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Contro E, Volpe N, Larcher L, Dall'Asta A, Penas Da Costa MA, Vairo G, Di Pasquo E, Giorgini I, Ghi T. Normal and abnormal appearance of fetal ganglionic eminence on second-trimester three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:398-404. [PMID: 37099497 DOI: 10.1002/uog.26229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To describe the appearance and size of the ganglionic eminence (GE) in normal fetuses on midtrimester three-dimensional (3D) neurosonography and to report on the association between GE alterations (cavitation or enlargement) and malformation of cortical development (MCD). METHODS This was a prospective multicenter cohort study of normal fetuses and a retrospective analysis of pathological cases with MCD. From January 2022 to June 2022, patients attending our tertiary centers for an expert fetal brain scan were recruited for the purpose of the study. A 3D volume of the fetal head, starting from the sagittal plane, was acquired in apparently normal fetuses using a transabdominal or transvaginal approach. Stored volume datasets were then evaluated independently by two expert operators. Two measurements (longitudinal diameter and transverse diameter) of the GE in the coronal view were obtained twice by each operator. Intra- and interobserver measurement variation was calculated. Reference ranges for GE measurements were calculated in the normal population. A previously stored volume dataset of 60 cases with MCD was also analyzed independently by the two operators using the same method in order to assess if GE abnormalities (cavitation or enlargement) were present. Postnatal follow-up was obtained in all cases. RESULTS In the study period, 160 normal fetuses between 19 and 22 weeks of gestation were included in the study. The GE was visible in the coronal plane on 3D neurosonography in 144 (90%) cases and was not clearly visible in the remaining 16 (10%) cases. The intra- and interobserver agreement was almost perfect for the longitudinal diameter, with an intraclass correlation coefficient (ICC) of 0.90 (95% CI, 0.83-0.93) and 0.90 (95% CI, 0.86-0.92), respectively, and substantial for the transverse diameter, with an ICC of 0.80 (95% CI, 0.70-0.87) and 0.64 (95% CI, 0.53-0.72), respectively. A retrospective analysis of 50 cases with MCD in the second trimester showed that GE enlargement was present in 12 cases and GE cavitation was present in four cases. CONCLUSIONS Systematic assessment of the GE in fetuses at 19-22 weeks of gestation is feasible on 3D neurosonography, with good reproducibility in normal cases. Cavitation or enlargement of the GE can be demonstrated in fetuses with MCD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Contro
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - N Volpe
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Larcher
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - A Dall'Asta
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - M A Penas Da Costa
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Vairo
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - E Di Pasquo
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - I Giorgini
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - T Ghi
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Stuempflen M, Taymourtash A, Kienast P, Schmidbauer VU, Schwartz E, Mitter C, Binder J, Prayer D, Kasprian G. Ganglionic eminence: volumetric assessment of transient brain structure utilizing fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:405-413. [PMID: 37099530 DOI: 10.1002/uog.26232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 04/15/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To provide quantitative magnetic resonance imaging (MRI) super-resolution-based three-dimensional volumetric reference data on the growth dynamics of the ganglionic eminence (GE) relative to cortical and total fetal brain volumes (TBV). METHODS This was a retrospective study of fetuses without structural central nervous system anomalies or other confounding comorbidities that were referred for fetal MRI. Super-resolution reconstructions of 1.5- and 3-Tesla T2-weighted images were generated. Semiautomatic segmentation of TBV and cortical volume and manual segmentation of the GE were performed. Cortical volume, TBV and GE volume were quantified and three-dimensional reconstructions were generated to visualize the developmental dynamics of the GE. RESULTS Overall, 120 fetuses that underwent 127 MRI scans at a mean gestational age of 27.23 ± 4.81 weeks (range, 20-37 weeks) were included. In the investigated gestational-age range, GE volume ranged from 74.88 to 808.75 mm3 and was at its maximum at 21 gestational weeks, followed by a linear decrease (R2 = 0.559) throughout the late second and third trimesters. A pronounced reduction in GE volume relative to cortical volume and TBV occurred in the late second trimester, with a decline in this reduction observed in the third trimester (R2 = 0.936 and 0.924, respectively). Three-dimensional rendering allowed visualization of a continuous change in the shape and size of the GE throughout the second and third trimesters. CONCLUSIONS Even small compartments of the fetal brain, which are not easily accessible by standardized two-dimensional modalities, can be assessed precisely by super-resolution processed fetal MRI. The inverse growth dynamics of GE volume compared with TBV and cortical volume reflects the transitory nature and physiological involution of this (patho-)physiologically important brain structure. The normal development and involution of the GE is mandatory for normal cortical development. Pathological changes of this transient organ precede impairment of cortical structures, and their detection may allow an earlier diagnosis of such anomalies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Stuempflen
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A Taymourtash
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - P Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - V U Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - E Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - C Mitter
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - J Binder
- Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - G Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Krajden Haratz K, Birnbaum R, Kidron D, Har-Toov J, Salemnick Y, Brusilov M, Malinger G. Malformation of cortical development with abnormal cortex: early ultrasound diagnosis between 14 and 24 weeks of gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:559-565. [PMID: 36484522 DOI: 10.1002/uog.26139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To describe neurosonographic findings diagnostic or highly suggestive of the presence of malformations of cortical development involving the cortex that may be identified before 24 weeks of gestation. METHODS This was a retrospective single-center study of fetuses referred for neurosonography, during 2012-2019, with an abnormal cortical or sulcation pattern diagnosed early in the mid trimester. Stored files were analyzed for demographic data, abnormal brain findings, non-central nervous system abnormalities, final diagnosis and postnatal outcome. RESULTS The study cohort included 20 fetuses, with a mean gestational age at diagnosis of 18.7 (range, 14.4-23.6) weeks, in 11 of which the diagnosis was made before 20 weeks of gestation. Reasons for referral were: midline anomaly (n = 7), ventriculomegaly (n = 4), infratentorial findings (n = 3), suspected malformation of cortical development (n = 3), 'abnormal brain' (n = 2) and skeletal dysplasia (n = 1). On neurosonography, both the sulcation pattern and the cortical layer were abnormal in four cases, only the sulcation pattern was considered abnormal in seven and only the cortical layer was abnormal in nine. Nineteen fetuses presented with associated central nervous system anomalies and six also had non-central nervous system malformations. One case was recurrent. Eighteen parents opted for termination of pregnancy, including one selective termination in a twin pregnancy, and two fetuses were liveborn. CONCLUSIONS Familiarity with fetal brain anatomy and its early sonographic landmarks allowed early diagnosis of malformations involving cortical development. These patients are likely to represent the most severe cases and all had associated malformations. The presence of an abnormal cortical layer and/or abnormal overdeveloped sulci appear to be early signs of malformation of cortical development. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Krajden Haratz
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Birnbaum
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Hospital, Kfar Saba, Israel
| | - J Har-Toov
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Salemnick
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Brusilov
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Malinger G. Re: Isolated, persisting, large choroid plexus cysts should warrant neurosonographic follow-up. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:495-496. [PMID: 34468061 DOI: 10.1002/uog.23750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Affiliation(s)
- G Malinger
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Brusilov M, Malinger G, Erlik U, Haratz KK. Ganglionic eminence cavitations - these are not choroid plexus cysts! ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:483-484. [PMID: 33428280 DOI: 10.1002/uog.23587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Affiliation(s)
- M Brusilov
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - U Erlik
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K K Haratz
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Goergen SK, Alibrahim E, Christie J, Dobrotwir A, Fahey M, Fender L, Frawley K, Manikkam SA, Pinner JR, Sinnott S, Romaniello R, Sandaradura SA, Taylor J, Vasudevan A, Righini A. The Fetus with Ganglionic Eminence Abnormality: Head Size and Extracranial Sonographic Findings Predict Genetic Diagnoses and Postnatal Outcomes. AJNR Am J Neuroradiol 2021; 42:1528-1534. [PMID: 33958329 DOI: 10.3174/ajnr.a7131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ganglionic eminence abnormalities on fetal MR imaging are associated with cerebral malformations. Their presumed genetic basis and associated postnatal outcomes remain largely unknown. We aimed to elucidate these through a multicenter study. MATERIALS AND METHODS Between January 2010 and June 2020, seven hospitals in 2 countries performing fetal MR imaging examinations identified fetal MR imaging studies demonstrating ganglionic eminence enlargement, cavitation, or both. Cases with no genetic diagnosis, no whole exome sequencing, or no outcome of a liveborn child were excluded. Head size was classified as large (fronto-occipital diameter > 95th centile), small (fronto-occipital diameter <5th centile), or normal. RESULTS Twenty-two fetuses with ganglionic eminence abnormalities were identified. Of 8 with large heads, 2 were diagnosed with MTOR mutations; 1 with PIK3CA mutation-producing megalencephaly, polymicrogyria, polydactyly, hydrocephalus (MPPH) syndrome; 3 with TSC mutations; 1 with megalencephaly capillary malformation syndrome; and 1 with hemimegalencephaly. Cardiac rhabdomyoma was present prenatally in all cases of TSC; mutation postaxial polydactyly accompanied megalencephaly capillary malformation and MPPH. Of 12 fetuses with small heads, 7 had TUBA1A mutations, 1 had a TUBB3 mutation, 2 had cobblestone lissencephaly postnatally with no genetic diagnosis, 1 had a PDHA1 mutation, and 1 had a fetal akinesia dyskinesia sequence with no pathogenic mutation on trio whole exome sequencing. One of the fetuses with a normal head size had an OPHN1 mutation with postnatal febrile seizures, and the other had peri-Sylvian polymicrogyria, seizures, and severe developmental delay but no explanatory mutation on whole exome sequencing. CONCLUSIONS Fetal head size and extracranial prenatal sonographic findings can refine the phenotype and facilitate genetic diagnosis when ganglionic eminence abnormality is diagnosed with MR imaging.
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Affiliation(s)
- S K Goergen
- From the Monash Imaging (S.K.G.), Monash Health, Victoria, Australia .,Departments of Imaging and Surgery (S.K.G.), School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - E Alibrahim
- Department of Radiology (E.A., A.D.), Royal Women's Hospital, Parkville, Victoria, Australia
| | - J Christie
- PRP Imaging (J.C.), Sydney, New South Wales, Australia
| | - A Dobrotwir
- Department of Radiology (E.A., A.D.), Royal Women's Hospital, Parkville, Victoria, Australia
| | - M Fahey
- Department of Paediatrics (M.F.), School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Neurogenetics Unit (M.F.), Monash Health, Victoria, Australia
| | - L Fender
- Department of Radiology (L.F.), King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - K Frawley
- Department of Medical Imaging and Nuclear Medicine (K.F., S.A.M.), Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - S A Manikkam
- Department of Medical Imaging and Nuclear Medicine (K.F., S.A.M.), Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - J R Pinner
- Centre for Clinical Genetics (J.R.P.), Sydney Children's Hospital, Sydney, New South Wales, Australia.,University of New South Wales (J.R.P.), Sydney, Australia
| | - S Sinnott
- SO + GI Scan I-MED Radiology (S.S.), Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - R Romaniello
- Child Neuropsychiatry and Neurorehabilitation Department (R.R.), Scientific Institute Eugenio Medea, La Nostra Famiglia, Bosiso Parini, Lecco, Italy
| | - S A Sandaradura
- Discipline of Child and Adolescent Health (S.A.S.), Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia.,Department of Clinical Genetics (S.A.S.), Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - J Taylor
- Department of Radiology (J.T.), Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - A Vasudevan
- Department of Clinical Genetics (A.V.), Royal Women's Hospital, Parkville, Victoria, Australia
| | - A Righini
- Department of Pediatric Radiology and Neuroradiology (A.R.), Vittore Buzzi Children's Hospital, Milan, Italy
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Scarabello M, Righini A, Severino M, Pinelli L, Parazzini C, Scola E, Palumbo G, Di Maurizio M, D'Errico I, Rossi A, Triulzi F, Griffiths PD. Ganglionic Eminence Anomalies and Coexisting Cerebral Developmental Anomalies on Fetal MR Imaging: Multicenter-Based Review of 60 Cases. AJNR Am J Neuroradiol 2021; 42:1151-1156. [PMID: 33707279 DOI: 10.3174/ajnr.a7062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/17/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The ganglionic eminences are transient fetal brain structures that produce a range of neuron types. Ganglionic eminence anomalies have been recognized on fetal MR imaging and anecdotally found in association with a number of neurodevelopmental anomalies. The aim of this exploratory study was to describe and analyze the associations between ganglionic eminence anomalies and coexisting neurodevelopmental anomalies. MATERIALS AND METHODS This retrospective study includes cases of ganglionic eminence anomalies diagnosed on fetal MR imaging during a 20-year period from 7 centers in Italy and England. Inclusion criteria were cavitation or increased volume of ganglionic eminences on fetal MR imaging. The studies were analyzed for associated cerebral developmental anomalies: abnormal head size and ventriculomegaly, reduced opercularization or gyration, and abnormal transient layering of the developing brain mantle. The results were analyzed using χ2 and Fisher exact tests. RESULTS Sixty fetuses met the inclusion criteria (21 females, 24 males, 15 sex unknown). Thirty-four had ganglionic eminence cavitations (29 bilateral and 5 unilateral), and 26 had increased volume of the ganglionic eminences (19 bilateral, 7 unilateral). Bilateral ganglionic eminence cavitations were associated with microcephaly (P = .01), reduced opercularization, (P < .001), reduced gyration (P < .001), and cerebellar anomalies (P = .01). Unilateral ganglionic eminence cavitations were not significantly associated with any particular feature. Bilateral increased volume of the ganglionic eminences showed an association with macrocephaly (P = .03). Unilateral increased volume was associated with macrocephaly (P = .002), abnormal transient layering (P = .001), unilateral polymicrogyria (P = .001), and hemimegalencephaly (P < .001). CONCLUSIONS Ganglionic eminence anomalies are associated with specific neurodevelopmental anomalies with ganglionic eminence cavitations and increased ganglionic eminence volume apparently having different associated abnormalities.
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Affiliation(s)
- M Scarabello
- From the Pediatric Radiology and Neuroradiology Department (M. Scarabello, A.R., C.P.), Children's Hospital V. Buzzi, Milan, Italy
| | - A Righini
- From the Pediatric Radiology and Neuroradiology Department (M. Scarabello, A.R., C.P.), Children's Hospital V. Buzzi, Milan, Italy
| | - M Severino
- Neuroradiology Department (M. Severino), Istituto Di Ricovero e Cura a Carattere Scientifico-Gaslini Children's Research Hospital, Genoa, Italy
| | - L Pinelli
- Neuroradiology Department (L.P.), Azienda Ospedaliera Spedali Civili Di Brescia, Brescia, Italy
| | - C Parazzini
- From the Pediatric Radiology and Neuroradiology Department (M. Scarabello, A.R., C.P.), Children's Hospital V. Buzzi, Milan, Italy
| | - E Scola
- Neuroradiology Department (E.S., F.T.), Istituto Di Ricovero e Cura a Carattere Scientifico-Fondazione Policlinico di Milano, Milan, Italy
| | - G Palumbo
- Radiology Department (G.P.), Azienda Ospedaliera Spedali Civili Di Brescia, Brescia, Italy
| | - M Di Maurizio
- Radiology Department (M.D.M.), Children's Hospital Meyer, Florence, Italy
| | - I D'Errico
- Neuroradiology Department (I.D.), University Hospital, Padua, Italy
| | - A Rossi
- Neuroradiology Department (M. Severino), Istituto Di Ricovero e Cura a Carattere Scientifico-Gaslini Children's Research Hospital, Genoa, Italy
| | - F Triulzi
- Neuroradiology Department (E.S., F.T.), Istituto Di Ricovero e Cura a Carattere Scientifico-Fondazione Policlinico di Milano, Milan, Italy
| | - P D Griffiths
- Academic Unit of Radiology (P.D.G.), University of Sheffield, Sheffield, UK
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Birnbaum R, Winsteen A, Brusilov M, Wolman I, Ben-Sira L, Malinger G, Krajden Haratz K. A unique brain germinal matrix involvement in cytomegalovirus infected fetuses: A retrospective neurosonographic analysis with outcome correlation. Prenat Diagn 2021; 41:877-883. [PMID: 33440022 DOI: 10.1002/pd.5888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the clinical significance of brain germinal matrix (GM) changes in cytomegalovirus (CMV) infected fetuses. METHOD This is a retrospective analysis. Group A; isolated GM finding, with or without lenticulostriatal vasculopathy (LSV). Group B; non-isolated lesion. Amniocentesis, urinalysis, postnatal US and developmental assessment, were obtained. RESULTS Group A and B included 18 and four fetuses, respectively. In group A, mean fetal age at diagnosis was 34.3 weeks (31-38 weeks). In 15/18 (83.3%), the lesion was bilateral and LSV was present in 8/18 (44.4%). Small cysts appeared inside the lesion in 5/18 (27.7%). MRI was normal in 8/18 (44.4%). Subtle or inconclusive findings were reported in the remaining fetuses. Brain ultrasound was normal in 10/18 (55.5%) of newborns. In the remaining, caudothalamic cyst with or without LSV, or isolated LSV were found. All newborns are developing normally at a mean follow-up age of 33.3 months (+/- 19.6 moths). In group B, all four patients requested for termination of pregnancy. CONCLUSION Fetal CMV infection may cause focal GM changes, frequently accompanied by LSV, late in pregnancy. These changes may be isolated, or as part of a more generalized brain damage. When isolated, favorable prognosis is expected.
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Affiliation(s)
- Roee Birnbaum
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Adi Winsteen
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michael Brusilov
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Igal Wolman
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Pediatric Radiology Unit, Tel Aviv, Israel
| | - Gustavo Malinger
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Karina Krajden Haratz
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Choi JJ, Yang E, Soul JS, Jaimes C. Fetal magnetic resonance imaging: supratentorial brain malformations. Pediatr Radiol 2020; 50:1934-1947. [PMID: 33252760 DOI: 10.1007/s00247-020-04696-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Abstract
Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence of events that occurs during prenatal brain development; this includes familiarity with the processes of hemispheric cleavage, formation of interhemispheric commissures, neuro-glial proliferation and migration, and cortical folding. Disruption of these processes results in malformations observed on fetal MRI including holoprosencephaly, callosal agenesis, heterotopic gray matter, lissencephaly and other malformations of cortical development (focal cortical dysplasia, polymicrogyria). The radiologist should also be familiar with findings that have high association with specific conditions affecting the central nervous system or other organ systems. This review summarizes and illustrates common patterns of supratentorial brain malformations and emphasizes aspects that are important to patient care.
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Affiliation(s)
- Jungwhan John Choi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Janet S Soul
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
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Govaert P, Triulzi F, Dudink J. The developing brain by trimester. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:245-289. [PMID: 32736754 DOI: 10.1016/b978-0-444-64239-4.00014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Transient anatomical entities play a role in the maturation of brain regions and early functional fetal networks. At the postmenstrual age of 7 weeks, major subdivisions of the brain are visible. At the end of the embryonic period, the cortical plate covers the neopallium. The choroid plexus develops in concert with it, and the dorsal thalamus covers about half the diencephalic third ventricle surface. In addition to the fourth ventricle neuroepithelium the rhombic lips are an active neuroepithelial production site. Early reciprocal connections between the thalamus and cortex are present. The corticospinal tract has reached the pyramidal decussation, and the arteries forming the mature circle of Willis are seen. Moreover, the superior sagittal sinus has formed, and at the rostral neuropore the massa commissuralis is growing. At the viable preterm age of around 24 weeks PMA, white matter tracts are in full development. Asymmetric progenitor division permits production of neurons, subventricular zone precursors, and glial cells. Myelin is present in the ventral spinal quadrant, cuneate fascicle, and spinal motor fibers. The neopallial mantle has been separated into transient layers (stratified transitional fields) between the neuroepithelium and the cortical plate. The subplate plays an important role in organizing the structuring of the cortical plate. Commissural tracts have shaped the corpus callosum, early primary gyri are present, and opercularization has started caudally, forming the lateral fissure. Thalamic and striatal nuclei have formed, although GABAergic neurons continue to migrate into the thalamus from the corpus gangliothalamicum. Near-term PMA cerebral sublobulation is active. Between 24 and 32 weeks, primary sulci develop. Myelin is present in the superior cerebellar peduncle, rubrospinal tract, and inferior olive. Germinal matrix disappears from the telencephalon, except for the GABAergic frontal cortical subventricular neuroepithelium.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Neonatology, ZNA Middelheim, Antwerp, Belgium; Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium.
| | - Fabio Triulzi
- Department of Pediatric Neuroradiology, Università Degli Studi di Milano, Milan, Italy
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center, Utrecht, The Netherlands
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Prefumo F, Petrilli G, Palumbo G, Sartori E, Izzi C, Pinelli L. Prenatal ultrasound diagnosis of cavitation of ganglionic eminence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:558-560. [PMID: 30740797 DOI: 10.1002/uog.20236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/26/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Affiliation(s)
- F Prefumo
- Prenatal Diagnosis Unit, Department of Obstetrics and Gynaecology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - G Petrilli
- Department of Pathology, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - G Palumbo
- Department of Radiology, University of Brescia, Brescia, Italy
| | - E Sartori
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - C Izzi
- Prenatal Diagnosis Unit, Department of Obstetrics and Gynaecology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - L Pinelli
- Neuroradiology Unit, Pediatric Neuroradiology Section, ASST Spedali Civili, Brescia, Italy
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Prayer D, Paladini D, Deprest J. Current Controversies in Prenatal Diagnosis 1: Should MRI be performed on all fetuses with mild ventriculomegaly? Prenat Diagn 2019; 39:331-338. [PMID: 30614017 DOI: 10.1002/pd.5416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 12/18/2022]
Abstract
A ventricular diameter of 10 mm correlates with more than two standard deviations of the normal and hence is qualified as ventriculomegaly. The relevance of this is dependent on whether there are associated infectious, genetic, or structural problems. The chance for neurodevelopmental delay in isolated ventriculomegaly less than 15 mm is 7.9% (4.7-11.1), and less if it is unilateral. It can be further divided in mild (10-12) or moderate (13-15), though this is not widely accepted. As part of the workup, structural assessment today may include ultrasound or magnetic resonance imaging, or both. Discussants agreed that the diagnostic performance of both methods is as good as the expertise with which the images are acquired and interpreted. Discussants agreed that when the initial neurosonogram is normal, the likelihood of finding significant findings on MRI is low. Nevertheless, some anomalies may only be picked up or better worked out by fetal MRI. In utero follow-up is advocated, as progression may indicate a poorer outcome, and some conditions are only obvious late in pregnancy. Most benefit for future patients is expected from appropriate training in prenatal neuroimaging.
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Affiliation(s)
- Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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