Corroenne R, Paladini D, Papastefanou I, Chaoui R, Pomar L, Guibaud L, Krajden Haratz K, Pooh R K, Herrera M, Ximenes R, Azumendi G, Pilu G, Salomon L J
LUMIERE Platform, Necker-Enfants Malades Hospital, University of Paris, Paris, France.
Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA.
Ultrasound Obstet Gynecol. 2025 Aug 23. doi: 10.1002/uog.70003.
The corpus callosum (CC) is an interhemispheric structure that facilitates communication between the two cerebral hemispheres. Anomalies of the CC are frequent and associated with a wide spectrum of altered neurodevelopmental outcomes. However, variability in diagnostic criteria and the lack of standardized management strategies create challenges for clinicians and anxiety for expectant parents. This study aimed to establish an international consensus on the prenatal evaluation, diagnosis and management of fetal CC abnormalities using a structured Delphi methodology.
A three-round Delphi process was conducted among an international panel of fetal medicine experts, identified based on clinical expertise and publication history. Structured statements regarding CC evaluation, diagnosis and management were developed through expert input and a scoping literature review. The statements were iteratively refined and scored by the panel using a five-point Likert scale in the first two rounds. During the final round, consensus was defined as > 70% agreement among participants.
Fifty-five experts participated in the first round, with 43 (78.2%) experts completing the entire process. Key consensus findings included the incorporation of obtaining a sagittal view of the brain in routine ultrasound screening (72.4% agreement), without requiring measurement even when an anomaly is suspected (93.1% agreement), but instead with recommended referral to a specialist (100% agreement). For diagnostic ultrasound, three-dimensional ultrasound imaging (72.4% agreement) and transvaginal ultrasound evaluation (82.8% agreement) were recommended, with targeted measurements of CC length in the case of a subjective impression of abnormal size (82.8% agreement). However, it was agreed that there is no consensus on the reference chart or cut-off values to be used for defining abnormal CC length (86.2% and 89.3% agreement, respectively). In terms of management, it was agreed that both an invasive genetic workup and magnetic resonance imaging (MRI) should be offered in case of suspected dysgenesis of the CC (100% agreement). MRI should be performed if the CC appears to be too short (100% agreement), thin (100% agreement) or thick (92.0% agreement). In the case of an isolated CC with heterogeneous echogenicity, an infectious workup is recommended (86.2% agreement).
This study provides a structured framework for the evaluation and management of fetal CC abnormalities. By standardizing approaches to imaging and management, the recommendations aim to improve diagnostic accuracy, optimize patient outcomes and reduce unnecessary interventions. Further prospective studies are needed to validate these recommendations and assess their impact on clinical care. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胼胝体（CC）是一种半球间结构，有助于两个大脑半球之间的交流。CC异常很常见，并与广泛的神经发育改变结果相关。然而，诊断标准的差异和缺乏标准化的管理策略给临床医生带来了挑战，并让准父母感到焦虑。本研究旨在使用结构化德尔菲法就胎儿CC异常的产前评估、诊断和管理达成国际共识。
在一个基于临床专业知识和发表历史确定的国际胎儿医学专家小组中进行了三轮德尔菲过程。通过专家意见和范围文献综述制定了关于CC评估、诊断和管理的结构化陈述。在前两轮中，专家小组使用五点李克特量表对陈述进行迭代完善和评分。在最后一轮中，共识被定义为参与者之间>70%的一致意见。
55名专家参与了第一轮，43名（78.2%）专家完成了整个过程。关键的共识结果包括在常规超声筛查中纳入获取大脑矢状面图像（72.4%的一致意见），即使怀疑有异常也无需测量（93.1%的一致意见），而是建议转诊给专科医生（100%的一致意见）。对于诊断性超声，推荐三维超声成像（72.4%的一致意见）和经阴道超声评估（82.8%的一致意见），如果主观感觉大小异常则对CC长度进行靶向测量（82.8%的一致意见）。然而，大家一致认为，对于用于定义异常CC长度的参考图表或临界值没有共识（分别为86.2%和89.3%的一致意见）。在管理方面，大家一致认为，如果怀疑CC发育不全，应同时进行侵入性基因检查和磁共振成像（MRI）（100%的一致意见）。如果CC看起来太短（100%的一致意见）、太薄（100%的一致意见）或太厚（92.0%的一致意见），则应进行MRI检查。对于孤立的CC且回声不均匀的情况，建议进行感染方面的检查（86.2%的一致意见）。
本研究为胎儿CC异常的评估和管理提供了一个结构化框架。通过使成像和管理方法标准化，这些建议旨在提高诊断准确性、优化患者预后并减少不必要的干预措施。需要进一步的前瞻性研究来验证这些建议并评估它们对临床护理的影响。© 2025作者。《妇产科超声》由约翰·威利父子有限公司代表国际妇产科超声学会出版。
