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Sethi S, Friesen-Waldner LJ, Regnault TRH, McKenzie CA. Quantifying Brain Myelin Water Fraction in a Guinea Pig Model of Spontaneous Intrauterine Growth Restriction. J Magn Reson Imaging 2024. [PMID: 38445838 DOI: 10.1002/jmri.29332] [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: 07/26/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is an obstetrical condition where a fetus has not achieved its genetic potential. A consequence of IUGR is a decrease in brain myelin content. Myelin water imaging (MWI) has been used to assess fetal myelin water fraction (MWF) and might potentially assess myelination changes associated with IUGR. PURPOSE To quantify and compare the MWF of non-IUGR and IUGR fetal guinea pigs (GPs) in late gestation. STUDY TYPE Prospective animal model. ANIMAL MODEL Dunkin-Hartley GP model of spontaneous IUGR (mean ± SD: 60 ± 1.2 days gestation; 19 IUGR, 52 control). FIELD STRENGTH/SEQUENCE Eight spoiled gradient-recalled (SPGR) gradient echo volumes (flip angles [α]: 2°-16°), and two sets of eight balanced steady-state free precession (bSSFP) gradient echo volumes (α: 8° - 64°), at 0° and 180° phase increments, at 3.0 T. ASSESSMENT MWF maps were generated for each fetal GP brain using multicomponent driven equilibrium single pulse observation of T1 /T2 (mcDESPOT). MWF was quantified in the fetal corpus callosum (CC), fornix (FOR), parasagittal white matter (PSW), and whole fetal brain. STATISTICAL TESTS Linear regression was performed between five fetal IUGR markers (body volume, body-to-pregnancy volume ratio, brain-to-liver volume ratio, brain-to-placenta volume ratio, and brain-to-body volume ratio) and MWF (coefficient of determination, R2 ). A t-test with a linear mixed model compared the MWF of non-IUGR and IUGR fetal GPs (significance was determined at α < 0.05). RESULTS The MWF of the control fetuses are (mean ± SD): 0.23 ± 0.02 (CC), 0.31 ± 0.02 (FOR), 0.28 ± 0.02 (PSW), and 0.20 ± 0.01 (whole brain). The MWF of the IUGR fetuses are (mean ± SD): 0.19 ± 0.02 (CC), 0.27 ± 0.01 (FOR), 0.24 ± 0.03 (PSW), and 0.16 ± 0.01 (whole brain). Significant differences in MWF were found between the non-IUGR and IUGR fetuses in every comparison. DATA CONCLUSION The mean MWF of IUGR fetal GPs is significantly lower than non-IUGR fetal GPs. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Simran Sethi
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - Timothy R H Regnault
- Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
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Rabinowich A, Avisdris N, Zilberman A, Link-Sourani D, Lazar S, Herzlich J, Specktor-Fadida B, Joskowicz L, Malinger G, Ben-Sira L, Hiersch L, Ben Bashat D. Reduced adipose tissue in growth-restricted fetuses using quantitative analysis of magnetic resonance images. Eur Radiol 2023; 33:9194-9202. [PMID: 37389606 DOI: 10.1007/s00330-023-09855-y] [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: 12/08/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Fat-water MRI can be used to quantify tissues' lipid content. We aimed to quantify fetal third trimester normal whole-body subcutaneous lipid deposition and explore differences between appropriate for gestational age (AGA), fetal growth restriction (FGR), and small for gestational age fetuses (SGAs). METHODS We prospectively recruited women with FGR and SGA-complicated pregnancies and retrospectively recruited the AGA cohort (sonographic estimated fetal weight [EFW] ≥ 10th centile). FGR was defined using the accepted Delphi criteria, and fetuses with an EFW < 10th centile that did not meet the Delphi criteria were defined as SGA. Fat-water and anatomical images were acquired in 3 T MRI scanners. The entire fetal subcutaneous fat was semi-automatically segmented. Three adiposity parameters were calculated: fat signal fraction (FSF) and two novel parameters, i.e., fat-to-body volume ratio (FBVR) and estimated total lipid content (ETLC = FSF*FBVR). Normal lipid deposition with gestation and differences between groups were assessed. RESULTS Thirty-seven AGA, 18 FGR, and 9 SGA pregnancies were included. All three adiposity parameters increased between 30 and 39 weeks (p < 0.001). All three adiposity parameters were significantly lower in FGR compared with AGA (p ≤ 0.001). Only ETLC and FSF were significantly lower in SGA compared with AGA using regression analysis (p = 0.018-0.036, respectively). Compared with SGA, FGR had a significantly lower FBVR (p = 0.011) with no significant differences in FSF and ETLC (p ≥ 0.053). CONCLUSIONS Whole-body subcutaneous lipid accretion increased throughout the third trimester. Reduced lipid deposition is predominant in FGR and may be used to differentiate FGR from SGA, assess FGR severity, and study other malnourishment pathologies. CLINICAL RELEVANCE STATEMENT Fetuses with growth restriction have reduced lipid deposition than appropriately developing fetuses measured using MRI. Reduced fat accretion is linked with worse outcomes and may be used for growth restriction risk stratification. KEY POINTS • Fat-water MRI can be used to assess the fetal nutritional status quantitatively. • Lipid deposition increased throughout the third trimester in AGA fetuses. • FGR and SGA have reduced lipid deposition compared with AGA fetuses, more predominant in FGR.
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Affiliation(s)
- Aviad Rabinowich
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Netanell Avisdris
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayala Zilberman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Sapir Lazar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacky Herzlich
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Neonatal Intensive Care Unit, Dana Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Bella Specktor-Fadida
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gustavo Malinger
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Ben-Sira
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liran Hiersch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Moradi B, Banihashemian M, Radmard AR, Tahmasebpour AR, Gity M, Zarkesh MR, Piri S, Zeinoddini A. A Spectrum of Ultrasound and MR Imaging of Fetal Gastrointestinal Abnormalities: Part 1 Esophagus to Colon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2601-2613. [PMID: 34962317 DOI: 10.1002/jum.15932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/03/2021] [Accepted: 11/20/2021] [Indexed: 06/14/2023]
Abstract
Ultrasound (US) and magnetic resonance imaging (MRI) are two modalities for diagnosing fetal gastrointestinal (GI) anomalies. Ultrasound (US) is the modality of choice. MRI can be used as a complementary method. Despite its expanding utilization in central nervous system (CNS) fetal malformation, MRI has not yet been established for evaluation of fetal GI abnormalities. Therefore, more attention should be paid to the clinical implications of MRI investigations following screening by US.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Banihashemian
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoumeh Gity
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zarkesh
- Department of Neonatology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Solmaz Piri
- Department of International Affairs, National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran
| | - Atefeh Zeinoddini
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
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Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
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5
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Ercolani G, Capuani S, Antonelli A, Camilli A, Ciulla S, Petrillo R, Satta S, Grimm R, Giancotti A, Ricci P, Catalano C, Manganaro L. IntraVoxel Incoherent Motion (IVIM) MRI of fetal lung and kidney: Can the perfusion fraction be a marker of normal pulmonary and renal maturation? Eur J Radiol 2021; 139:109726. [PMID: 33895624 DOI: 10.1016/j.ejrad.2021.109726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the use of IntraVoxel Incoherent Motion (IVIM) MRI in the study of microstructural tissue changes occurring in fetal lung and kidney during gestation. METHODS 34 normal pregnancies were enrolled. Patients were divided into two groups based on gestational age (GA): group A (21-29 weeks) and group B (30-39 weeks). MR examinations were performed at 1.5T, with a standard fetal MR protocol including a Diffusion-Weighted Echo-Planar Imaging sequence with 10 different b-values (0, 10, 30, 50, 75, 100, 200, 400, 700, 1000s/mm2). For each fetus, two bilateral ROIs were manually placed in lung and renal parenchyma. Mean values of perfusion fraction f, pseudo-diffusion coefficient D* and diffusion coefficient D were obtained. The correlation between IVIM parameters and GA was investigated. RESULTS In renal ROIs a positive correlation between fkidney and GA (p < 0.005) was found; similarly flung showed a statistically significant correlation with GA (p < 0.001). F mean values were significantly higher in group B compared to group A in both renal (p = 0.0002) and lung (p = 0.018) ROIs. No correlation was found in D and D* as a function of GA. CONCLUSIONS The IVIM perfusion fraction f may be considered as a potential marker of pulmonary and renal maturation in relation to hemodynamic changes described in intrauterine life. Our results highlight that IVIM model is useful as an additional prenatal diagnostic tool to study lung and renal development.
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Affiliation(s)
- Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Silvia Capuani
- CNR ISC, Physics Department, "Sapienza" University of Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Arianna Camilli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Roberta Petrillo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | | | - Antonella Giancotti
- Department of Gynecological-Obstetrical and Urological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy.
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Dhillon P, Kaur I, Singh K. Pregnancy-induced hypertension: Role of drug therapy and nutrition in the management of hypertension. PHARMANUTRITION 2021. [DOI: 10.1016/j.phanu.2021.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Sethi S, Giza SA, Goldberg E, Empey MEET, de Ribaupierre S, Eastabrook GDM, de Vrijer B, McKenzie CA. Quantification of 1.5 T T 1 and T 2 * Relaxation Times of Fetal Tissues in Uncomplicated Pregnancies. J Magn Reson Imaging 2021; 54:113-121. [PMID: 33586269 DOI: 10.1002/jmri.27547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite its many advantages, experience with fetal magnetic resonance imaging (MRI) is limited, as is knowledge of how fetal tissue relaxation times change with gestational age (GA). Quantification of fetal tissue relaxation times as a function of GA provides insight into tissue changes during fetal development and facilitates comparison of images across time and subjects. This, therefore, can allow the determination of biophysical tissue parameters that may have clinical utility. PURPOSE To demonstrate the feasibility of quantifying previously unknown T1 and T2 * relaxation times of fetal tissues in uncomplicated pregnancies as a function of GA at 1.5 T. STUDY TYPE Pilot. POPULATION Nine women with singleton, uncomplicated pregnancies (28-38 weeks GA). FIELD STRENGTH/SEQUENCE All participants underwent two iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) acquisitions at different flip angles (6° and 20°) at 1.5 T. ASSESSMENT Segmentations of the lungs, liver, spleen, kidneys, muscle, and adipose tissue (AT) were conducted using water-only images and proton density fat fraction maps. Driven equilibrium single pulse observation of T1 (DESPOT1 ) was used to quantify the mean water T1 of the lungs, intraabdominal organs, and muscle, and the mean water and lipid T1 of AT. IDEAL T2 * maps were used to quantify the T2 * values of the lungs, intraabdominal organs, and muscle. STATISTICAL TESTS F-tests were performed to assess the T1 and T2 * changes of each analyzed tissue as a function of GA. RESULTS No tissue demonstrated a significant change in T1 as a function of GA (lungs [P = 0.89]; liver [P = 0.14]; spleen [P = 0.59]; kidneys [P = 0.97]; muscle [P = 0.22]; AT: water [P = 0.36] and lipid [P = 0.14]). Only the spleen and muscle T2 * showed a significant decrease as a function of GA (lungs [P = 0.67); liver [P = 0.05]; spleen [P < 0.05]; kidneys [P = 0.70]; muscle [P < 0.05]). DATA CONCLUSION These preliminary data suggest that the T1 of the investigated tissues is relatively stable over 28-38 weeks GA, while the T2 * change in spleen and muscle decreases significantly in that period. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Simran Sethi
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Stephanie A Giza
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Estee Goldberg
- Department of Biomedical Engineering, Western University, London, Ontario, Canada
| | | | - Sandrine de Ribaupierre
- Department of Biomedical Engineering, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada.,Brain and Mind Institute, Western University, London, Ontario, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada
| | - Genevieve D M Eastabrook
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada
| | - Barbra de Vrijer
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada
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The application of in utero magnetic resonance imaging in the study of the metabolic and cardiovascular consequences of the developmental origins of health and disease. J Dev Orig Health Dis 2020; 12:193-202. [PMID: 33308364 PMCID: PMC8162788 DOI: 10.1017/s2040174420001154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Observing fetal development in utero is vital to further the understanding of later-life diseases. Magnetic resonance imaging (MRI) offers a tool for obtaining a wealth of information about fetal growth, development, and programming not previously available using other methods. This review provides an overview of MRI techniques used to investigate the metabolic and cardiovascular consequences of the developmental origins of health and disease (DOHaD) hypothesis. These methods add to the understanding of the developing fetus by examining fetal growth and organ development, adipose tissue and body composition, fetal oximetry, placental microstructure, diffusion, perfusion, flow, and metabolism. MRI assessment of fetal growth, organ development, metabolism, and the amount of fetal adipose tissue could give early indicators of abnormal fetal development. Noninvasive fetal oximetry can accurately measure placental and fetal oxygenation, which improves current knowledge on placental function. Additionally, measuring deficiencies in the placenta’s transport of nutrients and oxygen is critical for optimizing treatment. Overall, the detailed structural and functional information provided by MRI is valuable in guiding future investigations of DOHaD.
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Comparison of the Visibility of Fetal Tooth Buds on 1.5 and 3 Tesla MRI. J Clin Med 2020; 9:jcm9113424. [PMID: 33114485 PMCID: PMC7693030 DOI: 10.3390/jcm9113424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022] Open
Abstract
Dental anomalies coincide with genetic disorders, and prenatal identification may contribute to a more accurate diagnosis. The aim of this study was to assess whether fetal Magnet Resonance Imaging (MRI) is suitable to visualize and investigate intrauterine dental development in the upper jaw, and to compare the quality of visibility of tooth buds between 1.5 Tesla (T) and 3T images. MR images of fetuses Gestational Week (GW) 26.71 ± 4.97 from 286 pregnant women with diagnoses unrelated to dental anomalies were assessed by three raters. We compared the visibility between groups and field strengths in five gestational age groups, using chi square and Fisher’s exact tests. All ten primary tooth buds were identifiable in 5.4% at GW 18–21, in 75.5% at GW 26–29, and in 90.6% at GW 34+. Before GW 30, more tooth buds were identifiable on 3T images than on 1.5T images. Statistical significance was only reached for identification of incisors (p = 0.047). Therefore, 1.5T and 3T images are viable to visualize tooth buds, particularly after GW 25, and their analysis may serve as diagnostic criterion. MRI tooth bud data might have an impact on various fields of research, such as the maldevelopment of teeth and their causes. Analyzing tooth buds as an additional diagnostic criterion is not time consuming, and could lead to an improvement of syndrome diagnosis.
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10
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Normal size of the fetal adrenal gland on prenatal magnetic resonance imaging. Pediatr Radiol 2020; 50:840-847. [PMID: 32060593 DOI: 10.1007/s00247-020-04629-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The adrenal gland plays a vital role in fetal growth. Many disease states such as congenital adrenal hyperplasia, hemorrhage and tumors can lead to morphological changes in the gland. Ultrasound measurements of normal adrenal sizes in the fetus reported in the literature have shown a trend of increasing size with gestational age. There is no literature available on standard fetal adrenal sizes or detailed appearance by fetal MRI. OBJECTIVE The purpose of this study was to provide MR data on the size and signal characteristics of the fetal adrenal gland throughout the second and third trimesters. MATERIALS AND METHODS In this retrospective review, we selected 185 prenatal MRIs obtained from Jan. 1, 2014, to May 31, 2017, with normal abdominal findings for inclusion. The adrenal glands were identified in coronal, sagittal or axial T2-W planes and coronal T1-W plane when available. We measured the length and thickness of the medial and lateral limbs of the right and left adrenal glands and recorded signal intensity on T1-W and T2-W sequences, gender and gestational age in each case. RESULTS The gestational age (GA) ranged 18-37 weeks. Visibility of the adrenal glands on T2-W images was high (90.3-97.2%) up to 30 weeks of GA but declined afterward (47.5-62.2% at 31-37 weeks). Visibility on T1-W images increased with GA, ranging from 21.4% visibility at 18-22 weeks and increasing to 40% at 35-37 weeks. Mean lengths of the adrenal gland limbs steadily increased from 8.2 mm at 18-22 weeks to 11.0 mm at 35-37 weeks. In the second trimester, adrenal glands were low in signal intensity on T2-W images and were surrounded by hyperintense perirenal fatty tissue. In the third trimester, the glands became less distinct, with increasing signal and obliteration of perirenal tissue. The glands were moderately hyperintense on T1-W images throughout pregnancy, with increasing visibility as pregnancy progressed. CONCLUSION Normal sizes and signal intensities for adrenal glands are reported. Visibility of adrenal glands on T2-W images was 90.3-97.2% up to 30 weeks but declined thereafter. Visibility on T1-W images increased in the third trimester. Adrenal gland sizes increased with gestational age.
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11
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Ellman LM, Murphy SK, Maxwell SD, Calvo EM, Cooper T, Schaefer CA, Bresnahan MA, Susser ES, Brown AS. Maternal cortisol during pregnancy and offspring schizophrenia: Influence of fetal sex and timing of exposure. Schizophr Res 2019; 213:15-22. [PMID: 31345704 PMCID: PMC7074891 DOI: 10.1016/j.schres.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Maternal stress during pregnancy has been repeatedly linked to increased risk for schizophrenia; however, no study has examined maternal cortisol during pregnancy and risk for the disorder. Study aims were to determine whether prenatal cortisol was associated with risk for schizophrenia and risk for an intermediate phenotype-decreased fetal growth-previously linked to prenatal cortisol and schizophrenia. Timing of exposure and fetal sex also were examined given previous findings. METHODS Participants were 64 cases diagnosed with schizophrenia spectrum disorders (SSD) and 117 controls from a prospective birth cohort study. Maternal cortisol was determined from stored sera from each trimester and psychiatric diagnoses were assessed from offspring using semi-structured interviews and medical records review. RESULTS Maternal cortisol during pregnancy was not associated with risk for offspring schizophrenia. There was a significant interaction between 3rd trimester cortisol and case status on fetal growth. Specifically, cases exposed to higher 3rd trimester maternal cortisol had significantly decreased fetal growth compared to controls. In addition, these findings were restricted to male offspring. CONCLUSIONS Our results indicate that higher prenatal cortisol is associated with an intermediate phenotype linked to schizophrenia, fetal growth, but only among male offspring who developed schizophrenia. Findings were consistent with evidence that schizophrenia genes may disrupt placental functioning specifically for male fetuses, as well as findings that males are more vulnerable to maternal cortisol during pregnancy. Finally, results suggest that examining fetal sex and intermediate phenotypes may be important in understanding the mechanisms involved in prenatal contributors to schizophrenia.
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Affiliation(s)
- Lauren M Ellman
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Shannon K Murphy
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Seth D Maxwell
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Evan M Calvo
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Thomas Cooper
- Analytic Psychopharmacology, Nathan S. Kline Institute, 140 Old Orangeburg Road Orangeburg, NY 10962, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Catherine A Schaefer
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Michaeline A Bresnahan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Ezra S Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Alan S Brown
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
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Niles KM, Blaser S, Shannon P, Chitayat D. Fetal arthrogryposis multiplex congenita/fetal akinesia deformation sequence (FADS)-Aetiology, diagnosis, and management. Prenat Diagn 2019; 39:720-731. [PMID: 31218730 DOI: 10.1002/pd.5505] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 01/01/2023]
Abstract
Arthrogryposis multiplex congenita (AMC) refers to an aetiologically heterogenous condition, which consists of joint contractures affecting two or more joints starting prenatally. The incidence is approximately one in 3000 live births; however, the prenatal incidence is higher, indicating a high intrauterine mortality. Over 320 genes have been implicated showing the genetic heterogeneity of the condition. AMC can be of extrinsic aetiology resulting from intrauterine crowding secondary to congenital structural uterine abnormalities (eg, bicornuate or septate uterus), uterine tumors (eg, fibroid), or multifetal pregnancy or intrinsic/primary/fetal aetiology, due to functional abnormalities in the brain, spinal cord, peripheral nerves, neuromuscular junction, muscles, bones, restrictive dermopathies, tendons and joints. Unlike many of the intrinsic/primary/fetal causes which are difficult to treat, secondary AMC can be treated by physiotherapy with good response. Primary cases may present prenatally with fetal akinesia associated with joint contractures and occasionally brain abnormalities, decreased muscle bulk, polyhydramnios, and nonvertex presentation while the secondary cases usually present with isolated contractures. Complete prenatal and postnatal investigations are needed to identify an underlying aetiology and provide information regarding its prognosis and inheritance, which is critical for the obstetrical care providers and families to optimize the pregnancy management and address future reproductive plans.
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Affiliation(s)
- Kirsten M Niles
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, ON, Canada
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Shrot S, Johnson CT, Golden WC, Baschat AA, Bullard JE, Tekes A, Poretti A, Dunn E, Huisman TA. Persistent Extreme Hyperextension of the Fetal Neck: Clinical and Neuroimaging Findings. J Neuroimaging 2018; 28:278-282. [DOI: 10.1111/jon.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shai Shrot
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of Diagnostic ImagingSheba Medical Center Ramat‐Gan Israel
| | - Clark T. Johnson
- Department of Gynecology & ObstetricsJohns Hopkins University School of Medicine Baltimore MD
| | - W. Christopher Golden
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Ahmet A. Baschat
- Center for Fetal TherapyDepartment of ObstetricsGynecology, and Reproductive SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Janine E. Bullard
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Aylin Tekes
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Andrea Poretti
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of NeurogeneticsKennedy Krieger Institute Baltimore MD
| | - Emily Dunn
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Thierry A.G.M. Huisman
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
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14
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Özgüner G, Öztürk K, Bilkay C, Dursun A, Sulak O, Koyuncu E. Appearance of external genital organs and types of hymen in Turkish female foetal cadavers. J OBSTET GYNAECOL 2016; 37:215-222. [PMID: 27866459 DOI: 10.1080/01443615.2016.1233945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The present study's purpose was to determine the size and morphometric development of the female external genital organs on foetal cadavers. Dimensions of labia majora, labia minora and clitoris, bilabial diameter, vertical and horizontal diameters of hymenal opening, distance between the external urethral orifice and hymenal opening, distance between the clitoris and external urethral orifice and anogenital distance were measured. The hymenal types were determined. Mean values of parameters according to gestational weeks, months and trimesters were calculated. Imperforate hymen were determined in the first trimester. Twenty-eight foetuses with annular hymen, 25 foetuses with imperforate hymen, and 1 foetus with septated hymen were determined in the second trimester. Twenty-four foetuses with annular hymen, 3 foetuses with imperforate hymen, 1 foetus with fimbriated hymen, and 1 foetus with hymenal tag were determined in the third trimester. All foetuses in the full term were determined with annular hymen.
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Affiliation(s)
- Gülnur Özgüner
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Kenan Öztürk
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Cemil Bilkay
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Ahmet Dursun
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Osman Sulak
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Esra Koyuncu
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
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Millischer AE, Sonigo P, Ville Y, Brunelle F, Boddaert N, Salomon LJ. Standardized fetal anatomical examination using magnetic resonance imaging: a feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:553-559. [PMID: 23349068 DOI: 10.1002/uog.12415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/03/2013] [Accepted: 01/11/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine whether a standard complete fetal anatomical survey, as recommended for ultrasound examination guidelines, is feasible using a standardized magnetic resonance imaging (MRI) protocol. METHODS Based on guidelines for ultrasound examination, we created a specific MRI protocol for fetal anatomical survey. This protocol was then tested prospectively in 100 women undergoing fetal MRI examination for various specific indications at a median gestational age of 30 weeks. The feasibility of using MRI to perform the fetal anatomical survey was analyzed by two reviewers (A and B) based on 26 predefined anatomical criteria, yielding a score ranging from 0 to 26 (26 meaning successful complete anatomical study). Reproducibility was analyzed using percentage agreement and modified kappa statistics. RESULTS The mean score for the standardized MRI anatomical survey was 24.6 (SD, 1.4; range, 15-26) for Reviewer A and 24.2 (SD, 1.7; range, 15-26) for Reviewer B (P = 0.1). Twenty-two, two and two criteria could be assessed in > 95%, 80-95% and < 80% of cases by Reviewer A and 19, four and three criteria could be assessed in > 95%, 80-95% and < 80% of cases by Reviewer B. For both reviewers, the two most difficult criteria to evaluate were aorta and pulmonary artery. Inter-reviewer agreement was above 90% for 22 of the 26 anatomical criteria and adjusted kappa coefficients for each criterion demonstrated good, moderate and poor agreement for 22, two and two criteria, respectively. CONCLUSION Our data support the hypothesis that standardized fetal anatomical examination might be achieved and reproducible using MRI, although improvement is required for the cardiac part of the examination.
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Affiliation(s)
- A E Millischer
- Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Wielandner A, Mlczoch E, Prayer D, Berger-Kulemann V. Potential of magnetic resonance for imaging the fetal heart. Semin Fetal Neonatal Med 2013; 18:286-97. [PMID: 23742821 DOI: 10.1016/j.siny.2013.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Significant congenital heart disease (sCHD) affects 3.6 per 1000 births, and is often associated with extracardiac and chromosomal anomalies. Although early mortality has been substantially reduced and the rate of long-term survival has improved, sCHD is, after preterm birth, the second most frequent cause of neonatal infant death. The prenatal detection of cardiac and vascular abnormalities enables optimal parental counselling and perinatal management. Echocardiography (ECG) is the first-line examination and gold standard by which cardiac malformations are defined. However, adequate examination by an experienced healthcare provider with modern technical imaging equipment is required. In addition, maternal factors and the gestational age may lower the image quality. Fetal magnetic resonance imaging (MRI) has been implemented over the last several years and is already used in the clinical routine as a second-line approach to assess fetal abnormalities. MRI of the fetal heart is still not routinely performed. Nevertheless, fetal cardiac MRI has the potential to complement ultrasound in detecting cardiovascular malformations and extracardiac lesions. The present work reviews the potential of MRI to delineate the anatomy and pathologies of the fetal heart. This work also deals with the limitations and continuing developments designed to overcome the current problems in cardiac imaging, including fast fetal heart rates, the lack of ECG-gating, and the presence of fetal movements.
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Affiliation(s)
- Alice Wielandner
- Department of Radiology, Medical University of Vienna, AKH, Vienna, Austria
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Abstract
Prenatal magnetic resonance imaging (MRI) is being increasingly used, in addition to standard ultrasound, for the diagnosis of congenital diseases beyond the central nervous system. Previous studies have demonstrated that MRI may be useful for the in utero visualization of spinal dysraphism and for differentiating between isolated and complex skeletal disorders with associated abnormalities. More recently, attention has focused on the visualization of the human fetal skeleton for the delineation of normal and pathological development of skeletal structures. On 1.5 T, in particular, echoplanar imaging enables the delineation of various epimetaphyseal structures and morphometric measurements of the fetal long bones from 18 gestational weeks until term. This information gathered from prenatal MRI might be helpful in the diagnosis of focal bone abnormalities and generalized skeletal disorders, such as bone dysplasias. Further clinical research, along with the refinement of the newest techniques, will enable expansion of the preliminary findings and help in determining the impact of fetal magnetic resonance bone imaging in the routine clinical setting. This review summarizes the current data in the literature and the authors' clinical experience with the magnetic resonance visualization of the developing fetal skeleton and also comments on the potential future applications of this technique.
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Salomon LJ, Bernard JP, Millischer AE, Sonigo P, Brunelle F, Boddaert N, Ville Y. MRI and ultrasound fusion imaging for prenatal diagnosis. Am J Obstet Gynecol 2013; 209:148.e1-9. [PMID: 23685001 DOI: 10.1016/j.ajog.2013.05.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/14/2013] [Accepted: 05/14/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE A combination of magnetic resonance imaging (MRI) images with real time high-resolution ultrasound known as fusion imaging may improve prenatal examination. This study was undertaken to evaluate the feasibility of using fusion of MRI and ultrasound (US) in prenatal imaging. STUDY DESIGN This study was conducted in a tertiary referral center. All patients referred for prenatal MRI were offered to undergo fusion of MRI and US examination. All cases underwent 1.5 Tesla MRI protocol including at least 3 T2-weighted planes. The Digital Imaging and Communications in Medicine volume dataset was then loaded into the US system for manual registration of the live US image and fusion imaging examination. RESULTS Over the study period, 24 patients underwent fusion imaging at a median gestational age of 31 (range, 24-35) weeks. Data registration, matching and then volume navigation was feasible in all cases. Fusion imaging allowed superimposing MRI and US images therefore providing with real time imaging capabilities and high tissue contrast. It also allowed adding a real time Doppler signal on MRI images. Significant fetal movement required repeat-registration in 15 (60%) cases. The average duration of the overall additional scan with fusion imaging was 10 ± 5 minutes. CONCLUSION The combination of fetal real time MRI and US image fusion and navigation is feasible. Multimodality fusion imaging may enable easier and more extensive prenatal diagnosis.
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Koelblinger C, Herold C, Nemec S, Berger-Kulemann V, Brugger PC, Koller A, Tonnhofer U, Bettelheim D, Prayer D. Fetal magnetic resonance imaging of lymphangiomas. J Perinat Med 2013; 41:437-43. [PMID: 23314507 DOI: 10.1515/jpm-2012-0226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 12/04/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the fetal magnetic resonance imaging findings of lymphangiomas. METHODS The magnetic resonance scans of eight fetuses with lymphangiomas were evaluated. Magnetic resonance evaluation included: number; size; signal intensities of the lesions; thickness of the septae; configuration of the margins; presence of blood breakdown products; change in size or signal intensity (in four patients with multiple examinations); exact expansion of the lesions to the adjacent anatomical structures; and concomitant pathological findings. Results were compared with postpartum clinical assessment and imaging in seven patients and with autopsy in one patient. RESULTS Two retroperitoneal, three thoracic, and three cervical lymphangiomas (diameters between 3.3 and 15.6 cm) were included. All lesions consisted of macrocysts, and additional microcystic parts were found in three lymphangiomas. Blood breakdown products were found in one lesion. Agreement with postpartum imaging was excellent. One patient received intrauterine drainage for chylothorax, and one pregnancy was terminated. CONCLUSIONS Fetal lymphangiomas display the same magnetic resonance imaging features as postnatal lymphangiomas. Intrauterine magnetic resonance characterization of lymphangiomas provides the exact delineation, detection of associated and/or concomitant pathologies, and differential diagnosis among other cystic pathologies. Patient management may be altered with respect to the type and/or time of treatment, and with regard to the continuation or termination of pregnancy.
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Affiliation(s)
- Claus Koelblinger
- Department of Radiology, Medical University of Vienna, WaehringerGuertel 18-20, A-1090 Vienna, Austria.
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20
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[Fetal magnetic resonance imaging evaluation of congenital diaphragmatic hernia]. RADIOLOGIA 2013; 56:313-21. [PMID: 23523414 DOI: 10.1016/j.rx.2012.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 12/08/2012] [Accepted: 12/09/2012] [Indexed: 11/21/2022]
Abstract
A diaphragmatic hernia is defined as the protrusion of abdominal viscera into the thoracic cavity through a normal or pathological orifice. The herniated viscera compress the lungs, resulting in pulmonary hypoplasia and secondary pulmonary hypertension, which are the leading causes of neonatal death in patients with congenital diaphragmatic hernia. Congenital diaphragmatic hernia is diagnosed by sonography in routine prenatal screening. Although magnetic resonance imaging is fundamentally used to determine whether the liver is located within the abdomen or has herniated into the thorax, it also can provide useful information about other herniated structures and the degree of pulmonary hypoplasia. The aim of this article is to review the fetal magnetic resonance findings for congenital diaphragmatic hernia and the signs that enable us to establish the neonatal prognosis when evaluating pulmonary hypoplasia.
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21
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Structural congenital brain disease in congenital heart disease: results from a fetal MRI program. Eur J Paediatr Neurol 2013; 17:153-60. [PMID: 22944287 DOI: 10.1016/j.ejpn.2012.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 06/30/2012] [Accepted: 07/15/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To identify the type and incidence of fetal brain pathology in fetuses with a prenatal diagnosis of congenital heart disease (CHD). PATIENTS AND METHODS 67 pregnant women underwent a fetal MR-examinations between 20 and 38 gestational weeks. MR was done on a 1.5 T superconducting system. The type of cardiac malformation was defined by fetal echocardiography. Fetuses with a chromosomal abnormality or an extracardiac anomaly were excluded. RESULTS Fetal MRI scans in the final study cohort (53 fetuses) yielded normal results in 32 fetuses and a brain abnormality in 21 fetuses. Congenital brain disease (CBD) was found in 39% of the final study cohort of fetuses with CHD. MRI findings were classified into malformations, acquired lesions and widening of the ventricles and/or outer CSF spaces (malformations: 7 fetuses, acquired lesions: 5 fetuses, changes in CSF spaces: 9 fetuses). Asymmetry of the ventricles was the most common finding in the CSF group. CONCLUSIONS Our data suggest that fetal MRI can be used to characterize structural CBD in CHD. Advanced MRI techniques such as diffusion tensor imaging and proton spectroscopy are tools that, in the future, will certainly shed light on the spectrum of structural and functional CBDs that are associated with CHD.
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Nemec U, Nemec SF, Weber M, Brugger PC, Kasprian G, Bettelheim D, Rimoin DL, Lachman RS, Malinger G, Prayer D. Human long bone development in vivo: analysis of the distal femoral epimetaphysis on MR images of fetuses. Radiology 2013; 267:570-80. [PMID: 23392423 DOI: 10.1148/radiol.13112441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate human long bone development in vivo by analyzing distal femoral epimetaphyseal structures and bone morphometrics on magnetic resonance (MR) images of fetuses. MATERIALS AND METHODS An institutional review board approved this retrospective study, and informed consent was waived. Included were 272 MR imaging examinations (April 2004-July 2011) in 253 fetuses with a mean gestational age (GA) of 26 weeks 6 days (range, 19 weeks 2 days to 35 weeks 6 days) without known musculoskeletal abnormalities. Two independent readers qualitatively analyzed epiphyseal and metaphyseal shape, secondary ossification, and the perichondrium on 1.5-T echo-planar MR images and correlated the results with the GA that was derived from previous fetal ultrasonography (US). Diaphyseal and epiphyseal morphometric measurements were correlated with GA by means of the Pearson correlation and linear regression. MR imaging measurements of diaphyseal length and US normative values were compared graphically. Interreader agreement analysis was performed with weighted κ statistics and the intraclass correlation coefficient. RESULTS With advancing GA, the epiphyseal shape changed from spherical (r(2) = 0.664) to hemispherical with a notch (r(2) = 0.804), and the metaphyseal shape changed from flat (r(2) = 0.766) to clearly undulated (r(2) = 0.669). Secondary ossification (r(2) = 0.777) was not observed until 25 weeks 3 days. The perichondrium decreased (r(2) = 0.684) from 20 weeks onward. Correlation coefficients were 0.897 for diaphyseal length, 0.738 for epiphyseal length, and 0.801 for epiphyseal width with respect to GA. The range of measurements of diaphyseal length was larger than that of the reported US normative values. Interreader agreement was good for bone morphometrics (intraclass correlation coefficient, 0.906-0.976), and moderate for bone characteristics (weighted κ, 0.448-0.848). CONCLUSION Prenatal MR imaging allows visualization of human bone development in vivo by means of epimetaphyseal characteristics and bone morphometrics. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112441/-/DC1.
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Affiliation(s)
- Ursula Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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23
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Filges I, Hall JG. Failure to identify antenatal multiple congenital contractures and fetal akinesia - proposal of guidelines to improve diagnosis. Prenat Diagn 2013; 33:61-74. [DOI: 10.1002/pd.4011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Isabel Filges
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
- Division of Medical Genetics, University Children's Hospital and Department of Biomedicine; University of Basel; Basel Switzerland
| | - Judith G. Hall
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
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24
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Hansen K, Pedersen PBM, Pedersen M, Wang T. Magnetic Resonance Imaging Volumetry for Noninvasive Measures of Phenotypic Flexibility during Digestion in Burmese Pythons. Physiol Biochem Zool 2013; 86:149-58. [DOI: 10.1086/668915] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mailath-Pokorny M, Kasprian G, Mitter C, Schöpf V, Nemec U, Prayer D. Magnetic resonance methods in fetal neurology. Semin Fetal Neonatal Med 2012; 17:278-84. [PMID: 22749691 DOI: 10.1016/j.siny.2012.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Fetal magnetic resonance imaging (MRI) has become an established clinical adjunct for the in-vivo evaluation of human brain development. Normal fetal brain maturation can be studied with MRI from the 18th week of gestation to term and relies primarily on T2-weighted sequences. Recently diffusion-weighted sequences have gained importance in the structural assessment of the fetal brain. Diffusion-weighted imaging provides quantitative information about water motion and tissue microstructure and has applications for both developmental and destructive brain processes. Advanced magnetic resonance techniques, such as spectroscopy, might be used to demonstrate metabolites that are involved in brain maturation, though their development is still in the early stages. Using fetal MRI in addition to prenatal ultrasound, morphological, metabolic, and functional assessment of the fetus can be achieved. The latter is not only based on observation of fetal movements as an indirect sign of activity of the fetal brain but also on direct visualization of fetal brain activity, adding a new component to fetal neurology. This article provides an overview of the MRI methods used for fetal neurologic evaluation, focusing on normal and abnormal early brain development.
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Affiliation(s)
- M Mailath-Pokorny
- Medical University of Vienna, Department of Obstetrics and Gynecology, Vienna, Austria.
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26
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Abstract
Magnetic resonance imaging has a complementary role in obstetrical imaging to ultrasound (US). Although US has advantages as an initial imaging technique, there are significant numbers of patients who cannot be adequately evaluated for a variety of reasons including calvarial calcification, oligoanhydramnios, or simply obesity. MR can provide additional information that cannot be obtained by US and is invaluable in central nervous system anomaly evaluation, airway management, and planning for postnatal intervention. Newer techniques established in the postnatal population such as spectroscopy, diffusion-weighted imaging, and functional imaging have future applications in the fetus.
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27
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Nemec SF, Nemec U, Brugger PC, Bettelheim D, Rotmensch S, Graham JM, Rimoin DL, Prayer D. MR imaging of the fetal musculoskeletal system. Prenat Diagn 2012; 32:205-13. [DOI: 10.1002/pd.2914] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Stefan Franz Nemec
- Medical University Vienna; Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology; Waehringer Guertel 18-20 Vienna A-1090 Austria
- Cedars Sinai Medical Center; Medical Genetics Institute, 8700 Beverly Boulevard, PACT Suite 400; 8700 Beverly Boulevard, PACT Suite 400 Los Angeles CA, 90048 90048 USA
| | - Ursula Nemec
- Medical University Vienna; Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology; Waehringer Guertel 18-20 Vienna A-1090 Austria
| | - Peter C. Brugger
- Medical University Vienna; Center of Anatomy and Cell Biology, Integrative Morphology Group; Vienna Austria
| | - Dieter Bettelheim
- Medical University Vienna; Department of Obstetrics and Gynaecology, Division of Prenatal Diagnosis and Therapy; Vienna Austria
| | - Siegfried Rotmensch
- Cedars Sinai Medical Center; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine; Los Angeles CA USA
| | - John M. Graham
- Cedars Sinai Medical Center; Medical Genetics Institute, 8700 Beverly Boulevard, PACT Suite 400; 8700 Beverly Boulevard, PACT Suite 400 Los Angeles CA, 90048 90048 USA
| | - David L. Rimoin
- Cedars Sinai Medical Center; Medical Genetics Institute, 8700 Beverly Boulevard, PACT Suite 400; 8700 Beverly Boulevard, PACT Suite 400 Los Angeles CA, 90048 90048 USA
| | - Daniela Prayer
- Medical University Vienna; Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology; Waehringer Guertel 18-20 Vienna A-1090 Austria
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Clouchoux C, Guizard N, Evans AC, du Plessis AJ, Limperopoulos C. Normative fetal brain growth by quantitative in vivo magnetic resonance imaging. Am J Obstet Gynecol 2012; 206:173.e1-8. [PMID: 22055336 DOI: 10.1016/j.ajog.2011.10.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 07/15/2011] [Accepted: 10/03/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to characterize total and regional volumetric brain growth in healthy fetuses during the second and third trimesters of pregnancy, using an automated method. STUDY DESIGN We developed and validated an automated method to quantify global and regional in vivo brain volumes using fetal magnetic resonance imaging. We then computed the percentage of growth for each brain structure in a cohort of 64 healthy fetuses (25.4-36.6 weeks' gestational age). RESULTS The cerebellum demonstrated the greatest maturation rate, with a 4-fold increase (384%) in volume between 25.4 and 36.6 weeks, and a relative growth rate of 12.87% per week. Both total brain and cerebral volumes increased by 230% and brain stem volume by 134% over the same gestational age period. Conversely, lateral ventricular volume decreased by 4.18% per week. CONCLUSION The availability and ongoing validation of normative fetal brain growth trajectories will provide important tools for early detection of impaired fetal brain growth upon which to manage high-risk pregnancies.
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Affiliation(s)
- Cedric Clouchoux
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 20010, USA
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Clouchoux C, Limperopoulos C. Novel applications of quantitative MRI for the fetal brain. Pediatr Radiol 2012; 42 Suppl 1:S24-32. [PMID: 22395718 DOI: 10.1007/s00247-011-2178-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/27/2011] [Indexed: 11/30/2022]
Abstract
The advent of ultrafast MRI acquisitions is offering vital insights into the critical maturational events that occur throughout pregnancy. Concurrent with the ongoing enhancement of ultrafast imaging has been the development of innovative image-processing techniques that are enabling us to capture and quantify the exuberant growth, and organizational and remodeling processes that occur during fetal brain development. This paper provides an overview of the role of advanced neuroimaging techniques to study in vivo brain maturation and explores the application of a range of new quantitative imaging biomarkers that can be used clinically to monitor high-risk pregnancies.
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Affiliation(s)
- Cédric Clouchoux
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA.
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Nemec SF, Nemec U, Weber M, Kasprian G, Brugger PC, Krestan CR, Rotmensch S, Rimoin DL, Graham JM, Prayer D. Male sexual development in utero: testicular descent on prenatal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:688-694. [PMID: 21337441 DOI: 10.1002/uog.8964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To visualize in utero male fetal testicular descent on magnetic resonance imaging (MRI) and to correlate it with gestational age. METHODS This retrospective study included 202 MRI examination results of 199 male fetuses (17-39 gestational weeks) with normal anatomy or minor congenital abnormalities, following suspicion of anomalies on prenatal ultrasound examination. Using a 1.5-Tesla unit, multiplanar T2-weighted sequences were applied using a standard protocol to image and identify the scrotal content. The relative frequencies of unilateral and bilateral testicular descent were calculated and correlated with gestational age. RESULTS Between 17 and 25 gestational weeks, neither unilateral nor bilateral testicular descent was visualized on MRI. Testicular descent was first observed at 25 + 4 weeks, in 7.7% of cases. 12.5% of 27-week fetuses showed unilateral descent and 50% showed bilateral descent. Bilateral descent was observed in 95.7% of cases, on average, from 30 to 39 weeks. CONCLUSIONS Our results chart the time course of testicular descent on prenatal MRI, which may be helpful in the identification of normal male sexual development and in the diagnosis of congenital abnormalities, including the early detection of cryptorchidism.
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Affiliation(s)
- S F Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Vienna, Austria.
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Nemec SF, Nemec U, Weber M, Rotmensch S, Brugger PC, Kasprian G, Krestan CR, Rimoin DL, Graham JM, Prayer D. Female external genitalia on fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:695-700. [PMID: 21584884 DOI: 10.1002/uog.8973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To characterize the normal development of the female external genitalia on fetal magnetic resonance imaging (MRI). METHODS This retrospective study included MRI examinations of 191 female fetuses (20-36 gestational weeks) with normal anatomy or minor abnormalities, following suspicion of anomalies on prenatal ultrasound examination. Using a 1.5-Tesla unit, the bilabial diameter was measured on T2-weighted sequences. Statistical description, as well as correlation and regression analyses, was used to evaluate bilabial diameter in relation to gestational age. MRI measurements were compared with published ultrasound data. The morphological appearance and signal intensities of the external genitalia were also assessed. RESULTS Mean bilabial diameters, with 95% CIs and percentiles, were defined. The bilabial diameter as a function of gestational age was expressed by the regression equation: bilabial diameter = - 11.336 + 0.836 × (gestational age in weeks). The correlation coefficient, r = 0.782, was statistically significant (P < 0.001). Bilabial diameter on MRI was not significantly different from that on ultrasound (P < 0.001). In addition, on MRI we observed changes in morphology of the external genitalia and in signal intensities with increasing gestational age. CONCLUSIONS We have provided a reference range of fetal bilabial diameter on MRI, which, in addition to ultrasound findings, may be helpful in the identification of genital anomalies.
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Affiliation(s)
- S F Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Vienna, Austria.
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Kul S, Korkmaz HAA, Cansu A, Dinc H, Ahmetoglu A, Guven S, Imamoglu M. Contribution of MRI to ultrasound in the diagnosis of fetal anomalies. J Magn Reson Imaging 2011; 35:882-90. [DOI: 10.1002/jmri.23502] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/19/2011] [Indexed: 11/10/2022] Open
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Berger-Kulemann V, Brugger PC, Reisegger M, Klein K, Hachemian N, Koelblinger C, Weber M, Prayer D. Quantification of the subcutaneous fat layer with MRI in fetuses of healthy mothers with no underlying metabolic disease vs. fetuses of diabetic and obese mothers. J Perinat Med 2011; 40:179-84. [PMID: 22117112 DOI: 10.1515/jpm.2011.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 10/19/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the age-dependent fetal subcutaneous fat layer (SCFL) of non-diabetic, normal-weight mothers and fetuses of mothers with gestational diabetes (GDM) and normal body weight or obesity. METHODS In a prospective study, we evaluated 115 MRI examinations of fetuses with no history of (maternal) metabolic disease [gestational week (GW) 29 to 39/40] and 50 examinations of mothers with GDM and normal body weight or obesity. The SCFL was measured at predetermined anatomical landmarks. Measurements were correlated with the maternal body mass index (BMI) and glycated hemoglobin A1c (HbA1c)-values in diabetic mothers. RESULTS In fetuses of non-diabetic, normal-weight mothers, measurements showed high consistency within the respective GW and ranged from 2 mm at GW 29 at all measured points, up to 4.5 mm at the trunk and 6.0 mm at the extremities at GW 39/40. In 47/50 fetuses of mothers with GDM, the SCFL was within the range of fetuses of mothers with no metabolic disease. In three patients with GDM and BMI<30, the SCFL-thickness was decreased. No fetuses showed an increased SCFL-thickness. CONCLUSION The SCFL of normally developed fetuses is easily detectable from GW 29 on T1-weighted images (T1-W), and increases with gestational age. The presented data provide physiological benchmarks to evaluate developmental status and may help in the prenatal diagnosis of abnormal growth and macrosomia. In pregnant women with well-controlled GDM, an increase of the SCFL is not expected.
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Nemec SF, Kasprian G, Brugger PC, Bettelheim D, Amann G, Nemec U, Rotmensch S, Graham JM, Rimoin DL, Lachman RS, Prayer D. Abnormalities of the upper extremities on fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:559-567. [PMID: 21308835 DOI: 10.1002/uog.8949] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE In view of the increasing use of fetal magnetic resonance imaging (MRI) as an adjunct to prenatal ultrasonography, we sought to demonstrate the visualization of upper extremity abnormalities and associated defects on MRI, with regard to fetal outcomes and compared with ultrasound imaging. METHODS This retrospective study included 29 fetuses with upper extremity abnormalities visualized with fetal MRI following suspicious ultrasound findings and confirmed by postnatal assessment or autopsy. On a 1.5-Tesla unit, dedicated sequences were applied to image the extremities. Central nervous system (CNS) and extra-CNS anomalies were assessed to define extremity abnormalities as isolated or as complex, with associated defects. Fetal outcome was identified from medical records. MRI and ultrasound findings, when available, were compared. RESULTS Isolated upper extremity abnormalities were found in three (10.3%) fetuses. In 26 (89.7%) fetuses complex abnormalities, including postural extremity disorders (21/26) and structural extremity abnormalities (15/26), were demonstrated. Associated defects involved: face (15/26); musculoskeletal system (14/26); thorax and cardio/pulmonary system (12/26); lower extremities (12/26); brain and skull (10/26); and abdomen (8/26). Of the 29 cases, 18 (62.1%) pregnancies were delivered and 11 (37.9%) were terminated. MRI and US findings were compared in 27/29 cases: the diagnosis was concordant in 14 (51.9%) of these cases, and additional findings were made on MRI in 13/27 (48.1%) cases. CONCLUSIONS Visualization of upper extremity abnormalities on fetal MRI enables differentiation between isolated defects and complex ones, which may be related to poor fetal prognosis. MRI generally confirms the ultrasound diagnosis, and may provide additional findings in certain cases.
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Affiliation(s)
- S F Nemec
- Medical Genetics Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
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Messerschmidt A, Baschat A, Linduska N, Kasprian G, Brugger PC, Bauer A, Weber M, Prayer D. Magnetic resonance imaging of the placenta identifies placental vascular abnormalities independently of Doppler ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:717-722. [PMID: 21105016 DOI: 10.1002/uog.8891] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the relationship between placental vascular pathology detected by prenatal magnetic resonance imaging (MRI) and perinatal outcome. METHODS This was a retrospective, hospital-based, cross-sectional study in which all fetal MRI examinations of singleton pregnancies with vascular placental pathology (i.e. infarction with/without hemorrhage, subchorionic thrombi/hemorrhages, intervillous thrombi/hemorrhages, or retroplacental hematoma) in the period 2002-2007 were included. The extent of the pathology was expressed as a percentage of the total placental volume. Abnormalities of umbilical artery Doppler ultrasound examinations within 7 days between MRI and ultrasound examination were noted. Death in utero or postnatally was the primary outcome. Gestational age at MRI and at birth and the occurrence of intrauterine growth restriction (IUGR) were noted. Logistic regression analysis was performed to assess the impact of gestational age at MRI, extent of the vascular lesion and presence of pathological Doppler ultrasound measurements on the prediction of mortality. RESULTS Fifty-nine structurally normal singleton pregnancies with placental vascular abnormalities were included in the analysis. Mortality rate was 36%; among the survivors, 87% were born before 37 + 0 gestational weeks and 50% suffered from IUGR. In 55% of the pregnancies pathological umbilical artery Doppler findings were identified, of which 27% were non-survivors. Mortality was predicted by earlier gestational age at fetal MRI for placental pathology (P < 0.05) and increasing extent of the vascular lesion (P < 0.05), but not by the presence of pathological Doppler ultrasound data. Accuracy of the prediction was 82%, sensitivity was 67% and specificity 89%. CONCLUSION MRI-detected vascular placental pathologies may help to identify pregnancies at risk for adverse outcome and fetal death independently of umbilical artery Doppler status.
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Affiliation(s)
- A Messerschmidt
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
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Quantitative in vivo MRI measurement of cortical development in the fetus. Brain Struct Funct 2011; 217:127-39. [PMID: 21562906 DOI: 10.1007/s00429-011-0325-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/28/2011] [Indexed: 01/25/2023]
Abstract
Normal brain development is associated with expansion and folding of the cerebral cortex following a highly orchestrated sequence of gyral-sulcal formation. Although several studies have described the evolution of cerebral cortical development ex vivo or ex utero, to date, very few studies have characterized and quantified the gyrification process for the in vivo fetal brain. Recent advances in fetal magnetic resonance imaging and post-processing computational methods are providing new insights into fetal brain maturation in vivo. In this study, we investigate the in vivo fetal cortical folding pattern in healthy fetuses between 25 and 35 weeks gestational age using 3-D reconstructed fetal cortical surfaces. We describe the in vivo fetal gyrification process using a robust feature extraction algorithm applied directly on the cortical surface, providing an explicit delineation of the sulcal pattern during fetal brain development. We also delineate cortical surface measures, including surface area and gyrification index. Our data support an exuberant third trimester gyrification process and suggest a non-linear evolution of sulcal development. The availability of normative indices of cerebral cortical developing in the living fetus may provide critical insights on the timing and progression of impaired cerebral development in the high-risk fetus.
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Nemec SF, Höftberger R, Nemec U, Bettelheim D, Brugger PC, Kasprian G, Amann G, Rotmensch S, Graham JM, Rimoin DL, Prayer D. Fetal akinesia and associated abnormalities on prenatal MRI. Prenat Diagn 2011; 31:484-90. [PMID: 21374641 DOI: 10.1002/pd.2724] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/04/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In view of the increasing role of magnetic resonance imaging (MRI) as an adjunct to prenatal ultrasonography (US), this study sought to demonstrate the visualization of fetal akinesia and associated abnormalities on MRI. METHODS This retrospective study included six fetuses with akinesia and associated abnormalities, depicted on fetal MRI after suspicious prenatal US. The whole fetus was assessed for musculoskeletal abnormalities and associated pathological conditions elsewhere. Fetal outcome data were compared with prenatal imaging. US and MRI findings were also compared. RESULTS Akinesia resulting in arthrogryposis was seen in 6/6 fetuses, with abnormal musculature in 5/6 fetuses. Associated brain abnormalities were found in 2/6 fetuses; facial abnormalities in 3/6; lung hypoplasia in 3/6; and polyhydramnios in 2/6. There were 5/6 pregnancies that were terminated and one individual died neonatally. MRI and brain autopsy were concordant in 4/6 cases. MRI and body autopsy were concordant in 1/6 cases and in 5/6 cases, autopsy revealed additional abnormalities. In addition to US, MRI correctly identified central nervous system findings in four cases and lung hypoplasia in three cases. CONCLUSION Our MRI results demonstrate fetal akinesia and associated abnormalities, which may have an impact on perinatal management, as an adjunct to prenatal US.
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Affiliation(s)
- Stefan F Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Vienna, Austria.
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Nemec U, Nemec SF, Krakow D, Brugger PC, Malinger G, Graham JM, Rimoin DL, Prayer D. The skeleton and musculature on foetal MRI. Insights Imaging 2011; 2:309-318. [PMID: 22347955 PMCID: PMC3259321 DOI: 10.1007/s13244-011-0075-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 11/21/2010] [Accepted: 01/27/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Magnetic resonance imaging (MRI) is used as an adjunct to ultrasound in prenatal imaging, the latter being the standard technique in obstetrical medicine. METHODS: Initial results demonstrate the ability to visualise the foetal skeleton and muscles on MRI, and highlight the potentially useful applications for foetal MRI, which has significantly profited from innovations in sequence technology. Echoplanar imaging, thick-slab T2-weighted (w) imaging, and dynamic sequences are techniques complementary to classical T2-w imaging. RESULTS: Recent study data indicate that foetal MRI may be useful in the imaging of spinal dysraphism and in differentiating between isolated and complex skeletal deformities with associated congenital malformations, which might have an impact on pre- and postnatal management. CONCLUSION: More research and technical refinement will be necessary to investigate normal human skeletal development and to identify MR imaging characteristics of skeletal abnormalities.
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Affiliation(s)
- Ursula Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Stefan F. Nemec
- Medical Genetics Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, PACT Suite 400, Los Angeles, CA 90048 USA
| | - Deborah Krakow
- Department of Orthopedic Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095 USA
| | - Peter C. Brugger
- Center of Anatomy and Cell Biology, Integrative Morphology Group, Medical University Vienna, Waehringerstrasse 13, 1090 Vienna, Austria
| | - Gustavo Malinger
- Fetal Neurology Clinic, Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - John M. Graham
- Medical Genetics Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, PACT Suite 400, Los Angeles, CA 90048 USA
| | - David L. Rimoin
- Medical Genetics Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, PACT Suite 400, Los Angeles, CA 90048 USA
| | - Daniela Prayer
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Ulla M, Aiello H, Cobos MP, Orioli I, García-Mónaco R, Etchegaray A, Igarzábal ML, Otaño L. Prenatal diagnosis of skeletal dysplasias: contribution of three-dimensional computed tomography. Fetal Diagn Ther 2011; 29:238-47. [PMID: 21212631 DOI: 10.1159/000322212] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 10/20/2010] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To describe the contribution of 3-dimensional computed tomography (3D-CT) in the prenatal diagnosis of skeletal dysplasias (SD) in a cohort of patients with inconclusive diagnosis by ultrasound (US). METHODS Between May 2007 and February 2010, six pregnant women with suspected fetal SD on US examination but with no specific diagnosis were studied with 3D-CT. The images were evaluated by a multidisciplinary team who proposed a likely diagnosis. Further postnatal workup included clinical and radiological evaluation in all cases. Prenatal and postnatal diagnoses were compared. RESULTS The use of 3D-CT provided a precise diagnosis confirmed postnatally in 5/6 patients. These included osteogenesis imperfecta type II (n = 2), osteogenesis imperfecta type III (n = 1), chondrodysplasia punctata (n = 1) and thanatophoric dysplasia type I (n = 1). A precise diagnosis could not be made in 1 case - either pre- or postnatally. CONCLUSION Prenatal 3D-CT contributed to the diagnosis of the specific fetal SD in the majority of these cases. 3D-CT may have a complementary role to US where fetal SD is suspected, but no specific diagnosis can be made using US alone. Further studies on clinical performance and risk-benefit analysis are needed.
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Affiliation(s)
- Marina Ulla
- Department of Radiology, Hospital Italiano de Buenos Aires, Universidad de Buenos Aires, Argentina. marina.ulla @ hospitalitaliano.org.ar
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Abstract
Fetal MRI is becoming an increasingly powerful imaging tool for studying brain development in vivo. Until recently, the application of advanced magnetic resonance imaging techniques was limited by motion in the nonsedated fetus. Extensive research efforts currently underway are focusing on the development of dedicated magnetic resonance imaging sequences and sophisticated postprocessing techniques that are revolutionizing our ability to study the healthy and compromised fetus. The ongoing refinement of these magnetic resonance imaging techniques will undoubtedly lead to the development of cornerstone biomarkers that will provide healthcare caregivers with vital, and currently lacking, information upon which to counsel parents effectively, and base rational decisions regarding the timing and type of novel medical and surgical interventions currently on the horizon.
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Anquez J, Angelini E, Bloch I, Merzoug V, Bellaiche-Millischer AE, Adamsbaum C. Interest of the steady state free precession (SSFP) sequence for 3D modeling of the whole fetus. ACTA ACUST UNITED AC 2008; 2007:771-4. [PMID: 18002070 DOI: 10.1109/iembs.2007.4352404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fetal magnetic resonance imaging (MRI) has been gaining interest over the last two decades. Current fast MRI sequences provide imaging data of the whole uterus in less than 20 seconds, avoiding fetal motion related artifacts without any maternal or fetal sedation. MRI has proved to be a useful adjunct to echographic screening for prenatal diagnosis. However, MRI volumetric data is still mainly interpreted on 2D slices and 3D applications remain limited. In this paper, we discuss the qualities of the SSFP MRI sequences to provide adequate data for 3D segmentation and modeling of the fetus. Potential exploitations of 3D segmentation and derived anatomical models cover several domains: biometric and morphologic clinical studies, quantitative longitudinal studies of normal and abnormal fetus developments, direct visualization of the overall fetus body and simulations in different fields (surgery, radiation dosimetry,...).
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Affiliation(s)
- J Anquez
- Signal and Image Processing Department, GET-Telecom Paris (ENST)-CNRS UMR 5141 LTCI, Paris, France
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Bonel H, Frei KA, Raio L, Meyer-Wittkopf M, Remonda L, Wiest R. Prospective navigator-echo-based real-time triggering of fetal head movement for the reduction of artifacts. Eur Radiol 2007; 18:822-9. [PMID: 18075742 DOI: 10.1007/s00330-007-0812-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 08/30/2007] [Accepted: 10/16/2007] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the neuroimaging quality and accuracy of prospective real-time navigator-echo acquisition correction versus untriggered intrauterine magnetic resonance imaging (MRI) techniques. Twenty women in whom fetal motion artifacts compromised the neuroimaging quality of fetal MRI taken during the 28.7 +/- 4 week of pregnancy below diagnostic levels were additionally investigated using a navigator-triggered half-Fourier acquired single-shot turbo-spin echo (HASTE) sequence. Imaging quality was evaluated by two blinded readers applying a rating scale from 1 (not diagnostic) to 5 (excellent). Diagnostic criteria included depiction of the germinal matrix, grey and white matter, CSF, brain stem and cerebellum. Signal-difference-to-noise ratios (SDNRs) in the white matter and germinal zone were quantitatively evaluated. Imaging quality improved in 18/20 patients using the navigator echo technique (2.4 +/- 0.58 vs. 3.65 +/- 0.73 SD, p < 0.01 for all evaluation criteria). In 2/20 patients fetal movement severely impaired image quality in conventional and navigated HASTE. Navigator-echo imaging revealed additional structural brain abnormalities and confirmed diagnosis in 8/20 patients. The accuracy improved from 50% to 90%. Average SDNR increased from 0.7 +/- 7.27 to 19.83 +/- 15.71 (p < 0.01). Navigator-echo-based real-time triggering of fetal head movement is a reliable technique that can deliver diagnostic fetal MR image quality despite vigorous fetal movement.
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Affiliation(s)
- H Bonel
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Berne-Inselspital, Freiburgstrasse, 3010, Bern, Switzerland.
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Balassy C, Kasprian G, Brugger PC, Csapo B, Weber M, Hörmann M, Bankier A, Bammer R, Herold CJ, Prayer D. Diffusion-weighted MR imaging of the normal fetal lung. Eur Radiol 2007; 18:700-6. [DOI: 10.1007/s00330-007-0784-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/30/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
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