EARLY FETAL HYDROPIC CHANGES ARE ASSOCIATED WITH MODERATE DILATATION OF THE BRAIN VENTRICULAR SYSTEM: A CLUE TO A POSSIBLE LINK BETWEEN CERVICAL LYMPHATIC ENGORGEMENT AND VENTRICULAR DILATATION?

Abstract

The aim of this study is to assess whether early cervical lymphatic obstruction is associated with a sonographically detectable dilatation of the ventricular system in the 1st trimester of pregnancy. In particular, the objective is to assess whether fetuses with non-immune hydrops fetalis (NIHF), cystic hygroma, or enlarged nuchal translucency (NT) have a greater atrial width/biparietal diameter (AW/BPD) ratio than normal at time of the combined first trimester screening scan. This retrospective study included 96 first trimester fetuses (33 normal and 63 with various degree of cervical lymphatic engorgement). Inclusion criteria were CRL in the 45-84 mm range and availability of one or more three-dimensional volume datasets of the fetal head, acquired from the BPD plane. Each three-dimensional volume dataset was opened and multiplanar correlation employed to align the three orthogonal planes. The ratio between the atrial width and the BPD (AW/BPD ratio) was used to evaluate the possible presence of increased amount of cerebrospinal fluid. Abnormal cases were placed into 4 categories: 1)enlarged non-septated NT 2.5-3.9 mm, nohydrops; 2) grossly enlarged non-septated NT/ edema >3.9 mm; 3) cystic hygroma and/or NIHF; 4) major anomalies with NT <2.5 mm.Presence of dilatation of the latero-cervical jugular lymphatic sacs, karyotype andpresence of congenital anomalies were alsorecorded. The One-way ANOVA test was usedto compare means. Intra- and inter-observervariability were also assessed. The AW/BPDratio was found to be significantly higher infetuses with grossly enlarged NT/nuchal edemaand NIHF/septated cystic hygroma than innormal (p <0.05 and p <0.01, respectively).Also, the AW/BPD ratio was significantlyhigher in NIHF/septated cystic hygroma thanin enlarged NT 2.5-3.9 mm (p <0.05). In caseof enlarged NT (2.5-3.9 mm), the AW/BPDratio is significantly higher in presence of JLS(p <0.01). At the end of the first trimester,presence of cervical lymphatic engorgement,in terms of grossly enlarged NT, nuchaledema, septated cystic hygroma, and NIHF,is statistically associated with a moderatedilatation of the ventricular system. Of note,among fetuses with moderately enlarged NT,those with evidence of dilatation of the JLSshow a statistically significant increase in theAW/BPD ratio.