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Neural tube defects on ultrasound are among the most important congenital anomalies evaluated during prenatal scanning. During my obstetrical training, I learnt even a small abnormal finding can change the entire clinical approach. Therefore, experience reinforced an important lesson: successful prenatal ultrasound is not just identifying abnormalities but also understanding the clinical significance. Moreover, this guide explains the structured ultrasound approach. What are neural tube defects? Neural tube defects are serious birth defects that occur when the neural tube does not close completely during the third and fourth week of pregnancy. Therefore, the brain, spinal cord and vertebra developed abnormally. However, the neural tube closes early in pregnancy, so many affected pregnancies are already in progress before the mother realize that she is pregnant. As I was doing my fetal ultrasound rotations early on, one of my instructors kept saying that it was very important to know what is normal so you could see what is abnormal. Therefore, I came to the realization over the years that this concept is true for nearly all fetal abnormalities during USG exams. Why early prenatal ultrasound matters: Prenatal ultrasound is the first-line imaging modality for the detection of neural tube defects. Furthermore, early diagnosis facilitates timely referral and appropriate management of pregnancy and subsequent imaging that are required. While training to become a sonographer, I was taught never to access the fetal spine without assessing the rest of the body. Therefore I always evaluate skull, brain, posterior fossa and spine as a unit Benefits of prenatal ultrasound: Moreover, the benefits of early ultrasound are numerous. Therefore, here are some benefits of prenatal ultrasound: However, identify large neural tube defects before birth Then, systematically access the fetal brain and spine Improve prenatal counseling Provide multidisciplinary pregnancy management Therefore, provide direction for fetal MRI or genetic testing Normal fetal neural tube anatomy: However, all sonographers need to know the normal development of the foetal neural tube. Therefore, it’s become easier to identify the abnormalities when a routine obstetrical scan is performed. Embryology of neural tube: Although the embryonic ectoderm forms the neural tube soon after fertilisation. The neural folds then fuse together to form the neural tube Therefore this structure eventually becomes the Brain Brain stem Spinal cord Normal neural tube closure: The normal tube closure takes place between day 22 and day 28 post fertilisation. Moreover, at this time both the cranial and caudal neuropores are completely closed, and the normal development of the foetal nervous system occurs. However, if closing remains incomplete, then neural tissues are exposed to the central nervous system. As a result, birth defects like spina bifida or anencephaly can develop. Fortunately, sufficient folate intake by the mother before becoming pregnant and during early pregnancy can greatly lower the risk of neural defects.

Tag: medical imaging

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