Clinical Image: In Utero Ultrasound Imaging of Fetal Cerebral Venous Sinuses and Veins

Abstract

Fetal Doppler ultrasonographic images in a 35-year-old
woman at 25 weeks of gestation after minimally invasive fetoscopic in utero repair of fetal spina bifida. The
color Doppler ultrasonographic images were acquired at
low Nyquist limits in transverse planes below the level
of cisterna magna (first row) and demonstrate various
phases of flow in the bilateral transverse venous sinuses
and the right sigmoid venous sinus (second row).
Pulsed-wave Doppler interrogation at these sites demonstrated a pulsatile venous waveform (third row, left) with
a forward blunted waveform composed of systolic component (ventricular systole), forward early diastolic
component (passive ventricular filling) and a zero to
reverse flow component in late diastole (atrial contraction) as reported in normal pregnancies [1]. Reverse
flow during atrial contraction as seen in our case can be
seen before 28 weeks of gestation [1]. Pulsed-wave
Doppler ultrasonography at the skull base (third row,
right) demonstrates arterial and venous flow patterns at
the level of the carotid and jugular foramina with flow in
opposite directions [2].