Original Article

Diagnostic Value of Two-Dimensional plus Four-Dimensional Ultrasonography in Fetal Craniocerebral Anomalies


Background: To assess the clinical value of two-dimensional (2D) plus four-dimensional (4D) ultrasonography in diagnosis of fetal craniocerebral anomalies.

Methods: Retrospective analysis was performed on the sonographic features of 83 maternity patients admitted to Northwest Women’s and Children’s Hospital, Xian China from January 2013 to December 2017 diagnosed with suspected fetal anomalies of the brain and skull through 2D and 4D ultrasonography.

Results: Fifty six patients were diagnosed with the anomalies by 2D ultrasonography only, 65 patients by 4D ultrasonography only, and 74 patients by 2D plus 4D ultrasonography.76 patients were confirmed to have fetal craniocerebral anomalies after birth or induced labor. Diagnostic accuracies of 2D ultrasound only, 4D ultrasound only, and 2D plus 4D ultrasound were 68.67%, 81.93% and 95.18%, respectively (P<0.05). The accuracy of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only, and the accuracy of 4D ultrasound only was higher than that of 2D ultrasound only (P<0.05). The sensitivity of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only (P<0.05). The specificity of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only (P<0.05).

Conclusion: Combined ultrasonography can better differentiate fetal craniocerebral anomalies, providing early and more accurate information for clinicians as well as maternity patients to make a decision. This clinical practice would be valuable for improving the quality of the newborn population.





1. Malinger G (2017). The Fetal Brain in Fetuses with Orofacial Abnormalities. Cham, 131-141.
2. Garcia-Filion P, Almarzouki H, Fink C, Geffner M, Nelson M, Borchert M (2017). Brain Malformations Do Not Predict Hypopituitarism in Young Children with Optic Nerve Hypoplasia. Horm Res Paediatr, 88(3-4): 251-257.
3. Sabeti Rad Z, Friberg B, Henic E, Rylander L, Stahl O, Kallen B, Lingman G (2017). Congenital malformations in offspring of women with a history of malignancy. Birth Defects Res, 109(3): 224-233.
4. Salman MM, Twining P, Mousa H, James D, Momtaz M, Aboulghar M, El-Sheikhah A, Bugg GJ (2011). Evaluation of offline analysis of archived three-dimensional volume datasets in the diagnosis of fetal brain abnormalities. Ultrasound Obstet Gynecol, 38:165-9.
5. Hoekzema E, Barba-Muller E, Pozzobon C et al (2017). Pregnancy leads to long-lasting changes in human brain structure. Nat Neurosci, 20(2): 287-296.
6. Cloutier M, Gallagher L, Goldsmith C, Akiki S, Barrowman N, Morrison S (2017). Group genetic counseling: An alternate service delivery model in a high risk prenatal screening population. Prenat Diagn, 37(11): 1112-1119.
7. Vinals F, Ruiz P, Quiroz G, Guerra FA, Correa F, Martinez D, Puerto B (2017). Two-Dimensional Ultrasound Evaluation of the Fetal Cerebral Aqueduct: Improving the Antenatal Diagnosis and Counseling of Aqueductal Stenosis. Fetal Diagn Ther, 42(4): 278-84.
8. Sklar C, Yaskina M, Ross S, Naud K (2017). Accuracy of Prenatal Ultrasound in Detecting Growth Abnormalities in Triplets: A Retrospective Cohort Study. Twin Res Hum Genet, 20(1): 84-89.
9. Rossi AC, Prefumo F (2017). Correlation between fetal autopsy and prenatal diagnosis by ultrasound: A systematic review. Eur J Obstet Gynecol Reprod Biol, 210: 201-206.
10. Vora NL, Robinson S, Hardisty EE, Stamilio DM (2017). Utility of ultrasound examination at 10-14 weeks prior to cell-free DNA screening for fetal aneuploidy. Ultrasound Obstet Gynecol, 49(4): 465-469.
11. Shainker SA, Saia K, Lee-Parritz A (2012). Opioid addiction in pregnancy. Obstet Gynecol Surv, 67(12): 817-25.
12. Hazlett HC, Gu H, Munsell BC et al (2017). Early brain development in infants at high risk for autism spectrum disorder. Nature, 542(7641): 348-351.
13. Varcin KJ, Jeste SS (2017). The emergence of autism spectrum disorder: insights gained from studies of brain and behaviour in high-risk infants. Curr Opin Psychiatry, 30(2): 85-91.
14. Roy-Lacroix ME, Moretti F, Ferraro ZM, Brosseau L, Clancy J, Fung-Kee-Fung K (2017). A comparison of standard two-dimensional ultrasound to three-dimensional volume sonography for routine second-trimester fetal imaging. J Perinatol, 37(4): 380-386.
15. Kurian J, Sotardi S, Liszewski MC, Gomes WA, Hoffman T, Taragin BH (2017). Three-dimensional ultrasound of the neonatal brain: technical approach and spectrum of disease. Pediatr Radiol, 47(5): 613-627.
16. Barisic LS, Stanojevic M, Kurjak A, Porovic S, Gaber G (2017). Diagnosis of fetal syndromes by three- and four-dimensional ultrasound: is there any improvement? J Perinat Med, 45(6): 651-665.
17. Yagel S, Cohen SM, Shapiro I, Valsky DV (2007). 3D and 4D ultrasound in fetal cardiac scanning: a new look at the fetal heart. Ultrasound Obstet Gynecol, 29(1): 81-95.
18. Benzie RJ, Starcevic V, Viswasam K, Kennedy NJ, Mein BJ (2018). Effect of three- vs four-dimensional ultrasonography on maternal attachment. Ultrasound Obstet Gynecol, 51(4): 558-559.
19. Snoek R, Albers M, Mulder EJH et al (2018). Accuracy of diagnosis and counseling of fetal brain anomalies prior to 24 weeks of gestational age. J Matern Fetal Neonatal Med, 31(16): 2188-2194.
20. Moog NK, Entringer S, Heim C, Wadhwa PD, Kathmann N, Buss C (2017). Influence of maternal thyroid hormones during gestation on fetal brain development. Neuroscience, 342: 68-100.
IssueVol 48 No 2 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v48i2.831
Two-dimensional ultrasound Four-dimensional ultrasound Fetal craniocerebral anomalies Diag-nostic value

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How to Cite
WANG Y, CHEN X, ZHONG S, ZHANG R, PAN Y, AN P, GAO X. Diagnostic Value of Two-Dimensional plus Four-Dimensional Ultrasonography in Fetal Craniocerebral Anomalies. Iran J Public Health. 2019;48(2):323-330.