23rd World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts OC08.02 *Neurodevelopmental outcome in isolated mild ventriculomegaly: systematic review and meta-analysis G. Pagani 1,2 , F. Prefumo 2 , B. Thilaganathan 1 1 Fetal Medicine Unit, Division of Developmental Sciences, St George’s Hospital Medical School, London, United Kingdom; 2 Maternal Fetal Medicine Unit, Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Brescia, Italy Objectives: Diagnosis of ventriculomegaly (VM) is based on a reference range established in 1988. The finding of fetal VM is variably associated with other fetal abnormalities and, even when isolated, thought to be linked to abnormal neurodevelopmental outcome. The aim of this study was to undertake a systematic review of the current literature on the neurodevelopmental outcome of isolated fetal ventriculomegaly. Methods: Studies that assessed neurodevelopmental outcome in isolated ventriculomegaly were identified from a search of scientific databases. Studies that did not check for karyotype and that excluded cases of bilateral VM were not included in the analysis. VM was defined as mild with a ventricular width between 10 and 15 mm, and isolated when not associated with other abnormalities, abnormal karyotype or congenital infection. Neurodevelopmental delay was defined as abnormal neurodevelopmental score, regardless the test used. Results: The search yielded 940 possible citations; of these, 886 were excluded by review of the title or abstract as they did not meet the selection criteria. Full manuscripts were retrieved for 54, and a total of 19 studies were included in the review with a total of 699 cases of isolated mild ventriculomegaly. The overall prevalence of neurodevelopmental delay was 78/699 (9.65%, 95% CI 6.1-13.2%, I2=-1.51%). Conclusions: The findings of this study demonstrate that 90% of babies with isolated mild ventriculomegaly has a normal neurodevelopmental outcome. Because of this finding the definition of VM should be re-discussed and gestational age based reference ranges should be provided. A trial to establish the influence of co-variates (i.e. laterality, progression, fetal growth) in predicting neurodevelopmental outcome of isolated fetal VM is also required. OC08.03 Prenatal prediction of the need for a ventriculo-peritoneal shunt in spina bifida A. Khalil, V. Caric, A. Bhide, A.T. Papageorghiou, B. Thilaganathan Fetal Medicine Unit, St George’s, University of London, London, United Kingdom Objectives: The aim of this study was to investigate whether the need for ventriculo-peritoneal shunting in neonates with open spina bifida can be predicted prenatally. Methods: This was a retrospective cohort study of all fetuses with open spina bifida identified at a single referral centre between 1998 and 2012. Ultrasound records at the initial assessment and the last scan prior to delivery were reviewed and the outcomes ascertained from maternal, neonatal and pediatric records. The performance of screening was determined by ROC curve analysis. Results: We identified 131 cases of isolated spina bifida during this period. Of these 48 were liveborn. Detailed postnatal follow-up was available for 39 of these 48 cases, with an average follow- up time of 3.6 years. The median gestational age was 21 weeks * This presentation is eligible for the Young Investigator award (to be presented in the closing session). at the initial assessment and 36 weeks at the last prenatal scan. A shunt was inserted in 22 (56.4%) cases. Compared to those that did not subsequently require a shunt, the posterior horn of the lateral ventricle (Vp) and ratio between Vp and hemisphere (Vp/H) at diagnosis were significantly higher in cases that required a shunt (Vp: median 12.4mm vs 7.7mm, p<0.001 and Vp/H: median 0.54 vs 0.33, p<0.001, respectively). Similarly, Vp and Vp/H at the last scan were significantly higher in cases that later required a shunt compared to those that did not (Vp: median 23.1mm vs 8.2mm, p<0.001 and Vp/H: 0.54 vs 0.21, p<0.001, respectively). The detection rate using Vp at the initial assessment was 68.2% for a false positive rate of 12.7% (+ve LR 6); at the last scan it was 80.0% for a false positive rate of 7.1% (+ve LR 11). All fetuses with a Vp of ≥12mm at the time of diagnosis required a postnatal shunt insertion (PPV 100%). Conclusions: In cases with open spina bifida the need for a postnatal shunt can be predicted prenatally by identifying a larger Vp. This novel observation can be useful in the prediction of the outcome and accurate prenatal counseling. OC08.04 The ‘brain shadowing sign’: a simple marker of fetal craniosynostosis K.K. Haratz 1,2 , T. Lerman-Sagie 3,2 , D. Lev 4,2 , A.F. Moron 5 , G. Malinger 6,2 1 Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 3 Pediatric Neurology, Wolfson Medical Center, Holon, Israel; 4 Genetics Institute, Wolfson Medical Center, Holon, Israel; 5 Departamento de Obstetricia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; 6 OB-GYN Ultrasound Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Objectives: Prenatal diagnosis of fetal craniosynostosis is challeng- ing, especially when the sagittal suture is the only one involved, there is no family history and the skull is not yet deformed. The objective of this study is to describe the ‘brain shadowing sign’ as a novel sonographic marker of craniosynostosis. Methods: The ‘brain shadowing sign’, defined as a sharply demarcated line separating between a zone with clearly defined cerebral anatomy and another with non-visualized brain content due to acoustic shadowing, was evaluated in 16 patients with a postnatal diagnosis of craniosynostosis. Sonographic images were analyzed as well as postnatal data for confirmation of the diagnosis. Results: The mean gestational age at diagnosis was 29w0d (range 22w0d -36w3d). The diagnosis was made in the 2nd trimester in only two cases. Fourteen patients had non-syndromic isolated craniosynostosis and two suffered from Apert’s Syndrome. Single suture craniosynostosis was present in 13 cases (metopic 7, sagittal 5, coronal 1). The ‘brain shadowing sign’ was clearly depicted in all cases with craniosynostosis, even when the suture was only partially closed. Conclusions: The ‘brain shadowing sign’ is a novel sonographic marker of craniosynostosis, caused by the failure of the acoustic wave to cross the cortical bone. It can be easily identified, is not dependant on fetal position and does not require depiction by high definition 3D transducers. The ‘brain shadowing sign’ is a direct finding that enables precise prenatal diagnosis and appropriate counseling. 16 Ultrasound in Obstetrics & Gynecology 2013; 42 (Suppl. 1): 1–47.