{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:23:42Z","timestamp":1792063422271,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,2,4]],"date-time":"2015-02-04T00:00:00Z","timestamp":1423008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this article is to study secondary cranial signs in fetuses with spina bifida in a precisely defined screening period between 18\u2009+\u20090 and 22\u2009+\u20090\u2009weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>On the basis of retrospective analysis of 627 fetuses with spina bifida, the value of indirect cranial and cerebral markers was assessed by well\u2010trained ultrasonographers in 13 different prenatal centres in accordance with the ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) guidelines on fetal neurosonography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 <jats:italic>p<\/jats:italic>\u2009=\u20090.0068. Pregnancy was terminated in 89.6% of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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. \u00a9 2014 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.4524","type":"journal-article","created":{"date-parts":[[2014,10,24]],"date-time":"2014-10-24T22:01:12Z","timestamp":1414188072000},"page":"228-235","source":"Crossref","is-referenced-by-count":40,"title":["Cranial and cerebral signs in the diagnosis of spina bifida between 18 and 22 weeks of gestation: a German multicentre study"],"prefix":"10.1002","volume":"35","author":[{"given":"F.","family":"Bahlmann","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology B\u00fcrgerhospital  Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Reinhard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Central Institute of Mental Health Medical Faculty Mannheim\/Heidelberg University  Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Schramm","sequence":"additional","affiliation":[{"name":"Center of Prenatal Diagnosis and Human Genetics  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Geipel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Gembruch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. S.","family":"von Kaisenberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Hannover  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Stupin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Virchow University  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Chaoui","sequence":"additional","affiliation":[{"name":"Center of Prenatal Diagnosis and Human Genetics  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Karl","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Ludwig\u2010Maximilians\u2010University  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Kalache","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Charite University  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Faschingbauer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Friedrich\u2010Alexander University  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ponnath","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Regensburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Rempen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology  Schw\u00e4bisch\u2010Hall Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Kozlowski","sequence":"additional","affiliation":[{"name":"Center of Prenatal Diagnosis and Human Genetics  D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,2,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2009.05.002"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17445-X"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2250"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(75)91831-0"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/jms.7.4.169"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(94)70040-0"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70577-6"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000178780.63956.3b"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(98)70484-3"},{"key":"e_1_2_7_11_1","first-page":"330","article-title":"Comparison of six sonographic signs in the prenatal diagnosis of spina bifida","volume":"36","author":"D\u00b4Addario V","year":"2008","journal-title":"J Perinat Med"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)91610-7"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(90)90378-K"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1980.tb04522.x"},{"key":"e_1_2_7_15_1","first-page":"247","article-title":"Ultrasound screening for spina bifida: cranial and cerebellar signs in a high\u2010risk population","volume":"70","author":"Campbell J","year":"1987","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.167.2.3282259"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7329"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1000425"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3909"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1003172"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1994.04010034.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(88)90218-9"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3865"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-003-0792-3"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2281020448"},{"key":"e_1_2_7_26_1","first-page":"54","article-title":"Early diagnosis of spina bifida: the value of cranial ultrasound markers","volume":"76","author":"Thiagarajah S","year":"1990","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.7863\/jum.1993.12.3.131","article-title":"The lemon sign: not a specific indicator of meningomyelocele","volume":"3","author":"Ball RH","year":"1993","journal-title":"J Ultrasound Med"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11175"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12420"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.05.014"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1999.tb08212.x"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13202"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6456"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1028-4559(08)60002-9"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8628(19980526)77:4<317::AID-AJMG13>3.0.CO;2-L"},{"key":"e_1_2_7_36_1","doi-asserted-by":"crossref","unstructured":"JohnsonCY HoneinMA FlandersWD et al.Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: a systematic review of the literature. Birth defects research (Part A)2012.","DOI":"10.1002\/bdra.23086"}],"container-title":["Prenatal Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpd.4524","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pd.4524","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T03:09:33Z","timestamp":1696388973000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pd.4524"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,4]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2015,3]]}},"alternative-id":["10.1002\/pd.4524"],"URL":"https:\/\/doi.org\/10.1002\/pd.4524","archive":["Portico"],"relation":{},"ISSN":["0197-3851","1097-0223"],"issn-type":[{"value":"0197-3851","type":"print"},{"value":"1097-0223","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,4]]}}}