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Turgut GT, Altunoglu U, Gulec C, Sarac Sivrikoz T, Kalaycı T, Toksoy G, Avcı Ş, Yıldırım BT, Sayın GY, Kalelioglu IH, Karaman B, Has R, Başaran S, Yuksel A, Kayserili H, Uyguner ZO. Clinical and molecular characteristics of 26 fetuses with lethal multiple congenital contractures. Clin Genet 2024; 105:596-610. [PMID: 38278647 DOI: 10.1111/cge.14490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Multiple congenital contractures (MCC) due to fetal akinesia manifest across a broad spectrum of diseases, ranging from mild distal arthrogryposis to lethal fetal akinesia deformation sequence. We hereby present a series of 26 fetuses displaying severe MCC phenotypes from 18 families and describe detailed prenatal ultrasound findings, postmortem clinical evaluations, and genetic investigations. Most common prenatal findings were abnormal facial profile (65%), central nervous system abnormalities (62%), polyhydramnios (50%), increased nuchal translucency (50%), and fetal hydrops (35%). Postmortem examinations unveiled additional anomalies including facial dysmorphisms, dysplastic skeletal changes, ichthyosis, multiple pterygia, and myopathy, allowing preliminary diagnosis of particular Mendelian disorders in multiple patients. Evaluation of the parents revealed maternal grip myotonia in one family. By exome sequencing and targeted testing, we identified causative variants in ACTC1, CHST14, COG6, DMPK, DOK7, HSPG2, KLHL7, KLHL40, KIAA1109, NEB, PSAT1, RAPSN, USP14, and WASHC5 in 15 families, and one patient with a plausible diagnosis associated with biallelic NEB variants. Three patients received a dual diagnosis. Pathogenic alterations in newly discovered genes or in previously known genes recently linked to new MCC phenotypes were observed in 44% of the cohort. Our results provide new insights into the clinical and molecular landscape of lethal MCC phenotypes.
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Affiliation(s)
- Gozde Tutku Turgut
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Umut Altunoglu
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Cagri Gulec
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugba Sarac Sivrikoz
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuğba Kalaycı
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şahin Avcı
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Behiye Tuğçe Yıldırım
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gözde Yeşil Sayın
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ibrahim Halil Kalelioglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Birsen Karaman
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Recep Has
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seher Başaran
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atil Yuksel
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hülya Kayserili
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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2
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Murillo C, Eixarch E, Rueda C, Larroya M, Boada D, Grau L, Ponce J, Aldecoa V, Monterde E, Ferrero S, Andreu-Fernández V, Arca G, Oleaga L, Ros O, Hernández MP, Gratacós E, Palacio M, Cobo T. Evidence of brain injury in fetuses of mothers with preterm labor with intact membranes and preterm premature rupture of membranes. Am J Obstet Gynecol 2024:S0002-9378(24)00531-3. [PMID: 38685550 DOI: 10.1016/j.ajog.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers. OBJECTIVE This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator. STUDY DESIGN In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission. RESULTS Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non-intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8-37.6), 35.3 mm (interquartile range, 31.2-39.6), and 35.0 mm (interquartile range, 31.3-38.3), respectively (P=.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5-19.6), 17.2 mm (interquartile range, 16.0-18.9), and 17.1 mm (interquartile range, 15.7-19.0), respectively (P=.041). Second, they presented a lower corpus callosum area (0.72 mm2 [interquartile range, 0.59-0.81], 0.71 mm2 [interquartile range, 0.63-0.82], and 0.78 mm2 [interquartile range, 0.71-0.91], respectively; P=.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth-to-biparietal diameter ratios were 0.14 [interquartile range, 0.12-0.16], 0.14 [interquartile range, 0.13-0.16], and 0.16 [interquartile range, 0.15-0.17], respectively [P<.001], and the right parieto-occipital sulci depth ratios were 0.09 [interquartile range, 0.07-0.12], 0.11 [interquartile range, 0.09-0.14], and 0.11 [interquartile range, 0.09-0.14], respectively [P=.012]). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL [interquartile range, 6213.4-21,098.8], 8397.7 pg/mL [interquartile range, 3682.1-17,398.3], and 2393.7 pg/mL [interquartile range, 1717.1-3209.3], respectively; P<.001), protein S100B (2030.6 pg/mL [interquartile range, 993.0-4883.5], 1070.3 pg/mL [interquartile range, 365.1-1463.2], and 74.8 pg/mL [interquartile range, 44.7-93.7], respectively; P<.001), and glial fibrillary acidic protein (1.01 ng/mL [interquartile range, 0.54-3.88], 0.965 ng/mL [interquartile range, 0.59-2.07], and 0.24 mg/mL [interquartile range, 0.20-0.28], respectively; P=.002). CONCLUSION Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation.
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Affiliation(s)
- Clara Murillo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Claudia Rueda
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marta Larroya
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - David Boada
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Laia Grau
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Júlia Ponce
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Victoria Aldecoa
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Elena Monterde
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain. Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Silvia Ferrero
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Vicente Andreu-Fernández
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Biosanitary Research Institute, Valencian International University, Valencia, Spain
| | - Gemma Arca
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Olga Ros
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Maria Pilar Hernández
- Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain.
| | - Montse Palacio
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Teresa Cobo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
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3
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Jaillard A, Valence S, Vande Perre S, Dhombres F, Héron D, Billette de Villemeur T, Keren B, Afenjar A, Qebibo L, Harion M, Quenum-Miraillet G, Rodriguez D, Jouannic JM, Burglen L, Garel C. Prenatal diagnosis of pontocerebellar hypoplasia with postnatal follow-up. Prenat Diagn 2024; 44:35-48. [PMID: 38165124 DOI: 10.1002/pd.6495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To describe the MR features enabling prenatal diagnosis of pontocerebellar hypoplasia (PCH). METHOD This was a retrospective single monocentre study. The inclusion criteria were decreased cerebellar biometry on dedicated neurosonography and available fetal Magnetic Resonance Imaging (MRI) with PCH diagnosis later confirmed either genetically or clinically on post-natal MRI or by autopsy. The exclusion criteria were non-available MRI and sonographic features suggestive of a known genetic or other pathologic diagnosis. The collected data were biometric or morphological imaging parameters, clinical outcome, termination of pregnancy (TOP), pathological findings and genetic analysis (karyotyping, chromosomal microarray, DNA sequencing targeted or exome). PCH was classified as classic, non-classic, chromosomal, or unknown type. RESULTS Forty-two fetuses were diagnosed with PCH, of which 27 were referred for decreased transverse cerebellar diameter at screening ultrasound. Neurosonography and fetal MRI were performed at a mean gestational age of 29 + 4 and 31 + 0 weeks, respectively. Termination of pregnancy occurred. Pregnancy was terminated in 24 cases. Neuropathological examination confirmed the diagnosis in 24 cases and genetic testing identified abnormalities in 29 cases (28 families, 14 chromosomal anomaly). Classic PCH is associated with pontine atrophy and small MR measurements decreasing with advancing gestation. CONCLUSION This is the first large series of prenatally diagnosed PCHs. Our study shows the essential contribution of fetal MRI to the prenatal diagnosis of PCH. Classic PCHs are particularly severe and are associated with certain MR features.
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Affiliation(s)
- Alienor Jaillard
- Department of Radiology, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Stéphanie Valence
- Department of Pediatric Neurology, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Saskia Vande Perre
- Department of Radiology, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Ferdinand Dhombres
- Fetal Medicine Department, Armand-Trousseau Hospital, APHP, Sorbonne University, GRC-26, Paris, France
| | - Delphine Héron
- Department of Genetics, Division of Medical Genetics, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, La Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Thierry Billette de Villemeur
- Department of Pediatric Neurology, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Boris Keren
- Department of Genetics, APHP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandra Afenjar
- Clinical Genetics Unit, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Leila Qebibo
- Department of Genetics, Pediatric Neurogenetics Laboratory, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Madeleine Harion
- Department of Pediatric Neurology, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - Diana Rodriguez
- Department of Pediatric Neurology, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Lydie Burglen
- Department of Genetics, Pediatric Neurogenetics Laboratory, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Developmental Brain Disorders Laboratory, Imagine Institute, Paris, France
| | - Catherine Garel
- Department of Radiology, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand-Trousseau Hospital, APHP, Sorbonne University, INSERM UMR 1163, Paris, France
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4
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Lip-Sosa DL, Pérez-Cruz M, Ahumada-Droguett P, Ribas-Prats T, Puertollano M, García-Gómez MA, Mazarico E, Eixarch E, Escera C, Gómez-Roig MD. Corpus callosum-fastigium and tectal lengths in late-onset small fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:226-233. [PMID: 36722073 DOI: 10.1002/uog.26169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate measurements on neurosonography of midbrain morphology, including corpus callosum-fastigium length and tectal length, in late-onset small fetuses subclassified as small-for-gestational-age (SGA) or growth-restricted (FGR). METHODS This was a case-control study of consecutive singleton pregnancies delivered at term at a single center between January 2019 and July 2021, including those with late-onset smallness (estimated fetal weight (EFW) < 10th centile) and appropriate-for-gestational-age controls matched by age at neurosonography. Small fetuses were further subdivided into SGA (EFW between 3rd and 9th centile and normal fetoplacental Doppler) and FGR (EFW < 3rd centile or EFW < 10th centile with abnormal cerebroplacental ratio and/or uterine artery Doppler). Transvaginal neurosonography was performed at a mean ± SD gestational age of 33 ± 1 weeks in all fetuses to evaluate corpus callosum-fastigium length and tectal length in the midsagittal plane. Intra- and interobserver agreement was evaluated using the intraclass correlation coefficient and Bland-Altman plots. RESULTS A total of 70 fetuses with late-onset smallness (29 with SGA and 41 with FGR) and 70 controls were included. Compared with controls, small fetuses showed significantly shorter corpus callosum-fastigium length (median (interquartile range), 44.7 (43.3-46.8) mm vs 43.7 (42.4-45.5) mm, P < 0.001) and tectal length (mean ± SD, 10.5 ± 0.9 vs 9.6 ± 1.0 mm, P < 0.001). These changes were more prominent in FGR fetuses, with a linear trend across groups according to severity of smallness. Corpus callosum-fastigium length and tectal length measurements showed excellent intra- and interobserver reliability. CONCLUSIONS Small fetuses exhibited shorter corpus callosum-fastigium length and tectal length compared with controls, and these differences were more pronounced in fetuses with more severe smallness. These findings illustrate the potential value of midbrain measurements assessed on neurosonography as biomarkers for brain development in a high-risk population. However, further studies correlating these parameters with postnatal functional tests and follow-up are needed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D L Lip-Sosa
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - M Pérez-Cruz
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - P Ahumada-Droguett
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - T Ribas-Prats
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - M Puertollano
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - M A García-Gómez
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - E Mazarico
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - C Escera
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - M D Gómez-Roig
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
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5
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Manzo L, Orlandi G, Gabrielli O, Toscano P, Di Lella E, Lettieri A, Mazzarelli LL, Sica G, Di Meglio L, Di Meglio L, Ruffo G, Sica C, Gulino FA, Incognito GG, Tuscano A, Giorno A, Di Meglio A. Fetal Cerebellar Area: Ultrasound Reference Ranges at 13-39 Weeks of Gestation. J Clin Med 2023; 12:4080. [PMID: 37373772 DOI: 10.3390/jcm12124080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The present study aims to provide prenatal 2-dimensional ultrasonographic (2D-US) nomograms of the normal cerebellar area. MATERIALS AND METHODS This is a prospective cross-sectional analysis of 252 normal singleton pregnancies, ranging from 13 to 39 weeks of gestation. The operator performed measurements of the fetal cerebellar area in the transverse plane using 2D-US. The relationship between cerebellar area and gestational age (GA) was determined through regression equations. RESULTS A significant, strong positive correlation was investigated between the cerebellar area with GA (r-value = 0.89), and a positive correlation indicates that with increasing GA, the cerebellar area increased in all the participants of the study. Several 2D-US nomograms of the normal cerebellar area were provided, and an increase of 0.4% in the cerebellar area each week of GA was reported. CONCLUSIONS We presented information on the typical dimensions of the fetal cerebellar area throughout gestation. In future studies, it could be evaluated how the cerebellar area changes with cerebellar abnormalities. It should be established if calculating the cerebellar area in addition to the routine transverse cerebellar diameter may help in discriminating posterior fossa anomalies or even help to identify anomalies that would otherwise remain undetected.
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Affiliation(s)
- Luigi Manzo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Giuliana Orlandi
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Olimpia Gabrielli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Paolo Toscano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Enrica Di Lella
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Antonia Lettieri
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Laura Letizia Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Giordana Sica
- School of Medicine, University of Campania Luigi Vanvitelli, 81031 Caserta, Italy
| | - Letizia Di Meglio
- Radiology Department, School of Medicine, University of Milan, 20122 Milan, Italy
| | - Lavinia Di Meglio
- Pediatric Department, Bambino Gesù Children's Research Hospital IRCCS, 00165 Rome, Italy
| | - Gabriele Ruffo
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Carmine Sica
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Attilio Tuscano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Alice Giorno
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
| | - Aniello Di Meglio
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
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6
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Hagege R, Krajden Haratz K, Malinger G, Ben-Sira L, Leibovitz Z, Heron D, Burglen L, Birnbaum R, Valence S, Keren B, Blumkin L, Jouannic JM, Lerman-Sagie T, Garel C. Spectrum of brain malformations in fetuses with mild tubulinopathy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:740-748. [PMID: 36484554 DOI: 10.1002/uog.26140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To report on a large cohort of fetuses with mild forms of tubulinopathy and to define prenatal ultrasound and magnetic resonance imaging (MRI) features that can facilitate prenatal diagnosis. METHODS This was a retrospective multicenter study of fetuses diagnosed between January 2007 and February 2022 with a mild tubulinopathy (without lissencephaly or microlissencephaly). We collected and reviewed brain imaging and genetic data, and defined major criteria as findings observed in ≥ 70% of the patients and minor criteria as those observed in ≥ 50% but < 70% of the patients. RESULTS Our cohort included 34 fetuses. The mean gestational age at ultrasound screening, when suspicion of a central nervous system anomaly was first raised, was 24.2 (range, 17-33) weeks. Callosal anomalies (n = 19 (56%)) and abnormal ventricles (n = 18 (53%)) were the main reasons for referral. The mean gestational age at neurosonography was 28.3 (range, 23-34) weeks and that at MRI was 30.2 (range, 24-35) weeks. Major ultrasound criteria were midline distortion, ventricular asymmetry, dysmorphic and/or dilated frontal horn(s) and abnormal sulcation. Minor ultrasound criteria were distortion of the cavum septi pellucidi, abnormal corpus callosum, absent or asymmetric olfactory sulci, ventriculomegaly and basal ganglia dysmorphism. Major MRI criteria were midline distortion, distortion of the cavum septi pellucidi, ventricular asymmetry, dilatation (generally unilateral) and/or distortion, dysmorphic and/or dilated frontal horn(s) and abnormal sulcation (mainly dysgyria). Minor MRI criteria were absent or asymmetric olfactory sulci, abnormal bulge of the pons, anteroposterior diameter of the pons ≤ 5th centile and brainstem asymmetry. A mutation was found in TUBB3 (44.1% of cases), TUBB (23.5%), TUBB2B (14.7%) or TUBA1A (17.6%). The mutation was inherited from a parent in 18/34 cases. The pregnancy was terminated in 23/34 cases. CONCLUSIONS Prenatal diagnosis of mild forms of tubulinopathy is possible but challenging. We have defined, in this large series of fetuses, major and minor criteria that can help identify this entity in utero. Most findings can be visualized on ultrasound. This evaluation is also important for prenatal counseling. Once a prenatal diagnosis of mild tubulinopathy is suspected, the family members should be referred for exome sequencing and MRI. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Hagege
- Department of Radiology, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Ashdod, Israel
- Faculty of Medicine, Ben Gurion University, Beer Sheva, Israel
| | - K Krajden Haratz
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Division of Pediatric Radiology, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Leibovitz
- Obstetrics-Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Fetal Neurology Clinic, Obstetrics-Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - D Heron
- Department of Genetics, Division of Medical Genetics, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - L Burglen
- Department of Genetics, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - R Birnbaum
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Valence
- Department of Pediatric Neurology, Reference Center for Rare Diseases and Intellectual Deficiencies of Rare Causes, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - B Keren
- Department of Genetics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - L Blumkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Pediatric Neurology Unit, Magen Center for Rare Diseases, Wolfson Medical Center, Holon, Israel
| | - J-M Jouannic
- Fetal Medicine Department, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - T Lerman-Sagie
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Pediatric Neurology Unit, Magen Center for Rare Diseases, Wolfson Medical Center, Holon, Israel
| | - C Garel
- Department of Radiology, Reference Center for Cerebellar Malformations and Congenital Diseases, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
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7
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Turgut GT, Sarac Sivrikoz T, Komurcu-Bayrak E, Kalayci T. FREM2-related Fraser syndrome with popliteal pterygium and structural central nervous system anomalies. Eur J Med Genet 2023; 66:104712. [PMID: 36720431 DOI: 10.1016/j.ejmg.2023.104712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/16/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
Fraser syndrome (FS) is a rare multiple malformation disorder characterized by cryptophthalmos, characteristic craniofacial dysmorphism, cutaneous syndactyly, malformations of the respiratory and urinary tract, and anogenital anomalies. Although the characteristic presentation of FS can be detected prenatally, oligohydramnios often challenges the clinical diagnosis. Here we report on the atypical prenatal and postmortem findings of a fetus with FS caused by a novel homozygous frameshift variant in FREM2. Our study highlights the variable manifestations of the FS and expands the clinical spectrum to include popliteal pterygium and structural central nervous system anomalies.
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Affiliation(s)
- Gozde Tutku Turgut
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Tugba Sarac Sivrikoz
- Department of Obstetrics and Gynecology, Division of Perinatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Evrim Komurcu-Bayrak
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugba Kalayci
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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8
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Chanclud J, Valence S, Perre SV, Guilbaud L, Moutard ML, Jouannic JM, Ducou Le Pointe H, Blondiaux E, Garel C. Prenatal diagnosis of vermian cyst: a new type of posterior fossa cyst. Pediatr Radiol 2023; 53:461-469. [PMID: 36274068 DOI: 10.1007/s00247-022-05531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/25/2022] [Accepted: 10/03/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Prenatal diagnoses of cystic malformations of the posterior fossa mainly encompass arachnoid cysts, Blake's pouch cysts and Dandy-Walker syndrome. To date, vermian cysts have not been reported prenatally. OBJECTIVES To report a series of fetuses with a vermian cyst. MATERIALS AND METHODS This was a single-center retrospective study conducted from 2012 to 2021. We included all fetuses presenting with a vermian cyst and excluded all other types of posterior fossa cyst. The cyst was visible at prenatal ultrasound (US) and/or magnetic resonance imaging (MRI). Postnatal imaging and/or clinical outcome data were available. RESULTS Sixteen fetuses fulfilled the inclusion criteria with a strong female predominance (n=13). US and MRI were performed at a mean gestational age of 29+5 and 33+1 weeks, respectively. In all patients, the cyst was in the vermian horizontal fissure. The mean longest dimension was about 10 mm. The vermis and other posterior fossa structures were otherwise normal. At postnatal imaging, 13 children underwent brain imaging including 11 MRIs with complete regression (n=9), stability (n=1) and increase in size (n=3) of the cyst. Psychomotor development was normal in 14 children. One child (with an inner ear malformation) showed a slight delay in walking and language acquisition. Slight walking ataxia was present in another child. CONCLUSION We report 16 fetuses with posterior fossa cysts located within the vermis at the level of the horizontal fissure, diagnosed at US and/or MRI and carrying an overall excellent neurological prognosis.
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Affiliation(s)
- Justine Chanclud
- Department of Pediatric Radiology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France.
| | - Stéphanie Valence
- Department of Pediatric Neurology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Saskia Vande Perre
- Department of Pediatric Radiology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Lucie Guilbaud
- Department of Fetal Medecine, GRC Image, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Marie-Laure Moutard
- Department of Pediatric Neurology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medecine, GRC Image, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Hubert Ducou Le Pointe
- Department of Pediatric Radiology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Eléonore Blondiaux
- Department of Pediatric Radiology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
| | - Catherine Garel
- Department of Pediatric Radiology, Trousseau Hospital, APHP Sorbonne Université, 26 avenue du Docteur Arnold Netter, 75012, Paris, France
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9
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Rosenbloom JI, Yaeger LH, Porat S. Reference Ranges for Vermis Biometry on Prenatal Ultrasound: Systematic Review and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e25-e38. [PMID: 33836547 DOI: 10.1055/a-1408-1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of published nomograms for fetal vermis biometry. MATERIALS AND METHODS A structured literature search was conducted to identify studies that reported normal measurements of the fetal vermis. A customized quality assessment tool was used to review the selected articles. Random effects meta-analysis was used to calculate normal ranges for vermian craniocaudal diameter, anteroposterior diameter, and surface area. RESULTS A total of 21 studies were included for qualitative review and 3 studies were included for quantitative synthesis. The 3 included articles comprised a total of 10 910 measurements from gestational ages 17-35 weeks. The quality assessment demonstrated that there was generally poor reporting regarding maternal characteristics and neonatal outcomes. Except for one article with a large sample size, the mean number of fetuses per week of gestational age was 15.9, with the lowest number being 5. There was significant statistical heterogeneity. Non-visualization rates ranged from 0-35.4 %. The craniocaudal diameter (reported in 3 articles) increased from a mean of 7.90 mm (95 % confidence interval [CI] 7.42, 8.38) at 17 weeks to 21.90 mm (95 % CI 20.63, 23.16) at 35 weeks gestation. The anteroposterior diameter (reported in 2 articles) increased from 6.30 mm (95 % CI 5.42, 7.18) at 17 weeks to 15.85 (95 %CI 15.49, 16.21) at 32 weeks. CONCLUSION Reference ranges for vermis biometry across gestation based on meta-analysis of existing references are provided. However, because many of the underlying studies suffered from significant methodological issues, the ranges should be used with caution.
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Affiliation(s)
- Joshua I Rosenbloom
- Obstetrics and Gynecology Hadassah Medical Organization and Faculty of Medicine Hebrew University of Jerusalem Jerusalem, Israel
- Obstetrics and Gynecology, Washington University in Saint Louis School of Medicine, Saint Louis, United States
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in Saint Louis School of Medicine, Saint Louis, United States
| | - Shay Porat
- Obstetrics and Gynecology Hadassah Medical Organization and Faculty of Medicine Hebrew University of Jerusalem Jerusalem, Israel
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10
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Welp A, Gembicki M, Dracopoulos C, Scharf JL, Rody A, Weichert J. Applicability of a semiautomated volumetric approach (5D CNS+™) for detailed antenatal reconstruction of abnormal fetal CNS anatomy. BMC Med Imaging 2022; 22:154. [PMID: 36056307 PMCID: PMC9438215 DOI: 10.1186/s12880-022-00888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy and reliability of a semiautomated volumetric approach (5D CNS+™) when examining fetuses with an apparent abnormal anatomy of the central nervous system (CNS). METHODS Stored 3D volumes extracted from a cohort of > 1.400 consecutive 2nd and 3rd trimester pregnancies (range 15-36 gestational weeks) were analyzed using the semiautomatic software tool 5D CNS+™, enabling detailed reconstruction of nine diagnostic planes of the fetal brain. All 3D data sets were examined and judged for plane accuracy, the need for manual adjustment, and fetal CNS anomalies affecting successful plane reconstruction. RESULTS Based on our data of 91 fetuses with structural cerebral anomalies, we were able to reveal details of a wide range of CNS anomalies with application of the 5D CNS+™ technique. The corresponding anatomical features and consecutive changes of neighboring structures could be clearly demonstrated. Thus, a profound assessment of the entire altered CNS anatomy could be achieved in nearly all cases. The comparison with matched controls showed a significant difference in volume acquisition (p < 0.001) and in need for manual adjustment (p < 0.001) but not in the drop-out rates (p = 0.677) of both groups. CONCLUSION 5D CNS+™ is applicable in the majority of cases with brain lesions and constitutes a reliable tool even if the integrity of the fetal CNS is compromised by structural anomalies. Using volume data that were acquired in identical cutting sections needed for conventional biometry allows for detailed anatomic surveys grossly independent of the examiner's experience.
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Affiliation(s)
- Amrei Welp
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Michael Gembicki
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Christoph Dracopoulos
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jann Lennard Scharf
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Achim Rody
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jan Weichert
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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11
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Moosavi A, Kanekar S. Congenital Malformations of Cerebellum. Clin Perinatol 2022; 49:603-621. [PMID: 36113925 DOI: 10.1016/j.clp.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Advances in pre and postnatal neuroimaging techniques, and molecular genetics have increased our understanding of the congenital malformation of the brain. Correct diagnosis of these malformations in regards to embryology, and molecular neurogenetics is of paramount importance to understand the inheritance pattern and risk of recurrence. Lesions detected on prenatal imaging require confirmation either with postnatal ultrasound and/or with MR imaging. With the advent of the faster (rapid) MRI techniques, which can be conducted without sedation, MRI is commonly used in the evaluation of congenital malformation of the brain. Based on neuroimaging pattern, the congenital malformations of the posterior fossa are classified into 4 main categories: (a) predominantly cerebellar, (b) cerebellar and brainstem, (c) predominantly brainstem, and (d) predominantly midbrain malformations.
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Affiliation(s)
- Ali Moosavi
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA.
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12
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Di Mascio D, Buca D, Rizzo G, Khalil A, Timor-Tritsch IE, Odibo A, Mappa I, Flacco ME, Giancotti A, Liberati M, D'Antonio F. Methodological quality of fetal brain structure charts for screening examination and targeted neurosonography: a systematic review. Fetal Diagn Ther 2022; 49:145-158. [DOI: 10.1159/000521421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Introduction: The methodological quality of fetal brain charts has not been critically appraised yet.
Material and methods: MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to December 31, 2020. The primary outcome was to evaluate the methodology of the studies assessing the growth of fetal brain structures throughout gestation. A list of 28 methodological quality criteria divided into three domains according to “study design”, “statistical and reporting methods”, and “specific relevant neurosonography aspects” was developed in order to assess the methodological appropriateness of the included studies. The overall quality score was defined as the sum of low risk of bias marks, with the range of possible scores being 0–28. This quality assessment was applied to each individual study reporting reference ranges for fetal brain structures.
Results: Sixty studies were included in the systematic review. The overall mean quality score of the studies included in this review was 51.3%. When focusing on each of the assessed domains, the mean quality score was 53.7% for “study design”, 54.2% for “statistical and reporting methods” and 38.6% for “specific relevant neurosonography aspects”. The sample size calculation, the correlation with a postnatal imaging evaluation and the whole fetal brain assessment were the items at the highest risk of bias for each domain assessed, respectively. The subgroup analysis according to different anatomical location showed the lowest quality score for ventricular and periventricular structures and the highest for cortical structures.
Conclusions: Most previously published studies reporting fetal brain charts suffers from poor methodology and are at high risk of biases, mostly when focusing on neurosonography issues. Further prospective longitudinal studies aiming at constructing specific growth charts for fetal brain structures should follow rigorous methodology to minimize the risk of biases, guarantee higher levels of reproducibility and improve the standard of care.
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13
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Birnbaum R, Barzilay R, Brusilov M, Acharya P, Malinger G, Krajden Haratz K. Early second-trimester three-dimensional transvaginal neurosonography of fetal midbrain and hindbrain: normative data and technical aspects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:317-324. [PMID: 34002885 DOI: 10.1002/uog.23691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To provide a detailed description of the sonographic appearance and development of various fetal structures of the midbrain and hindbrain (MBHB) during the early second trimester, and to evaluate the impact of the frequency of the transvaginal sonography (TVS) transducer on the early recognition of these structures. METHODS This was a retrospective analysis of three-dimensional volumetric datasets of the MBHB from apparently normal fetuses at 14-19 gestational weeks, acquired by TVS in the midsagittal view through the posterior fontanelle. Using a multiplanar approach, we measured the tectal thickness and length, aqueductal thickness, tegmental thickness and width and height of the Blake's pouch (BP) neck. In addition, we assessed the existence of early vermian fissures, the linear shape of the brainstem and the components of the fastigium. The correlation between gestational age according to last menstrual period and sonographic measurements of MBHB structures was evaluated using Pearson's correlation (r). A subanalysis was performed to assess the performance of a 5-9-MHz vs a 6-12-MHz TVS transducer in visualizing the MBHB structures in the early second trimester. RESULTS Sixty brain volumes were included in the study, obtained at a mean gestational age of 16.2 weeks (range, 14.1-19.0 weeks), with a transverse cerebellar diameter range of 13.0-19.8 mm. We found a strong correlation between gestational age and all MBHB measurements, with the exception of the tectal, tegmental and aqueductal thicknesses, for which the correlation was moderate. There was good-to-excellent intraobserver and moderate-to-good interobserver correlation for most MBHB measurements. We observed that the BP neck was patent in all fetuses between 14 and 18 weeks with decreasing diameter, and that the aqueductal thickness was significantly smaller at ≥ 18 weeks compared with at < 16 weeks. The early vermian fissures and the linear shape of the brainstem were present in all fetuses from 14 weeks. We found that, in the early second trimester, the horizontal arm of the presumed 'fastigium' evolves from the fourth ventricular choroid plexus and not the posterior vermis, indicating that this is not the fastigium. Standard- and high-resolution TVS transducers performed similarly in the assessment of MBHB anatomy. CONCLUSION Detailed early second-trimester assessment of the MBHB is feasible by transvaginal neurosonography and provides reference data which may help in the early detection of brain pathology involving the MBHB. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Birnbaum
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Barzilay
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - M Brusilov
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Acharya
- Paras Advanced Center for Fetal Medicine, Ahmedabad, India
| | - G Malinger
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Krajden Haratz
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Krajden Haratz K, Oliveira Szejnfeld P, Govindaswamy M, Leibovitz Z, Gindes L, Severino M, Rossi A, Paladini D, Garcia Rodriguez R, Ben-Sira L, Borkowski Tillman T, Gupta R, Lotem G, Raz N, Hamamoto TENK, Kidron D, Arad A, Birnbaum R, Brussilov M, Pomar L, Vial Y, Leventer RJ, McGillivray G, Fink M, Krzeszowski W, Fernandes Moron A, Lev D, Tamarkin M, Shalev J, Har Toov J, Lerman-Sagie T, Malinger G. Prenatal diagnosis of rhombencephalosynapsis: neuroimaging features and severity of vermian anomaly. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:864-874. [PMID: 33942916 DOI: 10.1002/uog.23660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe the prenatal neuroimaging spectrum of rhombencephalosynapsis (RES) and criteria for its classification according to the severity of vermian anomaly. METHODS In this multicenter retrospective study of fetuses with RES between 2002 and 2020, the medical records and brain ultrasound and magnetic resonance images were evaluated comprehensively to determine the severity of the vermian anomaly and the presence of associated brain findings. RES was classified, according to the pattern of vermian agenesis and the extent of the fusion of the hemispheres, as complete RES (complete absence of the vermis) or partial RES (further classified according to the part of the vermis that was missing and, consequently, the region of hemispheric fusion, as anterior, posterior, severe or mixed RES). Findings were compared between cases with complete and those with partial RES. RESULTS Included in the study were 62 fetuses with a gestational age ranging between 12 and 37 weeks. Most had complete absence of the vermis (complete RES, 77.4% of cases), a 'round-shaped' cerebellum on axial views (72.6%) and a transverse cerebellar diameter (TCD) < 3rd centile (87.1%). Among the 22.6% of cases with partial RES, 6.5% were classified as severe partial, 6.5% as partial anterior, 8.1% as partial mixed and 1.6% as partial posterior. Half of these cases presented with normal or nearly normal cerebellar morphology and 28.5% had a TCD within the normal limits. Infratentorially, the fourth ventricle was abnormal in 88.7% of cases overall, and anomalies of the midbrain and pons were frequent (93.5% and 77.4%, respectively). Ventriculomegaly was observed in 80.6% of all cases, being more severe in cases with complete RES than in those with partial RES, with high rates of parenchymal and septal disruption. CONCLUSIONS This study provides prenatal neuroimaging criteria for the diagnosis and classification of RES, and identification of related features, using ultrasound and magnetic resonance imaging. According to our findings, a diagnosis of RES should be considered in fetuses with a small TCD (severe cerebellar hypoplasia) and/or a round-shaped cerebellum on axial views, during the second or third trimester, especially when associated with ventriculomegaly. Partial RES is more common than previously thought, but presents an extreme diagnostic challenge, especially in cases with normal or nearly-normal cerebellar morphobiometric features. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Krajden Haratz
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Oliveira Szejnfeld
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
- DDI UNIFESP, São Paulo, Brazil
- Fundação Instituto de Pesquisa e Estudo de Diagnostico por Imagem, São Paulo, Brazil
| | - M Govindaswamy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Severino
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - D Paladini
- Fetal Medicine Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - R Garcia Rodriguez
- Complejo Hospitalario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - L Ben-Sira
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Radiology Unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - T Borkowski Tillman
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Gupta
- Sunehri Devi Hospital, Sonepat India, Indraprastha Apollo Hospital, New Delhi, India
| | - G Lotem
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - N Raz
- Technion Faculty of Medicine, Haifa, Israel
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hedera, Israel
| | - T E N K Hamamoto
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - A Arad
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - R Birnbaum
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Brussilov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Pomar
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Y Vial
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - R J Leventer
- Department of Neurology, The Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia
| | - G McGillivray
- Royal Women's Hospital, Mercy Hospital for Women and Murdoch Children's Research Institute, Melbourne, Australia
| | - M Fink
- Department of Medical Imaging, The Royal Children's Hospital and Perinatal Unit, The Mercy Hospital for Women, Melbourne, Australia
| | | | - A Fernandes Moron
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Lev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - M Tamarkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Har Toov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - G Malinger
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Shen O. Commentary on "establishment of nomograms for fetal vermis and brainstem structures in the midsagittal cranial plane by ultrasonography" by Alpay et al. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:956-957. [PMID: 34695243 DOI: 10.1002/jcu.23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Ori Shen
- The Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hadassah Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Alpay V, Davutoglu EA, Kaymak D, Madazli R. Establishment of nomograms for fetal vermis and brainstem structures in the midsagittal cranial plane by ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:947-955. [PMID: 34363244 DOI: 10.1002/jcu.23053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To construct nomograms for the fetal cerebellar vermis and brainstem structures obtainable from the midsagittal plane of the brain by two-dimensional sonography. METHODS This was a prospective cross-sectional study of 434 healthy fetuses in low-risk singleton pregnancies between 18 and 35 gestational weeks. The following parameters were evaluated in the midsagittal cranial plane; cerebellar vermis anteroposterior diameter (APD), craniocaudal diameter (CCD), pons, midbrain and medulla oblongata APD and tectum length. The measurements were presented as growth charts according to gestational age. RESULTS The mean ± SD, and 5%, 50%, 95% centile charts according to gestational age for vermis APD and CCD, pons, midbrain and medulla oblongata APD and tectum length were constructed. Pearson's correlation coefficients for vermis CCD and APD, pons, midbrain, medulla oblongata APD and tectum length by gestational week were 0.961, 0.929, 0.918, 0.761, 0.731 and 0.854, respectively (p < 0.0001). CONCLUSION The reference data provided in the present study would be helpful in the prenatal diagnosis of challenging fetal conditions with involvement of the brainstem and cerebellum.
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Affiliation(s)
- Verda Alpay
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ebru Alıcı Davutoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Didem Kaymak
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Riza Madazli
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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17
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Dovjak GO, Schmidbauer V, Brugger PC, Gruber GM, Diogo M, Glatter S, Weber M, Ulm B, Prayer D, Kasprian GJ. Normal human brainstem development in vivo: a quantitative fetal MRI study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:254-263. [PMID: 32730667 PMCID: PMC8457244 DOI: 10.1002/uog.22162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To characterize spatiotemporal growth differences of prenatal brainstem substructures and cerebellum, using linear biometry and planimetry on fetal magnetic resonance imaging (MRI). METHODS In this retrospective study, we included fetuses with normal brain and a precise midsagittal T2-weighted brain MRI sequence obtained between May 2003 and April 2019. The cross-sectional area, rostrocaudal diameter and anteroposterior diameter of the midbrain, pons (basis pontis and pontine tegmentum), medulla oblongata and cerebellar vermis, as well as the transverse cerebellar diameter, were quantified by a single observer. The diameters were also assessed by a second observer to test inter-rater variability. RESULTS We included 161 fetuses with normal brain and a precise midsagittal MRI sequence, examined at a mean ± SD gestational age of 25.7 ± 5.4 (range, 14 + 0 to 39 + 2) weeks. All substructures of the fetal brainstem and the cerebellum could be measured consistently (mean ± SD interobserver intraclass correlation coefficient, 0.933 ± 0.065). We provide reference data for diameters and areas of the brainstem and cerebellum in the second and third trimesters. There was a significant quadratic relationship between vermian area and gestational age, and all other measured parameters showed a significant linear growth pattern within the observed period (P < 0.001). A significant change in the relative proportions of the brainstem substructures occurred between the beginning of the second trimester and the end of the third trimester, with an increase in the area of the pons (P < 0.001) and a decrease in that of the midbrain (P < 0.001), relative to the total brainstem area. CONCLUSIONS The substructures of the fetal brainstem follow a distinct spatiotemporal growth pattern, characterized by a relative increase in the pons and decrease in the midbrain, between 15 and 40 weeks of gestation. Caution is needed when interpreting fetal brainstem appearance during the early second trimester, as the brainstem proportions differ significantly from the adult morphology. The reference data provided herein should help to increase diagnostic accuracy in detecting disorders of defective hindbrain segmentation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G. O. Dovjak
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - V. Schmidbauer
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - P. C. Brugger
- Center for Anatomy and Cell Biology, Department of AnatomyMedical University of ViennaViennaAustria
| | - G. M. Gruber
- Department of Anatomy and BiomechanicsKarl Landsteiner University of Health SciencesKremsAustria
| | - M. Diogo
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - S. Glatter
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - M. Weber
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - B. Ulm
- Department of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - D. Prayer
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - G. J. Kasprian
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
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18
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Haratz KK, Shulevitz SL, Leibovitz Z, Lev D, Shalev J, Tomarkin M, Malinger G, Lerman-Sagie T, Gindes L. Fourth ventricle index: sonographic marker for severe fetal vermian dysgenesis/agenesis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:390-395. [PMID: 29484745 DOI: 10.1002/uog.19034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Prenatal diagnosis of midbrain-hindbrain (MB-HB) malformations relies primarily on abnormal size and shape of the cerebellum and retrocerebellar space, particularly 'open fourth ventricle' (4V), the most common indicator of MB-HB malformations. The aim of this study was to present the fourth ventricle index (4VI), and to evaluate its role as a marker for severe vermian dysgenesis/agenesis in cases without open 4V. METHODS This was a prospective cross-sectional study of patients with singleton low-risk pregnancy at 14 + 1 to 36 + 6 gestational weeks presenting between May 2016 and November 2017 for routine ultrasound examination. Axial images of the fetal 4V were obtained and the 4VI was calculated as the ratio between the laterolateral and the anteroposterior diameters. Reference ranges were constructed and retrospectively collected values from 44 fetuses with confirmed anomalies involving severe vermian dysgenesis/agenesis (Joubert syndrome and related disorders, rhombencephalosynapsis, cobblestone malformations and cerebellar hypoplasia) but without open 4V were compared with the normal values. RESULTS In total, 384 healthy fetuses were enrolled into the study, from which reference ranges were produced, and 44 cases were collected retrospectively. The 4VI in the normal fetuses was always > 1. In affected fetuses, it was always below mean -2 SD and < 1. CONCLUSIONS The 4VI is a sonographic marker for severe fetal vermian dysgenesis/agenesis in the absence of an open 4V. It may be incorporated easily into the routine brain scan; 4VI < 1 indicates a need for dedicated fetal neuroimaging for diagnosis and prenatal counseling. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K K Haratz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S L Shulevitz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Ultrasound in ObGyn Unit, Department of ObGyn, Bnai Zion Medical Center, Haifa, Israel
| | - D Lev
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Tomarkin
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - T Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Dall'Asta A, Paramasivam G, Basheer SN, Whitby E, Tahir Z, Lees C. How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology. Am J Obstet Gynecol 2019; 220:215-229. [PMID: 30447211 DOI: 10.1016/j.ajog.2018.11.1088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022]
Abstract
The antenatal evaluation of the fetal central nervous system (CNS) is among the most difficult tasks of prenatal ultrasound (US), requiring technical skills in relation to ultrasound and image acquisition as well as knowledge of CNS anatomy and how this changes with gestation. According to the International Guidelines for fetal neurosonology, the basic assessment of fetal CNS is most frequently performed on the axial planes, whereas the coronal and sagittal planes are required for the multiplanar evaluation of the CNS within the context of fetal neurosonology. It can be even more technically challenging to obtain "nonaxial" views with 2-dimensional (2D) US. The modality of 3-dimensional (3D) US has been suggested as a panacea to overcome the technical difficulties of achieving nonaxial views. The lack of familiarity of most sonologists with the use of 3D US and its related processing techniques may preclude its use even where it could play an important role in complementing antenatal 2D US assessment. Furthermore, once a 3D volume has been acquired, proprietary software allows it to be processed in different ways, leading to multiple ways of displaying and analyzing the same anatomical imaging or plane. These are difficult to learn and time consuming in the absence of specific training. In this article, we describe the key steps for volume acquisition of a 3D US volume, manipulation, and processing with reference to images of the fetal CNS, using a newly developed context-preserving rendering technique.
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Affiliation(s)
- Andrea Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Gowrishankar Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sheikh Nigel Basheer
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Sheffield, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Department of Development and Regeneration, KU Leuven, Belgium.
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20
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Haratz KK, Lerman-Sagie T. Prenatal diagnosis of brainstem anomalies. Eur J Paediatr Neurol 2018; 22:1016-1026. [PMID: 30448280 DOI: 10.1016/j.ejpn.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
Prenatal diagnosis of brainstem anomalies is important due to the usually associated neurodevelopmental impairment and genetic implications. The extreme developmental changes that the brainstem and cerebellum undergo during fetal life pose a challenge for the characterization and definition of the different malformations. The present review aims to demonstrate the normal development of the fetal brainstem and to present the main features required for diagnosis of its anomalies according to available data in the medical literature.
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Affiliation(s)
- Karina Krajden Haratz
- Fetal Neurology Clinic, Ultrasound in Ob-Gyn Unit, Wolfson Medical Center, Holon, Israel; Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tally Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in Ob-Gyn Unit, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
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21
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Ghi T, Dall'Asta A, Conturso R, Volpe N, Schivardi N, Monopoli V, Preziosa A, Tutschek B. Fetal Brain Tutor 4us: an app for interactive multiplanar navigation through the normal fetal brain. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:711-713. [PMID: 29148609 DOI: 10.1002/uog.18957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/15/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
- T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - A Dall'Asta
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - R Conturso
- Obstetrics and Gynecology Unit, Hospital Valduce Como, Como, Italy
| | - N Volpe
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | | | - V Monopoli
- Ultrasound Application Health & Medical Equipment, Samsung Electronics Italy, Rome, Italy
| | - A Preziosa
- Medical Engineering, Samsung Electronics Italy, Rome, Italy
| | - B Tutschek
- Prenatal Zurich, Zürich, Switzerland
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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22
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Lerman-Sagie T, Prayer D, Stöcklein S, Malinger G. Fetal cerebellar disorders. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:3-23. [PMID: 29891067 DOI: 10.1016/b978-0-444-64189-2.00001-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The embryologic development of the cerebellum extends over a long time period, thus making it vulnerable to a broad spectrum of malformations and disruptions. Knowledge of the main steps of fetal posterior fossa development; the normal imaging patterns at different stages of embryogenesis; the large spectrum of cerebellar malformations; and their clinical presentations enables diagnosis and precise counseling of parents. Sonography is the most important imaging method for the screening of cerebellar malformations since it is noninvasive, widely available, and safe for both mother and child. The ultrasonographic approach for the evaluation of the fetal posterior fossa is based on the classic transabdominal visualization of axial planes with addition when indicated of a more comprehensive, multiplanar transvaginal or transfundal approach, including coronal and sagittal imaging planes. Fetal magnetic resonance imaging (MRI) has become an adjunct to prenatal ultrasound since the 1980s. Good-quality images have been obtained thanks to the implementation of fast and ultrafast MRI sequences. Fetal MRI has higher-contrast resolution than prenatal sonography and may contribute to the differentiation of normal from abnormal tissue. Both prenatal neurosonography and fetal MRI enable accurate prenatal diagnosis of most posterior fossa anomalies.
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Affiliation(s)
- Tally Lerman-Sagie
- Fetal Neurology Clinic, Prenatal Ultrasound Unit, Department of Obstetrics and Gynecology, and Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.
| | - Daniella Prayer
- Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Sophia Stöcklein
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gustavo Malinger
- Fetal Neurology Clinic, Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv, Israel
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Ultrasound imaging for identification of cerebral damage in congenital Zika virus syndrome: a case series. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:45-55. [PMID: 30169227 DOI: 10.1016/s2352-4642(17)30001-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Zika virus is a novel teratogenic agent associated with cerebral anomalies. Because of the challenges associated with assessment of antenatal diagnosis and prognosis in fetuses, screening for other congenital infections mostly relies on ultrasound. We aimed to assess whether a similar approach might be adequate for Zika virus congenital syndrome provided that early markers of infection and adequate timing for screening are established. METHODS For this case series we reviewed all pregnant women who had a laboratory-confirmed Zika virus infection in their first trimester or early second trimester and abnormal fetal ultrasound findings who were managed at the Pluridisciplinary Center for Prenatal Diagnosis of Martinique during the Zika virus epidemic (Jan 1, 2016, to Nov 10, 2016) in Martinique, a French Caribbean island. Ultrasound imaging was done with GE Healthcare Voluson E10 and E8 machines with abdominal and vaginal probes. FINDINGS We analysed 14 cases of pregnant women with confirmed Zika virus infection and fetal abnormalities of the brain, and 31 ultrasound imaging results. Between 16 and 20 weeks of gestation, four (33%) of 12 fetuses had an abnormal ultrasound examination. Anomalies were detected in nine (90%) of the ten fetuses from whom ultrasound images were obtained between 20 and 24 weeks of gestation. All five remaining fetuses at 24-28 weeks of gestation, and all four after 28 weeks, had severe anomalies. Major anomalies identified were ventriculomegaly (12 fetuses, 86%), cortical atrophy (11, 79%), calcifications (ten, 71%; particularly located at the corticosubcortical junction), and anomalies of the corpus callosum (ten, 71%). Prenatal assessment of head circumference measurement by imaging was not an effective screening tool for congenital Zika virus infection, with microcephaly only identified in nine (64%) fetuses. INTERPRETATION Ultrasound monitoring appears to be a good screening strategy to monitor Zika virus-exposed pregnancies. Public health efforts should focus on scanning at 22-26 weeks of gestation. Identification of ventriculomegaly, cortical atrophy, calcifications, and anomalies of the corpus callosum should prompt laboratory screening for Zika virus. FUNDING None.
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Schaub B, Vouga M, Najioullah F, Gueneret M, Monthieux A, Harte C, Muller F, Jolivet E, Adenet C, Dreux S, Leparc-Goffart I, Cesaire R, Volumenie JL, Baud D. Analysis of blood from Zika virus-infected fetuses: a prospective case series. THE LANCET. INFECTIOUS DISEASES 2017; 17:520-527. [DOI: 10.1016/s1473-3099(17)30102-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 01/22/2023]
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25
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The Pediatric Cerebellum in Inherited Neurodegenerative Disorders: A Pattern-recognition Approach. Neuroimaging Clin N Am 2017; 26:373-416. [PMID: 27423800 DOI: 10.1016/j.nic.2016.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of imaging studies of the cerebellum in inherited neurodegenerative disorders is aided by attention to neuroimaging patterns based on anatomic determinants, including biometric analysis, hyperintense signal of structures, including the cerebellar cortex, white matter, dentate nuclei, brainstem tracts, and nuclei, the presence of cysts, brain iron, or calcifications, change over time, the use of diffusion-weighted/diffusion tensor imaging and T2*-weighted sequences, magnetic resonance spectroscopy; and, in rare occurrences, the administration of contrast material.
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26
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Leibovitz Z, Shkolnik C, Haratz KK, Malinger G, Shapiro I, Lerman-Sagie T. Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 2: application of nomograms to fetuses with posterior fossa malformations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:581-587. [PMID: 24478245 DOI: 10.1002/uog.13312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To apply fetal midbrain (MB) and hindbrain (HB) nomograms, developed using three-dimensional multiplanar sonographic reconstruction (3D-MPR) in the mid-sagittal cranial plane, to fetuses with known posterior fossa malformations. METHODS In this retrospective study we examined sonographic volumes obtained by sagittal acquisition in 43 fetuses diagnosed with posterior fossa abnormalities and evaluated in the mid-sagittal cranial plane, using 3D-MPR, the following: MB parameters tectal length (TL) and anteroposterior midbrain diameter (APMD), and HB parameters anteroposterior pons diameter (APPD), superoinferior vermian diameter (SIVD) and anteroposterior vermian diameter (APVD). Fetuses were grouped, according to malformation, into eight categories: cobblestone malformation complex (CMC, n = 3), Chiari-II malformation (C-II, n = 7), pontocerebellar hypoplasia (PCH, n = 2), rhombencephalosynapsis (RES, n = 4), Dandy-Walker malformation (n = 8), vermian dysgenesis (VD, n = 7), persistent Blake's pouch cyst (n = 6) and megacisterna magna (n = 6). In each case and for each subgroup, the MB-HB biometric parameters and their z-scores were evaluated with reference to our new nomograms. RESULTS The new MB-HB nomograms were able to identify the brainstem and vermian anomalies and differentiate fetuses with MB-HB malformations from those with isolated enlarged posterior fossa cerebrospinal fluid spaces. Use of the nomograms enabled detection of an elongated tectum in fetuses with CMC, C-II and RES, and a flattened pontine belly in cases of CMC, PCH and VD. In the fetuses with VD, the nomograms enabled division into three distinctive groups: (1) those with small SIVD and APVD, (2) those with normal SIVD but small APVD, and (3) those with small SIVD but normal APVD. CONCLUSIONS Application of our new reference data, that for the first time include the MB, enables accurate diagnosis of brain malformations affecting the MB and HB and makes possible novel characterization of previously described features of posterior fossa anomalies.
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Affiliation(s)
- Z Leibovitz
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
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