frequently best interpreted in combination with quantitative maternal serum hCG (human chorionic gonadotropin) with or without progesterone levels. The hepatic artery peak systolic velocity may be evaluated in the same section to aid in aneuploidy risk assessment (Fig. The vertebrae have three ossification centers visible prenatally: Vertebral body anteriorly and one in each of the vertebral arches (laminae) posteriorly. 1.1).47 This finding is considered normal until the early portion 12th week of gestation and should not be mistaken for an omphalocele. Dolichocephaly is a term used to describe a tall, narrow head. Open arrow, pulmonary artery; solid arrow, aorta; chevron, superior vena cava. The routine calculation of CI can be performed at antenatal scanning, and a value outside the normal range, or a . >> 4,f~Z]\1aHZ9Lx40!?-v*oTf+*i;/F@l#C5b[4I.uf B,\ux+~G39EzF^}gsR8v.jnS$6p-,b$1F3{o V W'4C8)3j|jO 7w&p5=Rj [BD,11X1vHd+/H3$S)`"A 1@"2FIcD]9Rt52D[ B: Section demonstrating vertebral body ossification centers (open arrow) only. Dont be afraid to contact your pediatrician or other healthcare provider with questions. At 12 to 13+6 weeks, an error of 7 days is considered to be acceptable.51,52, LATE FIRST TRIMESTER SCAN (11+1 TO 13+6 WEEKS GESTATION), The late first trimester scan is generally considered to be the first scheduled point for routine ultrasound assessment in pregnancy. Healthy Children. 1.5). The calvarium will be completely absent in anencephaly. It can also be helpful to get in touch with other parents who have been through similar experiences through an online or in-person support group. However, unlike the CSP, a thin echogenic line can be seen between the two fornices, which helps to differentiate between the two entities (Fig. The images can provide valuable information for diagnosing and directing treatment for a variety of diseases and conditions. Scaphocephaly accounts for approximately 50% of all cases of craniosynostosisand has a male predilection with an M:F ratio of 3:1. HC=90th percentile, . dolichocephaly is associated with dozens of developmental disabilities that can result in mental retardation. 137 (1): 83-5. Note that this is a neonatal image to show the anatomy in its entirety. They are hypoechoic and have a generally rectangular shape in the axial plane. doi:10.2176/nmc.ra.2017-0006. no financial relationships to ineligible companies to disclose. This slit-like structure is filled with CSF and is hypoechoic in its ultrasound appearance (see Fig. Please note the difference in anatomic detail between the proximal and distal half of the brain. In cases of isolated brachycephaly and dolichocephaly, our findings of a normal outcome in 80% of these cases confirm that these isolated features are rarely associated with a fetal abnormality. The face, specifically lips and nose, are best examined in sagittal section (see Fig. Facts about Craniosynostosis. FIGURE 1.30: Sagittal view of the lateral ventricle at 24 weeks gestation. anyone dealt with this? FIGURE 1.10: Coronal view of the fetal face. Images can often be improved by rotating the probe so the brain is imaged through the suture lines and fontanelles, using techniques similar to those applied during neonatal examination.