 Good morning everybody. My name is Dr. Sneha Bhaskar, junior resident 3 in the Department of Radiology, Divya Partial Medical College and Hospital, Navi, Mumbai. My topic for paper presentation is importance of early imaging in detecting fetal structures. Ames and objectives, importance of early imaging in detecting fetal structures. Introduction. The detailed first trimester ultrasound is performed at 11 to 13 plus 6 weeks of gestation. Components of the detailed first trimester ultrasound examination include general overview and fetal biometric comprehensive evaluation of fetal anatomy and assessment of the uterus and antidexal regions. This ultrasound examination is intended to complement the second trimester ultrasound and the majority of pregnancies to provide early reassurance of normalcy. Untreated soft ultrasound markers are fetal sonography findings that are generally not abnormalities as such, but are indicative of an increased age adjusted risk of an underlying fetal aneuploidy or certain non-chromosomal abnormalities. The presence or absence of these minor markers can be used to adjust a patient's prior risk for aneuploidy based on biochemical screening results or maternal age. This becomes particularly important in screening for trisomy 21 is approximately 75% of fetuses affected by trisomy 21 will not have an ultrasound detectable major congenital anomalies at the time of second trimester anatomic survey. Methodology. Five patients were included in the study referred from the OBGY department of D.Y. Partle Medical College between 11 to 14 weeks of gestation. The patient was screened on GE Logic P9 Arthi machine, a curvilinear 1 to 5 hertz drum was used. In the evaluated patients, two subjects were found to have thickened intake. Result of the evaluated five patients, two patients were found to have thickened intake, double iotikage and cystic hygroma in the fetuses. Imaging. A 34 year old female of G2 P1 L1 is considered for this study. Her first pregnancy was normal. Second pregnancy was scanned at 11 to 12 weeks of gestation. Here a thickened intake, cystic hygroma and double iotikage was detected on sonography. Imaging. On anti-scan, the CRLO is noted to be 56.5 mm, which corresponded to 12 weeks, 2 days. Subcutaneous edema is noted ahead, neck and torso region. Here an increased nuclear thickness of about 6.41 mm is seen in the same fetus. Cystic hygroma, which is seen in the same fetus, the images are shown here. These are few other images showing cystic hygroma in the same fetus. Double iotikage was seen on transverse genital scan in the same fetus. The iotikage was seen to bifurcate and form a ring other than the trachea. This is another image which shows double iotikage on transverse genital scan seen in the same fetus. Considering the presence of cystic hygroma and double iotikage, possibility of chromosomal abnormality was considered and corionic bilis sampling was performed for fish and microarray. The reports of corionic bilis sampling came as fish trisomy 21. Discussion. Nucleotranslucency is a normal fluid filled subcutaneous space at the back of the fetal neck from 11 weeks 3 days to 13 weeks 6 days period of gestation. Thickness of nucleotranslucency can be associated with a number of anomalies including aneuploidies such as trisomies including Down syndrome, Turner syndrome, known aneuploidy structural defects and syndromes such as congenital heart disease, skeletal dysplasia, miscarriage of fetal demise. Assessment of NT. The image should be magnified to occupy 75% of the screen and should show only the fetal head, neck and upper thorax. The fetus must be in mid-saggiant plate. The fetal neck must be in neutral position not hyperextended or hyperflex. Three cogenic lines indicating the inner and outer borders of the fetal skin and the avenue must be displayed. The ultrasonic alipers must be placed with the horizontal cross on the inner borders of the ecolusial space and perpendicular to the fetal axis. The measurements of the NT must be taken at the widest space. The values should be obtained when the CRL is between 45 and 84 mm that is between 11 weeks 3 days to 13 weeks 6 days. Cystic Hygroma. Cystic Hygroma also known as Cystic or Nuclelemphagyoma refers to the congenital microcystic lymphatic malformations that most commonly occur in the cervical facial regions particularly at the posterior cervical triangle and infants. Associations. Associated Anomalies with Cystic Hygroma. Aneuploidic. 65% of Cystic Hygromas can be associated with aneuploidic abnormalities such as Ternus syndrome, Down syndrome and few non-aneuploidic abnormalities such as congenital cardiac anomalies and pentology of cantral. Radiographic features. They are usually well circumscribed and are of fluid density. Cystic Hygromas may also have an infiltrative appearance and may be uni or multilocular. Antinatal Ultrason. On prenatal ultrason, they may present as a Nucleus cyst and may show separations plus or minus evidence of fetal Anasarka or Hydropsvitalis. Compared to Nucleus Translucency, it is a higher risk for aneuploidy, cardiac anomalies and fidget demise. Double Iotcatch. Diablet Iotcatches are the most common symptomatic type of Iotcatch variant. It may account for up to 50 to 60% of vascular rings, clinical presentation. Double Iotcatch is mostly diagnosed in childhood due to symptoms related to esophageal and or tracheal obstruction. Pathology. This anomaly is caused by persistence of the right and left embryonic fourth Iotcatches which results in formation of vascular ring from the splitting of the ascending Iota into two limbs that pass to either side of the trachea and esophagus, both of which get encircled, which then join as a single descending Iota. Prenatal Imaging is required for an accurate antinatal diagnosis and can be easily made by using antrasonography. The diagnosis can be obtained in a transverse view of the fetal thorax at the level of the three vessel and trachea view. The diagnosis of double Iotcatch is made when there are two Iotcatches that form a complete vascular ring encircling the trachea with a common character artery and supple even artery arises separately from each arch. After the diagnosis of double Iotcatches made, it is important to determine whether there are any associated cardiac malformations. The subtypes of double Iotcatch are right dominant arch, 75 to 80% which is the most common and co-dominant arch and another type is left dominant arch. Major congenital anomalies associated with fetal aneuploidy. In Trisomy 21, some of the major congenital anomalies are AB canal defect, brineal atresia, ventricleomegaly, other cardiac defects, cystic hygroma, non-immune hydrogs. In Trisomy 13, some of the major congenital anomalies are cardiac defects, CNS abnormalities, cleft lipapalate, umphalocytes, midline facial anomalies, ecogenic kidneys, urogenital anomalies, polydactylae, rocker bottom feet, cystic hygroma, non-immune hydrogs, congenital diaphragmatic hania. In Trisomy 18, some of the major congenital anomalies are cardiac defect, spina bifida, micrognathia, umphalocytes, clenched hands or wrists, radial eplasia, club feet, cerebellar dysgenesis, cystic hygroma, non-immune hydrogs, congenital diaphragmatic hania. Conclusion. Early fetal imaging helps identify major fetal malformation. The combination of ucal translucency measurement and methanol serum analytes, pregnancy-associated plasma proteinate and free beta-HCG is the most common aneuploidy screening paradigm in the first trimester of pregnancy. The fine human sonographic marker of aneuploidy should prompt a more targeted ultrasound examination to validate for additional signs of aneuploidy. These are some of the references which are taken for the preparation of this paper. Thank you.