Cranial and cerebral signs in the diagnosis of spina bifida between 18 and 22 weeks of gestation: a German multicentre study

Prenat Diagn. 2015 Mar;35(3):228-35. doi: 10.1002/pd.4524. Epub 2015 Feb 4.


Objective: The aim of this article is to study secondary cranial signs in fetuses with spina bifida in a precisely defined screening period between 18 + 0 and 22 + 0 weeks of gestation.

Method: On the basis of retrospective analysis of 627 fetuses with spina bifida, the value of indirect cranial and cerebral markers was assessed by well-trained ultrasonographers in 13 different prenatal centres in accordance with the ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) guidelines on fetal neurosonography.

Results: Open spina bifida was diagnosed in 98.9% of cases whereas 1.1% was closed spina bifida. Associated chromosomal abnormalities were found in 6.2%. The banana and lemon signs were evident in 97.1% and 88.6% of cases. Obliteration of the cisterna magna was seen in 96.7%. Cerebellar diameter, head circumference and biparietal diameter were below the 5th percentile in chromosomally normal fetuses in 72.5%, 69.7% and 52%, respectively. The width of the posterior horn of the lateral ventricle was above the 95th percentile in 57.7%. The secondary cranial and cerebral signs were dependent on fetal chromosome status and width of the posterior horn. Biparietal diameter was also dependent on the chromosome status with statistical significance p = 0.0068. Pregnancy was terminated in 89.6% of cases.

Conclusion: In standard measuring planes, lemon sign, banana sign and an inability to image the cistern magna are very reliable indirect ultrasound markers of spina bifida. © 2014 John Wiley & Sons, Ltd.

Publication types

  • Multicenter Study

MeSH terms

  • Abnormalities, Multiple / diagnostic imaging
  • Adolescent
  • Adult
  • Cerebellum / diagnostic imaging*
  • Cerebrum / diagnostic imaging*
  • Chromosome Disorders / complications
  • Cisterna Magna / diagnostic imaging*
  • Cohort Studies
  • Female
  • Germany
  • Humans
  • Pregnancy
  • Pregnancy Trimester, Second*
  • Retrospective Studies
  • Skull / diagnostic imaging*
  • Spina Bifida Cystica / complications
  • Spina Bifida Cystica / diagnostic imaging*
  • Spina Bifida Occulta / complications
  • Spina Bifida Occulta / diagnostic imaging*
  • Ultrasonography, Prenatal
  • Young Adult