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Re: microcephalyFrom: DuBose, Terry (DuboseTerryJ@exchange.uams.edu)Wed May 12 12:10:15 1999
While I agree that microcephaly can and does exist without ventriculomegaly, they can also be associated. However, I do disagree with the statement that we can not evaluate the head size in the face of head molding. I will reiterate my position that we can measure a molded head and evaluate for volumetric changes. The Vertical Cranial Diameter (VCD) is the most dynamic and compensates for BPD compression, while the BPD will compensate for VCD compression. While our study was published in a "lesser" peer reviewed journal (J Diag. Med. Sonography) almost 15 years ago and it has not been replicated, I have a database of over 10,000 sonographic cases that say we can measure the 3D head for this evaluation. It would take too much here to explain the concept and measurements in their entirety, but a 3D BPD Correction is possible and will exhibit the least variation of any other head measurement, particularly toward term in brachycephalics & dolichocephalics. For a complete discussion of this 3D fetal cranial biometry, see DuBose, FETAL SONOGRAPHY, Chapter 8 "Cranial Biometry", W. B. Saunders Co., 1996. Also, for references to the journal articles go to my Web pages which contains some brief discussion and images of the 3D measurements at: http://www.io.com/~dubose/ <http://www.io.com/~dubose/> On these pages look at BBII, and 3D evaluation of the mass of the fetal skull. The (3D BPD) <3d.html> Correction If you specific questions, I will try to give lucid responses. Peace, Terry J. DuBose, M.S., RDMS, FAIUM University of Arkansas for Medical Sciences Little Rock, AR, USA -----Original Message----- From: rwelch@liv.ac.uk [SMTP:rwelch@liv.ac.uk] Sent: Wednesday, May 12, 1999 11:18 AM To: Multiple recipients of list ULTRASOUND Subject: Re: microcephaly Your not suggesting that fetal microcephaly does not exist without ventriculomegaly? I have seen several cases of pathologic and nonpathologic microcephaly without ventriculomegaly. Dear all I echo Wayne's position. There are many recognised syndromes and genetic diseases with microcephally but no ventriculomegally....the problem is when to label the small head "microcephalic" Experience suggests that it is not usually possible until well into the third trimester unless there is previous pregnancy data to go on. This issue raised however was how do we differentiate between inaccurate measurement due to head engagement and microcephally. The answer has to be that we cannot. If the head is engaged then we should not attempt to measure the BPD/HC and state why. Ross -- Ross Welch Consultant in Fetomaternal medicine Duchess of Westminster Wing Arrowe Park Hospital Upton, Wirral. UK Current president International Fetal Medicine and Surgery Society.
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