Evaluation of fetal intracranial anatomy by static and real-time ultrasound

Improvements in ultrasound technology have now made possible detailed visualization of fetal intracranial anatomy. Structures such as the midbrain, thalami, and lateral ventricles can be routinely imaged. Measurements of the ratio between lateral ventricular width and cerebral hemispheric width demonstrate a steady decrease from a mean of 56% at 15 wk gestation to 28% at term reflecting the relatively more rapid growth of the cerebral hemispheres as compared with the cerebral ventricles. Application of this new ultrasound data greatly facilitates accurate and consistent biparietal diameter estimations and early diagnosis of fetal hydrocephalus and other fetal cranial anomalies. This article describes the axial fetal cranial anatomy as demonstrated sonically and includes a table for normal fetal ventricular size at various gestational ages, based on evaluation of 196 normal fetuses. Some of the more common fetal cranial anomalies amenable to ultrasound diagnosis in utero are discussed.