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Sukenik-Halevy R, Mevorach N, Basel-Salmon L, Matar RT, Kahana S, Klein K, Agmon-Fishman I, Levy M, Maya I. Chromosomal microarray testing yield in 829 cases of microcephaly: a clinical characteristics-based analysis for prenatal and postnatal cases. Arch Gynecol Obstet 2024; 310:1547-1554. [PMID: 38494511 PMCID: PMC11366728 DOI: 10.1007/s00404-024-07388-3] [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: 11/17/2023] [Accepted: 01/14/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Microcephaly, characterized by abnormal head growth, can often serve as an initial indicator of congenital, genetic, or acquired disorders. In this study, we sought to evaluate the effectiveness of chromosomal microarray (CMA) testing in detecting abnormalities in both prenatal and postnatal cases of microcephaly. MATERIALS AND METHODS CMA Testing: We conducted CMA testing on 87 prenatally-detected microcephaly cases and 742 postnatal cases at a single laboratory. We evaluated the CMA yield in relation to specific clinical characteristics. RESULTS In prenatal cases, pathogenic and likely pathogenic (LP) results were identified in 4.6% of cases, a significantly higher rate compared to low-risk pregnancies. The male-to-female ratio in this cohort was 3, and the CMA yield was not influenced by gender or other clinical parameters. For postnatal cases, the CMA yield was 15.0%, with a significantly higher detection rate associated with dysmorphism, hypotonia, epilepsy, congenital heart malformations (CHM), learning disabilities (LD), and a history of Fetal growth restriction (FGR). No specific recurrent copy number variations (CNVs) were observed, and the rate of variants of unknown significance was 3.9%. CONCLUSIONS The yield of CMA testing in prenatal microcephaly is lower than in postnatal cases (4.6% vs. 15%). The presence of microcephaly, combined with dysmorphism, hypotonia, epilepsy, CHD, LD, and FGR, significantly increases the likelihood of an abnormal CMA result.
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Affiliation(s)
- Rivka Sukenik-Halevy
- Genetic Institute, Meir Medical Center, Kfar Saba, Israel.
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Nir Mevorach
- Genetic Institute, Meir Medical Center, Kfar Saba, Israel
| | - Lina Basel-Salmon
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
- Pediatric Genetics Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | | | - Sarit Kahana
- Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Kochav Klein
- Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | | | - Michal Levy
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Idit Maya
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
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Wang JT, Lee HJ, Chang TY. Prenatal Ultrasound and Magnetic Resonance Findings of Glutaric Acidemia Type 1 and Its Challenges in Prenatal Diagnosis. J Med Ultrasound 2024; 32:202-208. [PMID: 39310876 PMCID: PMC11414954 DOI: 10.4103/jmu.jmu_63_24] [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: 06/03/2024] [Accepted: 07/15/2024] [Indexed: 09/25/2024] Open
Abstract
Glutaric acidemia type 1 (GA1) presents unique challenges in prenatal diagnosis, especially in cases with no family history. This review article aims to review and present the prenatal ultrasound and magnetic resonance findings of GA1 and consolidate key insights into the difficulties associated with GA1 prenatal diagnosis and the neuroimaging features that require careful differentiation during the diagnostic process.
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Affiliation(s)
- Jo-Ting Wang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan
| | - Han-Jui Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Yao Chang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan
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Shinar S, Chitayat D, Shannon P, Blaser S. Fetal macrocephaly: Pathophysiology, prenatal diagnosis and management. Prenat Diagn 2023; 43:1650-1661. [PMID: 38009873 DOI: 10.1002/pd.6473] [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: 08/19/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
Macrocephaly means a large head and is defined as a head circumference (HC) above the 98th percentile or greater than +2SD above the mean for gestational age. Macrocephaly can be primary and due to increased brain tissue (megalocephaly), which in most cases is familial and benign or secondary. The latter may be due to various causes, including but not limited to communicating or non-communicating hydrocephalus, cerebral edema, focal and pericerebral increased fluid collections, thickened calvarium and brain tumors. Megalocephaly can be syndromic or non-syndromic. In the former, gyral and structural CNS anomalies are common. It is important to exercise caution when considering a diagnosis of megalocephaly due to limitations in the accuracy of HC measurement, lack of nomograms for specific populations, inconsistencies between prenatal and postnatal HC growth curves and progression over time. The degree of macrocephaly is important, with mild macrocephaly ≤2.5SD carrying a good prognosis, especially when one of the parents has macrocephaly and normal development. Cases in which the patient history and/or physical exam are positive or when parental HC are normal are more worrisome and warrant a neurosonogram, fetal MRI and genetic testing to better delineate the underlying etiology and provide appropriate counseling.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Wandel A, Weissbach T, Katorza E, Ziv-Baran T. Subarachnoid Space Measurements in Apparently Healthy Fetuses Using MR Imaging. AJNR Am J Neuroradiol 2023; 44:716-721. [PMID: 37202119 PMCID: PMC10249698 DOI: 10.3174/ajnr.a7864] [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: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND PURPOSE The fetal subarachnoid space size serves as an indicator of normal brain development. The subarachnoid space is commonly measured by an ultrasound examination. Introduction of MR imaging for fetal brain evaluation enables standardization of MR imaging-driven subarachnoid space parameters for a more accurate evaluation. This study aimed to determine the normal range of MR imaging-derived subarachnoid space size in fetuses according to gestational age. MATERIALS AND METHODS A cross-sectional study based on a retrospective assessment of randomly selected brain MR images of apparently healthy fetuses performed between 2012 and 2020 at a large tertiary medical center was performed. Demographic data were collected from the mothers' medical records. Subarachnoid space size was measured at 10 reference points using the axial and coronal planes. Only MR imaging scans obtained between weeks 28 and 37 of pregnancy were included. Scans with low-quality images, multiple pregnancy, and cases with intracranial pathologic findings were excluded. RESULTS Overall, 214 apparently healthy fetuses were included (mean maternal age, 31.2 [SD, 5.4] years). Good interobserver and intraobserver agreement was observed (intraclass correlation coefficient > 0.75 for all except 1 parameter). For each gestational week, the 3rd, 15th, 50th, 85th, and 97th percentiles of each subarachnoid space measurement were described. CONCLUSIONS MR imaging-derived subarachnoid space values at a specific gestational age provide reproducible measurements, probably due to the high resolution of MR imaging and adherence to the true radiologic planes. Normal values for brain MR imaging could provide valuable reference information for assessing brain development, thus being an important tool in the decision-making process of both clinicians and parents.
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Affiliation(s)
- A Wandel
- From the Sackler School of Medicine (A.W., T.W., E.K.)
- Department of Diagnostic Radiology (A.W.), Shamir Medical Center, Zerifin, Israel
| | - T Weissbach
- From the Sackler School of Medicine (A.W., T.W., E.K.)
- Antenatal Diagnostic Unit (T.W., E.K.)
| | - E Katorza
- From the Sackler School of Medicine (A.W., T.W., E.K.)
- Antenatal Diagnostic Unit (T.W., E.K.)
- Department of Obstetrics and Gynecology, and Gertner Institute for Epidemiology and Health Policy Research (E.K.), Sheba Medical Center, Tel HaShomer, Israel
| | - T Ziv-Baran
- School of Public Health (T.Z.-B.), Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Papaioannou G, Garel C. The fetal brain: migration and gyration anomalies - pre- and postnatal correlations. Pediatr Radiol 2023; 53:589-601. [PMID: 35913508 DOI: 10.1007/s00247-022-05458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/16/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
The cerebral cortex represents a laminar structure of precisely spatially organized neurons in horizontal layers and vertical columns. Neurogenesis, neuronal migration and neuronal wiring are tightly regulated and coordinated procedures that result in the accurate formation of the human cerebral cortex. Abnormal fetal corticogenesis results in several types of migration and gyration anomalies, known as malformations of cortical development, which have long been a topic of investigation. According to the stage of cortical development that is affected, with diverse genetic and non-genetic etiologies, these malformations can cause abnormal head size, abnormal brain surface and abnormal cortical layering with various degrees of neurodevelopmental delay and epilepsy. The pathogenesis of these malformations is multifactorial and includes genetic mutations or environmental insults, acquired either in utero at varying stages of brain development or during the perinatal period after corticogenesis. In this article, we focus on cortical malformations detected on fetal MRI. We present the main antenatal findings that should raise suspicion for malformations of cortical development, together with findings that might be missed on prenatal imaging and describe the correlations between fetal and postnatal MRI.
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Affiliation(s)
- Georgia Papaioannou
- Department of Pediatric Radiology, Mitera Maternity and Children's Hospital, 6 Erythrou Stavrou str, 15123, Maroussi, Athens, Greece.
| | - Catherine Garel
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau APHP, Sorbonne Université, Paris, France
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Bastos GC, Tolezano GC, Krepischi ACV. Rare CNVs and Known Genes Linked to Macrocephaly: Review of Genomic Loci and Promising Candidate Genes. Genes (Basel) 2022; 13:genes13122285. [PMID: 36553552 PMCID: PMC9778424 DOI: 10.3390/genes13122285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Macrocephaly frequently occurs in single-gene disorders affecting the PI3K-AKT-MTOR pathway; however, epigenetic mutations, mosaicism, and copy number variations (CNVs) are emerging relevant causative factors, revealing a higher genetic heterogeneity than previously expected. The aim of this study was to investigate the role of rare CNVs in patients with macrocephaly and review genomic loci and known genes. We retrieved from the DECIPHER database de novo <500 kb CNVs reported on patients with macrocephaly; in four cases, a candidate gene for macrocephaly could be pinpointed: a known microcephaly gene-TRAPPC9, and three genes based on their functional roles-RALGAPB, RBMS3, and ZDHHC14. From the literature review, 28 pathogenic CNV genomic loci and over 300 known genes linked to macrocephaly were gathered. Among the genomic regions, 17 CNV loci (~61%) exhibited mirror phenotypes, that is, deletions and duplications having opposite effects on head size. Identifying structural variants affecting head size can be a preeminent source of information about pathways underlying brain development. In this study, we reviewed these genes and recurrent CNV loci associated with macrocephaly, as well as suggested novel potential candidate genes deserving further studies to endorse their involvement with this phenotype.
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Bourgon N, Carmignac V, Sorlin A, Duffourd Y, Philippe C, Thauvin-Robinet C, Guibaud L, Faivre L, Vabres P, Kuentz P. Clinical and molecular data in cases of prenatal localized overgrowth disorder: major implication of genetic variants in PI3K-AKT-mTOR signaling pathway. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:532-542. [PMID: 34170046 DOI: 10.1002/uog.23715] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe clinical and molecular findings in a French multicenter cohort of fetuses with prenatal diagnosis of congenital abnormality and suspicion of a localized overgrowth disorder (LOD) suggestive of genetic variants in the PI3K-AKT-mTOR signaling pathway. METHODS We analyzed retrospectively data obtained between 1 January 2013 and 1 May 2020 from fetuses with brain and/or limb overgrowth referred for molecular diagnosis of PI3K-AKT-mTOR pathway genes by next-generation sequencing (NGS) using pathological tissue obtained by fetal autopsy. We also assessed the diagnostic yield of amniotic fluid. RESULTS During the study period, 21 subjects with LOD suspected of being secondary to a genetic variant of the PI3K-AKT-mTOR pathway were referred for analysis. Of these, 17 fetuses had brain overgrowth, including six with isolated megalencephaly (MEG) and 11 with hemimegalencephaly (HMEG). Of the six with MEG, germline variants were identified in four cases, in either PIK3R2, AKT3 or MTOR, and a postzygotic PIK3R2 variant was found in the other two cases. Of the 11 with HMEG, a postzygotic PIK3CA variant was found in three fetuses with extracerebral features of PIK3CA-related overgrowth spectrum, and in seven fetuses with isolated HMEG. No pathogenic variant was identified in the 11th case with HMEG. Four fetuses with limb overgrowth also had one or more lymphatic malformations (LM) and harbored a postzygotic PIK3CA variant. NGS on cultured amniocytes performed in 10 cases, of which nine had been found positive on analysis of pathological fetal tissue, showed variants in four, in either PIK3CA, PIK3R2 or AKT3. CONCLUSIONS Isolated MEG or HMEG may lead to identification of genetic variants in the PI3K-AKT-mTOR signaling pathway. Cases of limb overgrowth and LM or isolated HMEG are likely associated with PIK3CA variants. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Bourgon
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Service d'Obstétrique-Maternité, Chirurgie Médecine et Imagerie Fœtale, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - V Carmignac
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Référence des Maladies Rares de la Peau et des Muqueuses d'Origine Génétique (MAGEC), Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - A Sorlin
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Référence des Maladies Rares de la Peau et des Muqueuses d'Origine Génétique (MAGEC), Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Génétique et Centre de Référence 'Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est', Hôpital d'Enfants, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- UF Innovation en Diagnostic Génomique des Maladies Rares, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - Y Duffourd
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - C Philippe
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- UF Innovation en Diagnostic Génomique des Maladies Rares, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - C Thauvin-Robinet
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Génétique et Centre de Référence 'Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est', Hôpital d'Enfants, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - L Guibaud
- Service d'Imagerie Médicale, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
| | - L Faivre
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Génétique et Centre de Référence 'Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est', Hôpital d'Enfants, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - P Vabres
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Référence des Maladies Rares de la Peau et des Muqueuses d'Origine Génétique (MAGEC), Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Service de Dermatologie, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - P Kuentz
- INSERM UMR 1231, Equipe 'Génétique des Anomalies du Développement', Université de Bourgogne Franche-Comté, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Centre de Référence des Maladies Rares de la Peau et des Muqueuses d'Origine Génétique (MAGEC), Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
- Oncobiologie Génétique Bioinformatique, PCBio, Centre Hospitalier Universitaire de Besançon, Besançon, France
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Hart AR, Vasudevan C, Griffiths PD, Foulds N, Piercy H, de Lacy P, Boxall S, Howe D, Vollmer B. Antenatal counselling for prospective parents whose fetus has a neurological anomaly: part 2, risks of adverse outcome in common anomalies. Dev Med Child Neurol 2022; 64:23-39. [PMID: 34482539 DOI: 10.1111/dmcn.15043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
After diagnosis of a fetal neurological anomaly, prospective parents want to know the best and worst-case scenarios and an estimation of the risk to their infant of having an atypical developmental outcome. The literature on developmental outcomes for fetal neurological anomalies is poor: studies are characterized by retrospective design, small sample size, often no standardized assessment of development, and differing definitions of anomalies. This review provides an aide-memoir on the risks of adverse neurodevelopmental outcome for ventriculomegaly, cortical anomalies, microcephaly, macrocephaly, agenesis of the corpus callosum, posterior fossa anomalies, and myelomeningocele, to assist healthcare professionals in counselling. The data in this review should be used alongside recommendations on counselling and service design described in part 1 to provide antenatal counselling.
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Affiliation(s)
- Anthony R Hart
- Department of Perinatal and Paediatric Neurology, Sheffield Children's NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
| | - Chakra Vasudevan
- Department of Neonatology, Bradford Royal Infirmary, Bradford, UK
| | - Paul D Griffiths
- Academic Unit of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Nicola Foulds
- Department of Clinical Genetics, Princess Anne Hospital, University Southampton NHS Foundation Trust, Southampton, UK
| | - Hilary Piercy
- The Centre for Health and Social Care, Sheffield Hallam University, Sheffield, UK
| | - Patricia de Lacy
- Department of Paediatric Neuosurgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Sally Boxall
- Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton, UK
| | - David Howe
- Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton, UK
| | - Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
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Fried S, Gafner M, Jeddah D, Gosher N, Hoffman D, Ber R, Mayer A, Katorza E. Correlation between 2D and 3D Fetal Brain MRI Biometry and Neurodevelopmental Outcomes in Fetuses with Suspected Microcephaly and Macrocephaly. AJNR Am J Neuroradiol 2021; 42:1878-1883. [PMID: 34385141 DOI: 10.3174/ajnr.a7225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Definitions of fetal microcephaly and macrocephaly are debatable. A better understanding of their long-term prognoses would help guide parental education and counseling. This study aimed to explore the correlation between 2D and 3D fetal brain MR imaging biometry results and the long-term neurodevelopmental outcomes. MATERIALS AND METHODS This analysis is a historical cohort study. Fetal brain biometry was measured on 2D and 3D MR imaging using a volumetric MR imaging semiautomated algorithm. We measured and assessed the following brain structures: the supratentorial brain volume and cerebellar volume and cerebellar volume/supratentorial brain volume ratio, in addition to commonly used 2D brain MR imaging biometric variables, including occipitofrontal diameter, biparietal diameter, and transcerebellar diameter. Microcephaly was defined as ≤ 3rd percentile; and macrocephaly, as ≥ 97th percentile, corresponding to -2 SDs and +2 SDs. The neurodevelopmental outcome of this study cohort was evaluated using the Vineland-II Adaptive Behavior Scales, and the measurements were correlated to the Vineland standard scores. RESULTS A total of 70 fetuses were included. No significant correlation was observed between the Vineland scores and either the supratentorial brain volume, cerebellar volume, or supratentorial brain volume/cerebellar volume ratio in 3D or 2D MR imaging measurements, after correction for multiple comparisons. No differences were found among fetuses with macrocephaly, normocephaly, or microcephaly regarding the median Vineland standard scores. CONCLUSIONS Provided there is normal brain structure on MR imaging, the developmental milestone achievements in early years are unrelated to 2D and 3D fetal brain MR imaging biometry, in the range of measurements depicted in this study.
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Affiliation(s)
- S Fried
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology (S.F., E.K.), Sheba Medical Center, Tel-Hashomer, Israel
| | - M Gafner
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Pediatrics B (M.G.), Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - D Jeddah
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
| | - N Gosher
- Hadassah Medical School (N.G.), The Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Hoffman
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
| | - R Ber
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
| | - A Mayer
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Diagnostic Radiology (A.M.), Sheba Medical Center, Tel-Hashomer, Israel
| | - E Katorza
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology (S.F., E.K.), Sheba Medical Center, Tel-Hashomer, Israel
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Malinger G, Hoffmann C, Achiron R, Berkenstadt M. Prenatal Diagnosis of Snijders Blok-Campeau Syndrome in a Fetus with Macrocephaly. Fetal Diagn Ther 2021; 48:407-410. [PMID: 34000720 DOI: 10.1159/000514326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
We present the prenatal imaging and whole exomics sequencing with the newly described Snijders Blok-Campeau macrocephaly syndrome.
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Affiliation(s)
- Gustavo Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Chen Hoffmann
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Michal Berkenstadt
- The Danek Gertner Institute of Human Genetics, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
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Gafner M, Fried S, Gosher N, Jeddah D, Sade EK, Barzilay E, Mayer A, Katorza E. Fetal Brain Biometry: Is there an Agreement among Ultrasound, MRI and the Measurements at Birth? Eur J Radiol 2020; 133:109369. [PMID: 33126174 DOI: 10.1016/j.ejrad.2020.109369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Measurement of the fetal brain can be achieved by different modalities, we aimed to assess the agreement between these methods and the head circumference at birth. METHODS A retrospective study conducted between 2011-2018 at a tertiary referral medical center. Sonographic head circumference (HC), 2D MRI bi-parietal diameter (BPD) and occipito-frontal diameter (OFD), 3D MRI supra-tentorial volume (STV), and head circumference (HC) at birth were measured and converted into centiles according to gestational age. Spearman's rank correlation coefficient was used to assess the correlation between the modalities. RESULTS A total of 88 fetuses were included. Mean gestational age at the time of fetal US and brain MRI acquisition were 34.4 ± 2.8 and 34.6 ± 2.6 weeks, respectively. A correlation was found between prenatal sonographic HC and the 3D MRI STV centiles (Rs = 0.859, p < 0.001), the BPD in 2D MRI (Rs = 0.813, p < 0.001), and the OFD in 2D MRI (Rs = 0.840, p < 0.001). Sonographic HC, OFD on 2D MRI, and STV on 3D MRI were all found to be correlated with the HC at birth (Rs = 0.865, p < 0.001; Rs 0.816, p < 0.001; Rs = 0.825, p < 0.001, respectively). CONCLUSIONS There is a statistically significant agreement among the different prenatal clinically used modalities for measuring fetal brain and the head circumference at birth, however, this correlation is not perfect. Further study is needed to investigate the long-term prognosis of these fetuses.
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Affiliation(s)
- Michal Gafner
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Shalev Fried
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noa Gosher
- Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Danielle Jeddah
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eliel Kedar Sade
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Arnaldo Mayer
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Diagnostic Radiology, Sheba Medical Center, Ramat-Gan, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Diagnostic Radiology, Sheba Medical Center, Ramat-Gan, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
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Pasternak Y, Singer A, Maya I, Sagi-Dain L, Ben-Shachar S, Khayat M, Greenbaum L, Feingold-Zadok M, Zeligson S, Sukenik Halevy R. The yield of chromosomal microarray testing for cases of abnormal fetal head circumference. J Perinat Med 2020; 48:553-558. [PMID: 32721143 DOI: 10.1515/jpm-2020-0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Chromosomal microarray analysis (CMA) is the method of choice for genetic work-up in cases of fetal malformations. We assessed the detection rate of CMA in cases of abnormal fetal head circumference (HC). METHODS The study cohort was based on 81 cases of amniocenteses performed throughout Israel for the indication of microcephaly (53) or macrocephaly (28), from January 2015 through December 2018. We retrieved data regarding the clinical background, parental HCs and work-up during the pregnancy from genetic counseling summaries and from patients' medical records. RESULTS There was only one likely pathogenic CMA result (1.89%): a 400-kb microdeletion at 16p13.3 detected in a case of isolated microcephaly. No pathogenic results were found in the macrocephaly group. Most fetuses with microcephaly were female (87.8%), while the majority with macrocephaly were males (86.4%). CONCLUSIONS The results imply that CMA analysis in pregnancies with microcephaly may carry a small yield compared to other indications. Regarding macrocephaly, our cohort was too small to draw conclusions. In light of the significant gender effect on the diagnosis of abnormal HC, standardization of fetal HC charts according to fetal gender may normalize cases that were categorized outside the normal range and may increase the yield of CMA for cases of abnormal HC.
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Affiliation(s)
- Yael Pasternak
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amihood Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Idit Maya
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shay Ben-Shachar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Genetics Institute, Sorasky Medical Center, Tel Aviv, Israel
| | - Morad Khayat
- Institute of Human Genetics, Haemek Medical Center, Afula, Israel
| | - Lior Greenbaum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel; and The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Sharon Zeligson
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rivka Sukenik Halevy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
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Aggarwal S. Counseling for Fetal Central Nervous System Defects. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero. Eur Radiol 2016; 27:2367-2380. [PMID: 27655301 PMCID: PMC5408056 DOI: 10.1007/s00330-016-4563-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022]
Abstract
Objectives This systematic review was undertaken to define the diagnostic performance of in utero MR (iuMR) imaging when attempting to confirm, exclude or provide additional information compared with the information provided by prenatal ultrasound scans (USS) when there is a suspicion of foetal brain abnormality. Methods Electronic databases were searched as well as relevant journals and conference proceedings. Reference lists of applicable studies were also explored. Data extraction was conducted by two reviewers independently to identify relevant studies for inclusion in the review. Inclusion criteria were original research that reported the findings of prenatal USS and iuMR imaging and findings in terms of accuracy as judged by an outcome reference diagnosis for foetal brain abnormalities. Results 34 studies met the inclusion criteria which allowed diagnostic accuracy to be calculated in 959 cases, all of which had an outcome reference diagnosis determined by postnatal imaging, surgery or autopsy. iuMR imaging gave the correct diagnosis in 91 % which was an increase of 16 % above that achieved by USS alone. Conclusion iuMR imaging makes a significant contribution to the diagnosis of foetal brain abnormalities, increasing the diagnostic accuracy achievable by USS alone. Key points • Ultrasound is the primary modality for monitoring foetal brain development during pregnancy • iuMRI used together with ultrasound is more accurate for detecting foetal brain abnormalities • iuMR imaging is most helpful for detecting midline brain abnormalities • The moderate heterogeneity of reviewed studies may compromise findings
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Jeong G, Kim M, Han BH. Clinical features of macrocephaly at birth in Korea. KOREAN JOURNAL OF PEDIATRICS 2014; 57:75-8. [PMID: 24678331 PMCID: PMC3965798 DOI: 10.3345/kjp.2014.57.2.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/19/2013] [Accepted: 08/27/2013] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed to investigate the clinical features of macrocephaly at birth in Korea using ultrasonography. Methods We retrospectively investigated the medical records of full-term birth neonates in Cheil General Hospital & Women's Healthcare Center from January 2000 to June 2012. The following parameters were recorded and analyzed: gestational age, sex, birth weight, height, occipitofrontal circumference (OFC), physical examination, perinatal problems, and ultrasonography results. Macrocephaly was diagnosed when the OFC was greater than two standard deviations, based on the 2007 Korean National Growth Charts. Results There were 75 neonates with macrocephaly at birth (52 boys and 23 girls), with a mean OFC of 38.1±0.49 cm. A comparison of the birth weight and height with the OFC value showed that height was correlated with OFC (r=0.35) but birth weight was not correlated with OFC (r=0.06). There were no remarkable findings in 56 cases (75%). Germinal matrix hemorrhage was identified in 10 cases (13%). An enlarged cerebrospinal fluid space was found in 5 cases (6.7%). There were 3 cases of mega-cisterna magna (4%), 1 case of ventriculomegaly, and 1 case of an enlarged interhemispheric space (6 mm) among these patients. In addition, a choroid plexus cyst was seen in 1 case. Mineralizing vasculopathy in both basal ganglia with no evidence of congenital infection was found in 2 cases and an asymptomatic subarachnoid hemorrhage was found in 1 case. Conclusion Our results indicate that macrocephaly at birth has benign ultrasonography findings and shows a pattern of male dominance.
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Affiliation(s)
- Goun Jeong
- Department of Pediatrics, Cheil General Hospital & Women's Healthcare Center, Seoul, Korea
| | - Minkyun Kim
- Department of Pediatrics, Cheil General Hospital & Women's Healthcare Center, Seoul, Korea
| | - Byoung Hee Han
- Department of Radiology, Cheil General Hospital & Women's Healthcare Center, Seoul, Korea
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Kim YH. Head circumference alone at birth, is it practical? KOREAN JOURNAL OF PEDIATRICS 2014; 57:72-4. [PMID: 24678330 PMCID: PMC3965797 DOI: 10.3345/kjp.2014.57.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Young-Hoon Kim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
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