EP05.26: Role of 3D ultrasound and Doppler technologies sensitive for low‐velocity flow in fetal imaging of the medullary veins of the CNS

The prenatal visualisation of arterial and venous cerebral vessels by Doppler ultrasound may be crucial for the diagnosis of the CNS's malformations. The recent Doppler technologies highly sensitive for low-velocity flow have allowed accurate imaging of the cerebral fetal venous system, which consists of dural sinuses and superficial and deep medullary veins, the latter originating in the subcortical white matter, running towards the periventricular subependymal veins and converging into the deep venous system at the level of the caudate nucleus. A parasagittal view demonstrating the radial direction of the deep medullary veins from the subcortical white matter (arrows) and the periventricular subependymal veins (arrow) using 3D US and Doppler technologies sensitive for low-velocity flow is shown in figure 1, while the convergence of the deep medullary veins at the level of the caudate nucleus (arrow) and the roof of the lateral ventricles (arrows) is shown in figure 2. Highly sensitive Doppler technology may also show the disruption of the anatomy of the medullary veins in CNS anomalies. Figure 3a shows the case of a 36 years-old woman scanned at 31+2 weeks due to a massive subarachnoid hemorrhage, which was featured by the asymmetrical widening of the subarachnoid space due to a large blood collection. The addition of Doppler technologies sensitive for low-velocity flow demonstrated the distorted architecture of the medullary veins draining the cerebral cortex due to brain compression in the parasagittal plane (see figure 3b). Lastly, Doppler technology sensitive for low-velocity flow with and without 3D US may enable prenatal visualisation of the medullary veins. Such property has the potential to substantiate the diagnosis of complex cerebral anomalies. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.