First-trimester choroid plexus to lateral ventricle disproportion and prediction of subsequent ventriculomegaly.

The analysis included 683 singleton pregnancies; of which 102 fetuses were diagnosed with ventriculomegaly. The ventriculomegaly was mild in the majority (n=86; 84.3%) of cases, while it was severe in 16 (15.7%) fetuses. All first trimester fetal choroid plexus to ventricle/head ratios were significantly lower in the ventriculomegaly cases than in controls (p<0.05 all) with good inter- and intra-observer agreement (>0.95 for the majority of the fetal head biometry assessed). After adjusting for crown-rump length, both PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98) and PA/VA ratio (AUC 0.90, 95% CI 0.82-0.98) showed good predictive accuracy for severe ventriculomegaly. PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90) had modest predictive ability, which was significantly lower than prediction using PA/VA ratio (P=0.003 and P=0.001, respectively). The predictive accuracy of PD/VD ratio was low with an AUC of 0.65 (95% CI 0.46- 0.84). Optimism adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy with an AUC of 0.90 (95% CI: 0.82-0.98), followed by PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98), PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90), and PD/VD ratio (AUC 0.65, 95% CI 0.47-0.84). Optimism-adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy for mild ventriculomegaly with an AUC of 0.83 (95% CI 0.78-0.88), followed by PL/VL ratio (AUC 0.82, 95% CI 0.76-0.88), PA/BPD ratio (AUC 0.75, 95% CI 0.68-0.81), and PD/VD ratio (AUC 0.74, 95% CI 0.67-0.80). Calibration plots show both PA/VA and PL/VL ratios have good calibration CONCLUSION: First-trimester prediction of ventriculomegaly using fetal choroid plexus to ventricle ratios appears promising. Future prospective studies are needed to validate the predictive accuracy of these ultrasound markers as a screening tool for ventriculomegaly. This article is protected by copyright. All rights reserved.