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Marathu KK, Vahedifard F, Kocak M, Liu X, Adepoju JO, Bowker RM, Supanich M, Cosme-Cruz RM, Byrd S. Fetal MRI Analysis of Corpus Callosal Abnormalities: Classification, and Associated Anomalies. Diagnostics (Basel) 2024; 14:430. [PMID: 38396468 PMCID: PMC10887608 DOI: 10.3390/diagnostics14040430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Corpus callosal abnormalities (CCA) are midline developmental brain malformations and are usually associated with a wide spectrum of other neurological and non-neurological abnormalities. The study aims to highlight the diagnostic role of fetal MRI to characterize heterogeneous corpus callosal abnormalities using the latest classification system. It also helps to identify associated anomalies, which have prognostic implications for the postnatal outcome. METHODS In this study, retrospective data from antenatal women who underwent fetal MRI between January 2014 and July 2023 at Rush University Medical Center were evaluated for CCA and classified based on structural morphology. Patients were further assessed for associated neurological and non-neurological anomalies. RESULTS The most frequent class of CCA was complete agenesis (79.1%), followed by hypoplasia (12.5%), dysplasia (4.2%), and hypoplasia with dysplasia (4.2%). Among them, 17% had isolated CCA, while the majority (83%) had complex forms of CCA associated with other CNS and non-CNS anomalies. Out of the complex CCA cases, 58% were associated with other CNS anomalies, while 8% were associated with non-CNS anomalies. 17% of cases had both. CONCLUSION The use of fetal MRI is valuable in the classification of abnormalities of the corpus callosum after the confirmation of a suspected diagnosis on prenatal ultrasound. This technique is an invaluable method for distinguishing between isolated and complex forms of CCA, especially in cases of apparent isolated CCA. The use of diffusion-weighted imaging or diffusion tensor imaging in fetal neuroimaging is expected to provide further insights into white matter abnormalities in fetuses diagnosed with CCA in the future.
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Affiliation(s)
- Kranthi K. Marathu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA; (F.V.); (M.K.); (X.L.); (J.O.A.); (S.B.)
| | - Farzan Vahedifard
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA; (F.V.); (M.K.); (X.L.); (J.O.A.); (S.B.)
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA; (F.V.); (M.K.); (X.L.); (J.O.A.); (S.B.)
| | - Xuchu Liu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA; (F.V.); (M.K.); (X.L.); (J.O.A.); (S.B.)
| | - Jubril O. Adepoju
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA; (F.V.); (M.K.); (X.L.); (J.O.A.); (S.B.)
| | - Rakhee M. Bowker
- Department of Pediatrics, Division of Neonatology, Rush Medical College, Chicago, IL 60612, USA;
| | - Mark Supanich
- Department of Radiology and Nuclear Medicine, Division for Diagnostic Medical Physics, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Rosario M. Cosme-Cruz
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL 60612, USA;
| | - Sharon Byrd
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA; (F.V.); (M.K.); (X.L.); (J.O.A.); (S.B.)
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Piccirilli E, Marchetti C, Panara V, Celentano C, D'Antonio F, Sensi S, Righini A, Caulo M. Fetal MR Imaging Anatomy of the Transverse Temporal Gyrus (Heschl Gyrus). AJNR Am J Neuroradiol 2023; 44:1325-1331. [PMID: 37884303 PMCID: PMC10631540 DOI: 10.3174/ajnr.a8026] [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: 06/11/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE The human auditory system develops early in fetal life. This retrospective MR imaging study describes the in vivo prenatal anatomic development of the transverse temporal gyrus (Heschl gyrus) site of the primary auditory cortex. MATERIALS AND METHODS Two hundred seventy-two MR imaging studies of the fetal brain (19-39 weeks' gestational age) acquired from a single institution's 1.5T scanner were retrospectively examined by 2 neuroradiologists. MR imaging with pathologic findings and extreme motion artifacts was excluded. Postnatal Heschl gyrus landmarks were used as a reference on T2-weighted ssFSE sequences in the 3 orthogonal planes. The frequency of the Heschl gyrus was reported for gestational age, hemisphere, and planes. Descriptive statistics and a McNemar test were performed. RESULTS Two hundred thirty MR imaging studies were finally included. Fetal brains were divided by gestational age (in weeks) into 8 groups (parentheses indicate the number of observations): 19-21 (29), 22-23 (32), 24-25 (21), 26-27 (18), 28-29 (35), 30-31 (30), 32-33 (33) and >34 (32). The Heschl gyrus appeared on MR imaging between 24 and 25 weeks' gestational age (14/21 fetuses, 67%) and was visible in all fetuses after the 28th week of gestation. By its appearance (24-28 weeks' gestational age), the sagittal plane was the most sensitive in its detectability. After 28-29 weeks' gestational age, the Heschl gyrus was evident in all acquisition planes and fetuses. Results did not differ between hemispheres. CONCLUSIONS The Heschl gyrus appears on MR imaging at 24-25 weeks' gestational age, paralleling the functional activation of the auditory system. We propose the Heschl gyrus as an early additional MR imaging marker of fetal brain development.
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Affiliation(s)
- Eleonora Piccirilli
- From the Department of Neuroscience (E.P., S.S., M.C.), Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
- Neuro-Oncology Unit (E.P.), Department of Imaging, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- ITAB-Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences (E.P., C.M., V.P., S.S., M.C.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Marchetti
- Radiology Unit (C.M.), San Pio Da Pietrelcina Hospital, Vasto, Chieti, Italy
- ITAB-Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences (E.P., C.M., V.P., S.S., M.C.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Valentina Panara
- Department of Radiology (V.P., M.C.), Santissima Annunziata Hospital, Chieti, Italy
- ITAB-Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences (E.P., C.M., V.P., S.S., M.C.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Claudio Celentano
- Obstetrics and Gynaecology Unit (C.C.), Santo Spirito Hospital, Pescara, Italy
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy (F.D.), Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Stefano Sensi
- From the Department of Neuroscience (E.P., S.S., M.C.), Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
- ITAB-Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences (E.P., C.M., V.P., S.S., M.C.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Andrea Righini
- Neuroradiology Unit (A.R.), Pediatric Radiology Department, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Massimo Caulo
- From the Department of Neuroscience (E.P., S.S., M.C.), Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
- Department of Radiology (V.P., M.C.), Santissima Annunziata Hospital, Chieti, Italy
- ITAB-Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences (E.P., C.M., V.P., S.S., M.C.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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Palumbo G, Arrigoni F, Peruzzo D, Parazzini C, D'Errico I, Agazzi GM, Pinelli L, Triulzi F, Righini A. Onset of Chiari type 1 malformation: insights from a small series of intrauterine MR imaging cases. Neuroradiology 2023; 65:1387-1394. [PMID: 37329352 DOI: 10.1007/s00234-023-03183-0] [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: 09/17/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Morphometric studies on idiopathic Chiari malformation type 1 (CM1) pathogenesis have been mainly based on post-natal neuroimaging. Prenatal clues related to CM1 development are lacking. We present pre- and post-natal imaging time course in idiopathic CM1 and assess fetal skull and brain biometry to establish if clues about CM1 development are present at fetal age. METHODS Multicenter databases were screened to retrieve intrauterine magnetic resonance (iuMR) of children presenting CM1 features at post-natal scan. Syndromes interfering with skull-brain growth were excluded. Twenty-two morphometric parameters were measured at fetal (average 24.4 weeks; range 21 to 32) and post-natal (average 15.4 months; range 1 to 45) age; matched controls were included. RESULTS Among 7000 iuMR cases, post-natal scans were available for 925, with postnatal CM1 features reported in seven. None of the fetuses presented CM1 features. Tonsillar descent was clear at a later post-natal scan in all seven cases. Six fetal parameters resulted to be statistically different between CM1 and controls: basal angle (p = 0.006), clivo-supraoccipital angle (p = 0.044), clivus' length (p = 0.043), posterior cranial fossa (PCF) width (p = 0.009), PCF height (p = 0.045), and PCFw/BPDb (p = 0.013). Postnatally, only the clivus' length was significant between CM1 cases and controls. CONCLUSION Pre- and post-natal CM1 cases did not share striking common features, making qualitative prenatal assessment not predictive; however, our preliminary results support the view that some of the pathogenetic basis of CM1 may be embedded to some extent already in intrauterine life.
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Affiliation(s)
- Giovanni Palumbo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy.
| | - Filippo Arrigoni
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS "Eugenio Medea", Bosisio Parini, Lecco, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | | | | | | | - Fabio Triulzi
- Neuroradiology Department, Fondazione IRRCS Ca' Granda Ospedale Policlinico Di Milano, Milan, Italy
| | - Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
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Ciceri T, Squarcina L, Pigoni A, Ferro A, Montano F, Bertoldo A, Persico N, Boito S, Triulzi FM, Conte G, Brambilla P, Peruzzo D. Geometric Reliability of Super-Resolution Reconstructed Images from Clinical Fetal MRI in the Second Trimester. Neuroinformatics 2023; 21:549-563. [PMID: 37284977 PMCID: PMC10406722 DOI: 10.1007/s12021-023-09635-5] [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] [Accepted: 05/20/2023] [Indexed: 06/08/2023]
Abstract
Fetal Magnetic Resonance Imaging (MRI) is an important noninvasive diagnostic tool to characterize the central nervous system (CNS) development, significantly contributing to pregnancy management. In clinical practice, fetal MRI of the brain includes the acquisition of fast anatomical sequences over different planes on which several biometric measurements are manually extracted. Recently, modern toolkits use the acquired two-dimensional (2D) images to reconstruct a Super-Resolution (SR) isotropic volume of the brain, enabling three-dimensional (3D) analysis of the fetal CNS.We analyzed 17 fetal MR exams performed in the second trimester, including orthogonal T2-weighted (T2w) Turbo Spin Echo (TSE) and balanced Fast Field Echo (b-FFE) sequences. For each subject and type of sequence, three distinct high-resolution volumes were reconstructed via NiftyMIC, MIALSRTK, and SVRTK toolkits. Fifteen biometric measurements were assessed both on the acquired 2D images and SR reconstructed volumes, and compared using Passing-Bablok regression, Bland-Altman plot analysis, and statistical tests.Results indicate that NiftyMIC and MIALSRTK provide reliable SR reconstructed volumes, suitable for biometric assessments. NiftyMIC also improves the operator intraclass correlation coefficient on the quantitative biometric measures with respect to the acquired 2D images. In addition, TSE sequences lead to more robust fetal brain reconstructions against intensity artifacts compared to b-FFE sequences, despite the latter exhibiting more defined anatomical details.Our findings strengthen the adoption of automatic toolkits for fetal brain reconstructions to perform biometry evaluations of fetal brain development over common clinical MR at an early pregnancy stage.
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Affiliation(s)
- Tommaso Ciceri
- NeuroImaging Laboratory, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Letizia Squarcina
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandro Pigoni
- Social and Affective Neuroscience Group, IMT School for Advanced Studies Lucca, Lucca, Italy
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Florian Montano
- NeuroImaging Laboratory, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Alessandra Bertoldo
- Department of Information Engineering, University of Padua, Padua, Italy
- Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Nicola Persico
- Department of Woman, Child and Newborn, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Boito
- Department of Woman, Child and Newborn, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Maria Triulzi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Services and Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Conte
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Services and Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Denis Peruzzo
- NeuroImaging Laboratory, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
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Tran CBN, Nedelec P, Weiss DA, Rudie JD, Kini L, Sugrue LP, Glenn OA, Hess CP, Rauschecker AM. Development of Gestational Age-Based Fetal Brain and Intracranial Volume Reference Norms Using Deep Learning. AJNR Am J Neuroradiol 2023; 44:82-90. [PMID: 36549845 PMCID: PMC9835919 DOI: 10.3174/ajnr.a7747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Fetal brain MR imaging interpretations are subjective and require subspecialty expertise. We aimed to develop a deep learning algorithm for automatically measuring intracranial and brain volumes of fetal brain MRIs across gestational ages. MATERIALS AND METHODS This retrospective study included 246 patients with singleton pregnancies at 19-38 weeks gestation. A 3D U-Net was trained to segment the intracranial contents of 2D fetal brain MRIs in the axial, coronal, and sagittal planes. An additional 3D U-Net was trained to segment the brain from the output of the first model. Models were tested on MRIs of 10 patients (28 planes) via Dice coefficients and volume comparison with manual reference segmentations. Trained U-Nets were applied to 200 additional MRIs to develop normative reference intracranial and brain volumes across gestational ages and then to 9 pathologic fetal brains. RESULTS Fetal intracranial and brain compartments were automatically segmented in a mean of 6.8 (SD, 1.2) seconds with median Dices score of 0.95 and 0.90, respectively (interquartile ranges, 0.91-0.96/0.89-0.91) on the test set. Correlation with manual volume measurements was high (Pearson r = 0.996, P < .001). Normative samples of intracranial and brain volumes across gestational ages were developed. Eight of 9 pathologic fetal intracranial volumes were automatically predicted to be >2 SDs from this age-specific reference mean. There were no effects of fetal sex, maternal diabetes, or maternal age on intracranial or brain volumes across gestational ages. CONCLUSIONS Deep learning techniques can quickly and accurately quantify intracranial and brain volumes on clinical fetal brain MRIs and identify abnormal volumes on the basis of a normative reference standard.
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Affiliation(s)
- C B N Tran
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - P Nedelec
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - D A Weiss
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - J D Rudie
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - L Kini
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - L P Sugrue
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - O A Glenn
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C P Hess
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - A M Rauschecker
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Aertsen M, Dymarkowski S, Vander Mijnsbrugge W, Cockmartin L, Demaerel P, De Catte L. Anatomical and diffusion-weighted imaging of brain abnormalities in third-trimester fetuses with cytomegalovirus infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:68-75. [PMID: 35018680 DOI: 10.1002/uog.24856] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In this study of cytomegalovirus (CMV)-infected fetuses with first-trimester seroconversion, we aimed to evaluate the detection of brain abnormalities using magnetic resonance imaging (MRI) and neurosonography (NSG) in the third trimester, and compare the grading systems of the two modalities. We also evaluated the feasibility of routine use of diffusion-weighted imaging (DWI) fetal MRI and compared the regional apparent diffusion coefficient (ADC) values between CMV-infected fetuses and presumed normal, non-infected fetuses in the third trimester. METHODS This was a retrospective review of MRI and NSG scans in fetuses with confirmed first-trimester CMV infection performed between September 2015 and August 2019. Brain abnormalities were recorded and graded using fetal MRI and NSG grading systems to compare the two modalities. To investigate feasibility of DWI, a four-point rating scale (poor, suboptimal, good, excellent) was applied to assess the quality of the images. Quantitative assessment was performed by placing a freehand drawn region of interest in the white matter of the frontal, parietal, temporal and occipital lobes and the basal ganglia, pons and cerebellum to calculate ADC values. Regional ADC measurements were obtained similarly in a control group of fetuses with negative maternal CMV serology in the first trimester, normal brain findings on fetal MRI and normal genetic testing. RESULTS Fifty-three MRI examinations of 46 fetuses with confirmed first-trimester CMV infection were included. NSG detected 24 of 27 temporal cysts seen on MRI scans, with a sensitivity of 78% and an accuracy of 83%. NSG did not detect abnormal gyration visible on two (4%) MRI scans. Periventricular calcifications were detected on two MRI scans compared with 10 NSG scans. While lenticulostriate vasculopathy was detected on 11 (21%) NSG scans, no fetus demonstrated this finding on MRI. MRI grading correlated significantly with NSG grading of brain abnormalities (P < 0.0001). Eight (15%) of the DWI scans in the CMV cohort were excluded from further analysis because of insufficient quality. The ADC values of CMV-infected fetuses were significantly increased in the frontal (both sides, P < 0.0001), temporal (both sides, P < 0.0001), parietal (left side, P = 0.0378 and right side, P = 0.0014) and occipital (left side, P = 0.0002 and right side, P < 0.0001) lobes and decreased in the pons (P = 0.0085) when compared with non-infected fetuses. The ADC values in the basal ganglia and the cerebellum were not significantly different in CMV-infected fetuses compared with normal controls (all P > 0.05). Temporal and frontal ADC values were higher in CMV-infected fetuses with more severe brain abnormalities compared to fetuses with mild abnormalities. CONCLUSIONS Ultrasound and MRI are complementary during the third trimester in the assessment of brain abnormalities in CMV-infected fetuses, with a significant correlation between the grading systems of the two modalities. On DWI in the third trimester, the ADC values in several brain regions are abnormal in CMV-infected fetuses compared with normal controls. Furthermore, they seem to correlate in the temporal area and, to a lesser extent, frontal area with the severity of brain abnormalities associated with CMV infection. Larger prospective studies are needed for further investigation of the microscopic nature of diffusion abnormalities and correlation of different imaging findings with postnatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Aertsen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - S Dymarkowski
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - L Cockmartin
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P Demaerel
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - L De Catte
- Division Woman and Child, Fetal Medicine Unit, Clinical Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium
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Pollatou A, Filippi CA, Aydin E, Vaughn K, Thompson D, Korom M, Dufford AJ, Howell B, Zöllei L, Martino AD, Graham A, Scheinost D, Spann MN. An ode to fetal, infant, and toddler neuroimaging: Chronicling early clinical to research applications with MRI, and an introduction to an academic society connecting the field. Dev Cogn Neurosci 2022; 54:101083. [PMID: 35184026 PMCID: PMC8861425 DOI: 10.1016/j.dcn.2022.101083] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Fetal, infant, and toddler neuroimaging is commonly thought of as a development of modern times (last two decades). Yet, this field mobilized shortly after the discovery and implementation of MRI technology. Here, we provide a review of the parallel advancements in the fields of fetal, infant, and toddler neuroimaging, noting the shifts from clinical to research use, and the ongoing challenges in this fast-growing field. We chronicle the pioneering science of fetal, infant, and toddler neuroimaging, highlighting the early studies that set the stage for modern advances in imaging during this developmental period, and the large-scale multi-site efforts which ultimately led to the explosion of interest in the field today. Lastly, we consider the growing pains of the community and the need for an academic society that bridges expertise in developmental neuroscience, clinical science, as well as computational and biomedical engineering, to ensure special consideration of the vulnerable mother-offspring dyad (especially during pregnancy), data quality, and image processing tools that are created, rather than adapted, for the young brain.
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Affiliation(s)
- Angeliki Pollatou
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Courtney A Filippi
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA; Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Ezra Aydin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Psychology, University of Cambridge, Cambridge, UK
| | - Kelly Vaughn
- Department of Pediatrics, University of Texas Health Sciences Center, Houston, TX, USA
| | - Deanne Thompson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Marta Korom
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Alexander J Dufford
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Brittany Howell
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA; Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - Lilla Zöllei
- Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | - Alice Graham
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Dustin Scheinost
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Marisa N Spann
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
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8
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Di Mascio D, Khalil A, Rizzo G, Kasprian G, Caulo M, Manganaro L, Odibo AO, Flacco ME, Giancotti A, Buca D, Liberati M, Timor-Tritsch IE, D'Antonio F. Reference ranges for fetal brain structures using magnetic resonance imaging: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:296-303. [PMID: 34405927 DOI: 10.1002/uog.23762] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the methodology of studies reporting reference ranges for fetal brain structures on magnetic resonance imaging (MRI). METHODS MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to 31 December 2020 to identify studies investigating biometry and growth of the fetal brain and reporting reference ranges for brain structures using MRI. The primary aim was to evaluate the methodology of these studies. A list of 26 quality criteria divided into three domains, including 'study design', 'statistical and reporting methods' and 'specific aspects relevant to MRI', was developed and applied to evaluate the methodological appropriateness of each of the included studies. The overall quality score of a study, ranging between 0 and 26, was defined as the sum of scores awarded for each quality criterion and expressed as a percentage (the lower the percentage, the higher the risk of bias). RESULTS Fifteen studies were included in this systematic review. The overall mean quality score of the studies evaluated was 48.7%. When focusing on each domain, the mean quality score was 42.0% for 'study design', 59.4% for 'statistical and reporting methods' and 33.3% for 'specific aspects relevant to MRI'. For the 'study design' domain, sample size calculation and consecutive enrolment of women were the items found to be at the highest risk of bias. For the 'statistical and reporting methods' domain, the presence of regression equations for mean and SD for each measurement, the number of measurements taken for each variable and the presence of postnatal assessment information were the items found to be at the highest risk of bias. For the 'specific aspects relevant to MRI' domain, whole fetal brain assessment was not performed in any of the included studies and was therefore considered to be the item at the highest risk of bias. CONCLUSIONS Most of the previously published studies reporting fetal brain reference ranges on MRI are highly heterogeneous and have low-to-moderate quality in terms of methodology, which is similar to the findings reported for ultrasound studies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - G Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - M Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. D'Annunzio' University, Chieti, Italy
| | - L Manganaro
- Department of Radiology, Sapienza University of Rome, Rome, Italy
| | - A O Odibo
- Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - M E Flacco
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - D Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - M Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - I E Timor-Tritsch
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, NY, USA
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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9
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Schlatterer SD, Sanapo L, du Plessis AJ, Whitehead MT, Mulkey SB. The Role of Fetal MRI for Suspected Anomalies of the Posterior Fossa. Pediatr Neurol 2021; 117:10-18. [PMID: 33607354 DOI: 10.1016/j.pediatrneurol.2021.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Posterior fossa anomalies can be diagnostic dilemmas during the fetal period. The prognosis for different diagnoses of the posterior fossa varies widely. We investigated whether fetal magnetic resonance imaging (MRI) and prenatal neurology consultation led to an alternate prognosis for fetuses referred due to concern for a fetal posterior fossa anomaly and concordance between pre- and postnatal diagnoses. METHODS This is a retrospective study of cases referred to the Prenatal Pediatrics Institute at Children's National Hospital from January 2012 to June 2018 due to concern for posterior fossa anomaly. Each encounter was scored for change in prognosis based upon clinical and fetal MRI report. Postnatal imaging was compared with prenatal imaging when available. RESULTS In total, 180 cases were referred for fetal posterior fossa anomalies based on outside obstetric ultrasound and had both fetal MRI and a neurology consultation. Fetal MRI and neurology consultation resulted in a change in fetal prognosis in 70% of cases. The most common referral diagnosis in our cohort was Dandy-Walker continuum, but it was not often confirmed by fetal MRI. In complex cases, posterior fossa diagnosis and prognosis determined by fetal MRI impacted choices regarding pregnancy management. Postnatal imaging was obtained in 57 (47%) live-born infants. Fetal and postnatal prognoses were similar in 60%. CONCLUSIONS Fetal diagnosis affects pregnancy management decisions. The fetal-postnatal imaging agreement of 60% highlights the conundrum of balancing the timing of fetal MRI to provide the most accurate diagnosis of the posterior fossa abnormalities in time to make pregnancy management decisions.
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Affiliation(s)
- Sarah D Schlatterer
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Laura Sanapo
- Women's Medicine Collaborative-Division of Research, The Miriam Hospital, Providence, Rhode Island; Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adre J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matthew T Whitehead
- Department of Neuroradiology, Children's National Hospital, Washington, District of Columbia; Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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10
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Mckinnon K, Kendall GS, Tann CJ, Dyet L, Sokolska M, Baruteau KP, Marlow N, Robertson NJ, Peebles D, Srinivasan L. Biometric assessments of the posterior fossa by fetal MRI: A systematic review. Prenat Diagn 2020; 41:258-270. [PMID: 33251640 DOI: 10.1002/pd.5874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Posterior fossa abnormalities (PFAs) are commonly identified within routine screening and are a frequent indication for fetal magnetic resonance imaging (MRI). Although biometric measurements of the posterior fossa (PF) are established on fetal ultrasound and MRI, qualitative visual assessments are predominantly used to differentiate PFAs. OBJECTIVES This systematic review aimed to assess 2-dimensional (2D) biometric measurements currently in use for assessing the PF on fetal MRI to delineate different PFAs. METHODS The protocol was registered (PROSPERO ID CRD42019142162). Eligible studies included T2-weighted MRI PF measurements in fetuses with and without PFAs, including measurements of the PF, or other brain areas relevant to PFAs. RESULTS 59 studies were included - 6859 fetuses had 62 2D PF and related measurements. These included linear, area and angular measurements, representing measures of PF size, cerebellum/vermis, brainstem, and supratentorial measurements. 11 measurements were used in 10 or more studies and at least 1200 fetuses. These dimensions were used to characterise normal for gestational age, diagnose a range of pathologies, and predict outcome. CONCLUSION A selection of validated 2D biometric measurements of the PF on fetal MRI may be useful for identification of PFA in different clinical settings. Consistent use of these measures, both clinically and for research, is recommended.
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Affiliation(s)
- Katie Mckinnon
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Giles S Kendall
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Cally J Tann
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Leigh Dyet
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Institute for Women's Health, University College London, London, UK.,Medical Physics Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kelly Pegoretti Baruteau
- Institute for Women's Health, University College London, London, UK.,Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Nicola J Robertson
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Donald Peebles
- Institute for Women's Health, University College London, London, UK.,Obstetric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Latha Srinivasan
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
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11
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Ibrahim RSM, Emad-Eldin S. Beyond fetal magnetic resonance diagnosis of corpus callosum agenesis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00182-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Corpus callosum agenesis (CCA) is a midline congenital anomaly. Routine prenatal 2D ultrasonography (2D US) can suggest CCA. A definitive diagnosis and identification of more subtle associated neurological or non-neurological abnormalities are difficult to be detected by prenatal 2D US; therefore, a further study by fetal magnetic resonance imaging (MRI) is needed. This study highlights the role and evaluates the diagnostic value of fetal MRI in the diagnosis of CCA and identifying the associated anomalies, which is a prognostic of the postnatal developmental outcome.
Results
Out of 27 fetuses that were suspected to have CCA on prenatal US, fetal MRI diagnosed 25/27 fetuses (92.5%) with CCA, while the last 2/27 (7.5%) were ruled out; being false positive (FP) on prenatal US, they had normal corpus callosum (CC). Cases diagnosed as CCA were either complete 77.7% (n = 21) or partial agenesis 14.8% (n = 4). They were classified as followed: Only 5/25 (18.5%) had isolated CCA, while the majority 20/25 (74%) of CCA were complex form associated with other anomalies (most of them 14 cases (70%) associated with other neurological anomalies, while 4 cases (20%) associated with other non-neurological anomalies, and last 2 cases (10%) were having both anomalies). The diagnostic performance of fetal MRI in diagnosis of CCA was as follows: sensitivity 100%, specificity 67%, positive predictive value (PPV) 96%, negative predictive value (NPV) 100%, and accuracy 96.3%. The sensitivity of the detection of associated neurological abnormalities was 100% by fetal MRI for 75% by 2D US.
Conclusion
The prevalence of the complex CCA is higher than the isolated form. Fetal MRI is a valuable adjunctive complementary imaging to prenatal 2D US with high diagnostic performance in the diagnosis of fetuses with CCA. It confirms the diagnosis, assesses the extent of agenesis, and detects coexisting anomalies, which is a prognostic of the postnatal developmental outcome.
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12
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Tepper R, Leibovitz Z, Garel C, Sukenik-Halevy R. A new method for evaluating short fetal corpus callosum. Prenat Diagn 2019; 39:1283-1290. [PMID: 31671211 DOI: 10.1002/pd.5598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sonographic diagnosis of short corpus callosum (SCC) is based on measurement of a short for gestational age antero-posterior length of the corpus callosum (CC) in the midsagittal plane. We suggest a new method for evaluating SCC without referring to biometry tables. METHODS We measured the ratio between the CC length and the internal cranial occipitofrontal dimension (ICOFD) in the midsagittal plane in 399 normal fetuses at 20 + 6 to 35 + 3 weeks of gestation and in 31 fetuses with a diagnosis of a SCC and compared the mean ratio between two groups. The impact of cephalic biometric parameters, fetal presentation, and gender was assessed. RESULTS The ICOFD/CC length for normal pregnancies was constant throughout the pregnancy (2.35 ± 0.11). There was no correlation between the ICOFD/CC length and cephalic index, Biparietal Diameter (BPD), head circumference, fetal sex, or fetal presentation. The ratio of pregnancies with SCC was significantly higher: 3.20 ± 0.84 (P < .0001). CONCLUSION The ICOFD/CC length practically does not change throughout a normal pregnancy. The ratio was significantly higher in pregnancies with SCC. Measuring this ratio during fetal anatomical scan may enable rapid evaluation of the CC without the need to refer to biometry tables.
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Affiliation(s)
- Ronnie Tepper
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Simultech Medical Simulation Center, Meir Medical Center, Kfar Saba, Israel
| | - Zvi Leibovitz
- Obstetrics and Gynecology, Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Catherine Garel
- Radiology, Hôpital d'Enfants Armand-Trousseau, Paris, France
| | - Rivka Sukenik-Halevy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Genetics Institute, Rabin Medical Center, Petach Tikva, Israel
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13
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Spinelli M, Di Meglio L, Mosimann B, Di Naro E, Surbek D, Raio L. The Vermian-Crest Angle: A New Method to Assess Fetal Vermis Position within the Posterior Fossa Using 3-Dimensional Multiplanar Sonography. Fetal Diagn Ther 2018; 46:223-230. [PMID: 30517923 DOI: 10.1159/000494721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal morphometry of the vermis and its relation to the posterior fossa (PF) rule out most major anomalies of the cerebellum. However, accurate categorization of the position and size of the fetal vermis remains a challenge. OBJECTIVE Our aim was to test a new method to assess the position and size of fetal vermis on 3-dimensional ultrasound (3D-US). METHODS We measured the vermian-crest angle (VCA) in normal fetuses using multiplanar 3D-US. We also assessed the diameters (superoinferior, anteroposterior, and horizontal) and volume of the vermis. The Spearman rank test and linear and polynomial regression analyses were used for statistical purposes. RESULTS We included 126 fetuses. Mean ± SD gestational age (GA) was 26.3 ± 4.6 (range 17-35.5) weeks. Mean ± SD superoinferior, anteroposterior, and horizontal diameters were 16.2 ± 4.9, 11.2 ± 3.6, and 5.6 ± 1.6 mm, respectively. Median (range) vermian volume was 0.50 (0.05-2.9) cm3. The VCA was 64.49° ± 11.45. We found no correlation between GA and VCA (r = 0.15; p = 0.13), a linear correlation between GA and vermian diameters, and a quadratic correlation between GA and vermian volume. CONCLUSIONS We provide a new method to assess vermian position and size within the PF using 3D-US. The combined information may be of value for screening purposes, particularly to differentiate between the various pathological situations encountered within the PF.
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Affiliation(s)
- Marialuigia Spinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy, .,Department of Clinical Research, University of Bern, Bern, Switzerland,
| | - Lavinia Di Meglio
- Private Centre "Diagnostica Ecografica Prenatale Aniello Di Meglio srl", Naples, Italy
| | - Beatrice Mosimann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Edoardo Di Naro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.,Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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14
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Chapman T, Menashe SJ, Zare M, Alessio AM, Ishak GE. Establishment of normative values for the fetal posterior fossa by magnetic resonance imaging. Prenat Diagn 2018; 38:1035-1041. [PMID: 30280395 DOI: 10.1002/pd.5367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Suspected Dandy-Walker continuum anomalies constitute a significant percentage of prenatal cases evaluated by magnetic resonance imaging (MRI). To unify the description of posterior fossa malformations, we sought to establish objective measurements for the posterior fossa in normal fetuses between 18 and 37 weeks gestation. METHODS T2-weighted images of normal fetal brains in sagittal projection were obtained from fetal magnetic resonance (MR) studies of normal brains performed from 2009 to 2017.121 fetal brains were included in the analysis. Three radiologists reviewed images and recorded the following for each case: superior posterior fossa angle (SPFA), posterior fossa perimeter, and tegmento-vermian angle (TVA). RESULTS For each feature, the mean of the measurements, the percentage of absolute difference of the reader measurement compared with mean measurement, and the interclass correlation (ICC) were calculated. Values are reported as mean ± standard deviation. Perimeter increases linearly with age, whereas the SPFA and the TVA are independent of gestational age. For all included cases, the SPFA averaged 100.9° ± 8° and the TVA averaged 2.5° ± 2.3°. CONCLUSION The superior posterior fossa angle, a novel measurement, and the posterior fossa perimeter can be used for establishing the expected size of the posterior fossa in second- and third-trimester fetuses by MRI.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Megan Zare
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Adam M Alessio
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
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15
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Cerebellar Ataxia in Children: A Clinical and MRI Approach to the Differential Diagnosis. Top Magn Reson Imaging 2018; 27:275-302. [PMID: 30086112 DOI: 10.1097/rmr.0000000000000175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: The cerebellum has long been recognized as a fundamental structure in motor coordination. Structural cerebellar abnormalities and diseases involving the cerebellum are relatively common in children. The not always specific clinical presentation of ataxia, incoordination, and balance impairment can often be a challenge to attain a precise diagnosis. Continuous advances in genetic research and moreover the constant development in neuroimaging modalities, particularly in the field of magnetic resonance imaging, have promoted a better understanding of cerebellar diseases and led to several modifications in their classification in recent years. Thorough clinical and neuroimaging investigation is recommended for proper diagnosis. This review outlines an update of causes of cerebellar disorders that present clinically with ataxia in the pediatric population. These conditions were classified in 2 major groups, namely genetic malformations and acquired or disruptive disorders recognizable by neuroimaging and subsequently according to their features during the prenatal and postnatal periods.
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16
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The challenge of cerebral magnetic resonance imaging in neonates: A new method using mathematical morphology for the segmentation of structures including diffuse excessive high signal intensities. Med Image Anal 2018; 48:75-94. [PMID: 29852312 DOI: 10.1016/j.media.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
Preterm birth is a multifactorial condition associated with increased morbidity and mortality. Diffuse excessive high signal intensity (DEHSI) has been recently described on T2-weighted MR sequences in this population and thought to be associated with neuropathologies. To date, no robust and reproducible method to assess the presence of white matter hyperintensities has been developed, perhaps explaining the current controversy over their prognostic value. The aim of this paper is to propose a new semi-automated framework to detect DEHSI on neonatal brain MR images having a particular pattern due to the physiological lack of complete myelination of the white matter. A novel method for semi- automatic segmentation of neonatal brain structures and DEHSI, based on mathematical morphology and on max-tree representations of the images is thus described. It is a mandatory first step to identify and clinically assess homogeneous cohorts of neonates for DEHSI and/or volume of any other segmented structures. Implemented in a user-friendly interface, the method makes it straightforward to select relevant markers of structures to be segmented, and if needed, apply eventually manual corrections. This method responds to the increasing need for providing medical experts with semi-automatic tools for image analysis, and overcomes the limitations of visual analysis alone, prone to subjectivity and variability. Experimental results demonstrate that the method is accurate, with excellent reproducibility and with very few manual corrections needed. Although the method was intended initially for images acquired at 1.5T, which corresponds to the usual clinical practice, preliminary results on images acquired at 3T suggest that the proposed approach can be generalized.
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17
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Conte G, Milani S, Palumbo G, Talenti G, Boito S, Rustico M, Triulzi F, Righini A, Izzo G, Doneda C, Zolin A, Parazzini C. Prenatal Brain MR Imaging: Reference Linear Biometric Centiles between 20 and 24 Gestational Weeks. AJNR Am J Neuroradiol 2018. [PMID: 29519792 DOI: 10.3174/ajnr.a5574] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Evaluation of biometry is a fundamental step in prenatal brain MR imaging. While different studies have reported reference centiles for MR imaging biometric data of fetuses in the late second and third trimesters of gestation, no one has reported them in fetuses in the early second trimester. We report centiles of normal MR imaging linear biometric data of a large cohort of fetal brains within 24 weeks of gestation. MATERIALS AND METHODS From the data bases of 2 referral centers of fetal medicine, accounting for 3850 examinations, we retrospectively collected 169 prenatal brain MR imaging examinations of singleton pregnancies, between 20 and 24 weeks of gestational age, with normal brain anatomy at MR imaging and normal postnatal neurologic development. To trace the reference centiles, we used the CG-LMS method. RESULTS Reference biometric centiles for the developing structures of the cerebrum, cerebellum, brain stem, and theca were obtained. The overall interassessor agreement was adequate for all measurements. CONCLUSIONS Reference biometric centiles of the brain structures in fetuses between 20 and 24 weeks of gestational age may be a reliable tool in assessing fetal brain development.
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Affiliation(s)
- G Conte
- From the Neuroradiology Unit (G.C.,G.P., F.T.)
| | - S Milani
- Department of Clinical Sciences and Community Health (S.M., A.Z.), Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro,"
| | - G Palumbo
- From the Neuroradiology Unit (G.C.,G.P., F.T.)
| | - G Talenti
- Neuroradiology Unit (G.T.), Padua University Hospital, Padua, Italy
| | - S Boito
- Division of Prenatal Diagnosis (S.B.), Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda Ospedale Policlinico, Milan, Italy
| | - M Rustico
- Fetal Therapy Unit "Umberto Nicolini" (M.R.), Department of Woman Mother and Neonate
| | - F Triulzi
- From the Neuroradiology Unit (G.C.,G.P., F.T.)
- Department of Pathophysiology and Transplantation (F.T.), Università degli Studi di Milano, Milan, Italy
| | - A Righini
- Department of Paediatric Radiology and Neuroradiology (A.R., G.I., C.D., C.P.), Ospedale dei Bambini "V. Buzzi," Milan, Italy
| | - G Izzo
- Department of Paediatric Radiology and Neuroradiology (A.R., G.I., C.D., C.P.), Ospedale dei Bambini "V. Buzzi," Milan, Italy
| | - C Doneda
- Department of Paediatric Radiology and Neuroradiology (A.R., G.I., C.D., C.P.), Ospedale dei Bambini "V. Buzzi," Milan, Italy
| | - A Zolin
- Department of Clinical Sciences and Community Health (S.M., A.Z.), Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro,"
| | - C Parazzini
- Department of Paediatric Radiology and Neuroradiology (A.R., G.I., C.D., C.P.), Ospedale dei Bambini "V. Buzzi," Milan, Italy
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18
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Robinson A, Teoh M, Edwards A, Fahey M, Goergen S. Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling. Prenat Diagn 2017; 37:611-627. [DOI: 10.1002/pd.5059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/13/2017] [Accepted: 04/21/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Alice Robinson
- Fetal Diagnostic Unit; Monash Health; Clayton Victoria Australia
| | - Mark Teoh
- Fetal Diagnostic Unit; Monash Health; Clayton Victoria Australia
| | - Andrew Edwards
- Fetal Diagnostic Unit; Monash Health; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
| | - Michael Fahey
- Department of Paediatrics; Monash University; Clayton Victoria Australia
- Paediatric Neurology Unit; Monash Health; Clayton Victoria Australia
| | - Stacy Goergen
- Department of Medical Imaging, School of Clinical Sciences; Monash University; Clayton Victoria Australia
- Monash Imaging; Monash Health; Clayton Victoria Australia
- Department of Surgery, School of Clinical Sciences; Monash University; Clayton Victoria Australia
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19
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Manganaro L, Bernardo S, De Vito C, Antonelli A, Marchionni E, Vinci V, Saldari M, Di Meglio L, Giancotti A, Silvestri E, Catalano C, Pizzuti A. Role of fetal MRI in the evaluation of isolated and non-isolated corpus callosum dysgenesis: results of a cross-sectional study. Prenat Diagn 2017; 37:244-252. [PMID: 27992967 DOI: 10.1002/pd.4990] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/23/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE The aims of this study were to characterize isolated and non-isolated forms of corpus callosum dysgenesis (CCD) at fetal magnetic resonance imaging (MRI) and to identify early predictors of associated anomalies. METHODS We retrospectively analyzed 104 fetuses with CCD undergoing MRI between 2006 and 2016. Corpus callosum, cavum septi pellucidi, biometry, presence of ventriculomegaly, gyration anomalies, cranio-encephalic abnormalities and body malformations were evaluated. Results of genetic tests were also recorded. RESULTS At MRI, isolated CCD was 26.9%, the rest being associated to other abnormalities. In the isolated group, median gestational age at MRI was lower in complete agenesis than in hypoplasia (22 vs 28 weeks). In the group with additional findings, cortical dysplasia was the most frequently associated feature (P = 0.008), with a more frequent occurrence in complete agenesis (70%) versus other forms; mesial frontal lobes were more often involved than other cortical regions (P = 0.006), with polymicrogyria as the most frequent cortical malformation (40%). Multivariate analysis confirmed the association between complete agenesis and cortical dysplasia (odds ratio = 7.29, 95% confidence interval 1.51-35.21). CONCLUSIONS CCD is often complicated by other intra-cranial and extra-cranial findings (cortical dysplasias as the most prevalent) that significantly affect the postnatal prognosis. The present study showed CCD with associated anomalies as more frequent than isolated (73.1%). In isolated forms, severe ventriculomegaly was a reliable herald of future appearance of associated features. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Marchionni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.,Casa Sollievo della Sofferenza, Istituto Mendel, Rome, Italy
| | - Valeria Vinci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Saldari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Letizia Di Meglio
- Private Prenatal Diagnostic Centre 'Diagnostica ecografica Aniello Di Meglio s.r.l.', Naples, Italy
| | - Antonella Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, Sapienza, University of Rome, Rome, Italy
| | - Evelina Silvestri
- Surgical Pathology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.,Casa Sollievo della Sofferenza, Istituto Mendel, Rome, Italy
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Xi Y, Brown E, Bailey A, Twickler DM. MR imaging of the fetal cerebellar vermis: Biometric predictors of adverse neurologic outcome. J Magn Reson Imaging 2016; 44:1284-1292. [DOI: 10.1002/jmri.25270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yin Xi
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Emily Brown
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | - April Bailey
- University of Texas Southwestern Medical Center; Dallas Texas USA
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21
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Katorza E, Bertucci E, Perlman S, Taschini S, Ber R, Gilboa Y, Mazza V, Achiron R. Development of the Fetal Vermis: New Biometry Reference Data and Comparison of 3 Diagnostic Modalities-3D Ultrasound, 2D Ultrasound, and MR Imaging. AJNR Am J Neuroradiol 2016; 37:1359-66. [PMID: 27032974 DOI: 10.3174/ajnr.a4725] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Normal biometry of the fetal posterior fossa rules out most major anomalies of the cerebellum and vermis. Our aim was to provide new reference data of the fetal vermis in 4 biometric parameters by using 3 imaging modalities, 2D ultrasound, 3D ultrasound, and MR imaging, and to assess the relation among these modalities. MATERIALS AND METHODS A retrospective study was conducted between June 2011 and June 2013. Three different imaging modalities were used to measure vermis biometry: 2D ultrasound, 3D ultrasound, and MR imaging. The vermian parameters evaluated were the maximum superoinferior diameter, maximum anteroposterior diameter, the perimeter, and the surface area. Statistical analysis was performed to calculate centiles for gestational age and to assess the agreement among the 3 imaging modalities. RESULTS The number of fetuses in the study group was 193, 172, and 151 for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. The mean and median gestational ages were 29.1 weeks, 29.5 weeks (range, 21-35 weeks); 28.2 weeks, 29.05 weeks (range, 21-35 weeks); and 32.1 weeks, 32.6 weeks (range, 27-35 weeks) for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. In all 3 modalities, the biometric measurements of the vermis have shown a linear growth with gestational age. For all 4 biometric parameters, the lowest results were those measured by MR imaging, while the highest results were measured by 3D ultrasound. The inter- and intraobserver agreement was excellent for all measures and all imaging modalities. Limits of agreement were considered acceptable for clinical purposes for all parameters, with excellent or substantial agreement defined by the intraclass correlation coefficient. CONCLUSIONS Imaging technique-specific reference data should be used for the assessment of the fetal vermis in pregnancy.
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Affiliation(s)
- E Katorza
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - E Bertucci
- Prenatal Medicine Unit (E.B., S.T., V.M.), Department of Obstetrics and Gynecology, Modena Hospital, Modena, Italy
| | - S Perlman
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - S Taschini
- Prenatal Medicine Unit (E.B., S.T., V.M.), Department of Obstetrics and Gynecology, Modena Hospital, Modena, Italy
| | - R Ber
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Y Gilboa
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - V Mazza
- Prenatal Medicine Unit (E.B., S.T., V.M.), Department of Obstetrics and Gynecology, Modena Hospital, Modena, Italy
| | - R Achiron
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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Cannie MM, Devlieger R, Leyder M, Claus F, Leus A, De Catte L, Cossey V, Foulon I, Van der valk E, Foulon W, Cos T, Bernaert A, Oyen R, Jani JC. Congenital cytomegalovirus infection: contribution and best timing of prenatal MR imaging. Eur Radiol 2016; 26:3760-9. [DOI: 10.1007/s00330-015-4187-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/04/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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23
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Conte G, Parazzini C, Falanga G, Cesaretti C, Izzo G, Rustico M, Righini A. Diagnostic Value of Prenatal MR Imaging in the Detection of Brain Malformations in Fetuses before the 26th Week of Gestational Age. AJNR Am J Neuroradiol 2015; 37:946-51. [PMID: 26721771 DOI: 10.3174/ajnr.a4639] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/05/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In several countries, laws and regulations allow abortion for medical reasons within 24-25 weeks of gestational age. We investigated the diagnostic value of prenatal MR imaging for brain malformations within 25 weeks of gestational age. MATERIALS AND METHODS We retrospectively included fetuses within 25 weeks of gestational age who had undergone both prenatal and postnatal MR imaging of the brain between 2002 and 2014. Two senior pediatric neuroradiologists evaluated prenatal MR imaging examinations blinded to postnatal MR imaging findings. With postnatal MR imaging used as the reference standard, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the prenatal MR imaging in detecting brain malformations. RESULTS One-hundred nine fetuses (median gestational age at prenatal MR imaging: 22 weeks; range, 21-25 weeks) were included in this study. According to the reference standard, 111 malformations were detected. Prenatal MR imaging failed to detect correctly 11 of the 111 malformations: 3 midline malformations, 5 disorders of cortical development, 2 posterior fossa anomalies, and 1 vascular malformation. Prenatal MR imaging misdiagnosed 3 findings as pathologic in the posterior fossa. CONCLUSIONS The diagnostic value of prenatal MR imaging between 21 and 25 weeks' gestational age is very high, with limitations of sensitivity regarding the detection of disorders of cortical development.
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Affiliation(s)
- G Conte
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.) Department of Health Sciences (G.C.), University of Milan, Milan, Italy
| | - C Parazzini
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
| | - G Falanga
- Department of Biopathology and Medical and Forensic Biotechnologies (G.F.), Section of Radiological Sciences, University of Palermo, Palermo, Italy
| | - C Cesaretti
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
| | - G Izzo
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
| | - M Rustico
- Gynecology and Obstetrics (M.R.), Children's Hospital Vittore Buzzi, Milan, Italy
| | - A Righini
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
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Bernardo S, Vinci V, Saldari M, Servadei F, Silvestri E, Giancotti A, Aliberti C, Porpora MG, Triulzi F, Rizzo G, Catalano C, Manganaro L. Dandy-Walker Malformation: is the 'tail sign' the key sign? Prenat Diagn 2015; 35:1358-64. [PMID: 26448595 DOI: 10.1002/pd.4705] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/22/2015] [Accepted: 10/02/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aims to demonstrate the value of the 'tail sign' in the assessment of Dandy-Walker malformation. METHODS A total of 31 fetal magnetic resonance imaging (MRI), performed before 24 weeks of gestation after second-line ultrasound examination between May 2013 and September 2014, were examined retrospectively. All MRI examinations were performed using a 1.5 Tesla magnet without maternal sedation. RESULTS Magnetic resonance imaging diagnosed 15/31 cases of Dandy-Walker malformation, 6/31 of vermian partial caudal agenesis, 2/31 of vermian hypoplasia, 4/31 of vermian malrotation, 2/31 of Walker-Warburg syndrome, 1/31 of Blake pouch cyst and 1/31 of rhombencephalosynapsis. All data were compared with fetopsy results, fetal MRI after the 30th week or postnatal MRI; the follow-up depended on the maternal decision to terminate or continue pregnancy. In our review study, we found the presence of the 'tail sign'; this sign was visible only in Dandy-Walker malformation and Walker-Warburg syndrome. CONCLUSION The 'tail sign' could be helpful in the difficult differential diagnosis between Dandy-Walker, vermian malrotation, vermian hypoplasia and vermian partial agenesis.
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Affiliation(s)
- Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Valeria Vinci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Saldari
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Evelina Silvestri
- Surgical Pathology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Aliberti
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabio Triulzi
- UOC Neuroradiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università Tor Vergata, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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25
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Baldarçara L, Currie S, Hadjivassiliou M, Hoggard N, Jack A, Jackowski AP, Mascalchi M, Parazzini C, Reetz K, Righini A, Schulz JB, Vella A, Webb SJ, Habas C. Consensus paper: radiological biomarkers of cerebellar diseases. THE CEREBELLUM 2015; 14:175-96. [PMID: 25382714 DOI: 10.1007/s12311-014-0610-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine.
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26
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Righini A, Cesaretti C, Conte G, Parazzini C, Frassoni C, Bulfamante G, Avagliano L, Inverardi F, Izzo G, Rustico M. Expanding the spectrum of human ganglionic eminence region anomalies on fetal magnetic resonance imaging. Neuroradiology 2015; 58:293-300. [DOI: 10.1007/s00234-015-1622-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/17/2015] [Indexed: 11/29/2022]
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27
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Lyons K, Cassady C, Jones J, Paldino M, Mehollin-Ray A, Guimaraes C, Krishnamurthy R. Current Role of Fetal Magnetic Resonance Imaging in Neurologic Anomalies. Semin Ultrasound CT MR 2015; 36:298-309. [DOI: 10.1053/j.sult.2015.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Abstract
Fetal magnetic resonance imaging (MRI) is currently offered in a limited number of centers but is predominantly used for suspected fetal central nervous system abnormalities. This article concentrates on the role of the different imaging sequences and their value to clinical practice. It also discusses the future of fetal MRI.
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Affiliation(s)
- Elspeth Whitby
- Academic Unit of Reproductive and Developmental Medicine, Sheffield, UK.
| | - Peter Wright
- Medical Imaging and Medical Physics, Radiology, Royal Hallamshire Hospital, Sheffield, UK
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29
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Averill LW, Kandula VVR, Akyol Y, Epelman M. Fetal Brain Magnetic Resonance Imaging Findings In Congenital Cytomegalovirus Infection With Postnatal Imaging Correlation. Semin Ultrasound CT MR 2015; 36:476-86. [PMID: 26614131 DOI: 10.1053/j.sult.2015.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fetal brain magnetic resonance imaging (MRI) is a powerful tool in the diagnosis of symptomatic congenital cytomegalovirus infection, requiring a detailed search for specific features. A combination of anterior temporal lobe abnormalities, white matter lesions, and polymicrogyria is especially predictive. Fetal MRI may provide a unique opportunity to detect anterior temporal cysts and occipital horn septations, as dilation of these areas may decrease later in development. Cortical migration abnormalities, white matter abnormalities, cerebellar dysplasia, and periventricular calcifications are often better depicted on postnatal imaging but can also be detected on fetal MRI. We present the prenatal brain MRI findings seen in congenital cytomegalovirus infection and provide postnatal imaging correlation, highlighting the evolution of findings at different times in prenatal and postnatal developments.
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Affiliation(s)
- Lauren W Averill
- Department of Medical Imaging, Nemours/A.I. duPont Hospital for Children, Wilmington, DE.
| | - Vinay V R Kandula
- Department of Medical Imaging, Nemours/A.I. duPont Hospital for Children, Wilmington, DE
| | - Yakup Akyol
- Department of Medical Imaging, Nemours/A.I. duPont Hospital for Children, Wilmington, DE
| | - Monica Epelman
- Department of Radiology (Medical Imaging), Nemours Children׳s Hospital, Orlando, FL
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30
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Chapman T, Mahalingam S, Ishak GE, Nixon JN, Siebert J, Dighe MK. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: Part 1, normal anatomy and classification of anomalies. Clin Imaging 2015; 39:1-8. [DOI: 10.1016/j.clinimag.2014.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
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Gholipour A, Estroff JA, Barnewolt CE, Robertson RL, Grant PE, Gagoski B, Warfield SK, Afacan O, Connolly SA, Neil JJ, Wolfberg A, Mulkern RV. Fetal MRI: A Technical Update with Educational Aspirations. CONCEPTS IN MAGNETIC RESONANCE. PART A, BRIDGING EDUCATION AND RESEARCH 2014; 43:237-266. [PMID: 26225129 PMCID: PMC4515352 DOI: 10.1002/cmr.a.21321] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Fetal magnetic resonance imaging (MRI) examinations have become well-established procedures at many institutions and can serve as useful adjuncts to ultrasound (US) exams when diagnostic doubts remain after US. Due to fetal motion, however, fetal MRI exams are challenging and require the MR scanner to be used in a somewhat different mode than that employed for more routine clinical studies. Herein we review the techniques most commonly used, and those that are available, for fetal MRI with an emphasis on the physics of the techniques and how to deploy them to improve success rates for fetal MRI exams. By far the most common technique employed is single-shot T2-weighted imaging due to its excellent tissue contrast and relative immunity to fetal motion. Despite the significant challenges involved, however, many of the other techniques commonly employed in conventional neuro- and body MRI such as T1 and T2*-weighted imaging, diffusion and perfusion weighted imaging, as well as spectroscopic methods remain of interest for fetal MR applications. An effort to understand the strengths and limitations of these basic methods within the context of fetal MRI is made in order to optimize their use and facilitate implementation of technical improvements for the further development of fetal MR imaging, both in acquisition and post-processing strategies.
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Affiliation(s)
- Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judith A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard L Robertson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Borjan Gagoski
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey J Neil
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Wolfberg
- Boston Maternal Fetal Medicine, Boston, Massachusetts, USA
| | - Robert V Mulkern
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Frick N, Fazelnia C, Kanzian K, Hitzl W, Fischer T, Forstner R, Bogner G. The Reliability of Fetal MRI in the Assessment of Brain Malformations. Fetal Diagn Ther 2014; 37:93-101. [DOI: 10.1159/000363652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/10/2014] [Indexed: 11/19/2022]
Abstract
Objectives: To assess the inter- and intraobserver reliability of different fetal MRI measurements in cases of fetal brain malformations and to examine the concordance between ultrasonography (US) and MRI findings. Methods: Fetal brain MRIs and US findings of 56 pregnant women were retrieved from the institutional database. Standardized fetal brain MRI measurements were performed by 4 observers, and the inter- and intraobserver reliability was determined. Additionally, US and MRI findings were retrospectively compared. Results: The interobserver intraclass correlation coefficient (ICC) was above 0.9 for the cerebellum and posterior horn of the lateral ventricle. The measurements regarding the third ventricle (0.50), the fourth ventricle (0.58), and the corpus callosum (0.63) showed poor reliability. Overall, the intraobserver reliability was greater than the interobserver reliability. US and MRI findings were discordant in 29% of the cases with MRI rendering an extended diagnosis in 18%, a change of diagnosis in 3.6%, and excluding pathological findings suspected on US in 7.1%. Conclusions: Fetal MRI is a valuable complement to US in the investigation of fetal brain malformations. The reliability of most parameters was high, except for the measurements of the third and fourth ventricles and the corpus callosum.
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Fetal adrenal gland in the second half of gestation: morphometrical assessment with 3.0T post-mortem MRI. PLoS One 2013; 8:e75511. [PMID: 24116052 PMCID: PMC3792139 DOI: 10.1371/journal.pone.0075511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/15/2013] [Indexed: 12/03/2022] Open
Abstract
Background The morphometry of fetal adrenal gland is rarely described with MRI of high magnetic field. The purpose of this study is to assess the normal fetal adrenal gland length (AL), width (AW), height (AH), surface area (AS) and volume (AV) in the second half of gestation with 3.0T post-mortem MRI. Methods and Findings Fifty-two fetal specimens of 23–40 weeks gestational age (GA) were scanned by 3.0T MRI. Morphological changes and quantitative measurements of the fetal adrenal gland were analyzed. Asymmetry and sexual dimorphism were also obtained. The shape of the fetal adrenal gland did not change substantially from 23 to 40 weeks GA. The bilateral adrenal glands appeared as a ‘Y’, pyramidal or half-moon shape after reconstruction. There was a highly linear correlation between AL, AW, AH, AS, AV and GA. AW, AH, AS and AV were larger for the left adrenal gland than the right. No sexual dimorphism was found. Conclusions Our data delineated the normal fetal adrenal gland during the second half of gestation, and can serve as a useful precise reference for anatomy or in vivo fetus.
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Righini A, Frassoni C, Inverardi F, Parazzini C, Mei D, Doneda C, Re TJ, Zucca I, Guerrini R, Spreafico R, Triulzi F. Bilateral cavitations of ganglionic eminence: a fetal MR imaging sign of halted brain development. AJNR Am J Neuroradiol 2013; 34:1841-5. [PMID: 23598830 DOI: 10.3174/ajnr.a3508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
SUMMARY Ganglionic eminence is the main transitory proliferative structure of the ventral telencephalon in human fetal brain and it contributes for at least 35% to the population of cortical interneurons; however data on the human GE anomalies are scarce. We report 5 fetal MR imaging observations with bilateral symmetric cavitations in their GE regions resembling an inverted open C shape and separating the GE itself form the deeper parenchyma. Imaging, neuropathology, and follow-up features suggested a malformative origin. All cases had in common characteristics of lissencephaly with agenesis or severe hypoplasia of corpus callosum of probable different genetic basis. From our preliminary observation, it seems that GE cavitations are part of conditions which are also accompanied by severe cerebral structure derangement.
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Affiliation(s)
- A Righini
- Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
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Vossough A, Limperopoulos C, Putt ME, du Plessis AJ, Schwab PJ, Wu J, Gee JC, Licht DJ. Development and validation of a semiquantitative brain maturation score on fetal MR images: initial results. Radiology 2013; 268:200-7. [PMID: 23440324 DOI: 10.1148/radiol.13111715] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a valid, reliable, and simple-to-use semiquantitative visual scale of fetal brain maturation for use in clinical fetal MR imaging assessment and interpretation. MATERIALS AND METHODS This is a retrospective assessment of data from a previous study that was prospective, institutional review board approved, and HIPAA compliant. Forty-eight normal pregnancies with a gestational age (GA) of 25 to 35 weeks were studied. A fetal total maturation score (fTMS) was developed by utilizing six subscores that evaluated cortical sulcation, myelination, and the germinal matrix and provided a single combined numerical value to be evaluated as a marker of brain maturity. The fTMS was correlated with GA and segmented brain volume. A regression model that associated GA based on the visual fTMS scoring was determined. The model was validated with a leave-one-out cross validation procedure. RESULTS Mean GA was 29.3 weeks ± 2.9 (standard deviation) (range, 25.2-35.3 weeks) and mean fTMS was 8.6 ± 3.7 (range, 4-16). The intraclass correlation coefficient between the three readers (independent and blinded) was 0.948 (P < .001). The correlations were as follows: GA and brain volume, r = 0.964 (P < .001); fTMS and brain volume, r = 0.970 (P < .001); and GA and fTMS, r = 0.975 (P < .001). A regression model to calculate GA based on fTMS yielded the following equation: calculated GA (weeks) = 22.86 + 0.748 fTMS (P < .001; adjusted R(2) = 0.946). The standard error of the model for calculation of fetal GA from the visual fTMS scale was ± 4.8 days. CONCLUSION If validated further, the fTMS scale might be used to assess morphologic brain maturity of fetuses between 25 and 35 weeks GA on a single-case basis in a clinical setting.
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Affiliation(s)
- Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, 324 S 34th St, Wood 2115, Philadelphia, PA 19004, USA.
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Zhang Z, Hou Z, Lin X, Teng G, Meng H, Zang F, Fang F, Liu S. Development of the fetal cerebral cortex in the second trimester: assessment with 7T postmortem MR imaging. AJNR Am J Neuroradiol 2013; 34:1462-7. [PMID: 23413246 DOI: 10.3174/ajnr.a3406] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few investigators have analyzed the fetal cerebral cortex with MR imaging of high magnetic strength. Our purpose was to document the sulcal development and obtain quantitative measurements of the fetal brain in the second trimester. MATERIALS AND METHODS The brains of 69 fetal specimens, with GA 12-22 weeks, were first scanned on a 7T MR imaging scanner. Then the sequential development of the different fissures and sulci was analyzed, and quantitative measurements of the cerebral cortex were obtained. RESULTS A new chronology of sulcal development during 12-22 weeks GA was summarized. Before 12 weeks, few sulci were present; by 16 weeks, many sulci were present. The 16th week could be considered the most intensive time point for sulcal emergence. Most sulci, except for the postcentral sulcus and intraparietal sulcus, were present by 22 weeks GA. Measurements of the fetal brains, each with different growth rates, linearly increased with GA, but no sexual dimorphisms or cerebral asymmetries were detected. CONCLUSIONS The second trimester is the most important phase, during which most sulci are present and can be clearly shown on 7T postmortem MR imaging. It is apparent that the specific time during which neuropathologic features of sulci appear, previously thought to be well understood, should be redefined. Quantitative data provide assistance in the precise understanding of the immature brain. The present results are valuable in anatomic education, research, and assessment of normal brain development in the uterus.
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Affiliation(s)
- Z Zhang
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
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O'Rahilly R, Müller F. The longitudinal growth of the neuromeres and the resulting brain in the human embryo. Cells Tissues Organs 2012. [PMID: 23183269 DOI: 10.1159/000343170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The growth of the human brain during the embryonic period was assessed in terms of longitudinal measurements in staged embryos. Precise graphic reconstructions prepared by the onerous point-plotting method were considered to be the most reliable, and 23 were examined in detail. A distinction is necessary between measurements of the brain (cerebral diameters) and those of the skull (osseous diameters), and also between those of the folded brain in situ, studied here, and the later relatively straightened brain. Longitudinal measurements were made of individual neuromeres and their successors in steps (neuromeric lengths). The sum of the neuromeric measurements at any given stage provides the total neuromeric length (TNL) of the folded brain in situ at that stage and it increases in keeping with the greatest length (GL) of the embryo. At stages 16-19, however, the neuromeric length of the brain may exceed the GL. From stage 20 onwards the body length increases more rapidly compared with the length of the brain. The most cephalic neuromere is the telencephalon medium, abbreviated T1 here. The cerebral hemispheres are derived from it, although they are not neuromeres. The hemispheres soon extend rostrally beyond the limit of T1 by an amount that is here designated T2, and that indicates the growth of the telencephalon rostral to the commissural plate, which is the site of the future corpus callosum. Further laterally, the hemispheric length (future fronto-occipital diameter) increases rapidly, as does also the bitemporal (biparietal) diameter. At the end of the embryonic period these diameters are one fourth to one fifth of the head circumference. Additional neuromeric information becomes manifest when the measurements are calculated as percentages of the total length of the brain. The rhombencephalon decreases considerably, diencephalon 2 increases greatly, whereas diencephalon 1 diminishes, and the cerebral hemispheres enlarge massively. In addition, specific neuromeres or subdivisions come to occupy relatively more or relatively less of the total. Three periods were found during which individual neuromeres acquire their maximal or minimal lengths: the maximal absolute lengths were in period 3, whereas the maximal and minimal percentage lengths were in periods 1 and 3. The various neuromeric changes are considered to be related to alterations in functional development. Finally, in furtherance of establishing continuity in prenatal data, comparisons were effected between embryonic and fetal measurements.
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Affiliation(s)
- Ronan O'Rahilly
- School of Medicine, University of California, Davis, CA, USA
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Parazzini C, Righini A, Doneda C, Arrigoni F, Rustico M, Lanna M, Triulzi F. Is fetal magnetic resonance imaging indicated when ultrasound isolated mild ventriculomegaly is present in pregnancies with no risk factors? Prenat Diagn 2012; 32:752-7. [DOI: 10.1002/pd.3896] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Cecilia Parazzini
- Department of Paediatric Radiology and Neuroradiology; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
| | - Andrea Righini
- Department of Paediatric Radiology and Neuroradiology; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
| | - Chiara Doneda
- Department of Paediatric Radiology and Neuroradiology; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
| | - Filippo Arrigoni
- Department of Paediatric Radiology and Neuroradiology; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
| | - Mariangela Rustico
- Department of Gynecology and Obstetric; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
| | - Mariano Lanna
- Department of Gynecology and Obstetric; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
| | - Fabio Triulzi
- Department of Paediatric Radiology and Neuroradiology; Children's Hospital V. Buzzi; Via Castelvetro 32 20154 Milan Italy
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Abstract
The cerebellum undergoes a protracted development, making it particularly vulnerable to a broad spectrum of developmental events. Acquired destructive and hemorrhagic insults may also occur. The main steps of cerebellar development are reviewed. The normal imaging patterns of the cerebellum in prenatal ultrasound and magnetic resonance imaging (MRI) are described with emphasis on the limitations of these modalities. Because of confusion in the literature regarding the terminology used for cerebellar malformations, some terms (agenesis, hypoplasia, dysplasia, and atrophy) are clarified. Three main pathologic settings are considered and the main diagnoses that can be suggested are described: retrocerebellar fluid enlargement with normal or abnormal biometry (Dandy-Walker malformation, Blake pouch cyst, vermian agenesis), partially or globally decreased cerebellar biometry (cerebellar hypoplasia, agenesis, rhombencephalosynapsis, ischemic and/or hemorrhagic damage), partially or globally abnormal cerebellar echogenicity (ischemic and/or hemorrhagic damage, cerebellar dysplasia, capillary telangiectasia). The appropriate timing for performing MRI is also discussed.
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Affiliation(s)
- Catherine Garel
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau, Paris, France.
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Liu F, Zhang Z, Lin X, Teng G, Meng H, Yu T, Fang F, Zang F, Li Z, Liu S. Development of the human fetal cerebellum in the second trimester: a post mortem magnetic resonance imaging evaluation. J Anat 2011; 219:582-8. [PMID: 21812776 DOI: 10.1111/j.1469-7580.2011.01418.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The cerebellum is one of the most important structures in the posterior cranial fossa, but the characterization of its development by magnetic resonance imaging (MRI) is incomplete. We scanned 40 fetuses that had no morphological brain disorder at 14-22 weeks of gestation using 7.0 T MRI. Amira 4.1 software was used to determine morphological parameters of the fetal cerebellum, which included the cerebellar volume (CV), transverse cerebellar diameter (TCD), and the length and width of the vermis. The relationship between these measurements and gestational age (GA) was analysed. We found that the primary fissure was visible at week 14 of gestation. From week 16, the prepyramidal fissure, the secondary fissure and the dentate nucleus could be identified. The posterolateral fissure and the fourth ventricle were recognized at week 17, whereas the tentorium of the cerebellum was visible at week 20. The relationships between GA and CV, TCD, and the width and length of the vermis were described adequately by second-order polynomial regression curves. The ratios between TCD and vermis length and between TCD and vermis width decreased with GA. These results show that 7.0 T MRI can show the trajectory of cerebellar development clearly. They increase our understanding of normal cerebellar development in the fetus, and will facilitate the diagnosis of pathological intrauterine changes in the cerebellum.
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Affiliation(s)
- Fei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Jinan, Shandong, China
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Lin X, Zhang Z, Teng G, Meng H, Yu T, Hou Z, Fang F, Zang F, Liu S. Measurements using 7.0 T post-mortem magnetic resonance imaging of the scalar dimensions of the fetal brain between 12 and 20 weeks gestational age. Int J Dev Neurosci 2011; 29:885-9. [PMID: 21820045 DOI: 10.1016/j.ijdevneu.2011.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022] Open
Abstract
In this study, scalar values for the fetal brain from 12 to 20 weeks gestational age were obtained. Fifty-two fetal specimens of 12-20 weeks gestational age with an anatomically normal and developmentally appropriate central nervous system (CNS) were scanned using a 7.0 T magnetic resonance imaging (MRI) scanner. The linear biometric measurements of the brain were then determined. All the measurements (except for the interhemispheric distance) were found to increase linearly with gestational age, although each increased at a different growth rates. The 95% confidence interval for each value was obtained. These data may be considered to be a valuable reference for the assessment of normal fetal brain development in clinical settings and as a supplement to post-mortem MRI or anatomical investigations.
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Affiliation(s)
- Xiangtao Lin
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, 250012 Jinan, Shandong, China
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Triulzi F, Manganaro L, Volpe P. Fetal magnetic resonance imaging: indications, study protocols and safety. Radiol Med 2011; 116:337-50. [DOI: 10.1007/s11547-011-0633-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/02/2010] [Indexed: 12/17/2022]
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Zhang Z, Liu S, Lin X, Teng G, Yu T, Fang F, Zang F. Development of fetal brain of 20 weeks gestational age: assessment with post-mortem Magnetic Resonance Imaging. Eur J Radiol 2010; 80:e432-9. [PMID: 21146341 DOI: 10.1016/j.ejrad.2010.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/06/2010] [Accepted: 11/12/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The 20th week gestational age (GA) is at mid-gestation and corresponds to the age at which the termination of pregnancy in several countries and the first Magnetic Resonance Imaging (MRI) can be performed, and at which the premature babies may survive. However, at present, very little is known about the exact anatomical character at this GA. OBJECTIVE To delineate the developing fetal brain of 20 weeks GA and obtain the three dimensional visualization model. MATERIALS AND METHODS 20 fetal specimens were scanned by 3.0 T and 7.0 T post-mortem MRI, and the three dimensional visualization model was obtained with Amira 4.1. RESULTS Most of the sulci or their anlage, except the postcentral sulcus and intraparietal sulcus, were present. The laminar organization, described as layers with different signal intensities, was most clearly distinguished at the parieto-occipital lobe and peripheral regions of the hippocampus. The basal nuclei could be clearly visualized, and the brain stem and cerebellum had formed their common shape. On the visualization model, the shape and relative relationship of the structures could be appropriately delineated. The ranges of normal values of the brain structures were obtained, but no sexual dimorphisms or cerebral asymmetries were found. CONCLUSIONS The developing fetal brain of 20 weeks GA can be clearly delineated on 3.0 T and 7.0 T post-mortem MRIs, and the three dimensional visualization model supplies great help in precise cognition of the immature brain. These results may have positive influences on the evaluation of the fetal brain in the uterus.
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Affiliation(s)
- Zhonghe Zhang
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, 44 Wen-hua Xi Road, 250012 Jinan, Shandong, China
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Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study. Neuroradiology 2010; 53:43-8. [DOI: 10.1007/s00234-010-0772-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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Posterior fossa malformations: main features and limits in prenatal diagnosis. Pediatr Radiol 2010; 40:1038-45. [PMID: 20432023 DOI: 10.1007/s00247-010-1617-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 01/06/2010] [Indexed: 12/11/2022]
Abstract
Posterior fossa (PF) malformations are commonly observed during prenatal screening. Their understanding requires knowledge of the main steps of PF development and knowledge of normal patterns in US and MR imaging. The vast majority of PF malformations can be strongly suspected by acquiring a midline sagittal slice and a transverse slice and by systematically scrutinizing the elements of the PF: cerebellar vermis, hemispheres, brainstem, fourth ventricle, PF fluid spaces and tentorium. Analysis of cerebellar echogenicity and biometry is also useful. This review explains how to approach the diagnosis of the main PF malformations by performing these two slices and answering six key questions about the elements of the PF. The main imaging characteristics of PF malformations are also reviewed.
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Doneda C, Parazzini C, Righini A, Rustico M, Tassis B, Fabbri E, Arrigoni F, Consonni D, Triulzi F. Early Cerebral Lesions in Cytomegalovirus Infection: Prenatal MR Imaging. Radiology 2010; 255:613-21. [DOI: 10.1148/radiol.10090749] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW Fetal magnetic resonance imaging (MRI) is a relatively new clinical application but is becoming increasingly used in fetal medicine in combination with the established technique of antenatal ultrasound. A review of the literature to date provides information for clinicians to help assess which patients they should be referring for fetal MRI and what additional information to ultrasound they can obtain. RECENT FINDINGS This review covers recent articles on practical aspects of imaging, MR findings in common disorders and comparisons with ultrasound. It includes information on current applications for fetal MRI, new sequence acquisitions and postprocessing techniques. Fetal motion is the single most important barrier to improving image data. SUMMARY Fetal MR has become an established tool for assessing the fetal brain. It provides complementary information to ultrasound. However, further optimization of this technique is still required to ensure it is exploited to the full in fetal medicine.
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Abstract
Fetal MRI is clinically performed to evaluate the brain in cases where an abnormality is detected by prenatal sonography. These most commonly include ventriculomegaly, abnormalities of the corpus callosum, and abnormalities of the posterior fossa. Fetal MRI is also increasingly performed to evaluate fetuses who have normal brain findings on prenatal sonogram but who are at increased risk for neurodevelopmental abnormalities, such as complicated monochorionic twin pregnancies. This paper will briefly discuss the common clinical conditions imaged by fetal MRI as well as recent advances in fetal MRI research.
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Abstract
The fetal brain is a dynamic structure, which can now be imaged using magnetic resonance imaging (MRI). This article will review techniques of fetal MRI as well as several key aspects of brain development and their appearance on MRI. An understanding of normal fetal brain development is essential to correctly identifying developmental abnormalities.
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Affiliation(s)
- Orit A Glenn
- Department of Radiology, Neuroradiology Section, University of California, San Francisco, CA 94143, USA.
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Joó JG, Rigó J. [Significance of magnetic resonance studies in prenatal diagnosis of malformations of the fetal central nervous system]. Orv Hetil 2009; 150:1275-80. [PMID: 19531461 DOI: 10.1556/oh.2009.28626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MRI investigation, as an imaging technique, has been gaining more and more importance in prenatal diagnostics. It has become essential due to its advantages in diagnosing the malformations of the central nervous system. Similarly to ultrasonography, its reliability is greatly dependent on the knowledge of the person performing the investigation. In addition to the knowledge of the exact anatomy of central nervous system, the researcher should have a multidisciplinary approach. In the case of malformations where repeated investigations are needed to provide a diagnosis in early pregnancy (e.g. neural tube defects), ultrasonography is more effective than MRI. In case of intrauterine infections and malformations of the posterior fossa, however, the two imaging techniques are excellent supplements to each other. MRI also plays an important role in making the prognosis for fetal ventriculomegaly, as well as in the short term diagnosis of ischaemias affecting the fetal nervous system. Difficulties in evaluating ultrasonographic images (owing to maternal obesity, oligohydramnion) render MRI an important technique in making the final diagnosis. Currently, the drawbacks of MRI include reduced accessibility, poor cost-effectiveness and shortage of skilled experts in this technique.
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Affiliation(s)
- József Gábor Joó
- Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Szülészeti és Nogyógyászati Klinika, Budapest.
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