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Sanz Cortes M, Johnson RM, Sangi-Haghpeykar H, Bedei I, Greenwood L, Nassr AA, Donepudi R, Whitehead W, Belfort M, Mehollin-Ray AR. Perforation of cavum septi pellucidi in open spina bifida and need for hydrocephalus treatment by 1 year of age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:60-67. [PMID: 37698345 DOI: 10.1002/uog.27480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE In-utero repair of an open neural tube defect (ONTD) reduces the risk of developing severe hydrocephalus postnatally. Perforation of the cavum septi pellucidi (CSP) may reflect increased intraventricular pressure in the fetal brain. We sought to evaluate the association of perforated CSP visualized on fetal imaging before and/or after in-utero ONTD repair with the eventual need for hydrocephalus treatment by 1 year of age. METHODS This was a retrospective cohort study of consecutive patients who underwent laparotomy-assisted fetoscopic ONTD repair between 2014 and 2021 at a single center. Eligibility criteria for surgery were based on those of the Management of Myelomeningocele Study (MOMS), although a maternal prepregnancy body mass index of up to 40 kg/m2 was allowed. Fetal brain imaging was performed with ultrasound and magnetic resonance imaging (MRI) at referral and 6 weeks postoperatively. Stored ultrasound and MRI scans were reviewed retrospectively to assess CSP integrity. Medical records were reviewed to determine whether hydrocephalus treatment was needed within 1 year of age. Parametric and non-parametric tests were used as appropriate to compare outcomes between cases with perforated CSP and those with intact CSP as determined on ultrasound at referral. Logistic regression analysis was performed to assess the predictive performance of various imaging markers for the need for hydrocephalus treatment. RESULTS A total of 110 patients were included. Perforated CSP was identified in 20.6% and 22.6% of cases on preoperative ultrasound and MRI, respectively, and in 26.6% and 24.2% on postoperative ultrasound and MRI, respectively. Ventricular size increased between referral and after surgery (median, 11.00 (range, 5.89-21.45) mm vs 16.00 (range, 7.00-43.5) mm; P < 0.01), as did the proportion of cases with severe ventriculomegaly (ventricular width ≥ 15 mm) (12.7% vs 57.8%; P < 0.01). Complete CSP evaluation was achieved on preoperative ultrasound in 107 cases, of which 22 had a perforated CSP and 85 had an intact CSP. The perforated-CSP group presented with larger ventricles (mean, 14.32 ± 3.45 mm vs 10.37 ± 2.37 mm; P < 0.01) and a higher rate of severe ventriculomegaly (40.9% vs 5.9%; P < 0.01) compared to those with an intact CSP. The same trends were observed at 6 weeks postoperatively for mean ventricular size (median, 21.0 (range, 13.0-43.5) mm vs 14.3 (range, 7.0-29.0) mm; P < 0.01) and severe ventriculomegaly (95.0% vs 46.8%; P < 0.01). Cases with a perforated CSP at referral had a lower rate of hindbrain herniation (HBH) reversal postoperatively (65.0% vs 88.6%; P = 0.01) and were more likely to require treatment for hydrocephalus (89.5% vs 22.7%; P < 0.01). The strongest predictor of the need for hydrocephalus treatment within 1 year of age was lack of HBH reversal on MRI (odds ratio (OR), 36.20 (95% CI, 5.96-219.12); P < 0.01) followed by perforated CSP on ultrasound at referral (OR, 23.40 (95% CI, 5.42-100.98); P < 0.01) and by perforated CSP at 6-week postoperative ultrasound (OR, 19.48 (95% CI, 5.68-66.68); P < 0.01). CONCLUSIONS The detection of a perforated CSP in fetuses with ONTD can reliably identify those cases at highest risk for needing hydrocephalus treatment by 1 year of age. Evaluation of this brain structure can improve counseling of families considering fetal surgery for ONTD, in order to set appropriate expectations about postnatal outcome. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Sanz Cortes
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - R M Johnson
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - H Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - I Bedei
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Gießen, Gießen, Germany
| | - L Greenwood
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - A A Nassr
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - R Donepudi
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - W Whitehead
- Department of Neurosurgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - M Belfort
- Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - A R Mehollin-Ray
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX, USA
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Saleh K, Al-Ajmi E, Al Futaisi A. Absent Septum Pellucidum: Search for other anomalies. Sultan Qaboos Univ Med J 2023; 23:423-424. [PMID: 37655086 PMCID: PMC10467560 DOI: 10.18295/squmj.5.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/08/2023] [Accepted: 04/19/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Khadija Saleh
- Pediatrics Program, Oman Medical Specialty Board, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Amna Al Futaisi
- Department of Paediatrics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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BAYRAKTAR B, TANER CE. Fetal cavum septum pellucidum nomogram and its relationship with fetal Doppler: a prospective study of a Turkish population. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1200856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim: Septum pellucidum is a thin membrane with right and left leaves, and cavum septum pellucidum (CSP) is formed in the intermembrane region. This study investigates CSP nomogram dimensions for all trimesters in the Turkish population. In addition, the relationship between fetal Doppler flow and CSP size was investigated in this study.
Methods: This study was designed as a prospective cohort between 2019-2020. Pregnant women between 19-42 weeks who were followed up at XXX, Department of Obstetrics and Gynecology were included in the study. (blind review)
Results: A total of 517 fetuses meeting our criteria were included in this prospective study. In the second trimester (19-28 weeks) CSP width (4.12±0.88 vs. 4.91±1.42, p < 0.001) and length (7.95±1.04 vs. 9.48±2.19, p < 0.001) were significantly higher than in the third trimester (28-42 weeks). While the mean CSP width increased up to 32th weeks, there was no clear increase-decrease pattern between 32th-38th weeks, and it was observed to decrease after 38th weeks. The mean CSP length increased up to 29th weeks, while there was no clear increase-decrease pattern between 29th-38th weeks, but decreased after 38th weeks. While a significant correlation was observed between gestational week and CSP width (r = 0.118, p = 0.010), there was no significant correlation between CSP length (r = 0.086, p =0.062). A significant correlation was observed between biparietal diameter (BPD) and CSP width (r = 0.180, p < 0.001) and length (r = 0.202, p < 0.001), but not with head circumference (HC). There was a significant correlation between middle cerebral artery (MCA) systolic/diastolic ratio (S/D) (r = 0.185, p < 0.001), pulsatility index (PI) (r = 0.210, p < 0.001) and resistive index (RI) (r = 0.233, p < 0.001) and CSP length, but not with CSP width.
Conclusion: Turkish population fetal CSP nomogram is presented in this study. Fetal middle cerebral artery Doppler measurements (S/D, PI, and RI) showing cerebral blood flow correlate with CSP length, but not with CSP width. There was no correlation between fetal umbilical artery Doppler measurements and CSP sizes. The results pave the way for population-based studies with much larger samples.
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Affiliation(s)
- Burak BAYRAKTAR
- UNIVERSITY OF HEALTH SCIENCES, İZMİR TEPECİK HEALTH RESEARCH CENTER
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Greenbaum L, Maya I, Sagi-Dain L, Sukenik-Halevy R, Berkenstadt M, Yonath H, Rienstein S, Shalata A, Katorza E, Singer A. Chromosomal Microarray Analysis in Pregnancies With Corpus Callosum or Posterior Fossa Anomalies. Neurol Genet 2021; 7:e585. [PMID: 34079909 PMCID: PMC8163489 DOI: 10.1212/nxg.0000000000000585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 02/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We investigated the detection rate of clinically significant chromosomal microarray analysis (CMA) results in pregnancies with sonographic diagnosis of fetal corpus callosum anomalies (CCA) or posterior fossa anomalies (PFA). METHODS All CMA tests in pregnancies with CCA or PFA performed between January 2015 and June 2020 were retrospectively evaluated from the Israeli Ministry of Health database. The rate of CMA with clinically significant (pathogenic or likely pathogenic) findings was calculated and compared to a local Israeli cohort of 5,541 pregnancies with normal ultrasound. RESULTS One hundred eighty-two pregnancies were enrolled: 102 cases with CCA and 89 with PFA (9 cases had both). Clinically significant CMA results were found in 7/102 of CCA (6.9%) and in 7/89 of PFA (7.9%) cases. The CMA detection rate in pregnancies with isolated CCA (2/57, 3.5%) or PFA (2/50, 4.0%) was lower than in nonisolated cases, including additional CNS and/or extra-CNS sonographic anomalies (CCA-5/45, 11.1%; PFA-5/39, 12.8%), but this was not statistically significant. However, the rate among pregnancies that had extra-CNS anomalies, with or without additional CNS involvement (CCA-5/24, 20.8%; PFA-5/29, 17.2%), was significantly higher compared to all other cases (p = 0.0075 for CCA; p = 0.035 for PFA). Risk of CMA with clinically significant results for all and nonisolated CCA or PFA pregnancies was higher compared to the background risk reported in the control cohort (p < 0.001), but was not significant for isolated cases. CONCLUSIONS Our findings suggest that CMA testing is beneficial for the genetic workup of pregnancies with CCA or PFA, and is probably most informative when additional extra-CNS anomalies are observed.
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Affiliation(s)
- Lior Greenbaum
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Idit Maya
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Lena Sagi-Dain
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Rivka Sukenik-Halevy
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Michal Berkenstadt
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Hagith Yonath
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Shlomit Rienstein
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Adel Shalata
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Eldad Katorza
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - Amihood Singer
- From the The Danek Gertner Institute of Human Genetics (L.G., M.B., H.Y., S.R.), Sheba Medical Center, Tel Hashomer; The Joseph Sagol Neuroscience Center (L.G.), Sheba Medical Center, Tel Hashomer; Sackler Faculty of Medicine (L.G., I.M., R.S.-H., M.B., H.Y., E.K.), Tel Aviv University; Recanati Genetics Institute (I.M., R.S.-H.), Beilinson Hospital, Rabin Medical Center, Petach Tikva; Genetics Institute (L.S.-D.), Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa; Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer; The Simon Winter Institute for Human Genetics (A.S.), Bnai Zion Medical Center, Haifa; Department of Obstetrics and Gynecology (E.K.), Sheba Medical Center, Tel Hashomer; and Department of Community Genetics (A.S.), Public Health Services, Ministry of Health, Jerusalem, Israel.
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Ozcan T, Lazebnik N. Bilateral subependymal pseudocysts as a pitfall in diagnosis of absence of the cavum septum pellucidum. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:502-505. [PMID: 33188541 DOI: 10.1002/jcu.22943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Absent cavum septum pellucidum in the fetus is a common condition that may be associated with a variety of associated abnormalities. Herein, we present a case to emphasize a new pitfall in the differential diagnosis of the absence of the cavum septum pellucidum (CSP). Prenatal ultrasound views were concerning for partially absent CSP in the third trimester and subependymal pseudocysts (SEC) after a normal CSP visualization in the second trimester. The postnatal MRI demonstrated a normal corpus callosum, normal gyration, normal opthalmic nerves, and isolated SEC blocking the views of cavum septum pellucidum.
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Affiliation(s)
- Tulin Ozcan
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Noam Lazebnik
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Abstract
Cranial ultrasound (CUS) is an extremely valuable tool to evaluate the brain during the first year of life, in experienced hands. It is the initial screening imaging tool to evaluate the infants' brain and complementary to the use of computed tomography (CT) and magnetic resonance imaging (MRI). It is an accessible, inexpensive and harmless technique that can be used bedside as frequently as needed. The aim of this article is to provide a guide for beginners about the indications, basic technical parameters, scanning technique, standardized planes, common variants and the most frequent abnormal findings visualized with this technique. This article will explain a systematic technique to adequately visualize and document all the relevant intracranial structures, using the anterior fontanelle, mastoid fontanelle and Doppler ultrasound. The variants described in this review include the normal sulcation of the premature baby, the peritrigonal echogenic "blush", lenticulostriate vasculopathy (LSV), benign enlargement of the subrarachnoid space in infancy, asymmetric lateral ventricles, connatal cysts, cavum septum pellucidum (CSP), cavum vergae (CV), cavum velum interpositum, megacisterna magna and choroid plexus cysts. This article will describe the sonographic appearance of different types of intracranial hemorrhage of the preterm and term baby, periventricular leukomalacia (PVL), central and peripheral hypoxic-ischemic events of the term baby, neonatal arterial infarction, cerebro-venous sinus thrombosis, congenital and neonatal cerebral infections, hydrocephalus, intracranial solid and cystic masses, and congenital brain malformations.
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Affiliation(s)
- Pablo Caro-Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Catalina Lecacheux
- Department of Radiology, University of Toronto, Toronto, ON, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cristina Hernandez-Herrera
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Roberto Llorens-Salvador
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Kertes I, Hoffman D, Yahal O, Berknstadt M, Bar-Yosef O, Ezra O, Katorza E. The normal fetal Cavum Septum Pellucidum in MR imaging - New biometric data. Eur J Radiol 2020; 135:109470. [PMID: 33338761 DOI: 10.1016/j.ejrad.2020.109470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/30/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The cavum septum pellucidum (CSP) is an important landmark in the evaluation of the fetal neural axis. A deviation from the ultrasonic normal values may be associated with unfavorable outcomes, and a normal CSP provides reassurance of normal central forebrain development. Today, there is biometric data regarding the normal values for the width of the CSP in fetal ultrasound, but there is no such data for fetal MRI. The aim of this study was to determine the normal values for the measurements of the fetal CSP on MRI. MATERIALS AND METHODS We retrospectively examined 307 MRI scans of fetuses between 25 and 41 weeks gestation. Data was collected from the electronic charts of patients who underwent fetal MR imaging at a single tertiary Medical Center. The width and length of the CSP were measured in the axial plane, and the width and height were measured in the coronal plane. RESULTS The width and height of the CSP in fetuses tend to decrease starting from the 27th week of gestation onwards. High levels of intraobserver and interobserver agreements were calculated. The sex of the fetus does not appear to influence the biometry of the CSP. CONCLUSION This study provides MRI reference values for the dimensions of the CSP starting from the 25th week of gestation. Knowing the normal values for MRI could provide valuable information for researchers and in the decision-making process in patient's consultations.
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Affiliation(s)
- Itay Kertes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dana Hoffman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orr Yahal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Unit, Sheba Medical Center, Tel HaShomer, Israel
| | - Michal Berknstadt
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel HaShomer, Israel
| | - Omer Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Unit, Sheba Medical Center, Tel HaShomer, Israel
| | - Osnat Ezra
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel
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Ghassemi N, Rupe E, Perez M, Lamale-Smith L, Fratto VM, Farid N, Hahn M, Ramos GA, Ho Y, Rakow-Penner R, Horton K, Khan S, Jones M, Pretorius DH. Ultrasound and Magnetic Resonance Imaging of Agenesis of the Corpus Callosum in Fetuses: Frontal Horns and Cavum Septi Pellucidi Are Clues to Earlier Diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2389-2403. [PMID: 32597533 DOI: 10.1002/jum.15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We hypothesized that: (1) fetal frontal horn (FH) morphology and their proximity to the cavum septi pellucidi (CSP) can assist in suspecting complete agenesis of the corpus callosum (cACC) and partial agenesis of the corpus callosum (pACC) earlier than known indirect ultrasound (US) findings; (2) FHs assist in differentiating a true CSP from a pseudocavum; and (3) magnetic resonance imaging (MRI) is useful in learning FH morphology and pseudocavum etiology. METHODS Thirty-two patients with cACC and 9 with pACC were identified on an Institutional Review Board-approved retrospective review. Of the 41 cases, 40 had prenatal US, and 21 had prenatal MRI; 17 had follow-up neonatal US, and 14 had follow-up neonatal MRI. Variables evaluated retrospectively were the presence of a CSP or a pseudocavum, ventricle size and shape, and FH shape (comma, trident, parallel, golf club, enlarged, or fused). Displacement between the inferior edge of the FH and the midline or cavum/pseudocavum was measured. RESULTS Fetal FHs had an abnormal shape in 77% ≤20 weeks' gestation, 86% ≤24 weeks, and 90% >24 weeks. Frontal horns were laterally displaced greater than 2 mm in 85% ≤20 weeks, 91% ≤24 weeks, and 95% >24 weeks. The CSP was absent in 100% of cACC cases and 78% of pACC cases, and a pseudocavum was present in 88% of cACC cases and 78% of pACC cases across gestation. Magnetic resonance imaging confirmed US pseudocavums to be focal interhemispheric fluid or an elevated/dilated third ventricle. CONCLUSIONS Frontal horns assist in assessing ACC ≤24 weeks and throughout gestation. Pseudocavums, often simulating CSPs, are common in ACC. Frontal horn lateral displacement and abnormal morphology, recognized by MRI correlations, are helpful in differentiating a pseudocavum from a true CSP. A normal CSP should not be cleared on screening US unless normally shaped FHs are seen directly adjacent to it.
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Affiliation(s)
- Neda Ghassemi
- University of California, San Diego, School of Medicine (N.G.)
| | - Eric Rupe
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Mishella Perez
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Leah Lamale-Smith
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Victoria M Fratto
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Nikdokht Farid
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Michael Hahn
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
| | - Gladys A Ramos
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- Obstetrics, Gynecology and Reproductive Sciences (M.P., L.L.-S., V.M.F., G.A.R.), USA
| | - Yoona Ho
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Rebecca Rakow-Penner
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
| | - Katelyn Horton
- University of California, Berkeley, California, USA (K.H.), USA
| | - Sohini Khan
- University of California, Berkeley, California, USA (K.H.), USA
| | - Marilyn Jones
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
- General Surgery (S.K.) and Pediatrics (M.J.), University of California, USA
| | - Dolores H Pretorius
- University of California, San Diego, Maternal-Fetal Care and Genetics (M.P., L.L.-S., V.M.F., M.H., G.A.R., M.J., D.H.P.), USA
- Departments of Radiology (E.R., N.F., M.H., Y.H., R.R.-P., D.H.P.), USA
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11
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Maduram A, Farid N, Rakow-Penner R, Ghassemi N, Khanna PC, Robbins SL, Hull A, Gold J, Pretorius DH. Fetal Ultrasound and Magnetic Resonance Imaging Findings in Suspected Septo-Optic Dysplasia: A Diagnostic Dilemma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1601-1614. [PMID: 32118312 DOI: 10.1002/jum.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/23/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To investigate prenatal imaging findings supporting a diagnosis of suspected septo-optic dysplasia (SOD) by fetal ultrasound (US), magnetic resonance imaging (MRI), or both. METHODS A retrospective review identified 11 patients with SOD: 9 had a clinical diagnosis of SOD postnatally, and 2 were terminated on the basis of suspicious prenatal imaging. Prenatal and neonatal imaging of the cavum septi pellucidi (CSP), frontal horns (FHs), and lateral ventricles was evaluated. RESULTS The appearance of the CSP varied on US and MRI. Complete ("fused") FHs or partial absence of the CSP was reported in 6 of 11 patients by fetal US and 7 of 8 patients by fetal MRI. The diagnosis of SOD was prospectively suspected prenatally in 6 of 11 and in an additional 5 of 11 cases retrospectively. Fetal MRI incorrectly initially reported normal morphologic abnormalities for 2 cases with partial absence of the CSP, whereas US accurately identified the morphologic abnormalities in 1 of these cases before MRI. Imaging features were first suggested at anatomic US (4 patients) and follow-up prenatal US (2 patients). Neonatal imaging was concordant in all 9 live births: 5 completely absent CSP, 3 partially absent CSP, and 1 completely present CSP. Clinical manifestations included optic nerve hypoplasia (9 of 9), panhypopituitarism (5 of 9), and neurodevelopmental delays. CONCLUSIONS Primary imaging features of SOD are "continuous" FHs with complete or partial absence of the CSP. Septo-optic dysplasia can be suspected in utero and can appear isolated but has substantial associated central nervous system anomalies identified on fetal MRI or after birth. Partial absence of the CSP can be a prenatal sign of suspected SOD, although fetal MRI lacked the spatial resolution to identify it accurately in all cases.
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Affiliation(s)
| | | | | | | | - Paritosh C Khanna
- Rady's Children's Hospital and Sharp Healthcare, Department of Radiology
| | - Shira L Robbins
- Viterbi Family Department of Ophthalmology, Ratner Children's Eye Center
| | - Andrew Hull
- Reproductive Medicine
- University of California San Diego Maternal Fetal Care and Genetics, University of California, San Diego, La Jolla, California, USA
| | | | - Dolores H Pretorius
- Departments of Radiology
- University of California San Diego Maternal Fetal Care and Genetics, University of California, San Diego, La Jolla, California, USA
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Scelsi CL, Rahim TA, Morris JA, Kramer GJ, Gilbert BC, Forseen SE. The Lateral Ventricles: A Detailed Review of Anatomy, Development, and Anatomic Variations. AJNR Am J Neuroradiol 2020; 41:566-572. [PMID: 32079598 PMCID: PMC7144651 DOI: 10.3174/ajnr.a6456] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
The cerebral ventricles have been studied since the fourth century BC and were originally thought to harbor the soul and higher executive functions. During the infancy of neuroradiology, alterations to the ventricular shape and position on pneumoencephalography and ventriculography were signs of mass effect or volume loss. However, in the current era of high-resolution cross-sectional imaging, variation in ventricular anatomy is more easily detectable and its clinical significance is still being investigated. Interpreting radiologists must be aware of anatomic variations of the ventricular system to prevent mistaking normal variants for pathology. We will review of the anatomy and development of the lateral ventricles and discuss several ventricular variations.
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Affiliation(s)
- C L Scelsi
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - T A Rahim
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - J A Morris
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - G J Kramer
- From the Departments of Radiology (C.L.S., T.A.R., J.A.M., G.J.K.)
| | - B C Gilbert
- Neuroradiology (B.C.G., S.E.F.), Medical College of Georgia, Augusta, Georgia
| | - S E Forseen
- Neuroradiology (B.C.G., S.E.F.), Medical College of Georgia, Augusta, Georgia
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Jacob E, Braun J, Oelmeier K, Köster HA, Möllers M, Falkenberg M, Klockenbusch W, Schmitz R, Hammer K. Fetal brain development in small-for-gestational age (SGA) fetuses and normal controls. J Perinat Med 2020; 48:/j/jpme.ahead-of-print/jpm-2019-0401/jpm-2019-0401.xml. [PMID: 32126016 DOI: 10.1515/jpm-2019-0401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
Objective To assess whether fetal brain structures routinely measured during the second and third trimester ultrasound scans, particularly the width of the cavum septi pellucidi (CSP), differ between fetuses small for gestational age (SGA), fetuses very small for gestational age (VSGA) and normal controls. Methods In this retrospective study, we examined standard ultrasound measurements of 116 VSGA, 131 SGA fetuses and 136 normal controls including the head circumference (HC), transversal diameter of the cerebellum (TCD), the sizes of the lateral ventricle (LV) and the cisterna magna (CM) from the second and third trimester ultrasound scans extracted from a clinical database. We measured the CSP in these archived ultrasound scans. The HC/CSP, HC/LV, HC/CM and HC/TCD ratios were calculated as relative values independent of the fetal size. Results The HC/CSP ratio differed notably between the controls and each of the other groups (VSGA P = 0.018 and SGA P = 0.017). No notable difference in the HC/CSP ratio between the VSGA and SGA groups could be found (P = 0.960). The HC/LV, HC/CM and HC/TCD ratios were similar in all the three groups. Conclusion Relative to HC, the CSP is larger in VSGA and SGA fetuses than in normal controls. However, there is no notable difference between VSGA and SGA fetuses, which might be an indicator for abnormal brain development in this group.
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Affiliation(s)
- Elena Jacob
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Maria Falkenberg
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Kerstin Hammer
- Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
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A Case of Septum Pellucidum Agenesis in a Patient with Psychotic Symptoms. Case Rep Psychiatry 2020; 2020:8935986. [PMID: 31976110 PMCID: PMC6970483 DOI: 10.1155/2020/8935986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022] Open
Abstract
Agenesis of the septum pellucidum is a rare congenital defect that has been associated with psychiatric disorders, cognitive deficits, learning disabilities, seizures, and neuropsychiatric disturbances. We present the case of a patient with partial agenesis of the septum pellucidum who exhibits disorganized behavior and paranoid and persecutory delusions. We add to the literature of incidental neuropsychiatric symptoms in patients with partial agenesis of the septum pellucidum which is an area that requires further exploration and study. We discuss the implications of these findings in light of previous literature findings.
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Ho Y, Herrero T, Aguinaldo J, Hahn ME, Klisser K, Ghassemi N, Alagh A, Hamlin A, Pretorius M, Horton K, Hull A, Pretorius DH. Ultrasound Measurements of Frontal Horns and the Cavum Septi Pellucidi in Healthy Fetuses in the Second and Third Trimesters of Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:127-137. [PMID: 31281992 DOI: 10.1002/jum.15086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 06/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the visualization rate and size of the frontal horns (FHs) and cavum septi pellucidi (CSP) in healthy fetuses throughout pregnancy. METHODS After Institutional Review Board approval, 522 consecutive uncomplicated singleton pregnancies between 15 and 39 gestational weeks were enrolled in the study. Ultrasound measurements of the anterior horn width (AHW), center from the horn distance (CFHD), distance from the FHs to the CSP, and CSP width were retrospectively performed using axial transventricular or transcerebellar planes. Available maternal body mass indices were recorded. RESULTS At least 1 FH was seen in 78% of the cases. The mean AHW decreased over the second trimester and plateaued in the third trimester. The CFHD plateaued in the second trimester and increased in the third trimester. Downside FHs were generally larger than upside FHs. More FHs were measured in transventricular (69%) than transcerebellar (31%) planes. Frontal horns were seen with high, low, and no confidence in 57%, 21%, and 22% of cases, respectively. No-confidence rates were 17% in the second trimester and 42% in the third trimester. The CSP was not visualized in 4% of cases; 15 of 19 cases of a nonvisualized CSP were scanned between 18 and 37 weeks. Mean body mass indices ± SDs were 27.6 ± 6.7 kg/m2 for the patients in cases of a visualized CSP and 32.4 ± 9.1 kg/m2 for the patients in cases of a nonvisualized CSP. CONCLUSIONS Normative data for the fetal FH and CSP width were established. Frontal horns are more frequently seen on transventricular views and are difficult to confidently assess in the late third trimester. This study challenges previously reported data that the CSP is seen in 100% of cases from 18 to 37 weeks.
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Affiliation(s)
- Yoona Ho
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
| | - Tiffany Herrero
- Reproductive Medicine, University of California, San Diego, California, USA
- Stanford University Maternal-Fetal Medicine, Stanford, California, USA
| | - Jennifer Aguinaldo
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
| | - Michael E Hahn
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
| | - Kristin Klisser
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
| | - Neda Ghassemi
- University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Amy Alagh
- Department of Obstetrics and Gynecology, University of California, San Francisco, Fresno, California, USA
| | - Alyssa Hamlin
- Department of Obstetrics and Gynecology, University of Colorado, Boulder, Colorado, USA
| | | | | | - Andrew Hull
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Reproductive Medicine, University of California, San Diego, California, USA
| | - Dolores H Pretorius
- University of California, San Diego, Maternal-Fetal Care and Genetics, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
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Pilliod RA, Pettersson DR, Gibson T, Gievers L, Kim A, Sohaey R, Oh KY, Shaffer BL. Diagnostic accuracy and clinical outcomes associated with prenatal diagnosis of fetal absent cavum septi pellucidi. Prenat Diagn 2018. [DOI: 10.1002/pd.5247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rachel A. Pilliod
- Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
| | - David R. Pettersson
- Department of Diagnostic Radiology; Oregon Health & Science University; Portland OR USA
| | - Thomas Gibson
- Department of Diagnostic Radiology; Oregon Health & Science University; Portland OR USA
| | - Ladawna Gievers
- Department of Pediatrics; Oregon Health & Science University; Portland OR USA
| | - Amanda Kim
- Department of Pediatrics; Oregon Health & Science University; Portland OR USA
| | - Roya Sohaey
- Department of Diagnostic Radiology; Oregon Health & Science University; Portland OR USA
| | - Karen Y. Oh
- Department of Diagnostic Radiology; Oregon Health & Science University; Portland OR USA
| | - Brian L. Shaffer
- Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
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Kaur C, Ling EA. Transitory cystic cavities in the developing mammalian brain - normal or anomalous? J Anat 2016; 230:197-202. [PMID: 27761896 DOI: 10.1111/joa.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/28/2022] Open
Abstract
Transitory cavities associated with the ventricular system represent probably one of the most unique features in the developing mammalian brain. In rodents, the cavities exist transiently in the developing brain and do not appear to be associated with any pathological events. Among the various cavities, the pyramidal-shaped cavum septum pellucidum (CSP) located beneath the corpus callosum and between the lateral ventricles is most well defined. In addition to the CSP are the bilateral subependymal cysts that are consistently associated with the third and fourth ventricles as well as the aqueduct. The cavities/cysts contain a large number of amoeboid microglia expressing surface receptors and hydrolytic enzymes common to tissue macrophages. The significance of these cavities in the developing brain remains a conjecture. Firstly, the cavity walls are free of an apparent epithelial lining; hence, it is speculated that the cavities that appear to communicate with the widened neighboring interstitial tissue spaces may have resulted from physical traction due to the rapid growth of the perinatal brain. Secondly, the cavities contain prominent clusters of amoeboid microglia that may be involved in clearing the debris of degenerating axons and cells resulting from the early brain tissue remodeling. With the increase in brain tissue compactness following the beginning of myelination in the second postnatal week, all cavities are obliterated; concomitantly, the number of amoeboid microglia in them diminishes and all this might signal further maturation of the brain.
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Affiliation(s)
- Charanjit Kaur
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eng-Ang Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Sefidbakht S, Dehghani S, Safari M, Vafaei H, Kasraeian M. Fetal Central Nervous System Anomalies Detected by Magnetic Resonance Imaging: A Two-Year Experience. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e4589. [PMID: 27729957 PMCID: PMC5046157 DOI: 10.5812/ijp.4589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/18/2016] [Accepted: 03/12/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is gradually becoming more common for thorough visualization of the fetus than ultrasound (US), especially for neurological anomalies, which are the most common indications for fetal MRI and are a matter of concern for both families and society. OBJECTIVES We investigated fetal MRIs carried out in our center for frequency of central nervous system anomalies. This is the first such report in southern Iran. MATERIALS AND METHODS One hundred and seven (107) pregnant women with suspicious fetal anomalies in prenatal ultrasound entered a cross-sectional retrospective study from 2011 to 2013. A 1.5 T Siemens Avanto scanner was employed for sequences, including T2 HASTE and Trufisp images in axial, coronal, and sagittal planes to mother's body, T2 HASTE and Trufisp relative to the specific fetal body part being evaluated, and T1 flash images in at least one plane based on clinical indication. We investigated any abnormality in the central nervous system and performed descriptive analysis to achieve index of frequency. RESULTS Mean gestational age ± standard deviation (SD) for fetuses was 25.54 ± 5.22 weeks, and mean maternal age ± SD was 28.38 ± 5.80 years Eighty out of 107 (74.7%) patients who were referred with initial impression of borderline ventriculomegaly. A total of 18 out of 107 (16.82%) patients were found to have fetuses with CNS anomalies and the remainder were neurologically normal. Detected anomalies were as follow: 3 (16.6%) fetuses each had the Dandy-Walker variant and Arnold-Chiari II (with myelomeningocele). Complete agenesis of corpus callosum, partial agenesis of corpus callosum, and aqueductal stenosis were each seen in 2 (11.1%) fetuses. Arnold-Chiari II without myelomeningocele, anterior spina bifida associated with neurenteric cyst, arachnoid cyst, lissencephaly, and isolated enlarged cisterna magna each presented in one (5.5%) fetus. One fetus had concomitant schizencephaly and complete agenesis of the corpus callosum. CONCLUSIONS MRI is superior to ultrasound and physical exam of live births in detection of CNS anomalies. In this investigation within a single referral center in southern Iran, anomalies included Dandy-Walker variant and Arnold-Chiari II as the most common findings. Other findings with lower incidence were complete and partial agenesis of corpus callosum, aqueductal stenosis, anterior spina bifida, schizencephaly, arachnoid cyst, lissencephaly, and isolated enlarged cisterna magna.
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Affiliation(s)
- Sepideh Sefidbakht
- Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Sakineh Dehghani
- Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Sakineh Dehghani, Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9171076240, Fax: +98-7136474329, E-mail:
| | - Maryam Safari
- Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Homeira Vafaei
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Maryam Kasraeian
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
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