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Kim O, Hong S, Jung YM, Seol HJ, Na S, Bae JG, Ahn KH, Lee MY, Kwon HY, Sung JH, Choi SR, Kim SC, Lee KA, Kim HS, Kim MJ, Song JE, Hwang HS, Won HS, Jun JK, Ko HS. Prenatal Diagnosis and Clinical Outcomes of Isolated Mega Cisterna Magna. J Child Neurol 2024:8830738241282037. [PMID: 39360439 DOI: 10.1177/08830738241282037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Objective: The study aimed to investigate the clinical outcomes of fetuses diagnosed with isolated mega cisterna magna in utero. Methods: A multicenter retrospective cohort study was conducted across 18 university hospitals from 2010 to 2019. Cases diagnosed with isolated mega cisterna magna, defined as a cisterna magna >10 mm with a normal cerebellar vermis and no cystic dilation of the fourth ventricle, were included. Cases with other central nervous system (CNS) anomalies, extra-central nervous system anomalies, chromosomal abnormalities, or congenital infections were excluded. Maternal demographics, prenatal findings, delivery outcomes, and postnatal outcomes were analyzed. Results: The mean gestational age at initial diagnosis was 28.6 ± 3.9 weeks, and the mean anteroposterior diameter of the cisterna magna was 12.5 ± 3.2 mm. Of the 71 cases initially assessed, 48 (67.6%) showed self-regression in utero. Postnatally, 13 cases (18.3%) had persistent isolated mega cisterna magna, whereas 10 cases (14.1%) were diagnosed with other central nervous system anomalies. Among the persistent isolated mega cisterna magna cases, one child exhibited delayed neurodevelopment. There was a higher incidence of isolated mega cisterna magna in male fetuses, which exhibited a significantly larger mean cisterna magna diameter compared with female fetuses (P = .045). Conclusion: Male fetuses exhibited a higher incidence of isolated mega cisterna magna compared with female fetuses and had larger anteroposterior diameters of the cisterna magna. The study demonstrated favorable neurodevelopmental outcomes associated with isolated mega cisterna magna, with self-regression observed in two-thirds of the cases. However, consecutive prenatal and postnatal evaluations for additional central nervous system or extra-central nervous system malformations need to be performed, considering the differences between prenatal and postnatal diagnoses.
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Affiliation(s)
- Oyoung Kim
- Department of Obstetrics and Gynecology, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Jin Gon Bae
- Department of Obstetrics and Gynecology, Keimyung University College of Medicine, Daegu, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ha Yan Kwon
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University Health System, Seodaemun-gu, Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Ran Choi
- Department of Obstetrics and Gynecology, Inha University College of Medicine, Incheon, Korea
| | - Seung Cheol Kim
- Department of Obstetrics and Gynecology, Biomedical Research Institute, Pusan National University College of Medicine, Busan, Korea
| | - Kyung A Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee Sun Kim
- Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Mi Ju Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Eun Song
- Department of Obstetrics and Gynecolgy, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Han Sung Hwang
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Costa S, Cocca C, D'Apolito G, De Gisi A, Fattore S, Tataranno ML, Benders M, Pastorino R, Colosimo C, Vento G. Effects of a Multicomponent Lipid Emulsion on Brain Volumes in Extremely Low Birth Weight Infants. Am J Perinatol 2024; 41:e1813-e1819. [PMID: 37075786 DOI: 10.1055/a-2077-2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE During the early weeks of life optimization of nutrition in extremely preterm infants presents a critical opportunity to attenuate the adverse neurological consequences of prematurity and potentially improve neurodevelopmental outcome. We hypothesized that the use of multicomponent lipid emulsion (MLE) in parenteral nutrition (PN) would be related to larger volume of the cerebellum on brain magnetic resonance at term of equivalent age (TEA) in extremely low birth weight (ELBW) infants. STUDY DESIGN We analyzed the brain magnetic resonance imaging (MRI) at TEA of a cohort of preterm infants with gestational age ≤28 weeks and/or birth weight <1,000 g randomly assigned in our previous trial to receive an MLE or soybean-based lipid emulsion (SLE). The primary outcome of the study was the cerebellar volume (CeV), valued on MRI acquired at TEA. Secondary outcomes included total brain volume (TBV), supratentorial volume, brainstem volume, and CeV corrected for TBV evaluated on MRI acquired at TEA. RESULTS MRIs at TEA of 34 infants were then analyzed: 17 in the MLE group and 17 in the SLE group. The postmenstrual age (PMA) at which MRIs were performed were comparable between the two study groups. The CeV as well as the PMA-corrected CeV were significantly higher in the MLE group than in the SLE group. No difference was found among the other brain volumes considered. CONCLUSION Our results suggest that the use of MLE in PN could promote CeV growth in ELBW infants, valued with MRI at TEA. KEY POINTS · Optimization of nutrition in extremely low birthweight infants.. · Use of multicomponent lipid emulsions in parenteral nutrition.. · Larger cerebellar volume with use of multicomponent lipid emulsion..
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Affiliation(s)
- Simonetta Costa
- Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmen Cocca
- Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella D'Apolito
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Diagnostic Imaging Area, Rome, Italy
| | - Antonietta De Gisi
- Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Fattore
- Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria L Tataranno
- Unit of Neonatology, Wilhemina Children's Hospital University Medical Center, Utrecht, The Netherlands
| | - Manon Benders
- Unit of Neonatology, Wilhemina Children's Hospital University Medical Center, Utrecht, The Netherlands
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Diagnostic Imaging Area, Rome, Italy
- Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Kobets AJ, Alavi SAN, Ahmad SJ, Castillo A, Young D, Minuti A, Altschul DJ, Zhu M, Abbott R. Volumetric segmentation in the context of posterior fossa-related pathologies: a systematic review. Neurosurg Rev 2024; 47:170. [PMID: 38637466 PMCID: PMC11026186 DOI: 10.1007/s10143-024-02366-4] [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: 01/28/2024] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Segmentation tools continue to advance, evolving from manual contouring to deep learning. Researchers have utilized segmentation to study a myriad of posterior fossa-related conditions, such as Chiari malformation, trigeminal neuralgia, post-operative pediatric cerebellar mutism syndrome, and Crouzon syndrome. Herein, we present a summary of the current literature on segmentation of the posterior fossa. The review highlights the various segmentation techniques, and their respective strengths and weaknesses, employed along with objectives and outcomes of the various studies reported in the literature. METHODS A literature search was conducted in PubMed, Embase, Cochrane, and Web of Science up to November 2023 for articles on segmentation techniques of posterior fossa. The two senior authors searched through databases based on the keywords of the article separately and then enrolled joint articles that met the inclusion and exclusion criteria. RESULTS The initial search identified 2205 articles. After applying inclusion and exclusion criteria, 77 articles were selected for full-text review after screening of titles/abstracts. 52 articles were ultimately included in the review. Segmentation techniques included manual, semi-automated, and fully automated (atlas-based, convolutional neural networks). The most common pathology investigated was Chiari malformation. CONCLUSIONS Various forms of segmentation techniques have been used to assess posterior fossa volumes/pathologies and each has its advantages and disadvantages. We discuss these nuances and summarize the current state of literature in the context of posterior fossa-associated pathologies.
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Affiliation(s)
- Andrew J Kobets
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA
| | - Seyed Ahmad Naseri Alavi
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA.
| | | | | | | | | | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA
| | - Michael Zhu
- Albert Einstein College of Medicine, New York City, USA
| | - Rick Abbott
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA
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She J, Huang H, Ye Z, Huang W, Sun Y, Liu C, Yang W, Wang J, Ye P, Zhang L, Ning G. Automatic biometry of fetal brain MRIs using deep and machine learning techniques. Sci Rep 2023; 13:17860. [PMID: 37857681 PMCID: PMC10587162 DOI: 10.1038/s41598-023-43867-4] [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: 03/08/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Linear biometric measurements on magnetic resonance images are important for the assessment of fetal brain development, which is expert knowledge dependent and laborious. This study aims to construct a segmentation-based method for automatic two-dimensional biometric measurements of fetal brain on magnetic resonance images that provides a fast and accurate measurement of fetal brain. A total of 268 volumes (5360 images) magnetic resonance images of normal fetuses were included. The automatic method involves two steps. First, the fetal brain was segmented into four parts with a deep segmentation network: cerebrum, cerebellum, and left and right lateral ventricles. Second, the measurement plane was determined, and the corresponding biometric parameters were calculated according to clinical guidelines, including cerebral biparietal diameter (CBPD), transverse cerebellar diameter (TCD), left and right atrial diameter (LAD/RAD). Pearson correlation coefficient and Bland-Altman plots were used to assess the correlation and agreement between computer-predicted values and manual measurements. Mean differences were used to evaluate the errors quantitatively. Analysis of fetal cerebral growth based on the automatic measurements was also displayed. The experiment results show that correlation coefficients for CBPD, TCD, LAD and RAD were as follows: 0.977, 0.990, 0.817, 0.719, mean differences were - 2.405 mm, - 0.008 mm, - 0.33 mm, - 0.213 mm, respectively. The correlation between the errors and gestational age was not statistically significant (p values were 0.2595, 0.0510, 0.1995, and 0.0609, respectively). The proposed automatic method for linear measurements on fetal brain MRI achieves excellent performance, which is expected to be applied in clinical practice and be helpful for prenatal diagnosis and clinical work efficiency improvement.
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Affiliation(s)
- Jiayan She
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Haiying Huang
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Zhijun Ye
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Huang
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Yan Sun
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Chuan Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Weilin Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiaxi Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Pengfei Ye
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Lei Zhang
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Gang Ning
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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Cavalheiro S, da Costa MDS, Barbosa MM, Suriano IC, Ottaiano AC, de Andrade Lourenção Freddi T, Ferreira NPFD, Kusano CU, Dastoli PA, Nicácio JM, Sarmento SGP, Moron AF. Fetal neurosurgery. Childs Nerv Syst 2023; 39:2899-2927. [PMID: 37606832 DOI: 10.1007/s00381-023-06109-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
Among fetal surgical procedures, neurosurgery stands out due to the number of cases and the possibility of developing new procedures that can be performed in the fetal period. To perform fetal neurosurgical procedures, there is a need for specialized centers that have experts in the diagnosis of fetal pathologies and a highly complex obstetrics service with specialized maternal-fetal teams associated with a pediatric neurosurgery center with expertise in the diverse pathologies of the fetus and the central nervous system that offers multidisciplinary follow-up during postnatal life. Services that do not have these characteristics should refer their patients to these centers to obtain better treatment results. It is essential that the fetal neurosurgical procedure be performed by a pediatric neurosurgeon with extensive experience, as he will be responsible for monitoring these patients in the postnatal period and for several years. The objective of this manuscript is to demonstrate the diagnostic and treatment possibilities, in the fetal period, of some neurosurgical diseases such as hydrocephalus, tumors, occipital encephalocele, and myelomeningocele.
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Affiliation(s)
- Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
| | - Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil.
| | | | - Italo Capraro Suriano
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
| | - Ana Carolina Ottaiano
- Diagnostic Imaging Department, Neuroradiology Subdivision, Hospital do Coração, São Paulo, SP, Brazil
- Teleimaging, São Paulo, SP, Brazil
| | - Tomás de Andrade Lourenção Freddi
- Diagnostic Imaging Department, Neuroradiology Subdivision, Hospital do Coração, São Paulo, SP, Brazil
- Teleimaging, São Paulo, SP, Brazil
| | - Nelson Paes Fortes Diniz Ferreira
- Diagnostic Imaging Department, Neuroradiology Subdivision, Hospital do Coração, São Paulo, SP, Brazil
- Teleimaging, São Paulo, SP, Brazil
| | - Cid Ura Kusano
- Department of Fetal Medicine, Hosptial e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Patricia Alessandra Dastoli
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
| | - Jardel Mendonça Nicácio
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
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Calandrelli R, Pilato F, Massimi L, Onesimo R, D’Apolito G, Tenore L, Romeo D, Leoni C, Zampino G, Colosimo C. Impairment of motor skills in children with achondroplasia-usefulness of brain and cranio-cervical junction evaluation by quantitative magnetic resonance imaging: a case-control study. Acta Radiol 2021; 63:1703-1711. [PMID: 34779271 DOI: 10.1177/02841851211055821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most infants and children with achondroplasia show delayed motor skill development; however, some patients may have clinical consequences related to cranio-cervical junction stenosis and compression. PURPOSE To assess, using brain magnetic resonance imaging (MRI), quantitative variables linked to neuromotor impairment in achondroplasic children. MATERIAL AND METHODS In total, 24 achondroplasic children underwent pediatric neurological assessment and were grouped in two cohorts according to relevant motor skill impairment. Achondroplasic children with (n=12) and without (n=12) motor symptoms were identified, and brain MRI scans were quantitatively evaluated. 3D fast spoiled gradient echo T1-weighted images were used to assess: supratentorial intracranial volumes (SICV); supratentorial intracranial brain volume (SICBV); SICV/SICBV ratio; posterior cranial fossa volume (PCFV); posterior cranial fossa brain volume (PCBFV); PCFV/PCFBV ratio; ventricular and extra-ventricular cerebrospinal fluid (CSF) volumes; foramen magnum (FM) area; and jugular foramina (JF) areas. RESULTS In both groups, SICV/SICBV ratio, supratentorial ventricular and extra-ventricular space volumes were increased while SICBV was increased only in the asymptomatic group (P < 0.05). PCFV/PCFBV ratio, IV ventricle, infratentorial extra-ventricular spaces volumes were reduced (P < 0.05) in the symptomatic group while PCFBV was increased only in the asymptomatic group (P < 0.05). Foramen magnum (FM) area was more reduced in the symptomatic group than the asymptomatic group (P < 0.05) but no correlation between FM area and ventriculomegaly was found (P > 0.05). CONCLUSION Evaluation of the FM area together with infratentorial ventricular and extra-ventricular space volume reduction may be helpful in differentiating patients at risk of developing motor skill impairment. Further investigation is needed to better understand the temporal profile between imaging and motor function in order to propose possible personalized surgical treatment.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, Neurosurgery Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Roberta Onesimo
- Rare Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Gabriella D’Apolito
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Tenore
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Pediatric Neurology Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Leoni
- Rare Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Giuseppe Zampino
- Rare Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
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Dovjak GO, Schmidbauer V, Brugger PC, Gruber GM, Diogo M, Glatter S, Weber M, Ulm B, Prayer D, Kasprian GJ. Normal human brainstem development in vivo: a quantitative fetal MRI study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:254-263. [PMID: 32730667 PMCID: PMC8457244 DOI: 10.1002/uog.22162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To characterize spatiotemporal growth differences of prenatal brainstem substructures and cerebellum, using linear biometry and planimetry on fetal magnetic resonance imaging (MRI). METHODS In this retrospective study, we included fetuses with normal brain and a precise midsagittal T2-weighted brain MRI sequence obtained between May 2003 and April 2019. The cross-sectional area, rostrocaudal diameter and anteroposterior diameter of the midbrain, pons (basis pontis and pontine tegmentum), medulla oblongata and cerebellar vermis, as well as the transverse cerebellar diameter, were quantified by a single observer. The diameters were also assessed by a second observer to test inter-rater variability. RESULTS We included 161 fetuses with normal brain and a precise midsagittal MRI sequence, examined at a mean ± SD gestational age of 25.7 ± 5.4 (range, 14 + 0 to 39 + 2) weeks. All substructures of the fetal brainstem and the cerebellum could be measured consistently (mean ± SD interobserver intraclass correlation coefficient, 0.933 ± 0.065). We provide reference data for diameters and areas of the brainstem and cerebellum in the second and third trimesters. There was a significant quadratic relationship between vermian area and gestational age, and all other measured parameters showed a significant linear growth pattern within the observed period (P < 0.001). A significant change in the relative proportions of the brainstem substructures occurred between the beginning of the second trimester and the end of the third trimester, with an increase in the area of the pons (P < 0.001) and a decrease in that of the midbrain (P < 0.001), relative to the total brainstem area. CONCLUSIONS The substructures of the fetal brainstem follow a distinct spatiotemporal growth pattern, characterized by a relative increase in the pons and decrease in the midbrain, between 15 and 40 weeks of gestation. Caution is needed when interpreting fetal brainstem appearance during the early second trimester, as the brainstem proportions differ significantly from the adult morphology. The reference data provided herein should help to increase diagnostic accuracy in detecting disorders of defective hindbrain segmentation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G. O. Dovjak
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - V. Schmidbauer
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - P. C. Brugger
- Center for Anatomy and Cell Biology, Department of AnatomyMedical University of ViennaViennaAustria
| | - G. M. Gruber
- Department of Anatomy and BiomechanicsKarl Landsteiner University of Health SciencesKremsAustria
| | - M. Diogo
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - S. Glatter
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - M. Weber
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - B. Ulm
- Department of Obstetrics and Feto‐Maternal MedicineMedical University of ViennaViennaAustria
| | - D. Prayer
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - G. J. Kasprian
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
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Calandrelli R, Pilato F, Panfili M, Battaglia D, Gambardella ML, Colosimo C. Brain structural changes in patients with cardio-facio-cutaneous syndrome: effects of BRAF gene mutation and epilepsy on brain development. A case-control study by quantitative magnetic resonance imaging. Neuroradiology 2021; 64:185-195. [PMID: 34309696 DOI: 10.1007/s00234-021-02769-w] [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: 02/26/2021] [Accepted: 07/10/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the brain volumetric changes caused by BRAF gene mutation in non-epileptic CFC patients and the influence of the age of epilepsy onset on brain development in 2 cohorts of epileptic CFC patients. METHODS We enrolled CFC patients carrying BRAF gene mutations without epilepsy (4 patients) and with epilepsy (16 patients). CFC epileptic patients were divided into two cohorts based on the age of seizure onset: early-age onset (7 children) and late-age onset (9 adolescents). All three cohorts of patients underwent 3D FSPGR T1-weighted imaging to assess supratentorial and infratentorial brain volumes. Moreover, for each compartment, gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) volumes were measured. All measurements were compared with those of age-matched controls without neuroimaging abnormalities. RESULTS All CFC patients showed supratentorial and infratentorial WM reduction and supratentorial ventricular enlargement (p < 0.01). However, patients with early age of epilepsy onset, compared with the other two cohorts of CFC patients, showed both GM and a more pronounced WM volume reduction (p < 0.01). CONCLUSION In non-epileptic CFC children, we demonstrated WM volumetric reduction suggesting a direct effect of BRAF gene mutation on brain development. Nevertheless, in CFC epileptic patients, the age of epilepsy onset may contribute to brain atrophy. Brain atrophy in CFC patients, in part due to the natural history of the disease, may be worsened by epilepsy when it begins in the early ages because of interference with brain growth at that critical age of development.
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Affiliation(s)
- Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128, Rome, Italy.
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
| | - Domenica Battaglia
- Child Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Neuropsichiatria infantile, Rome, Italy
| | - Maria Luigia Gambardella
- Child Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Cesare Colosimo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
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9
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van Dijk T, Barth P, Baas F, Reneman L, Poll-The BT. Postnatal Brain Growth Patterns in Pontocerebellar Hypoplasia. Neuropediatrics 2021; 52:163-169. [PMID: 33111306 DOI: 10.1055/s-0040-1716900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pontocerebellar hypoplasia (PCH) is a rare group of disorders mainly affecting the cerebellum and pons. Supratentorial structures are variably involved. We assessed brain growth patterns in patients with the most frequent forms of PCH, namely PCH1B (OMIM#614678) and PCH2A (OMIM#277470), since in these types of PCH, pre- and postnatal neurodegeneration is established by neuropathological profiling. To assess the influence of the different pathomechanisms on postnatal growth patterns, we included CASK-associated microcephaly and PCH (MICPCH, OMIM#300749) patients in our analyses, as MICPH mimics PCH on magnetic resonance imaging (MRI) but represents a developmental disorder including abnormal neuronal migration. METHODS A total of 66 patients were included: 9 patients with PCH1B, 18 patients with PCH2A, 6 patients with MICPCH, and 33 age- and gender-matched hospital-based controls. Segmentation of the vermis and cerebellum was performed manually, as were measurements of the thickness of the head of the caudate nucleus, the width of the anterior horn, and lateral ventricle size. RESULTS The cerebellum was severely hypoplastic at birth in all patients, and postnatal growth was nearly absent. In patients with PCH1B/2A, we found relative sparing of the vermis compared with the cerebellar hemispheres. In addition, PCH1B and PCH2A cases demonstrated thinning of the head of the caudate nucleus, an associated increase in anterior horn width, and an increase in lateral ventricle size. None of these features were seen in the MICPCH group. CONCLUSIONS Our findings confirm the progressive nature including caudate nucleus atrophy in PCH1B and PCH2A. In MICPCH, the relative sparing of supratentorial structures confirms its different pathomechanism.
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Affiliation(s)
- Tessa van Dijk
- Department of Clinical Genetics, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Barth
- Department of Pediatric Neurology, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bwee Tien Poll-The
- Department of Pediatric Neurology, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
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10
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Mckinnon K, Kendall GS, Tann CJ, Dyet L, Sokolska M, Baruteau KP, Marlow N, Robertson NJ, Peebles D, Srinivasan L. Biometric assessments of the posterior fossa by fetal MRI: A systematic review. Prenat Diagn 2020; 41:258-270. [PMID: 33251640 DOI: 10.1002/pd.5874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Posterior fossa abnormalities (PFAs) are commonly identified within routine screening and are a frequent indication for fetal magnetic resonance imaging (MRI). Although biometric measurements of the posterior fossa (PF) are established on fetal ultrasound and MRI, qualitative visual assessments are predominantly used to differentiate PFAs. OBJECTIVES This systematic review aimed to assess 2-dimensional (2D) biometric measurements currently in use for assessing the PF on fetal MRI to delineate different PFAs. METHODS The protocol was registered (PROSPERO ID CRD42019142162). Eligible studies included T2-weighted MRI PF measurements in fetuses with and without PFAs, including measurements of the PF, or other brain areas relevant to PFAs. RESULTS 59 studies were included - 6859 fetuses had 62 2D PF and related measurements. These included linear, area and angular measurements, representing measures of PF size, cerebellum/vermis, brainstem, and supratentorial measurements. 11 measurements were used in 10 or more studies and at least 1200 fetuses. These dimensions were used to characterise normal for gestational age, diagnose a range of pathologies, and predict outcome. CONCLUSION A selection of validated 2D biometric measurements of the PF on fetal MRI may be useful for identification of PFA in different clinical settings. Consistent use of these measures, both clinically and for research, is recommended.
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Affiliation(s)
- Katie Mckinnon
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Giles S Kendall
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Cally J Tann
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Leigh Dyet
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Institute for Women's Health, University College London, London, UK.,Medical Physics Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kelly Pegoretti Baruteau
- Institute for Women's Health, University College London, London, UK.,Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Nicola J Robertson
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Donald Peebles
- Institute for Women's Health, University College London, London, UK.,Obstetric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Latha Srinivasan
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
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11
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Gafner M, Yagel I, Fried S, Ezra O, Bar-Yosef O, Katorza E. Fetal brain biometry in isolated mega cisterna magna: MRI and US study. J Matern Fetal Neonatal Med 2020; 35:4199-4207. [PMID: 33207970 DOI: 10.1080/14767058.2020.1849094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To characterize the biometric parameters in ultrasound and brain MRI of fetuses with isolated mega cisterna magna (MCM). METHODS Cross-sectional historical cohort study conducted at a single tertiary medical center between 2011 and 2018. All fetuses underwent US and brain MRI scans. Matching analysis was performed according to gender and gestational age. RESULTS The study included a total of 103 fetuses; 44 fetuses with isolated MCM in the study group, and a control group of 59 fetuses with normal CNS. The study group had larger biparietal diameter (BPD) (86 vs. 79.8 mm, p = .001) and head circumference (HC) (318 vs. 292 mm, p < .001) on ultrasound. On MRI, study group had larger occipitofrontal diameter (OFD) (99 vs. 92 mm, p < .001) and BPD (77 vs. 72 mm, p < .001). Male fetuses' prevalence was higher in the study group (77.3% vs. 47.5%). After matching 20 fetuses from each group, the study group had larger HC (310.1 versus 300.7 mm, p = .029) and OFD (113.4 versus 108.3 mm, p = .009) on ultrasound, and larger OFD (97.4 versus 94.6, p = .013) on brain MRI. CONCLUSIONS Isolated MCM may be related to other large fetal CNS biometric measurements in both ultrasound and MRI and might be influenced by fetal gender.
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Affiliation(s)
- Michal Gafner
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itai Yagel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
| | - Shalev Fried
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Ezra
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
| | - Omer Bar-Yosef
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Neurology Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
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12
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Delteil C, Lesieur E, Tuchtan L, Carballeira Alvarez A, Chaumoitre K, Saliba B, Adalian P, Piercecchi-Marti MD. Study of the growth and shape of the brain and cranial base during the first two years of life. Morphologie 2020; 105:45-53. [PMID: 33069567 DOI: 10.1016/j.morpho.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
Ontogeny of the cranial base and the brain integrates data on growth, maturation and ontogenetic allometry of these two systems in the course of development. The aim of our work was to study the ontogeny of the cranial base and the brain in order to understand their growth dynamic and shape changes using a traditional morphometric approach in individuals with normal (non-pathological) development. MATERIEL AND METHOD Forty-seven infants having been included in the unexpected infant death french protocol were analyzed. Medical imaging (CT and MRI) exams, followed by an autopsy and pathology examination allowed us to include only infants free from brain disease or pathology affecting growth. RESULTS Testing of measurement reliability validated 12 distances and 3 angles as well as the positioning of the landmarks that had been used to obtain the distances and the angles. No correlation between sex and the various variables studied was found. However, a correlation was observed between these variables and age, making it possible to propose a growth curve. A medium to strong correlation was found between brain variables and the bone variables of the cranial base, underlining the parallel development of the two systems. CONCLUSION Our study, carried out in a rigorously selected population of infants, presents a fundamental approach to the study of ontogenesis.
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Affiliation(s)
- C Delteil
- Forensic Department, APHM, La Timone, 264, rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - E Lesieur
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France
| | - L Tuchtan
- Forensic Department, APHM, La Timone, 264, rue St Pierre, 13385 Marseille Cedex 05, France
| | - A Carballeira Alvarez
- Department of Radiology, Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147, boulevard Baille, 13005 Marseille Cedex 05, France
| | - K Chaumoitre
- Department of Radiology, CHU Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - B Saliba
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - P Adalian
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - M-D Piercecchi-Marti
- Forensic Department, APHM, La Timone, 264, rue St Pierre, 13385 Marseille Cedex 05, France
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13
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Calandrelli R, Pilato F, Massimi L, Panfili M, Di Rocco C, Colosimo C. Posterior Cranial Fossa Maldevelopment in Infants with Repaired Open Myelomeningoceles: Double Trouble or a Dynamic Process of Posterior Cranial Fossa Abnormalities? World Neurosurg 2020; 141:e989-e997. [PMID: 32585377 DOI: 10.1016/j.wneu.2020.06.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Two degrees of posterior cranial fossa (PCF) maldevelopment can be hypothesized in children with myelomeningocele (MMC). This paper investigates the PCF deformation by quantitative magnetic resonance imaging analysis in MMC subjects with and without Chiari 2 malformation (CM2). METHODS PCF bone volume (PCFV), PCF brain volume (PCFBV), lengths of PCF, ventriculomegaly, level, and extension of the dysraphism were analyzed by magnetic resonance image scanning of 51 newborns with MMC surgically repaired at birth (and 41 controls). The possible correlation among PCF hypoplasia, level/extension of the spinal dysraphism, and ventriculomegaly was assessed. RESULTS In MMC and CM2, the dysraphism level was above L4 in 30 and below L4 in 10 subjects. PCFV/PCFBV ratio and supraocciput and exocciput lengths were significantly reduced; foramen magnum diameters, mammillo-pontine distance, and pons length were significantly increased (P < 0.05). In isolated MMC, the dysraphism level was below L4 in all cases. PCFV/PCFBV ratio and supraocciput length were significantly reduced; pons length was significantly increased (P < 0.05). The lower the MMC level, the lower the incidence of CM2. A positive correlation was found between PCF hypoplasia and MMC level above L4 (P < 0.001), while a negative correlation was found among PCF hypoplasia and MMC extension (P = 0.006), PCF hypoplasia, and ventriculomegaly (P = 0.02). CONCLUSIONS PCF hypoplasia has to be considered a dynamic maldevelopment process in the 2 cohorts rather than 2 separated entities. The level of MMC is the main but not the unique cause influencing the severity of PCF maldevelopment.
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Affiliation(s)
- Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Radiology and Neuroradiology, Diagnostics For Images, Radiotherapy, Oncology and Hematology, Diagnostic Area for Images, Rome, Italy
| | - Fabio Pilato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Neurology-Polo Sciences of Aging, Neurological, Orthopedics and Head-Neck, Neuroscience Area, Rome, Italy
| | - Luca Massimi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Child Neurosurgery-Pole Sciences of Aging, Neurological, Orthopedics and Head-Neck, Neuroscience Area, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Radiology and Neuroradiology, Diagnostics For Images, Radiotherapy, Oncology and Hematology, Diagnostic Area for Images, Rome, Italy
| | - Concezio Di Rocco
- Pediatric Neurosuergery, International Neuroscience Institute, Hannover, Germany
| | - Cesare Colosimo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Radiology and Neuroradiology, Diagnostics For Images, Radiotherapy, Oncology and Hematology, Diagnostic Area for Images, Rome, Italy; Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
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14
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Xu F, Ge X, Shi Y, Zhang Z, Tang Y, Lin X, Teng G, Zang F, Gao N, Liu H, Toga AW, Liu S. Morphometric development of the human fetal cerebellum during the early second trimester. Neuroimage 2019; 207:116372. [PMID: 31751665 PMCID: PMC7055298 DOI: 10.1016/j.neuroimage.2019.116372] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/02/2019] [Accepted: 11/16/2019] [Indexed: 11/28/2022] Open
Abstract
The protracted nature of development makes the cerebellum vulnerable to a broad spectrum of pathologic conditions, especially during the early fetal period. This study aims to characterize normal cerebellar growth in human fetuses during the early second trimester. We manually segmented the fetal cerebellum using 7.0-T high-resolution MR images obtained in 35 specimens with gestational ages ranging from 15 to 22 weeks. Volume measurements and shape analysis were performed to quantitatively evaluate global and regional cerebellar growth. The absolute volume of the fetal cerebellum showed a quadratic growth with increasing gestational age, while the pattern of relative volume changes revealed that the cerebellum grew at a greater pace than the cerebrum after 17 gestational weeks. Shape analysis was used to examine the distinctive development of subregions of the cerebellum. The extreme lateral portions of both cerebellar hemispheres showed the lowest rate of growth. The anterior lobe grew faster than most of the posterior lobe. These findings expand our understanding of the early growth pattern of the human cerebellum and could be further used to assess the developmental conditions of the fetal brain.
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Affiliation(s)
- Feifei Xu
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, 250012, Jinan, Shandong, China; Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Xinting Ge
- Department of Medical Imaging, Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China; Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Zhonghe Zhang
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, 250012, Jinan, Shandong, China; Department of Medical Imaging, Provincial Hospital Affiliated to Shandong University, 250021, Jinan, Shandong, China
| | - Yuchun Tang
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, 250012, Jinan, Shandong, China
| | - Xiangtao Lin
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, 250012, Jinan, Shandong, China; Department of Medical Imaging, Provincial Hospital Affiliated to Shandong University, 250021, Jinan, Shandong, China
| | - Gaojun Teng
- Department of Radiology, Zhong Da Hospital, Southeast University School of Clinical Medicine, 210009, Nanjing, Jiangsu, China
| | - Fengchao Zang
- Department of Radiology, Zhong Da Hospital, Southeast University School of Clinical Medicine, 210009, Nanjing, Jiangsu, China
| | - Nuonan Gao
- Nanjing First Hospital, Affiliated to Nanjing Medical University, 210006, Nanjing, Jiangsu, China
| | - Haihong Liu
- Department of Medical Imaging, Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China
| | - Arthur W Toga
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA.
| | - Shuwei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, 250012, Jinan, Shandong, China.
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15
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Spinelli M, Wiest R, Di Meglio L, Baumann M, Raio L, Surbek D. The "vermian-crest angle": does it allow accurate categorisation of fetal upward rotation of cerebellar vermis on intrauterine MRI? A pilot study. Clin Radiol 2019; 74:489.e1-489.e7. [PMID: 30954236 DOI: 10.1016/j.crad.2019.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
AIM To test a new parameter to assess the position of the fetal cerebellar vermis in the posterior fossa (PF) using intrauterine magnetic resonance imaging (MRI). MATERIALS AND METHODS The angle between the cerebellar vermis and the internal occipital crest (vermian-crest angle, VCA) was assessed retrospectively using MRI in fetuses with and without PF anomalies. Spearman's rank test was used to investigate correlation of the VCA with gestational age (GA). Groups were compared using Student's t-test and the one-way analysis of variance (ANOVA) with the Bonferroni adjustment. Box-and-whisker plots were also used. RESULTS One hundred and two normal cases were identified. Mean±SD GA at MRI was 26.5±2.8 weeks (range: 22-32 weeks). The VCA was 64.49±11.5° independently of GA (r=0.19; p=0.12). In addition, 30 fetuses at 19-28 weeks were identified with Blake's pouch cyst (BPC; n=5), Dandy-Walker malformation (DWM; n=12), mega cisterna magna (MCM; n=10), and vermian hypoplasia (VH; n=3). The VCA was significantly different in the DWM (p<0.001) and BPC (p<0.001) subgroups, but was not significantly different in cases of VH (p=0.84) and MCM (p=0.95) in comparison with controls. CONCLUSIONS A new method to assess vermian position within the PF using intrauterine MRI was assessed. In combination with the other existing parameters, it may be helpful for addressing the categorisation of upward rotation of the fetal cerebellar vermis; however, further studies are necessary to strengthen the present findings.
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Affiliation(s)
- M Spinelli
- Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - R Wiest
- Department of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - L Di Meglio
- Private Centre "Diagnostica ecografica Aniello Di Meglio srl", Naples, Italy
| | - M Baumann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - L Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - D Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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16
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Haratz KK, Shulevitz SL, Leibovitz Z, Lev D, Shalev J, Tomarkin M, Malinger G, Lerman-Sagie T, Gindes L. Fourth ventricle index: sonographic marker for severe fetal vermian dysgenesis/agenesis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:390-395. [PMID: 29484745 DOI: 10.1002/uog.19034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Prenatal diagnosis of midbrain-hindbrain (MB-HB) malformations relies primarily on abnormal size and shape of the cerebellum and retrocerebellar space, particularly 'open fourth ventricle' (4V), the most common indicator of MB-HB malformations. The aim of this study was to present the fourth ventricle index (4VI), and to evaluate its role as a marker for severe vermian dysgenesis/agenesis in cases without open 4V. METHODS This was a prospective cross-sectional study of patients with singleton low-risk pregnancy at 14 + 1 to 36 + 6 gestational weeks presenting between May 2016 and November 2017 for routine ultrasound examination. Axial images of the fetal 4V were obtained and the 4VI was calculated as the ratio between the laterolateral and the anteroposterior diameters. Reference ranges were constructed and retrospectively collected values from 44 fetuses with confirmed anomalies involving severe vermian dysgenesis/agenesis (Joubert syndrome and related disorders, rhombencephalosynapsis, cobblestone malformations and cerebellar hypoplasia) but without open 4V were compared with the normal values. RESULTS In total, 384 healthy fetuses were enrolled into the study, from which reference ranges were produced, and 44 cases were collected retrospectively. The 4VI in the normal fetuses was always > 1. In affected fetuses, it was always below mean -2 SD and < 1. CONCLUSIONS The 4VI is a sonographic marker for severe fetal vermian dysgenesis/agenesis in the absence of an open 4V. It may be incorporated easily into the routine brain scan; 4VI < 1 indicates a need for dedicated fetal neuroimaging for diagnosis and prenatal counseling. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K K Haratz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S L Shulevitz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Ultrasound in ObGyn Unit, Department of ObGyn, Bnai Zion Medical Center, Haifa, Israel
| | - D Lev
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Tomarkin
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - T Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Fetal Neurology Clinic, Ultrasound in ObGyn Unit, Wolfson Medical Center, Holon, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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van der Knoop BJ, Vermeulen RJ, Verbeke JIML, Pistorius LR, de Vries JIP. Fetal MRI, lower acceptance by women in research vs. clinical setting. J Perinat Med 2018; 46:983-990. [PMID: 29031020 DOI: 10.1515/jpm-2016-0360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/31/2017] [Indexed: 12/28/2022]
Abstract
AIM To determine acceptance of pregnant women to undergo fetal magnetic resonance imaging (MRI) examination in research and clinical setting. METHODS A prospective study included a research group [part of a study comparing brain ultrasound (US) to MRI in fetuses at risk for acquired brain damage] and a clinical group [fetuses with suspected (brain) anomalies after structural US examination] from 2011 to 2014. All women were advised to use sedatives. MRI declinations, use of sedation, MRI duration and imaging quality were compared between both groups. RESULTS Study participation was accepted in 57/104 (55%) research cases. Fetal MRI was performed in 34/104 (33%) research and 43/44 (98%) clinical cases. Reasons to decline study participation were MRI related in 41%, and participation was too burdensome in 46%. Acceptance was highest for indication infection and lowest in alloimmune thrombocytopenia and monochorionic twin pregnancy. Sedatives were used in 14/34 research and 43/43 clinical cases. Scan duration and quality were comparable (21 and 20 min in research and clinical cases, respectively, moderate/good quality in both groups). CONCLUSIONS Pregnant women consider MRI more burdensome than professionals realize. Two-third of women at risk for fetal brain damage decline MRI examination. Future studies should evaluate which information about fetal MRI is supportive.
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Affiliation(s)
- Bloeme J van der Knoop
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands, Tel.: +31 (0) 20 4443239 or +31 (0) 20 4444444, pager 6112, Fax: +31 (0) 20 4443333.,Neuroscience Campus, VU University, Amsterdam, The Netherlands
| | - Roland J Vermeulen
- Department of Child Neurology, VU University Medical Center, P.O. Box 7057,1007 MB Amsterdam, TheNetherlands
| | - Jonathan I M L Verbeke
- Department of Pediatric Radiology, VU University Medical Center, P.O. Box 7057,1007 MB Amsterdam, TheNetherlands
| | - Lourens R Pistorius
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, TheNetherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057,1007 MB Amsterdam, TheNetherlands.,Research Institute MOVE, VU University, Amsterdam, TheNetherlands
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18
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Koning IV, Dudink J, Groenenberg IAL, Willemsen SP, Reiss IKM, Steegers-Theunissen RPM. Prenatal cerebellar growth trajectories and the impact of periconceptional maternal and fetal factors. Hum Reprod 2018; 32:1230-1237. [PMID: 28453631 DOI: 10.1093/humrep/dex079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/30/2017] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION CAN WE assess human prenatal cerebellar growth from the first until the third trimester of pregnancy and create growth trajectories to investigate associations with periconceptional maternal and fetal characteristics? SUMMARY ANSWER Prenatal growth trajectories of the human cerebellum between 9 and 32 weeks gestational age (GA) were created using three-dimensional ultrasound (3D-US) and show negative associations with pre-pregnancy and early first trimester BMI calculated from self-reported and standardized measured weight and height, respectively. WHAT IS KNOWN ALREADY The cerebellum is essential for normal neurodevelopment and abnormal cerebellar development has been associated with neurodevelopmental impairments and psychiatric diseases. Cerebellar development is particularly susceptible to exposures during the prenatal period, including maternal folate status, smoking habit and alcohol consumption. STUDY DESIGN, SIZE, DURATION From 2013 until 2015, we included 182 singleton pregnancies during the first trimester as a subgroup in a prospective periconception cohort with follow-up until birth. For the statistical analyses, we selected 166 pregnancies ending in live born infants without congenital malformations. PARTICIPANTS/MATERIALS, SETTING, METHODS We measured transcerebellar diameter (TCD) at 9, 11, 22, 26 and 32 weeks GA on ultrasound scans. Growth rates were calculated and growth trajectories of the cerebellum were created. Linear mixed models were used to estimate associations between cerebellar growth and maternal age, parity, mode of conception, geographic origin, pre-pregnancy and first trimester BMI, periconceptional smoking, alcohol consumption, timing of folic acid supplement initiation and fetal gender. MAIN RESULTS AND THE ROLE OF CHANCE In total, 166 pregnancies provided 652 (87%) ultrasound images eligible for TCD measurements. Cerebellar growth rates increased with advancing GA being 0.1691 mm/day in the first trimester, 0.2336 mm/day in the second trimester and 0.2702 mm/day in the third trimester. Pre-pregnancy BMI, calculated from self-reported body weight and height, was significantly associated with decreased cerebellar growth trajectories (β = -0.0331 mm, 95% CI = -0.0638; -0.0024, P = 0.035). A similar association was found between cerebellar growth trajectories and first trimester BMI, calculated from standardized measurements of body weight and height (β = -0.0325, 95% CI = -0.0642; -0.0008, P = 0.045, respectively). LIMITATIONS, REASONS FOR CAUTION As the study population largely consisted of tertiary hospital patients, external validity should be studied in the general population. Whether small differences in prenatal cerebellar growth due to a higher pre-pregnancy and first trimester BMI have consequences for neurodevelopmental outcome needs further investigation. WIDER IMPLICATIONS OF THE FINDINGS Our findings further substantiate previous evidence for the detrimental impact of a higher maternal BMI on neurodevelopmental health of offspring in later life. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Department of Obstetrics and Gynecology, Erasmus MC University Medical Centre and Sophia Children's Hospital Fund, Rotterdam, The Netherlands (SSWO grant number 644). No competing interests are declared.
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Affiliation(s)
- I V Koning
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands
| | - J Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands.,Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - I A L Groenenberg
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands
| | - I K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC University Medical Center, Postbus 2040, 3000CA Rotterdam, The Netherlands
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19
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Calandrelli R, Panfili M, D'Apolito G, Zampino G, Pedicelli A, Pilato F, Colosimo C. Quantitative approach to the posterior cranial fossa and craniocervical junction in asymptomatic children with achondroplasia. Neuroradiology 2017; 59:1031-1041. [PMID: 28819680 DOI: 10.1007/s00234-017-1887-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We propose an magnetic resonance imaging (MRI)-based quantitative morphovolumetric approach to the posterior cranial fossa (PCF) and craniocervical junction (CCJ) changes in achondroplastic patients investigating possible associations with ventriculomegaly and medullary compression. METHODS We analyzed MRI of 13 achondroplastic children not treated by surgery. 3D FSPGR T1-weighted images were used to analyze (1) PCF synchondroses; (2) PCF volume (PCFV), PCF brain volume (PCFBV), PCFV/PCFBV ratio, cerebellar volume, cerebrospinal fluid (CSF) spaces volume, and IV ventricle volume; (3) PCF (clivus, supraocciput, exocciput lengths, tentorial angle) and CCJ (AP and LL diameters of foramen magnum (FM)) morphometry; (4) measurements of FM and jugular foramina (JF) areas; and (5) supratentorial ventricular volume. RESULTS All patients showed synostosis of spheno-occipital synchondroses, eight showed synostosis of intra-occipital synchondroses, nine showed CCJ impingement on the cervical cord but only three had cervical myelopathy. Compared to controls, clivus and exocciput lengths, LL and AP diameters of FM, FM area and JF area were significantly reduced, supraocciput length, tentorial angle, PCFV, PCFBV, cerebellar volume, supratentorial ventricular system volume were significantly increased. A correlation was found between clivus length and supratentorial ventricular volume, premature closure of intra-occipital synchondroses and FM area while a trend was found between FM area and supraocciput length. CONCLUSION Our analysis demonstrates a relationship between the shortening of the clivus and the ventriculomegaly. On the other hand the premature closure of PCF synchondroses, the shape, and the growth direction of supraocciput bone contribute to reduce the FM area, causing in some patients medullary compression.
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Affiliation(s)
- Rosalinda Calandrelli
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, L.go F. Vito 1, 00168, Roma, Italia.
| | - Marco Panfili
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, L.go F. Vito 1, 00168, Roma, Italia
| | - Gabriella D'Apolito
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, L.go F. Vito 1, 00168, Roma, Italia
| | - Giuseppe Zampino
- Polo scienze della salute della donna e del bambino, Area salute del bambino, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, L.go F. Vito 1, 00168, Roma, Italia
| | - Alessandro Pedicelli
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, L.go F. Vito 1, 00168, Roma, Italia
| | - Fabio Pilato
- Polo scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Area neuroscienze, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, L.go F. Vito 1, 00168, Roma, Italia
| | - Cesare Colosimo
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, L.go F. Vito 1, 00168, Roma, Italia
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20
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Kyriakopoulou V, Vatansever D, Davidson A, Patkee P, Elkommos S, Chew A, Martinez-Biarge M, Hagberg B, Damodaram M, Allsop J, Fox M, Hajnal JV, Rutherford MA. Normative biometry of the fetal brain using magnetic resonance imaging. Brain Struct Funct 2017; 222:2295-2307. [PMID: 27885428 PMCID: PMC5504265 DOI: 10.1007/s00429-016-1342-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022]
Abstract
The fetal brain shows accelerated growth in the latter half of gestation, and these changes can be captured by 2D and 3D biometry measurements. The aim of this study was to quantify brain growth in normal fetuses using Magnetic Resonance Imaging (MRI) and to produce reference biometry data and a freely available centile calculator ( https://www.developingbrain.co.uk/fetalcentiles/ ). A total of 127 MRI examinations (1.5 T) of fetuses with a normal brain appearance (21-38 gestational weeks) were included in this study. 2D and 3D biometric parameters were measured from slice-to-volume reconstructed images, including 3D measurements of supratentorial brain tissue, lateral ventricles, cortex, cerebellum and extra-cerebral CSF and 2D measurements of brain biparietal diameter and fronto-occipital length, skull biparietal diameter and occipitofrontal diameter, head circumference, transverse cerebellar diameter, extra-cerebral CSF, ventricular atrial diameter, and vermis height, width, and area. Centiles were constructed for each measurement. All participants were invited for developmental follow-up. All 2D and 3D measurements, except for atrial diameter, showed a significant positive correlation with gestational age. There was a sex effect on left and total lateral ventricular volumes and the degree of ventricular asymmetry. The 5th, 50th, and 95th centiles and a centile calculator were produced. Developmental follow-up was available for 73.1% of cases [mean chronological age 27.4 (±10.2) months]. We present normative reference charts for fetal brain MRI biometry at 21-38 gestational weeks. Developing growth trajectories will aid in the better understanding of normal fetal brain growth and subsequently of deviations from typical development in high-risk pregnancies or following premature delivery.
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Affiliation(s)
- Vanessa Kyriakopoulou
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK.
| | - Deniz Vatansever
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Alice Davidson
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Prachi Patkee
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Samia Elkommos
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Andrew Chew
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Miriam Martinez-Biarge
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Bibbi Hagberg
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Kungsgatan, 12 411 18, Gothenburg, Sweden
| | - Mellisa Damodaram
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Joanna Allsop
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Matt Fox
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
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21
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Jarvis D, Akram R, Mandefield L, Paddock M, Armitage P, Griffiths PD. Quantification of total fetal brain volume using 3D MR imaging data acquired in utero. Prenat Diagn 2016; 36:1225-1232. [PMID: 27862111 DOI: 10.1002/pd.4961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Interpretation of magnetic resonance (MR) imaging of the fetal brain in utero is primarily undertaken using 2D images to provide anatomical information about structural abnormalities. It is now possible to obtain 3D image acquisitions that allow measurement of fetal brain volumes that are potentially useful clinically. The aim of our current work is to provide reference values of total brain volumes obtained from a cohort of low risk fetuses with no abnormalities on ante-natal ultrasonography and in utero MR imaging. METHOD Images from volume MR acquisitions of 132 fetuses were used to extract brain volumes by manual segmentation. Reproducibility and reliability were assessed by analysis of the results of two subgroups who had repeated measurements made by the primary and a secondary observer. RESULTS Intra-observer and inter-observer agreement was high with no statistically significant differences between and within observers (p = 0.476 and p = 0.427, respectively). The results of the brain volume assessments are presented graphically with mean and 95% prediction limits alongside estimates of normal growth rates. CONCLUSION We have shown that fetal brain volumes can be reliably extracted from in utero MR (iuMR) imaging 3D datasets with a high degree of reproducibility. The resultant data could potentially be used as a reference tool in the clinical setting. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Deborah Jarvis
- Academic Unit of Radiology, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Rahim Akram
- Academic Unit of Radiology, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Laura Mandefield
- ScHARR Clinical Trials and Research Unit, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Michael Paddock
- Academic Unit of Radiology, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Paul Armitage
- Academic Unit of Radiology, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Paul D Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, South Yorkshire, UK
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22
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:28-37. [PMID: 26394557 DOI: 10.1002/uog.15755] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/10/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Diagnosis of isolated posterior fossa anomalies in children is biased by the fact that only those that are symptomatic are brought to the attention of the appropriate clinical personnel, and the reported rate is often affected by the adoption of different nomenclature, diagnostic criteria, outcome measures, duration of follow-up and neurodevelopmental tools. The aim of this systematic review was to explore the neurodevelopmental outcome of fetuses with a prenatal diagnosis of isolated posterior fossa anomalies. METHODS MEDLINE and EMBASE were searched electronically, utilizing combinations of the relevant medical subject heading terms for 'posterior fossa' and 'outcome'. Studies assessing the neurodevelopmental outcome in children with a prenatal diagnosis of isolated posterior fossa malformations were considered eligible. The posterior fossa anomalies analyzed included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). Two authors reviewed all abstracts independently. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Meta-analyses of proportions were used to combine data, and between-study heterogeneity was explored using the I(2) statistic. RESULTS A total of 1640 articles were identified; 95 were assessed for eligibility and a total of 16 studies were included in the systematic review. The overall rate of abnormal neurodevelopmental outcome in children with a prenatal diagnosis of DWM was 58.2% (95% CI, 21.8-90.0%) and varied from 0-100%. In those with a prenatal diagnosis of MCM, the rate of abnormal neurodevelopmental outcome was 13.8% (95% CI, 7.3-21.9%), with a range of 0-50%. There was no significant association between BPC and the occurrence of abnormal neurodevelopmental delay, with a rate of 4.7% (95% CI, 0.7-12.1%) and range of 0-5%. Although affected by the very small number of studies, there was a non-significant occurrence of abnormal neurodevelopmental delay in children with a prenatal diagnosis of VH, with a rate of 30.7% (95% CI, 0.6-79.1%) and range of 0-100%. CONCLUSIONS Fetuses diagnosed with isolated DWM are at high risk of abnormal neurodevelopmental outcome, while isolated MCM or BPC have a generally favorable outcome. The risk of abnormal developmental delay in cases with isolated VH needs to be further assessed. In view of the wide heterogeneity in study design, time of follow-up, neurodevelopmental tests used and the very small number of included cases, further future large prospective studies with standardized and objective protocols for diagnosis and follow-up are needed in order to ascertain the rate of abnormal neurodevelopmental outcome in children with isolated posterior fossa anomalies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hôpital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex 12, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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23
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal ultrasound imaging (part 1): nomenclature, diagnostic accuracy and associated anomalies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:690-7. [PMID: 25970099 DOI: 10.1002/uog.14900] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/07/2015] [Accepted: 04/17/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the outcome in fetuses with prenatal diagnosis of posterior fossa anomalies apparently isolated on ultrasound imaging. METHODS MEDLINE and EMBASE were searched electronically utilizing combinations of relevant medical subject headings for 'posterior fossa' and 'outcome'. The posterior fossa anomalies analyzed were Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). The outcomes observed were rate of chromosomal abnormalities, additional anomalies detected at prenatal magnetic resonance imaging (MRI), additional anomalies detected at postnatal imaging and concordance between prenatal and postnatal diagnoses. Only isolated cases of posterior fossa anomalies - defined as having no cerebral or extracerebral additional anomalies detected on ultrasound examination - were included in the analysis. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. We used meta-analyses of proportions to combine data and fixed- or random-effects models according to the heterogeneity of the results. RESULTS Twenty-two studies including 531 fetuses with posterior fossa anomalies were included in this systematic review. The prevalence of chromosomal abnormalities in fetuses with isolated DWM was 16.3% (95% CI, 8.7-25.7%). The prevalence of additional central nervous system (CNS) abnormalities that were missed at ultrasound examination and detected only at prenatal MRI was 13.7% (95% CI, 0.2-42.6%), and the prevalence of additional CNS anomalies that were missed at prenatal imaging and detected only after birth was 18.2% (95% CI, 6.2-34.6%). Prenatal diagnosis was not confirmed after birth in 28.2% (95% CI, 8.5-53.9%) of cases. MCM was not significantly associated with additional anomalies detected at prenatal MRI or detected after birth. Prenatal diagnosis was not confirmed postnatally in 7.1% (95% CI, 2.3-14.5%) of cases. The rate of chromosomal anomalies in fetuses with isolated BPC was 5.2% (95% CI, 0.9-12.7%) and there was no associated CNS anomaly detected at prenatal MRI or only after birth. Prenatal diagnosis of BPC was not confirmed after birth in 9.8% (95% CI, 2.9-20.1%) of cases. The rate of chromosomal anomalies in fetuses with isolated VH was 6.5% (95% CI, 0.8-17.1%) and there were no additional anomalies detected at prenatal MRI (0% (95% CI, 0.0-45.9%)). The proportions of cerebral anomalies detected only after birth was 14.2% (95% CI, 2.9-31.9%). Prenatal diagnosis was not confirmed after birth in 32.4% (95% CI, 18.3-48.4%) of cases. CONCLUSIONS DWM apparently isolated on ultrasound imaging is a condition with a high risk for chromosomal and associated structural anomalies. Isolated MCM and BPC have a low risk for aneuploidy or associated structural anomalies. The small number of cases with isolated VH prevents robust conclusions regarding their management from being drawn. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hôpital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex 12, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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24
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Pier DB, Gholipour A, Afacan O, Velasco-Annis C, Clancy S, Kapur K, Estroff JA, Warfield SK. 3D Super-Resolution Motion-Corrected MRI: Validation of Fetal Posterior Fossa Measurements. J Neuroimaging 2016; 26:539-44. [PMID: 26990618 DOI: 10.1111/jon.12342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/04/2016] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Current diagnosis of fetal posterior fossa anomalies by sonography and conventional MRI is limited by fetal position, motion, and by two-dimensional (2D), rather than three-dimensional (3D), representation. In this study, we aimed to validate the use of a novel magnetic resonance imaging (MRI) technique, 3D super-resolution motion-corrected MRI, to image the fetal posterior fossa. METHODS From a database of pregnant women who received fetal MRIs at our institution, images of 49 normal fetal brains were reconstructed. Six measurements of the cerebellum, vermis, and pons were obtained for all cases on 2D conventional and 3D reconstructed MRI, and the agreement between the two methods was determined using concordance correlation coefficients. Concordance of axial and coronal measurements of the transcerebellar diameter was also assessed within each method. RESULTS Between the two methods, the concordance of measurements was high for all six structures (P < .001), and was highest for larger structures such as the transcerebellar diameter. Within each method, agreement of axial and coronal measurements of the transcerebellar diameter was superior in 3D reconstructed MRI compared to 2D conventional MRI (P < .001). CONCLUSIONS This comparison study validates the use of 3D super-resolution motion-corrected MRI for imaging the fetal posterior fossa, as this technique results in linear measurements that have high concordance with 2D conventional MRI measurements. Lengths of the transcerebellar diameter measured within a 3D reconstruction are more concordant between imaging planes, as they correct for fetal motion and orthogonal slice acquisition. This technique will facilitate further study of fetal abnormalities of the posterior fossa.
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Affiliation(s)
- Danielle B Pier
- Department of Neurology, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, MA.,Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Boston, MA.,Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Clemente Velasco-Annis
- Department of Radiology, Boston Children's Hospital, Boston, MA.,Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA
| | - Sean Clancy
- Department of Radiology, Boston Children's Hospital, Boston, MA.,Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, MA.,Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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25
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Calandrelli R, D'Apolito G, Panfili M, Massimi L, Caldarelli M, Colosimo C. Role of "major" and "minor" lambdoid arch sutures in posterior cranial fossa changes: mechanism of cerebellar tonsillar herniation in infants with multisutural craniosynostosis. Childs Nerv Syst 2016; 32:451-9. [PMID: 26572514 DOI: 10.1007/s00381-015-2956-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to explain the functional role of lambdoid arch sutures in the development of cerebellar tonsillar herniation. Posterior cranial fossa (PCF) changes were investigated in infants with premature synostosis of the major and minor sutures of the lambdoid arch without premature synostosis of the PCF synchondroses. METHODS Morphometric and volumetric PCF measurements were performed on preoperative high-resolution CT studies in 12 infants with multisutural craniosynostosis involving the lambdoid arch and compared with those of 12 age-matched healthy subjects. RESULTS All 12 patients had hypoplasia of PCF bone structures and normal volumes of the PCF and neural structures. PCF hypoplasia was related to exocciput length in infants with isolated involvement of major sutures, while it was related to posterior skull base hemifossae in infants with isolated involvement of minor lambdoid arch sutures. Foramen magnum AP diameter was reduced in babies with major suture involvement and tonsillar herniation, while foramen magnum AP and LL diameters were reduced in babies with minor suture involvement without tonsillar herniation. Right and left jugular foramen (JF) areas differed in all infants; however, the area of the smaller JF was significantly reduced only in infants with involvement of minor lambdoid arch sutures. CONCLUSION Hypoplasia of PCF bone structures due to sutural synostosis of the lambdoid arch is a required predisposing but not sufficient factor for the development of cerebellar tonsillar herniation through the foramen magnum. Normal PCF volume and foramen magnum anatomy may partly explain the development of cerebellar tonsil herniation in infants with lambdoid arch synostosis.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Università Cattolica Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Gabriella D'Apolito
- Institute of Radiology, Università Cattolica Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Marco Panfili
- Institute of Radiology, Università Cattolica Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Luca Massimi
- Institute of Neurosurgery, Università Cattolica Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Massimo Caldarelli
- Institute of Neurosurgery, Università Cattolica Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Università Cattolica Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
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26
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Calandrelli R, D'Apolito G, Marco P, Zampino G, Tartaglione T, Colosimo C. Costello syndrome: Analysis of the posterior cranial fossa in children with posterior fossa crowding. Neuroradiol J 2015; 28:254-8. [PMID: 26246091 DOI: 10.1177/1971400915592549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to assess changes in the posterior cranial fossa (PCF) to shed light on the mechanism of cerebellar herniation in children with Costello syndrome (CS) and posterior fossa crowding. We performed a morphovolumetric PCF analysis on brain magnetic resonance imaging (MRI) in seven children with CS (mean age 31 ± 16 months) comparing the MRI scans with those of seven age-matched healthy subjects.PCF volume (PCFV), PCF brain volume (PCFBV) and cerebellar volume (CeV) were assessed on axial T2-weighted MRI. Morphometric parameters (diameters of the foramen magnum, tentorial angle, basiocciput, supraocciput, basisphenoid and exocciput lengths) were measured on sagittal T1-weighted MRI. The volume of the cerebrospinal fluid (CSF) spaces was calculated as PCFV minus PCFBV.Five out of seven CS children showed tonsillar herniation in the upper cervical canal; no child had hydrocephalus but three out of seven children showed ventriculomegaly. In addition, the PCFV/PCFBV ratio, PCFV, CSF spaces volume, basiocciput, basisphenoid and exocciput lengths and latero-lateral and antero-posterior diameters of the foramen magnum were significantly reduced, whereas no significant changes were found in supraocciput length, PCFBV, CeV or hindbrain volume. The volumetric reduction of the PCF due to bony posterior fossa hypoplasia is a predisposing factor for developing cerebellar tonsillar herniation through the foramen magnum in children with CS. The altered anatomy of the foramen magnum and upward expansion of the PCF secondary to an increased tentorial slope serves to explain the possible mechanism of cerebellar herniation in patients with CS.
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Affiliation(s)
| | | | - Panfili Marco
- Institute of Radiology, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giuseppe Zampino
- Department of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Cesare Colosimo
- Institute of Radiology, Università Cattolica Sacro Cuore, Rome, Italy
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27
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Weisstanner C, Kasprian G, Gruber GM, Brugger PC, Prayer D. MRI of the Fetal Brain. Clin Neuroradiol 2015; 25 Suppl 2:189-96. [PMID: 26063004 DOI: 10.1007/s00062-015-0413-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/12/2015] [Indexed: 12/17/2022]
Abstract
The purpose of this article is to provide an overview of the possibilities for fetal magnetic resonance imaging (MRI) in the evaluation of the fetal brain. For brain pathologies, fetal MRI is usually performed when an abnormality is detected by previous prenatal ultrasound, and is, therefore, an important adjunct to ultrasound. The most commonly suspected brain pathologies referred to fetal MRI for further evaluation are ventriculomegaly, missing corpus callosum, and abnormalities of the posterior fossa. We will briefly discuss the most common indications for fetal brain MRI, as well as recent advances.
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Affiliation(s)
- C Weisstanner
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - G Kasprian
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - G M Gruber
- Center of Anatomy and Cell Biology, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria
| | - P C Brugger
- Center of Anatomy and Cell Biology, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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28
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Ber R, Bar-Yosef O, Hoffmann C, Shashar D, Achiron R, Katorza E. Normal fetal posterior fossa in MR imaging: new biometric data and possible clinical significance. AJNR Am J Neuroradiol 2015; 36:795-802. [PMID: 25655869 DOI: 10.3174/ajnr.a4258] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Posterior fossa malformations are a common finding in prenatal diagnosis. The objectives of this study are to re-evaluate existing normal MR imaging biometric data of the fetal posterior fossa, suggest and evaluate new parameters, and demonstrate the possible clinical applications of these data. MATERIALS AND METHODS This was a retrospective review of 215 fetal MR imaging examinations with normal findings and 5 examinations of fetuses with a suspected pathologic posterior fossa. Six previously reported parameters and 8 new parameters were measured. Three new parameter ratios were calculated. Interobserver agreement was calculated by using the intraclass correlation coefficient. RESULTS For measuring each structure, 151-211 MR imaging examinations were selected, resulting in a normal biometry curve according to gestational age for each parameter. Analysis of the ratio parameters showed that vermian lobe ratio and cerebellar hemisphere ratio remain constant with gestational age and that the vermis-to-cisterna magna ratio varies with gestational age. Measurements of the 5 pathologic fetuses are presented on the normal curves. Interobserver agreement was excellent, with the intraclass correlation coefficients of most parameters above 0.9 and only 2 parameters below 0.8. CONCLUSIONS The biometry curves derived from new and existing biometric data and presented in this study may expand and deepen the biometry we use today, while keeping it simple and repeatable. By applying these extensive biometric data on suspected abnormal cases, diagnoses may be confirmed, better classified, or completely altered.
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Affiliation(s)
- R Ber
- From the Departments of Obstetrics and Gynecology (R.B., D.S., R.A., E.K.)
| | | | - C Hoffmann
- Diagnostic Imaging (C.H.), Chaim Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - D Shashar
- From the Departments of Obstetrics and Gynecology (R.B., D.S., R.A., E.K.)
| | - R Achiron
- From the Departments of Obstetrics and Gynecology (R.B., D.S., R.A., E.K.)
| | - E Katorza
- From the Departments of Obstetrics and Gynecology (R.B., D.S., R.A., E.K.)
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29
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Gholipour A, Estroff JA, Barnewolt CE, Robertson RL, Grant PE, Gagoski B, Warfield SK, Afacan O, Connolly SA, Neil JJ, Wolfberg A, Mulkern RV. Fetal MRI: A Technical Update with Educational Aspirations. CONCEPTS IN MAGNETIC RESONANCE. PART A, BRIDGING EDUCATION AND RESEARCH 2014; 43:237-266. [PMID: 26225129 PMCID: PMC4515352 DOI: 10.1002/cmr.a.21321] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Fetal magnetic resonance imaging (MRI) examinations have become well-established procedures at many institutions and can serve as useful adjuncts to ultrasound (US) exams when diagnostic doubts remain after US. Due to fetal motion, however, fetal MRI exams are challenging and require the MR scanner to be used in a somewhat different mode than that employed for more routine clinical studies. Herein we review the techniques most commonly used, and those that are available, for fetal MRI with an emphasis on the physics of the techniques and how to deploy them to improve success rates for fetal MRI exams. By far the most common technique employed is single-shot T2-weighted imaging due to its excellent tissue contrast and relative immunity to fetal motion. Despite the significant challenges involved, however, many of the other techniques commonly employed in conventional neuro- and body MRI such as T1 and T2*-weighted imaging, diffusion and perfusion weighted imaging, as well as spectroscopic methods remain of interest for fetal MR applications. An effort to understand the strengths and limitations of these basic methods within the context of fetal MRI is made in order to optimize their use and facilitate implementation of technical improvements for the further development of fetal MR imaging, both in acquisition and post-processing strategies.
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Affiliation(s)
- Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judith A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard L Robertson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Borjan Gagoski
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey J Neil
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Wolfberg
- Boston Maternal Fetal Medicine, Boston, Massachusetts, USA
| | - Robert V Mulkern
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
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