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Davutoglu EA, Arica G, Sahin NE, Ucar AK, Adaletli I, Vural ZM, Madazli R. Clinical characteristics and perinatal outcome of fetuses with ventriculomegaly. Arch Gynecol Obstet 2024; 310:2065-2071. [PMID: 38926203 PMCID: PMC11393207 DOI: 10.1007/s00404-024-07599-8] [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: 10/10/2023] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To assess the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections, and perinatal outcomes of fetuses with ventriculomegaly (VM), also to evaluate the role of fetal magnetic resonance imaging (MRI) in detecting associated intracranial anomalies. METHODS Retrospective cohort study of 149 prenatally diagnosed pregnancies with fetal VM. VM was classified as mild (Vp = 10-12 mm), moderate (Vp = 12.1-15 mm), and severe (Vp > 15 mm). Fetal MRI was performed to 97 pregnancies. RESULTS The incidences of an associated CNS, non-CNS, chromosomal anomaly, genetic abnormality and fetal infection were 42.3%, 11.4%, 6.1%, 2.1% and 1.3%, respectively. Fetal MRI identified additional CNS anomalies in 6.7% of cases, particularly in severe VM. The incidences of perinatal outcomes were 18.8% termination of pregnancy, 4% intrauterine and 8.1% neonatal or infant death. The rates of fetuses alive at > 12 months of age with neurological morbidity were 2.6%, 11.1% and 76.9% for mild, moderate and severe isolated VM, respectively. CONCLUSION The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. Mild to moderate isolated VM generally have favorable outcomes. Fetal MRI is particularly valuable in fetuses with isolated severe VM.
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Affiliation(s)
- Ebru Alici Davutoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey
| | - Gorkem Arica
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey
| | - Nazli Ece Sahin
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Department of Pediatric Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Pediatric Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zekeriyya Mehmet Vural
- Department of Neonatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Riza Madazli
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
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Zamłyński M, Zhemela O, Olejek A. Isolated Fetal Ventriculomegaly: Diagnosis and Treatment in the Prenatal Period. CHILDREN (BASEL, SWITZERLAND) 2024; 11:957. [PMID: 39201892 PMCID: PMC11352226 DOI: 10.3390/children11080957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
Fetal ventriculomegaly (VM) is a defect of the central nervous system, typically diagnosed during the second-trimester ultrasound in fetuses with an atrial diameter (AD) of >10 mm. Non-isolated ventriculomegaly (NIVM) is heterogeneous in nature, coexisting with additional intracranial and/or extracranial malformations and genetic syndromes, resulting in an unfavorable prognosis for the further development of the child. Both the pregnancy management and counseling are dependent on the findings of combined ultrasound/MRI, genetic testing, and gestational age at diagnosis. The purpose of this review is to propose a hypothesis that diagnostic advancements allow to define the process of identification of the isolated forms of VM (IVM). Based on the evidence presented in the literature, we consider whether prenatal decompression for severe isolated VM (ISVM) is supported by the experimental trials and whether it might be implemented in clinical practice. Also, we describe the evolution of the diagnostic methods and expert opinions about the previously used prenatal decompression techniques for ISVM. In conclusion, we introduce the idea that fetal surgery centers have either reached or nearly reached the necessary level of expertise to perform such procedures. Endoscopic cystoventriculostomy (ETV) appears to be the most promising, as it is associated with minimal perinatal complications and favorable neurological outcomes in the neonatal period. Randomized trials with long-term neurodevelopmental follow-up of children who underwent prenatal decompression due to ISVM are necessary.
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Affiliation(s)
- Mateusz Zamłyński
- Department of Gynecology, Obstetrics and Oncological Gynecology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Stefana Batorego 15, 41-902 Bytom, Poland;
| | - Olena Zhemela
- Department of Obstetrics and Gynecology, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine;
| | - Anita Olejek
- Department of Gynecology, Obstetrics and Oncological Gynecology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Stefana Batorego 15, 41-902 Bytom, Poland;
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Agarwal S, Venkatesan C, Vollmer B, Scelsa B, Lemmon ME, Pardo AC, Mulkey SB, Tarui T, Dadhwal V, Scher M, Hart AR, Gano D. Fetal Cerebral Ventriculomegaly: A Narrative Review and Practical Recommendations for Pediatric Neurologists. Pediatr Neurol 2024; 156:119-127. [PMID: 38761643 DOI: 10.1016/j.pediatrneurol.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/19/2024] [Indexed: 05/20/2024]
Abstract
Fetal cerebral ventriculomegaly is one of the most common fetal neurological disorders identified prenatally by neuroimaging. The challenges in the evolving landscape of conditions like fetal cerebral ventriculomegaly involve accurate diagnosis and how best to provide prenatal counseling regarding prognosis as well as postnatal management and care of the infant. The purpose of this narrative review is to discuss the literature on fetal ventriculomegaly, including postnatal management and neurodevelopmental outcome, and to provide practice recommendations for pediatric neurologists.
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Affiliation(s)
- Sonika Agarwal
- Division of Neurology & Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Charu Venkatesan
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brigitte Vollmer
- Faculty of Medicine, Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Barbara Scelsa
- Department of Pediatric Neurology, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Monica E Lemmon
- Department of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Andrea C Pardo
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Departments of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Division of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Tomo Tarui
- Division of Pediatric Neurology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vatsla Dadhwal
- Professor, Maternal Fetal Medicine, Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mark Scher
- Emeritus Full Professor Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anthony R Hart
- Department of Paediatric Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dawn Gano
- Department of Neurology & Pediatrics, University of California San Francisco, San Francisco, California
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Yue F, Yang X, Liu N, Liu R, Zhang H. Prenatal diagnosis and pregnancy outcomes in fetuses with ventriculomegaly. Front Med (Lausanne) 2024; 11:1349171. [PMID: 38784233 PMCID: PMC11111914 DOI: 10.3389/fmed.2024.1349171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Genetic etiology plays a critical role in fetal ventriculomegaly (VM). However, the studies on chromosomal copy number variants (CNVs) in fetal VM are limited. This study aimed to investigate the chromosomal CNVs in fetuses with mild to moderate VM, and explore its genotype-phenotype correlation. Methods A total of 242 fetuses with mild to moderate VM detected by prenatal ultrasound were enrolled in our study from October 2018 to October 2022. All cases underwent chromosomal microarray analysis (CMA) and G-banding simultaneously. All VM cases were classified different subgroups according to the maternal age, severity, VM distribution and presence/absence of other ultrasound abnormalities. The pregnancy outcomes and health conditions after birth were followed up. We also performed a pooled analysis regarding likely pathogenic and pathogenic CNVs (LP/P CNVs) for VM. Results The detection rate of chromosomal abnormalities by karyotyping was 9.1% (22/242), whereas it was 16.5% (40/242) when CMA was conducted (P < 0.05). The total detection rate of chromosomal abnormalities by karyotyping and CMA was 21.1% (51/242). A 12.0% incremental yield of CMA over karyotyping was observed. The detection rate of total genetic variants in fetuses with bilateral VM was significantly higher than in fetuses with unilateral VM (30.0% vs. 16.7%, P = 0.017). No significant differences were discovered between isolated VM and non-isolated VM, or between mild and moderate VM, or between advanced maternal age (AMA) and non-AMA (all P > 0.05). 28 fetuses with VM were terminated and 214 fetuses were delivered: one presented developmental delay and one presented congenital heart disease. The VM cases with both positive CMA and karyotypic results had a higher rate of termination of pregnancy than those with either a positive CMA or karyotypic result, or both negative testing results (P < 0.001). Conclusion The combination of CMA and karyotyping should be adopted to improve the positive detection rate of chromosomal abnormalities for VM. The total genetic abnormalities detected using both techniques would affect the final pregnancy outcomes. LP/P CNVs at 16p11.2, 17p13, and 22q11.21 were identified as the top three chromosomal hotspots associated with VM, which would enable genetic counselors to provide more precise genetic counseling for VM pregnancies.
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Affiliation(s)
- Fagui Yue
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Xiao Yang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Ning Liu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Ruizhi Liu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Hongguo Zhang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
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Wang X, Zhang S, Wang J, Zhang S, Feng L, Wu Q. Follow-up outcome analysis of 324 cases of early-onset and late-onset mild fetal ventriculomegaly: a retrospective cohort study. Eur J Med Res 2024; 29:128. [PMID: 38365795 PMCID: PMC10870476 DOI: 10.1186/s40001-024-01709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Mild fetal ventriculomegaly (VM) is a nonspecific finding common to several pathologies with varying prognosis and is, therefore, a challenge in fetal consultation. We aimed to perform a constant, detailed analysis of prenatal findings and postnatal outcomes in fetuses with early-onset and late-onset mild ventriculomegaly, and provide a new evidence basis and new perspective for prenatal counseling. METHODS This is a retrospective cohort study of women with a diagnosis of mild fetal VM between January 2018 and October 2020. The population was divided into two groups according to the gestational ages (GAs) at initial diagnosis: the early-onset group (diagnosed at/before 24+6 weeks) and the late-onset group (diagnosed after 24+6 weeks). Clinical data and pregnancy outcomes were obtained from hospital records. The children's neurodevelopment status was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3) and telephone interviews. RESULTS Our study cohort comprised 324 fetuses, out of which 94 (29%) were classified as early-onset group and 230 (71%) late-onset group. Early-onset group was more likely to have concurrent additional abnormalities, whereas in the late-onset group, isolated enlargement was more common (P = 0.01). Unilateral enlargement was more common in the late-onset group (P = 0.05), and symmetrical enlargement in the early-onset group (P < 0.01). In addition, early-onset mild VM cases were more likely to have intrauterine progression (P = 0.03), and many had a higher proportion of complex multisystem abnormalities. Compared with the late-onset group, the early-onset group was more often associated with congenital brain structure malformations. Approximately 11% of fetuses with mild VM had postnatal neurodevelopmental delay/disorders, and the risk was higher in the early-onset group (19.4% vs. 7.4%). Regression analysis showed that the GA at first diagnosis, non-isolated, and intrauterine progression significantly correlated with neurodevelopmental abnormalities. CONCLUSIONS Early-onset and late-onset mild VM had significantly different ultrasound features and outcomes. Early-onset mild VM may have more complex potential abnormalities and are more likely to predict poor prognosis than the late-onset.
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Affiliation(s)
- Xuemei Wang
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
- Ultrasound Department, The Second Affiliated Hospital of Shandong First Medical University, 271000, Taian, Shandong, People's Republic of China
| | - Shanlong Zhang
- Ultrasound Department, The Second Affiliated Hospital of Shandong First Medical University, 271000, Taian, Shandong, People's Republic of China
| | - Jingjing Wang
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
| | - Simin Zhang
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
| | - Li Feng
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
| | - Qingqing Wu
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
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Di Mascio D, D'Antonio F, Rizzo G, Pilu G, Khalil A, Papageorghiou AT. Counseling in fetal medicine: update on mild and moderate fetal ventriculomegaly. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:153-163. [PMID: 38301072 DOI: 10.1002/uog.26251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/31/2023] [Accepted: 05/07/2023] [Indexed: 02/03/2024]
Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - G Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - A T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Gómez-Arriaga PI, Núñez N, Zamora B, Villalaín C, Risco B, Liébana C, Herraiz I, Galindo A. Natural history and mid-term neurodevelopmental outcome of fetuses with isolated mild ventriculomegaly diagnosed in the second half of pregnancy. J Matern Fetal Neonatal Med 2023; 36:2214836. [PMID: 37217456 DOI: 10.1080/14767058.2023.2214836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Prenatal diagnosis and counseling of isolated ventriculomegaly (VM) represent a considerable challenge. We aimed to analyze the intrauterine evolution, associated anomalies, and neurodevelopmental outcome using the Battelle Development Inventory (BDI) of fetuses with an initial diagnosis of isolated mild VM. MATERIAL AND METHODS Retrospective cohort study of fetuses diagnosed with mild isolated VM (10 -12 mm) between 2012 and 2016 in a tertiary hospital. In 2018, parents were invited to complete the structured BDI test for the neurodevelopmental evaluation of their children in five domains (personal-social skills, adaptive behavior, psychomotor ability, communication, and cognition). Results exceeding two standard deviations were considered abnormal and referred to an expert neuropediatrician. RESULTS We identified 43 cases of mild isolated VM. In 5 (11%), structural abnormalities were detected during prenatal follow-up, being related to non-regressive forms (p = .01) and bilateral VM (p = .04). The BDI test was completed by 19/43 (44%). The global score was abnormal in 10/19 (53%). Of them, the neuropediatrician confirmed a neurodevelopmental delay solely in 3 cases that had already been diagnosed with neurological disorders. The most affected domains were gross motor skills (63%), personal-social (63%), and adaptive domains (47%). Communicative and cognitive areas were abnormal in 26% of cases. CONCLUSION In fetuses with isolated mild VM detected in the second half of pregnancy, 53% had an abnormal BDI test at 2-6 years, but a neurological disorder was only confirmed in the 30% of them.
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Affiliation(s)
- Paula I Gómez-Arriaga
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Noemí Núñez
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Pediatric Neurology Unit, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Berta Zamora
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Pediatric Rare Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cecilia Villalaín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Beatriz Risco
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Constanza Liébana
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Pediatric Radiology, Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS network, Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Galindo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS network, Instituto de Salud Carlos III, Madrid, Spain
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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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Pan L, Wu J, Liang D, Yuan J, Wang J, Shen Y, Lu J, Xia A, Li J, Wu L. Association analysis between chromosomal abnormalities and fetal ultrasonographic soft markers based on 15,263 fetuses. Am J Obstet Gynecol MFM 2023; 5:101072. [PMID: 37393030 DOI: 10.1016/j.ajogmf.2023.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Soft markers are common prenatal ultrasonographic findings that indicate an increased risk for fetal aneuploidy. However, the association between soft markers and pathogenic or likely pathogenic copy number variations is still unclear, and clinicians lack clarity on which soft markers warrant a recommendation for invasive prenatal genetic testing of the fetus. OBJECTIVE This study aimed to provide guidance on ordering prenatal genetic testing for fetuses with different soft markers and to elucidate the association between specific types of chromosomal abnormalities and specific ultrasonographic soft markers. STUDY DESIGN Low-pass genome sequencing was performed for 15,263 fetuses, including 9123 with ultrasonographic soft markers and 6140 with normal ultrasonographic findings. The detection rate of pathogenic or likely pathogenic copy number variants among fetuses with various ultrasonographic soft markers were compared with that of fetuses with normal ultrasonography. The association of soft markers with aneuploidy and pathogenic or likely pathogenic copy number variants were investigated using Fisher exact tests with Bonferroni correction. RESULTS The detection rate of aneuploidy and pathogenic or likely pathogenic copy number variants was 3.04% (277/9123) and 3.40% (310/9123), respectively, in fetuses with ultrasonographic soft markers. An absent or a hypoplastic nasal bone was the soft marker in the second trimester with the highest diagnostic rate for aneuploidy of 5.22% (83/1591) among all isolated groups. Four types of isolated ultrasonographic soft markers, namely a thickened nuchal fold, single umbilical artery, mild ventriculomegaly, and absent or hypoplastic nasal bone, had higher diagnostic rates for pathogenic or likely pathogenic copy number variants (P<.05; odds ratio, 1.69-3.31). Furthermore, this study found that the 22q11.2 deletion was associated with an aberrant right subclavian artery, whereas the 16p13.11 deletion, 10q26.13-q26.3 deletion, and 8p23.3-p23.1 deletion were associated with a thickened nuchal fold, and the 16p11.2 deletion and 17p11.2 deletion were associated with mild ventriculomegaly (P<.05). CONCLUSION Ultrasonographic phenotype-based genetic testing should be considered in clinical consultations. Copy number variant analysis is recommended for fetuses with an isolated thickened nuchal fold, a single umbilical artery, mild ventriculomegaly, and an absent or a hypoplastic nasal bone. A comprehensive definition of genotype-phenotype correlations in aneuploidy and pathogenic or likely pathogenic copy number variants could provide better information for genetic counseling.
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Affiliation(s)
- Lijuan Pan
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China (Drs Pan, J Wu, Liang, and L Wu); Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China (Dr Pan)
| | - Jiayu Wu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China (Drs Pan, J Wu, Liang, and L Wu)
| | - Desheng Liang
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China (Drs Pan, J Wu, Liang, and L Wu)
| | - Jing Yuan
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (Dr Yuan)
| | - Jue Wang
- Department of Obstetrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (Dr Wang)
| | - Yinchen Shen
- Department of Maternity Care, Nanning Maternity and Child Health Hospital, Nanning, Guangxi, China (Dr Shen)
| | - Junjie Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, China (Dr Lu)
| | - Aihua Xia
- Department of Obstetrics, Beihai People's Hospital, Beihai, Guangxi, China (Dr Xia)
| | - Jinchen Li
- Bioinformatics Center and National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China (Dr Li).
| | - Lingqian Wu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China (Drs Pan, J Wu, Liang, and L Wu).
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10
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Tao H, Zhang L, Tan F, Han Y, Wang X, Wu J, Zhai J. Pregnancy outcomes and genetic analysis for fetal ventriculomegaly. Front Genet 2023; 14:1186660. [PMID: 37795247 PMCID: PMC10545856 DOI: 10.3389/fgene.2023.1186660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction: Fetal ventriculomegaly (VM) is associated with neurodevelopmental disorders, partly caused by genetic factor. Methods: To systematically investigate the genetic etiology of fetal VM and related pregnancy outcomes in different subgroups: IVM (isolated VM) and NIVM (non-isolated VM); unilateral and bilateral VM; mild, moderate, and severe VM, a retrospective study including 131 fetuses with VM was carried out from April 2017 to August 2022. Results: 82 cases underwent amniocentesis or cordocentesis, of whom 8 cases (9.8%) were found chromosomal abnormalities by karyotyping. Meanwhile, additional 8 cases (15.7%) with copy number variations (CNVs) were detected by copy number variation sequencing (CNV-seq). The detection rate (DR) of chromosomal abnormalities was higher in NIVM, bilateral VM and severe VM groups. And CNVs frequently occurred in NIVM, bilateral VM and moderate VM groups. In the NIVM group, the incidence of chromosomal aberrations and CNVs in multiple system anomalies (19.0%, 35.7%) was higher than that in single system anomalies (10.0%, 21.1%). After dynamic ultrasound follow-up, 124 cases were available in our cohort. 12 cases were further found other structural abnormalities, and lateral ventricular width was found increased in 8 cases and decreased in 15 cases. Meanwhile, 82 cases underwent fetal brain MRI, 10 cases of brain lesions and 11 cases of progression were additionally identified. With the involvement of a multidisciplinary team, 45 cases opted for termination of pregnancy (TOP) and 79 cases were delivered with live births. One infant death and one with developmental retardation were finally found during postnatal follow-ups. Discussion: CNV-seq combined with karyotyping could effectively improve the diagnostic rate in fetuses with VM. Meanwhile, dynamic ultrasound screening and multidisciplinary evaluation are also essential for assessing the possible outcomes of fetuses with VM.
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Affiliation(s)
- Huimin Tao
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
| | - Lin Zhang
- School of Information and Control Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Fangfang Tan
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
| | - Yu Han
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
| | - Xuezhen Wang
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
| | - Jiebin Wu
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
| | - Jingfang Zhai
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
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11
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Tarui T, Venkatesan C, Gano D, Lemmon ME, Mulkey SB, Pardo AC, Emrick L, Scher M, Agarwal S. Fetal Neurology Practice Survey: Current Practice and the Future Directions. Pediatr Neurol 2023; 145:74-79. [PMID: 37290231 DOI: 10.1016/j.pediatrneurol.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Fetal neurology is a rapidly evolving field. Consultations aim to diagnose, prognosticate, and coordinate prenatal and perinatal management along with other specialists and counsel expectant parents. Practice parameters and guidelines are limited. METHODS A 48-question online survey was administered to child neurologists. Questions targeted current care practices and perceived priorities for the field. RESULTS Representatives from 43 institutions in the United States responded; 83% had prenatal diagnosis centers, and the majority performed on-site neuroimaging. The earliest gestational age for fetal magnetic resonance imaging was variable. Annual consultations ranged from <20 to >100 patients. Fewer than half (n = 17.40%) were subspecialty trained. Most respondents (n = 39.91%) were interested in participating in a collaborative registry and educational initiatives. CONCLUSIONS The survey highlights heterogeneity in clinical practice. Large multisite and multidisciplinary collaborations are essential to gather data that inform outcomes for fetuses evaluated across institutions through registries as well as creation of guidelines and educational material.
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Affiliation(s)
- Tomo Tarui
- Division of Pediatric Neurology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Charu Venkatesan
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dawn Gano
- Department of Neurology & Pediatrics, University of California San Francisco, San Francisco, California
| | - Monica E Lemmon
- Department of Pediatrics and Population Health Sciences, Duke University School of Medicine
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Departments of Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Andrea C Pardo
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Lisa Emrick
- Department of Pediatrics, Neurology and Developmental Neuroscience, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Mark Scher
- Emeritus Full Professor Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sonika Agarwal
- Division of Neurology & Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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12
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Zhang H, Linpeng S, Teng Y, Peng C, Liang D, Li Z, Wu L. A de novo heterozygous POU3F3 genotype for the p.(Q214*) variant in a fetus with transient isolated bilateral mild ventriculomegaly: a case report and review of the literature. Front Pediatr 2023; 11:1177137. [PMID: 37593446 PMCID: PMC10427865 DOI: 10.3389/fped.2023.1177137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
The prenatal prevalence of isolated ventriculomegaly is 0.039%-0.087%. Most isolated mild ventriculomegaly (MV) fetuses (>90%) have a favorable prognosis. However, 5.6% to 7.9% of fetuses with isolated MV have adverse neurodevelopmental outcomes. In this study, we reported the first case of prenatal Snijders Blok-Fisher syndrome (OMIM: #618604) caused by a truncating variant of POU3F3 (OMIM: *602480) in a fetus with transient isolated bilateral MV. The results of karyotype analysis, chromosomal microarray analysis, and TORCH infection evaluation for the fetus were all negative. However, a de novo likely pathogenic nonsense variant of NM_006236.3 (POU3F3): c.640C > T [rs1254251078] p.(Q214*) was identified by whole-exome sequencing (WES). Despite sufficient genetic counseling, the mother refused to undertake further brain magnetic resonance imaging (MRI) and decided to keep the fetus. She gave birth to a male infant through a full-term vaginal delivery. With a long-term follow-up, the infant unfortunately gradually presented with delayed motor development. The postnatal brain MRI of the proband showed dysplasia of the corpus callosum and ventriculomegaly. Considering the high probability of misdiagnosis for such cases, we further summarized the prenatal phenotypes from 19 reported patients with variants in POU3F3. The results revealed that 14 patients displayed a normal prenatal ultrasonographic manifestation, while only approximately 26.32% of fetuses showed MV or cysts without structural deformity. Thus our findings expand the variant spectrum of POU3F3 and suggest the importance of undertaking WES and brain MRI when the fetus has isolated bilateral MV.
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Affiliation(s)
- Hongyun Zhang
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Siyuan Linpeng
- Department of Genetics and Eugenics, Hunan Provincial Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal and Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Yanling Teng
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Can Peng
- Department of Genetics and Eugenics, Hunan Provincial Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal and Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Desheng Liang
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- Laboratory of Molecular Genetics, Hunan Jiahui Genetics Hospital, Changsha, China
| | - Zhuo Li
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Lingqian Wu
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- Laboratory of Molecular Genetics, Hunan Jiahui Genetics Hospital, Changsha, China
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13
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Whitehead MT, Limperopoulos C, Schlatterer SD, Mulkey SB, Fraser JL, du Plessis AJ. Hippocampal rotation is associated with ventricular atrial size. Pediatr Radiol 2023; 53:1941-1950. [PMID: 37183230 DOI: 10.1007/s00247-023-05687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Fetal ventriculomegaly is a source of apprehension for expectant parents and may present prognostic uncertainty for physicians. Accurate prenatal counseling requires knowledge of its cause and associated findings as the differential diagnosis is broad. We have observed an association between ventriculomegaly and incomplete hippocampal inversion. OBJECTIVE To determine whether ventricular size is related to incomplete hippocampal inversion. MATERIALS AND METHODS We retrospectively evaluated pre- and postnatal brain MRIs in normal subjects (mean GA, 31 weeks; mean postnatal age, 27 days) and patients with isolated ventriculomegaly (mean GA, 31 weeks; mean postnatal age, 68 days) at a single academic medical center. Lateral ventricular diameter, multiple qualitative and quantitative markers of hippocampal inversion, and evidence of intraventricular hemorrhage were documented. RESULTS Incomplete hippocampal inversion and ventricular size were associated in both normal subjects (n=51) and patients with ventriculomegaly (n=32) (P<0.05). Severe ventriculomegaly was significantly associated with adverse clinical outcome in postnatal (P=0.02) but not prenatal (P=0.43) groups. In all additional cases of isolated ventriculomegaly, clinical outcome was normal over the time of assessment (mean 1±1.9 years; range 0.01 to 10 years). CONCLUSION Lateral ventricular atrial diameter and incomplete hippocampal inversion are associated. Less hippocampal inversion correlates with larger atria. For every 1-mm increase in fetal ventricular size, the odds of incomplete hippocampal inversion occurring increases by a factor of 1.6 in normal controls and 1.4 in patients with ventriculomegaly.
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Affiliation(s)
- Matthew T Whitehead
- Department of Neuroradiology, Children's National Hospital, Washington, DC, USA.
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA.
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Radiology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Catherine Limperopoulos
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Sarah D Schlatterer
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Jamie L Fraser
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Adre J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
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14
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Vahedifard F, Ai HA, Supanich MP, Marathu KK, Liu X, Kocak M, Ansari SM, Akyuz M, Adepoju JO, Adler S, Byrd S. Automatic Ventriculomegaly Detection in Fetal Brain MRI: A Step-by-Step Deep Learning Model for Novel 2D-3D Linear Measurements. Diagnostics (Basel) 2023; 13:2355. [PMID: 37510099 PMCID: PMC10378043 DOI: 10.3390/diagnostics13142355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
In this study, we developed an automated workflow using a deep learning model (DL) to measure the lateral ventricle linearly in fetal brain MRI, which are subsequently classified into normal or ventriculomegaly, defined as a diameter wider than 10 mm at the level of the thalamus and choroid plexus. To accomplish this, we first trained a UNet-based deep learning model to segment the brain of a fetus into seven different tissue categories using a public dataset (FeTA 2022) consisting of fetal T2-weighted images. Then, an automatic workflow was developed to perform lateral ventricle measurement at the level of the thalamus and choroid plexus. The test dataset included 22 cases of normal and abnormal T2-weighted fetal brain MRIs. Measurements performed by our AI model were compared with manual measurements performed by a general radiologist and a neuroradiologist. The AI model correctly classified 95% of fetal brain MRI cases into normal or ventriculomegaly. It could measure the lateral ventricle diameter in 95% of cases with less than a 1.7 mm error. The average difference between measurements was 0.90 mm in AI vs. general radiologists and 0.82 mm in AI vs. neuroradiologists, which are comparable to the difference between the two radiologists, 0.51 mm. In addition, the AI model also enabled the researchers to create 3D-reconstructed images, which better represent real anatomy than 2D images. When a manual measurement is performed, it could also provide both the right and left ventricles in just one cut, instead of two. The measurement difference between the general radiologist and the algorithm (p = 0.9827), and between the neuroradiologist and the algorithm (p = 0.2378), was not statistically significant. In contrast, the difference between general radiologists vs. neuroradiologists was statistically significant (p = 0.0043). To the best of our knowledge, this is the first study that performs 2D linear measurement of ventriculomegaly with a 3D model based on an artificial intelligence approach. The paper presents a step-by-step approach for designing an AI model based on several radiological criteria. Overall, this study showed that AI can automatically calculate the lateral ventricle in fetal brain MRIs and accurately classify them as abnormal or normal.
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Affiliation(s)
- Farzan Vahedifard
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - H Asher Ai
- Division for Diagnostic Medical Physics, Department of Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Mark P Supanich
- Division for Diagnostic Medical Physics, Department of Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Kranthi K Marathu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Xuchu Liu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Shehbaz M Ansari
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Melih Akyuz
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Jubril O Adepoju
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Seth Adler
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
| | - Sharon Byrd
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA
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15
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Horgos B, Mecea M, Boer A, Buruiana A, Ciortea R, Mihu CM, Florian IS, Florian AI, Stamatian F, Szabo B, Albu C, Susman S, Pascalau R. White matter changes in fetal brains with ventriculomegaly. Front Neuroanat 2023; 17:1160742. [PMID: 37389403 PMCID: PMC10303118 DOI: 10.3389/fnana.2023.1160742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Ventriculomegaly (VM) is a fetal brain malformation which may present independently (isolated form) or in association with different cerebral malformations, genetic syndromes or other pathologies (non-isolated form). Methods This paper aims to study the effect of ventriculomegaly on the internal tridimensional architecture of fetal brains by way of Klingler's dissection. Ventriculomegaly was diagnosed using fetal ultrasonography during pregnancy and subsequently confirmed by necropsy. Taking into consideration the diameter of the lateral ventricle (measured at the level of the atrium), the brains were divided into two groups: moderate ventriculomegaly (with atrial diameter between 13 and 15 mm) and severe ventriculomegaly (with atrial diameter above 15 mm). Results and discussion The results of each dissection were described and illustrated, then compared with age-matched reference brains. In the pathological brains, fascicles in direct contact with the enlarged ventricles were found to be thinner and displaced inferiorly, the opening of the uncinate fasciculus was wider, the fornix was no longer in contact with the corpus callosum and the convexity of the corpus callosum was inverted. We have studied the prevalence of neurodevelopmental delay in children born with ventriculomegaly in the literature and discovered that a normal developmental outcome was found in over 90% of the mild VM cases, approximately 75% of the moderate and 60% in severe VM, with the correlated neurological impairments ranging from attention deficits to psychiatric disorders.
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Affiliation(s)
- Bianca Horgos
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Miruna Mecea
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Armand Boer
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Buruiana
- Department of Oncology, “Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania
| | - Razvan Ciortea
- Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Obstetrics and Gynecology, Emergency County Hospital, Cluj-Napoca, Romania
| | - Carmen-Mihaela Mihu
- Department of Morphological Sciences—Histology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Stefan Florian
- Department of Neuroscience—Neurosurgery, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Neurosurgery, Emergency County Hospital, Cluj-Napoca, Romania
| | - Alexandru Ioan Florian
- Department of Neuroscience—Neurosurgery, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Neurosurgery, Emergency County Hospital, Cluj-Napoca, Romania
| | - Florin Stamatian
- Department of Obstetrics and Gynecology, IMOGEN Centre of Advanced Research Studies, Cluj-Napoca, Romania
| | - Bianca Szabo
- Department of Morphological Sciences—Anatomy and Embryology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Albu
- Department of Morphological Sciences—Pathology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pathology, IMOGEN Centre of Advanced Research Studies, Emergency County Hospital, Cluj-Napoca, Romania
| | - Sergiu Susman
- Department of Morphological Sciences—Histology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pathology, IMOGEN Centre of Advanced Research Studies, Emergency County Hospital, Cluj-Napoca, Romania
| | - Raluca Pascalau
- Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania
- Research and Development Institute, Transilvania University of Brasov, Brasov, Romania
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16
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Hu X, Shang N. Fetal agenesis of the septum pellucidum: Ultrasonic diagnosis and clinical significance. Prenat Diagn 2023; 43:763-772. [PMID: 36670513 DOI: 10.1002/pd.6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To describe the prenatal ultrasound (US) findings, genetic results, and clinical outcomes of fetuses with suspected agenesis of the septum pellucidum (ASP) in the Chinese population. METHODS This retrospective, single-center study included a cohort of fetuses with ASP diagnosed by prenatal imaging over a 10-year period. We evaluated US findings, associated anomalies, genetic results, and clinical outcomes. Prenatal and postnatal imaging findings were compared as well as the clinical outcome of delivery. RESULTS Ninety patients were included, with a median follow-up time of 36 months (1-96 months). Thirty-six fetuses (40%) with isolated ASP were diagnosed by prenatal US or magnetic resonance imaging (MRI); 39 cases (43.3%) had ASP with central nervous system malformations and 15 cases (16.6%) had ASP with non-CNS abnormalities. Additional imaging findings were supplemented with prenatal MRI in 13 cases. Genetic tests were performed on 32 patients, of whom six had abnormalities. Prenatal US results of 40 patients (40/70) diagnosed by referral hospitals did not correspond to our findings. Of the 38 patients with postnatal records, 11 had abnormal neurological development. CONCLUSION(S) The outcome of an isolated ASP is usually favorable; however, neurological developmental delay is commonly observed if it is combined with other malformations.
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Affiliation(s)
- Xueyi Hu
- ultrasound Department, Guangdong Women and Children Hospital, Guangzhou, China
- Guangzhou Medical University, Guangzhou, China
| | - Ning Shang
- ultrasound Department, Guangdong Women and Children Hospital, Guangzhou, China
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17
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Petpichetchian C, Carpineta L, Brown R. Cerebral Lateral Ventricular Asymmetry: Normal Variant or an Indicator of Underlying Pathology. Fetal Diagn Ther 2023; 50:179-186. [PMID: 37231824 DOI: 10.1159/000531091] [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: 02/03/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Isolated lateral ventricular asymmetry has been associated with a favorable prognosis; however, prenatal evaluations in existing studies have been conducted using ultrasonography (US). This study aimed to describe the magnetic resonance imaging (MRI) findings, progression of ventricular asymmetry, and perinatal outcomes in fetuses prenatally diagnosed with isolated ventricular asymmetry. METHODS This retrospective study included patients who underwent MRI for isolated fetal ventricular asymmetry at a tertiary center between January 2012 and January 2020. Information, including pregnancy history, US, MRI findings, and perinatal outcomes, was obtained from medical records. RESULTS The study cohort included 17 women with fetal ventricular asymmetry but without ventriculomegaly at the time of index US. Mild ventriculomegaly subsequently developed in 13 patients; 12 of them showed spontaneous resolution before delivery. MRI identified low-grade intraventricular hemorrhage (IVH) in 13 fetuses. Postnatally, 12 newborns underwent neonatal cranial US where two of them showed evidence of germinal matrix hemorrhage. Both newborns appeared normal at birth without neonatal complications. CONCLUSION MRI identified low-grade IVH in most fetuses with isolated ventricular asymmetry. These fetuses were also likely to develop mild ventriculomegaly with spontaneous resolution. Although perinatal outcomes appeared good, careful follow-up in both prenatal and postnatal periods is warranted.
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Affiliation(s)
- Chusana Petpichetchian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,
- Department of Obstetrics and Gynecology and Maternal Fetal Medicine, McGill University Health Centre, Montreal, Québec, Canada,
| | - Lucia Carpineta
- Department of Radiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Richard Brown
- Department of Obstetrics and Gynecology and Maternal Fetal Medicine, McGill University Health Centre, Montreal, Québec, Canada
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18
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Advances in Fetal Surgical Repair of Open Spina Bifida. Obstet Gynecol 2023; 141:505-521. [PMID: 36735401 DOI: 10.1097/aog.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
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Pagan M, Magann EF, Rabie N, Steelman SC, Hu Z, Ounpraseuth S. Idiopathic polyhydramnios and pregnancy outcome: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:302-309. [PMID: 35723677 DOI: 10.1002/uog.24973] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze outcomes of singleton pregnancies with idiopathic polyhydramnios through a systematic review and meta-analysis. METHODS Electronic databases, including MEDLINE, OVID, EBSCO, Cochrane collection and Science Citation Index, were searched from 1946 to 2019. Gray literature and tables of contents of relevant journals were also screened. Prospective and retrospective studies with a control group were included. Two authors independently reviewed the abstracts retrieved from the literature search. Inclusion criteria were: studies documented in English, singleton pregnancy and idiopathic polyhydramnios determined by amniotic fluid volume assessment on ultrasound. Exclusion criteria were: maternal diabetes, fetal structural or chromosomal anomaly, alloimmunization and intrauterine fetal infection. RESULTS Twelve studies met the inclusion criteria, giving a total of 2392 patients with idiopathic polyhydramnios and 160 135 patients with normal amniotic fluid volume. Pregnancies complicated by idiopathic polyhydramnios were at a higher risk of neonatal death (odds ratio (OR), 8.68 (95% CI, 2.91-25.87)), intrauterine fetal demise (OR, 7.64 (95% CI, 2.50-23.38)), neonatal intensive care unit admission (OR, 1.94 (95% CI, 1.45-2.59)), 5-min Apgar score < 7 (OR, 2.21 (95% CI, 1.34-3.62)), macrosomia (OR, 2.93 (95% CI, 2.39-3.59)), malpresentation (OR, 2.73 (95% CI, 2.06-3.61)) and Cesarean delivery (OR, 2.31 (95% CI, 1.79-2.99)). CONCLUSIONS This study suggests that pregnancies complicated by idiopathic polyhydramnios are at increased risk of adverse outcome. Future investigations should aim to determine an amniotic fluid volume threshold above which antenatal fetal surveillance is appropriate in the management of these pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Pagan
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Rabie
- Department of Obstetrics and Gynecology, Tripler Army Hospital, Honolulu, HI, USA
| | - S C Steelman
- Divison of Academic Affairs, University of Arkansas for Medical Sciences Library, Little Rock, AR, USA
| | - Z Hu
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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20
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Zhou Y, Wu S, Han J, Zhen L, Yang X, Li R, Zhang Y, Jing X, Li F, Liu H. Prenatal diagnosis of ultrasound soft markers in a single medical center of mainland China. Mol Cytogenet 2023; 16:3. [PMID: 36765363 PMCID: PMC9912520 DOI: 10.1186/s13039-022-00633-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/20/2022] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND There are a few studies on the chromosomal aberration of Ultrasound soft markers (USMs). The aim of this study was to determine the detection rate of clinically significant chromosomal abnormalities (CSCA) in fetuses with different USMs. METHODS This study included fetuses with USMs who underwent invasive prenatal diagnosis for karyotype and/or chromosomal microarray (CMA) by categorizing into two groups: a single USM (SUSM) and multiple USMs (MUSMs). RESULTS Of the 358 cases with USMs, CSCA occurred in 3.09% (8/259) and 8.08% (8/99) of the SUSM and MUSM groups, respectively (P < 0.05). Of 16 cases identified with CSCA, theoretically 68.75% (11/16) could be detected by karyotype, while 31.25% (5/16) could be recognized only by CMA. Among CSCA cases, the most frequent USM was an absent or hypoplastic nasal bone (62.5%, 10/16). In cases with negative karyotypes and/or CMA, follow-up results were available in 307 cases, including 292 term deliveries, 6 preterm deliveries, 8 terminations of pregnancy due to USMs, and 1 still birth. CONCLUSION MUSMs increased the risk of chromosomal abnormalities. An absent or hypoplastic nasal bone was the most clinically significant marker either alone or in combination with other USMs. Most of SUSM had a good prognosis.
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Affiliation(s)
- Yanhong Zhou
- grid.412601.00000 0004 1760 3828Department of Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, China ,grid.410737.60000 0000 8653 1072Department of Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Siqi Wu
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, Guangdong Province China
| | - Jin Han
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Li Zhen
- grid.410737.60000 0000 8653 1072Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xin Yang
- grid.410737.60000 0000 8653 1072Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ru Li
- grid.410737.60000 0000 8653 1072Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yongling Zhang
- grid.410737.60000 0000 8653 1072Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiangyi Jing
- grid.410737.60000 0000 8653 1072Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fucheng Li
- grid.410737.60000 0000 8653 1072Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huishu Liu
- Department of Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, China. .,Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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21
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Vasung L, Rollins CK, Zhang J, Velasco-Annis C, Yang E, Lin PY, Sutin J, Warfield SK, Soul J, Estroff J, Connolly S, Barnewolt C, Gholipour A, Feldman HA, Grant PE. Abnormal development of transient fetal zones in mild isolated fetal ventriculomegaly. Cereb Cortex 2023; 33:1130-1139. [PMID: 35349640 PMCID: PMC9930628 DOI: 10.1093/cercor/bhac125] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Mild isolated fetal ventriculomegaly (iFVM) is the most common abnormality of the fetal central nervous system. It is characterized by enlargement of one or both of the lateral ventricles (defined as ventricular width greater than 10 mm, but less than 12 mm). Despite its high prevalence, the pathophysiology of iFVM during fetal brain development and the neurobiological substrate beyond ventricular enlargement remain unexplored. In this work, we aimed to establish the relationships between the structural development of transient fetal brain zones/compartments and increased cerebrospinal fluid volume. For this purpose, we used in vivo structural T2-weighted magnetic resonance imaging of 89 fetuses (48 controls and 41 cases with iFVM). Our results indicate abnormal development of transient zones/compartments belonging to both hemispheres (i.e. on the side with and also on the contralateral side without a dilated ventricle) in fetuses with iFVM. Specifically, compared to controls, we observed enlargement of proliferative zones and overgrowth of the cortical plate in iFVM with associated reduction of volumes of central structures, subplate, and fetal white matter. These results indicate that enlarged lateral ventricles might be linked to the development of transient fetal zones and that global brain development should be taken into consideration when evaluating iFVM.
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Affiliation(s)
- Lana Vasung
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Caitlin K Rollins
- Department of Neurology Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Jennings Zhang
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Clemente Velasco-Annis
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Edward Yang
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Pei-Yi Lin
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Jason Sutin
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Simon Keith Warfield
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Janet Soul
- Department of Neurology Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Judy Estroff
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Maternal Fetal Care Center, Boston Children’s Hospital, Boston, MA 02115, United States
| | - Susan Connolly
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Maternal Fetal Care Center, Boston Children’s Hospital, Boston, MA 02115, United States
| | - Carol Barnewolt
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Maternal Fetal Care Center, Boston Children’s Hospital, Boston, MA 02115, United States
| | - Ali Gholipour
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Henry A Feldman
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Patricia Ellen Grant
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
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22
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Prayer D, Malinger G, De Catte L, De Keersmaecker B, Gonçalves LF, Kasprian G, Laifer-Narin S, Lee W, Millischer AE, Platt L, Prayer F, Pugash D, Salomon LJ, Sanz Cortes M, Stuhr F, Timor-Tritsch IE, Tutschek B, Twickler D, Raine-Fenning N. ISUOG Practice Guidelines (updated): performance of fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:278-287. [PMID: 36722431 PMCID: PMC10107509 DOI: 10.1002/uog.26129] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 05/03/2023]
Affiliation(s)
- D Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L De Catte
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L F Gonçalves
- Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - S Laifer-Narin
- Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - A-E Millischer
- Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - F Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - D Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada
| | - L J Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Paris, France
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - F Stuhr
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU Grossmann School of Medicine, New York, NY, USA
| | - B Tutschek
- Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Prenatal Zurich, Zürich, Switzerland
| | - D Twickler
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Raine-Fenning
- Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK; Nurture Fertility, The Fertility Partnership, Nottingham, UK
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23
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Short-Term and Long-Term Outcomes of Fetal Ventriculomegaly beyond Gestational 37 Weeks: A Retrospective Cohort Study. J Clin Med 2023; 12:jcm12031065. [PMID: 36769715 PMCID: PMC9917544 DOI: 10.3390/jcm12031065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
Birth defects have brought about major public health problems, and studying the clinical outcomes of the most common prenatal central nervous system abnormality, namely, fetal ventriculomegaly (VM), is helpful for improving reproductive health and fertility quality. This is a retrospective cohort study from 2011 to 2020 in the West China Second University Hospital, Sichuan University, aiming to evaluate the short-term and long-term outcomes of VM over 37 weeks' gestation to exclude the influence of preterm birth. The study analyzed data from 401 term pregnancies, with 179 VM and 222 controls. From the short-term outcomes, the rate of the neonatal intensive care unit (NICU) admission under the VM group (10.06%) was comparatively higher than the control (0.45%), but Apgar scores between both groups at 1 min, 5 min and 10 min were not significantly different. From the long-term outcomes, there were more infants with abnormal neurodevelopment under the VM group than control (14.53% vs. 2.25%, p < 0.001). In addition, NICU admission (p = 0.006), peak width of lateral ventricles (p = 0.030) and postnatal cranial ultrasound suggestive with VM (p = 0.002) were related to infants' long-term outcomes. NICU admission during the perinatal period was an independent risk factor for the adverse long-term outcomes (OR = 3.561, 95% CI 1.029-12.320, p = 0.045). In conclusion, VM impairs short-term and long-term outcomes of term infants. Short-term outcome, especially NICU admission, could predict their adverse long-term outcomes.
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24
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Labrosse KB, Buechel J, Guelmez H, Butenschoen A, Schoenberger H, Visca E, Schoetzau A, Manegold-Brauer G. Presentation of ventriculomegaly at 11-14 weeks of gestation: An analysis of longitudinal data. Prenat Diagn 2023. [PMID: 36588196 DOI: 10.1002/pd.6293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to examine the value of the sonographic measurements of the choroid plexus and the lateral ventricles at 11-14 gestational weeks in fetuses that had the diagnosis of second-trimester ventriculomegaly (VM) as a clinical reference. METHODS The standard axial plane used for biparietal diameter measurement from 2D stored images in the first trimester was used to calculate the ratio between the choroid plexus and lateral ventricle diameter (PDVDR), the choroid plexus and lateral ventricle length (PLVLR) and the choroid plexus and lateral ventricle area (PAVAR) in 100 normal and 15 fetuses diagnosed with second-trimester VM. RESULTS In fetuses with VM, the measurements of PDVDR, PLVLR and PAVAR were all significantly smaller compared to normal fetuses (p = < 0.001, <0.001, <0.01). Four out of seven cases with mild VM had measurements below the 5th percentile (57%). 75% of cases with moderate or severe VM had at least one measurement below the 5th percentile. CONCLUSIONS Since the axial plane of the fetal head is obtained in all first-trimester routine screenings, the measurements of PDVDR, PLVLR and PAVAR could easily be integrated into routine examinations for an early detection of VM.
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Affiliation(s)
- Kathrin B Labrosse
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland.,Department of Biomedicine, University Basel, Basel, Switzerland
| | - Johanna Buechel
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Huelya Guelmez
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | - Annkathrin Butenschoen
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | - Heidrun Schoenberger
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | - Eva Visca
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | | | - Gwendolin Manegold-Brauer
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland.,Department of Biomedicine, University Basel, Basel, Switzerland.,Medical Faculty, University Basel, Basel, Switzerland
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25
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Scelsa B. Fetal Neurology: From Prenatal Counseling to Postnatal Follow-Up. Diagnostics (Basel) 2022; 12:diagnostics12123083. [PMID: 36553090 PMCID: PMC9776544 DOI: 10.3390/diagnostics12123083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Brain abnormalities detected in fetal life are being increasingly recognized. Child neurologists are often involved in fetal consultations, and specific fetal neurology training has been implemented in many countries. Pediatric neurologists are asked to examine the data available and to contribute to the definition of the long-term outcomes. Ventriculomegaly, posterior fossa malformations, and agenesis/dysgenesis of corpus callosum are among the most common reasons for antenatal neurological consultations. Fetuses with central nervous system and extra-CNS anomalies should ideally be managed in secondary/tertiary hospitals where obstetricians who are experts in fetal medicine and pediatric specialists are available. Obstetricians play a critical role in screening, performing detailed neurosonography, and referring to other specialists for additional investigations. Clinical geneticists are frequently asked to propose diagnostic tests and counsel complex fetal malformations whose phenotypes may differ from those during postnatal life. Advances in fetal MRI and genetic investigations can support the specialists involved in counseling. Nevertheless, data interpretation can be challenging, and it requires a high level of expertise in a multidisciplinary setting. Postnatally, child neurologists should be part of an integrated multidisciplinary follow-up, together with neonatologists and pediatricians. The neurodevelopmental outcomes should be assessed at least up to school age. Children should be evaluated with formal tests of their gross motor, cognitive, language, fine motor/visuo-perceptual skills, and their behavior. In this perspective, fetal neurology can be regarded as the beginning of a long journey which continues with a prolonged, structured follow-up, support to the families, and transition to adult life. A review of the most common conditions is presented, along with the long-term outcomes and a proposal of the neurodevelopmental follow-up of children with CNS malformation which are diagnosed in uterus.
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Affiliation(s)
- Barbara Scelsa
- Department of Pediatric Neurology and Psychiatry, V. Buzzi Children's Hospital, ASST-FBF-Sacco, via Castelvetro 32, 20154 Milan, Italy
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26
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Li Q, Ju XW, Xu J, Jiang J, Lu C, Ju XD. Maternal blood inflammatory marker levels increased in fetuses with ventriculomegaly. Front Hum Neurosci 2022; 16:998206. [PMID: 36545352 PMCID: PMC9760835 DOI: 10.3389/fnhum.2022.998206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
Background Fetal ventriculomegaly (VM) is one of the most common abnormalities of the central nervous system (CNS), which can be significantly identified by brain anomalies prenatally by magnetic resonance imaging (MRI). Aberrant white blood cells (WBCs) levels indicate that the maternal is suffering from the infection. Previous studies have confirmed that prenatal infection can affect fetal brain structure, but there is no research revealed the association between maternal blood parameters with fetal VM until now. Methods We measured the width of the lateral ventricle of 142 fetuses, which were divided into the fetal VM group (n = 70) and the normal lateral ventricle group (n = 72). We compared maternal blood cell levels between the two groups and investigate potential biomarkers of fetal VM. Result High levels of maternal WBC and neutrophil (NE#) levels were observed in fetuses with VM (p < 0.001), while lymphocyte percentage, monocytes (MO#), neutrophil/lymphocyte ratio (NLR), and platelet were also increased in the fetal VM group (p = 0.033, 0.027, 0.034, and 0.025, respectively). receiver-operator curve (ROC) analysis suggested that WBC and NE# counts might be useful to distinguish fetuses with enlarged lateral ventricles (AUC = 0.688, 0.678, respectively). Conclusion The current study emphasizes the importance of maternal infection for fetal brain growth, which could provide important information for prenatal diagnosis of CNS anomalies. Future research needs longitudinal analysis and exploration of the influence of maternal blood inflammatory marker levels on fetal brain development.
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Affiliation(s)
- Qiang Li
- School of Psychology, Northeast Normal University, Changchun, China
| | - Xin-Wei Ju
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Jing Xu
- School of Life Sciences, Northeast Normal University, Changchun, China
| | - Jiuhong Jiang
- School of Information Science and Technology, Northeast Normal University, Changchun, China
| | - Chang Lu
- School of Psychology, Northeast Normal University, Changchun, China,Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, Changchun, China,*Correspondence: Chang Lu,
| | - Xing-Da Ju
- School of Psychology, Northeast Normal University, Changchun, China,Autism Centre of Excellence, Northeast Normal University, Changchun, China,Xing-Da Ju,
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27
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Ryan GA, Start AO, Cathcart B, Hughes H, Denona B, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Robinson I, Colleran G, McParland P, McAuliffe FM. Prenatal findings and associated survival rates in fetal ventriculomegaly: A prospective observational study. Int J Gynaecol Obstet 2022; 159:891-897. [PMID: 35373343 PMCID: PMC9790218 DOI: 10.1002/ijgo.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Fetal ventriculomegaly is associated with varying degrees of genetic and structural abnormalities. The objective was to present the experience of fetal ventriculomegaly in a large European center in relation to: 1. grade of ventriculomegaly; 2. additional chromosomal/structural abnormalities; and 3. perinatal survival rates. METHODS This was a prospective observational study of patients referred with fetal ventriculomegaly from January 2011 to July 2020. Data were obtained from the hospital database and analyzed to determine the rate of isolated ventriculomegaly, associated structural abnormalities, chromosomal/genetic abnormalities, and survival rates. Data were stratified into three groups; mild (Vp = 10-12 mm), moderate (Vp = 13-15 mm) and severe (Vp > 15 mm) ventriculomegaly. RESULTS There were 213 fetuses included for analysis. Of these 42.7% had mild ventriculomegaly, 44.6% severe and 12.7% had moderate ventriculomegaly. Initial ultrasound assessment reported isolated ventriculomegaly in 45.5% fetuses, with additional structural abnormalities in 54.5%. The rate of chromosomal/genetic abnormalities was high,16.4%. After all investigations, the true rate of isolated VM was 36.1%. The overall survival was 85.6%. Survival was higher for those with isolated VM across all groups (P < 0.05). CONCLUSION Ventriculomegaly is a complex condition and patients should be counselled that even with apparently isolated VM, there remains the possibility of additional genetic and/or structural problems being diagnosed in up to 10% of fetuses.
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Affiliation(s)
- Gillian A. Ryan
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Alexander O. Start
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Barbara Cathcart
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Heather Hughes
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | | | - Shane Higgins
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Siobhan Corcoran
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Jennifer Walsh
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Stephen Carroll
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Rhona Mahony
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Darach Crimmins
- Neurosurgery DepartmentChildren's University HospitalDublinIreland,UCD School of MedicineUniversity College DublinIreland
| | - John Caird
- Neurosurgery DepartmentChildren's University HospitalDublinIreland
| | - Ian Robinson
- Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Gabrielle Colleran
- UCD School of MedicineUniversity College DublinIreland,Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Peter McParland
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
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Role of Sonographic Second Trimester Soft Markers in the Era of Cell-Free DNA Screening Options: A Review. REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3030017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Soft markers are sonographic structural, nonspecific signs with little pathological significance, often transient, usually considered as normal variants. However, they may also be associated with chromosomal abnormalities. The most widely examined soft markers include absent or hypoplastic nasal bone (NB), intracardiac echogenic focus (IEF), ventriculomegaly (VM), thickened nuchal fold (NF), choroid plexus cyst (CPC), echogenic bowel, short long bones, and urinary tract dilation (UTD). Although the use of noninvasive prenatal testing (NIPT) has been spreading quickly in maternal–fetal medicine, it is not a diagnostic test and it still remains unavailable or cost-prohibitive for most of the population in many countries. After normal screening test results in the first trimester, there is no uniform consensus regarding the clinical significance of isolated soft markers for aneuploidy. Nowadays, the search for soft markers in an ultrasound is still part of clinical evaluation, and the interpretation of these findings is often a matter of debate. In the present review, we summarize the recent literature about the role of soft markers in the era of NIPT and propose an overview of the different clinical guidelines.
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Hernandez NE, Lu VM, Altman N, Ragheb J, Niazi TN, Wang S. Incidence, follow-up, and postnatal clinical progress of children with central nervous system anomalies on fetal MRI. J Neurosurg Pediatr 2022; 30:160-168. [PMID: 35901770 DOI: 10.3171/2022.4.peds2269] [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] [Received: 02/23/2022] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI is increasingly employed to assess intrauterine fetal anomalies. Central nervous system (CNS) anomalies are common structural conditions that warrant evaluation with fetal MRI and subsequent prenatal consultation with a pediatric neurosurgeon. As the use of fetal MRI increases, there is greater impetus to understand the most common CNS structural anomalies diagnosed in utero, as well as their natural histories. METHODS The authors performed a single-center retrospective review of fetal MRI evaluations performed between January 2012 and December 2020. Children who underwent both prenatal and postnatal neurosurgical evaluations of CNS anomalies were included. Specific CNS anomalies on fetal MRI, associated extra-CNS findings, and suspicion for genetic abnormality or syndromes were noted. Postnatal clinical status and interventions were assessed. RESULTS Between January 2012 and December 2020, a total of 469 fetal MRI evaluations were performed; of these, 114 maternal-fetal pairs had CNS anomalies that warranted prenatal consultation and postnatal pediatric neurosurgical follow-up. This cohort included 67 male infants (59%), with a mean ± SD follow-up of 29.8 ± 25.0 months after birth. Fetal MRI was performed at 27.3 ± 5.8 weeks of gestational age. The most frequently reported CNS abnormalities were ventriculomegaly (57%), agenesis or thinning of the corpus callosum (33%), Dandy-Walker complex (DWC) (21%), neuronal migration disorders (18%), and abnormalities of the septum pellucidum (17%). Twenty-one children (18%) required neurosurgical intervention at a mean age of 2.4 ± 3.7 months. The most common surgical conditions included myelomeningocele, moderate to severe ventriculomegaly, encephalocele, and arachnoid cyst. Corpus callosum agenesis or thinning was associated with developmental delay (p = 0.02) and systemic anomalies (p = 0.05). The majority of prenatal patients referred for DWC had Dandy-Walker variants that did not require surgical intervention. CONCLUSIONS The most common conditions for prenatal neurosurgical assessment were ventriculomegaly, corpus callosum anomaly, and DWC, whereas the most common surgical conditions were myelomeningocele, hydrocephalus, and arachnoid cyst. Only 18% of prenatal neurosurgical consultations resulted in surgical intervention during infancy. The majority of referrals for prenatal mild ventriculomegaly and DWC were not associated with developmental or surgical sequelae. Patients with corpus callosum abnormalities should be concurrently referred to a neurologist for developmental assessments.
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Affiliation(s)
- Nicole E Hernandez
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
| | - Victor M Lu
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Nolan Altman
- 3Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | - John Ragheb
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Toba N Niazi
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Shelly Wang
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
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Adiyaman D, Öztekin Ö, Kuyucu M, Atakul BK, Toklu G, Aykut İ, Yıldırım AGŞ, Özeren M, Öztekin D. Contribution of fetal magnetic resonance imaging in the evaluation of neurosonographically detected cases of isolated mild and moderate cerebral ventriculomegaly. J Obstet Gynaecol Res 2022; 48:2314-2324. [PMID: 35778980 DOI: 10.1111/jog.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to present the contribution of prenatal magnetic resonance imaging (MRI) in the diagnosis of fetuses that were previously identified as isolated mild and moderate cerebral ventriculomegaly (VM) by ultrasound (US). METHODS The data between February 2013 and August 2020 were collected for women who were diagnosed with isolated mild or moderate fetal VM by US and subsequently underwent a fetal MRI. RESULTS Among 321 women, 21 (6.5%) had a clinically important additional finding after MRI. Twelve of 276 (4.3%) fetuses with mild VM and 9 of 45 (20%) with moderate VM had turned out to have additional central nervous system abnormalities. Additional findings were detected more in fetuses with moderate VM, mothers with an anterior-located placenta, and mothers with higher body mass indexes (BMIs) with statistical significance (p = 0.001, p = 0.013, p = 0.036, respectively). The most common additional MRI finding was grade 3 or 4 germinal matrix hemorrhage, which was detected in 11 of 21 fetuses (52.3%). CONCLUSIONS Considering the countries' health policies, prenatal MRI would contribute mostly to the diagnosis of fetuses with moderate VM, pregnancies with anterior-located placenta, and mothers with high BMIs. According to our data, we believe that MRI will be valuable, especially in the diagnosis of grade 3 and 4 intracranial hemorrhage group.
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Affiliation(s)
- Duygu Adiyaman
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Özgür Öztekin
- Faculty of Medicine, Department of Radiology, Bakırcay University, Izmir, Turkey
| | - Melda Kuyucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Bahar K Atakul
- Izmir University of Economics, Faculty of Medicine, Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Izmir, Turkey
| | - Gizem Toklu
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - İsmail Aykut
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkım G Ş Yıldırım
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Özeren
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Deniz Öztekin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Bakırcay University, Izmir, Turkey
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Zhang YL, Jing XY, Zhen L, Pan M, Han J, Li DZ. Prenatal diagnosis of Miller-Dieker syndrome/PAFAH1B1-related lissencephaly: Ultrasonography and genetically investigative results. Eur J Obstet Gynecol Reprod Biol 2022; 274:28-32. [PMID: 35567955 DOI: 10.1016/j.ejogrb.2022.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present the experience on prenatal diagnosis of Miller-Dieker syndrome (MDS)/PAFAH1B1-related lissencephaly to further determine fetal phenotypes of this syndrome. STUDY DESIGN This was a retrospective study of ten pregnancies with fetal MDS/PAFAH1B1-related lissencephaly identified by chromosomal microarray (CMA)/exome sequencing (ES). Clinical and laboratory data were collected and reviewed for these cases, including maternal demographics, prenatal sonographic findings, CMA or ES results and pregnancy outcomes. RESULTS Two cases were diagnosed in the first trimester because of an increased nuchal translucency. The remaining eight cases were identified at late gestation, including four in the second trimester because of fetal cardiac anomalies or ventriculomegaly, and four in the third trimester because of ventriculomegaly. CMA revealed 17p13.3 deletions in nine cases, and ES detected a de novo PAFAH1B1 missense mutation in one case. CONCLUSION The prenatal presentation of MDS/PAFAH1B1-related lissencephaly depended on the gestational age when the diagnosis was made. Mild ventriculomegaly was the most common prenatal sonographic sign identified in cases of MDS/PAFAH1B1-related lissencephaly. It is important that fetal MRI and invasive testing with CMA should be considered in fetuses with apparently 'isolated' mild ventriculomegaly.
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Affiliation(s)
- Yong-Ling Zhang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiang-Yi Jing
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Min Pan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jin Han
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China.
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Pindrik J, Schulz L, Drapeau A. Diagnosis and Surgical Management of Neonatal Hydrocephalus. Semin Pediatr Neurol 2022; 42:100969. [PMID: 35868728 DOI: 10.1016/j.spen.2022.100969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Neonatal hydrocephalus represents an important pathological condition with significant impact on medical care and neurocognitive development. This condition requires early recognition, appropriate medical and surgical management, and long-term surveillance by clinicians and pediatric neurosurgeons. Common etiologies of neonatal and infant hydrocephalus include intraventricular hemorrhage related to prematurity with subsequent post-hemorrhagic hydrocephalus, myelomeningocele, and obstructive hydrocephalus due to aqueductal stenosis. Clinical markers of elevated intracranial pressure include rapid increases in head circumference across percentiles, elevation and firmness of the anterior fontanelle, splitting or splaying of cranial sutures, upgaze palsy, lethargy, frequent emesis, or episodic bradycardia (unrelated to other comorbidities). Complementing these clinical markers, imaging modalities used for the diagnosis of neonatal hydrocephalus include head ultrasonography, brain magnetic resonance imaging, and head computed tomography in urgent or emergent situations. Following diagnosis, temporizing measures may be employed prior to definitive treatment and include ventricular access device or ventriculo-subgaleal shunt insertion. Definitive surgical management involves permanent cerebrospinal fluid (CSF) diversion via CSF shunt insertion, or endoscopic third ventriculostomy with or without choroid plexus cauterization. Surgical decision-making and approaches vary based on patient age, hydrocephalus etiology, neuroanatomy, imaging findings, and medical comorbidities. Indications, surgical techniques, and clinical outcomes of these procedures continue to evolve and elicit significant attention in the research environment. In this review we describe the epidemiology, pathophysiology, clinical markers, imaging findings, early management, definitive surgical management, and clinical outcomes of pediatric patients with neonatal hydrocephalus.
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Affiliation(s)
- Jonathan Pindrik
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH; Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH.
| | - Lauren Schulz
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Annie Drapeau
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH; Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH
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Qiu L, Chen N, Luo H. Fetal periventricular pseudocysts: is MRI evaluation needed? What is the long-term neurodevelopmental outcome? Systematic review and meta-analysis. Arch Gynecol Obstet 2022; 307:1697-1711. [PMID: 35674830 DOI: 10.1007/s00404-022-06624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To explore the value of magnetic resonance imaging (MRI) in fetuses with periventricular pseudocysts (PVPC) and the neurodevelopmental outcomes of these fetuses via meta-analysis. METHODS MEDLINE and EMBASE database were searched for studies reporting on the MRI assessment of fetuses diagnosed with PVPC on neurosonography. The neurosonography was conducted according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines or standard axial, coronal and sagittal planes for advanced central nervous system (CNS) assessment. Single-shot fast spin-echo T2-weighted sequences of MRI technique in three orthogonal planes were necessarily performed. The pooled proportion of CNS anomalies missed on neurosonography and detected only at prenatal MRI was calculated. Subanalysis was performed according to the types of intracranial anomalies. The pregnancy outcomes (including normal, abnormal, termination of pregnancy, and perinatal death) of PVPC fetuses were also analyzed. RESULTS Five studies comprising 136 fetuses were included in this meta-analysis. Mean gestational age was 29.8 weeks (16-38 weeks) at ultrasonography and 31.5 weeks (25-37 weeks) at MRI. Overall, MRI detected exclusively CNS anomalies in 25.2% (95% CI 15.9-35.8%) of cases. Among them, the highest incidence was white matter abnormalities with the pooled proportion of 16.3% (95% CI 9.7-24.2%). When getting rid of white matter abnormalities, the risk of associated CNS anomalies only detected on MRI was reduced to 9.1% (95% CI 1.8-21.4%). Meanwhile, 130 cases were studied to assess the pregnancy outcomes with the scope of 1 month to 10 years. The pooled proportion of normal outcomes in isolated PVPC fetuses was as high as 95.0% (95% CI 83.9-99.8%). When analyzing the neurodevelopmental outcomes in non-isolated PVPC fetuses, the incidence of normal neurodevelopmental outcomes was about 22.1% (95% CI 5.6-45.5%) with mild and single additional abnormalities, the rate of abnormal neurodevelopmental outcomes was 19.5% (95% CI 11.0-29.7%) with apparent and/or multiple abnormalities. Besides, 53.6% (95% CI 35.4-71.3%) of non-isolated PVPC cases were terminated mainly due to infections, genetic anomalies, metabolic disorders and hemorrhage. CONCLUSIONS MRI assessment of PVPC fetuses is recommended to detect associated intracranial anomalies that may be missed on dedicated neurosonography. White matter abnormalities on MRI account for the majority of additional anomalies, which might to be the clue of CMV infection, aminoacidopathy or white matter disease. Moreover, the neurodevelopmental outcome of isolated PVPC fetuses remains favorable, while the neurodevelopmental outcomes of non-isolated PVPC fetuses depend on the accompanying anomaly.
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Affiliation(s)
- Li Qiu
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Ni Chen
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Hong Luo
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China. .,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China.
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Leibovitz Z, Lerman-Sagie T, Haddad L. Fetal Brain Development: Regulating Processes and Related Malformations. Life (Basel) 2022; 12:life12060809. [PMID: 35743840 PMCID: PMC9224903 DOI: 10.3390/life12060809] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
This paper describes the contemporary state of knowledge regarding processes that regulate normal development of the embryonic–fetal central nervous system (CNS). The processes are described according to the developmental timetable: dorsal induction, ventral induction, neurogenesis, neuronal migration, post-migration neuronal development, and cortical organization. We review the current literature on CNS malformations associated with these regulating processes. We specifically address neural tube defects, holoprosencephaly, malformations of cortical development (including microcephaly, megalencephaly, lissencephaly, cobblestone malformations, gray matter heterotopia, and polymicrogyria), disorders of the corpus callosum, and posterior fossa malformations. Fetal ventriculomegaly, which frequently accompanies these disorders, is also reviewed. Each malformation is described with reference to the etiology, genetic causes, prenatal sonographic imaging, associated anomalies, differential diagnosis, complimentary diagnostic studies, clinical interventions, neurodevelopmental outcome, and life quality.
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Affiliation(s)
- Zvi Leibovitz
- Obstetrics-Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Fetal Neurology Clinic, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 5822012, Israel;
- Obstetrics-Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Rappaport Faculty of Medicine, The Technion, Haifa 31048, Israel;
- Correspondence:
| | - Tally Lerman-Sagie
- Obstetrics-Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Fetal Neurology Clinic, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 5822012, Israel;
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 5822012, Israel
| | - Leila Haddad
- Obstetrics-Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Rappaport Faculty of Medicine, The Technion, Haifa 31048, Israel;
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Novel prenatally diagnosed compound heterozygous POMT2 variants in fetal congenital primary aqueduct stenosis. Taiwan J Obstet Gynecol 2022; 61:517-520. [PMID: 35595449 DOI: 10.1016/j.tjog.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the etiology of congenital hydrocephalus in genetic aqueduct stenosis. CASE REPORT We report the case of a 31-year-old pregnant female, G2P0A1, with a history of hyperthyroidism under medical control. The patient received regular prenatal care, with no specific findings in the Level II ultrasound at 21 weeks of gestation. However, hydrocephalus was noted at GA 31 weeks. High-resolution sonography and fetal magnetic resonance imaging (MRI) reported fetal aqueduct stenosis. Maternal HSV, CMV, and toxoplasma infection were not detected. Fetal karyotype and chromosomal microarray analysis (CMA) indicated a normal. After intensive counseling, the parents decided to terminate the pregnancy due to the poor fetal prognosis. Post-mortem, a whole-exome sequencing (WES) and Sanger sequencing analysis trio study identified two compound heterozygous variants in the POMT2 gene inherited from both recessive parents. In the subsequent pregnancy, a WES survey revealed inheritance of only the maternal POMT2 gene variant; a live, healthy male baby was born. CONCLUSION Extended WES represents a precision maternal medicine tool for novel prenatal diagnosis of congenital aqueduct stenosis.
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Ren JY, Zhu M, Wang G, Gui Y, Jiang F, Dong SZ. Quantification of Intracranial Structures Volume in Fetuses Using 3-D Volumetric MRI: Normal Values at 19 to 37 Weeks' Gestation. Front Neurosci 2022; 16:886083. [PMID: 35645723 PMCID: PMC9133784 DOI: 10.3389/fnins.2022.886083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe purpose of this study is to establish a reference of intracranial structure volumes in normal fetuses ranging from 19 to 37 weeks' gestation (mean 27 weeks).Materials and MethodsA retrospective analysis of 188 MRI examinations (1.5 T) of fetuses with a normal brain appearance (19–37 gestational weeks) from January 2018 to December 2021 was included in this study. Three dimensional (3-D) volumetric parameters from slice-to-volume reconstructed (SVR) images, such as total brain volume (TBV), cortical gray matter volume (GMV), subcortical brain tissue volume (SBV), intracranial cavity volume (ICV), lateral ventricles volume (VV), cerebellum volume (CBV), brainstem volume (BM), and extra-cerebrospinal fluid volume (e-CSFV), were quantified by manual segmentation from two experts. The mean, SD, minimum, maximum, median, and 25th and 75th quartiles for intracranial structures volume were calculated per gestational week. A linear regression analysis was used to determine the gestational weekly age-related change adjusted for sex. A t-test was used to compare the mean TBV and ICV values to previously reported values at each gestational week. The formulas to calculate intracranial structures volume derived from our data were created using a regression model. In addition, we compared the predicted mean TBV values derived by our formula with the expected mean TBV predicted by the previously reported Jarvis' formula at each time point. For intracranial volumes, the intraclass correlation coefficient (ICC) was calculated to convey association within and between observers.ResultsThe intracranial volume data are shown in graphs and tabular summaries. The male fetuses had significantly larger VV compared with female fetuses (p = 0.01). Measured mean ICV values at 19 weeks are significantly different from those published in the literature (p < 0.05). Means were compared with the expected TBV generated by the previously reported formula, showing statistically differences at 22, 26, 29, and 30 weeks' gestational age (GA) (all p < 0.05). A comparison between our data-derived formula and the previously reported formula for TBV showed very similar values at every GA. The predicted TBV means derived from the previously reported formula were all within the 95% confidence interval (CI) of the predicted means of this study. Intra- and inter-observer agreement was high, with an intraclass correlation coefficient larger than 0.98.ConclusionWe have shown that the intracranial structural volume of the fetal brain can be reliably quantified using 3-D volumetric MRI with a high degree of reproducibility and reinforces the existing data with more robust data in the earlier second and third stages of pregnancy.
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Affiliation(s)
- Jing-Ya Ren
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghai Wang
- Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Yiding Gui
- Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Fan Jiang
- Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Su-Zhen Dong
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ZHANG-RUTLEDGE K, OWEN M, SWEENEY NM, DIMMOCK D, KINGSMORE SF, LAURENT LC. Retrospective identification of prenatal fetal anomalies associated with diagnostic neonatal genomic sequencing results. Prenat Diagn 2022; 42:705-716. [PMID: 35141907 PMCID: PMC9886440 DOI: 10.1002/pd.6111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine which types of fetal anomalies are associated with postnatal diagnoses of genetic diseases by genomic sequencing and to assess how prenatal genomic sequencing could affect clinical management. METHOD This was a secondary analysis of the second Newborn Sequencing in Genomic Medicine and Public Health study that compared fetal imaging results in critically ill infants who had actionable versus negative postnatal genomic sequencing results. RESULTS Of 213 infants who received genomic sequencing, 80 had available prenatal ultrasounds. Twenty-one (26%) of these were found to have genetic diseases by genomic sequencing. Fourteen (67%) of the 21 with genetic diseases had suspected anomalies prenatally, compared with 33 (56%) of 59 with negative results. Among fetuses with suspected anomalies, genetic diseases were 4.5 times more common in those with multiple anomalies and 6.7 times more common in those with anomalies of the extremities compared to those with negative results. Had the genetic diseases been diagnosed prenatally, clinical management would have been altered in 13 of 14. CONCLUSION Critically ill infants with diagnostic genomic sequencing were more likely to have multiple anomalies and anomalies of the extremities on fetal imaging. Among almost all infants with suspected fetal anomalies and diagnostic genomic sequencing results, prenatal diagnosis would have likely altered clinical management.
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Affiliation(s)
- Kathy ZHANG-RUTLEDGE
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California, San Diego, CA
| | - Mallory OWEN
- Rady Children’s Institute of Genomic Medicine, San Diego, CA
| | - Nathaly M. SWEENEY
- Rady Children’s Institute of Genomic Medicine, San Diego, CA, Department of Pediatrics; University of California, San Diego, CA
| | - David DIMMOCK
- Rady Children’s Institute of Genomic Medicine, San Diego, CA
| | | | - Louise C. LAURENT
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California, San Diego, CA
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Baptiste C, Mellis R, Aggarwal V, Lord J, Eberhardt R, Kilby MD, Maher ER, Wapner R, Giordano J, Chitty LS. Fetal central nervous system anomalies: When should we offer exome sequencing? Prenat Diagn 2022; 42:736-743. [PMID: 35411553 DOI: 10.1002/pd.6145] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the detection of pathogenic variants using exome sequencing in an international cohort of fetuses with central nervous system (CNS) anomalies. METHODS We reviewed trio exome sequencing (ES) results for two previously reported unselected cohorts (Prenatal Assessment of Genomes and Exomes (PAGE) and CUIMC) to identify fetuses with CNS anomalies with unremarkable karyotypes and chromosomal microarrays. Variants were classified according to ACMG guidelines and association of pathogenic variants with specific types of CNS anomalies explored. RESULTS ES was performed in 268 pregnancies with a CNS anomaly identified using prenatal ultrasound . Of those with an isolated, single, CNS anomaly, 7/97 (7.2%) had a likely pathogenic/pathogenic (LP/P) variant. This includes 3/23 (13%) fetuses with isolated mild ventriculomegaly and 3/10 (30%) fetuses with isolated agenesis of the corpus callosum. Where there were multiple anomalies within the CNS, 12/63 (19%) had LP/P variants. Of the 108 cases with CNS and other organ system anomalies, 18 (16.7%) had LP/P findings. CONCLUSION ES is an important tool in the prenatal evaluation of fetuses with any CNS anomaly. The rate of LP/P variants tends to be highest in fetuses with multiple CNS anomalies and multisystem anomalies, however, ES may also be of benefit for isolated CNS anomalies.
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Affiliation(s)
- C Baptiste
- Columbia University Irving Medical Center, 3959 Broadway, New York, 10032-3784, United States
| | - R Mellis
- Genetics and Genomic MedicineUCL GOS Institute of Child Health, UCL, 30 Guilford St, London, WC1N 1EH, United Kingdom of Great Britain and Northern Ireland
| | - V Aggarwal
- Columbia University Irving Medical Center, New York, United States
| | - J Lord
- Southampton University Hospitals NHS Trust, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - R Eberhardt
- Wellcome Sanger Institute, Hinxton, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
| | - M D Kilby
- Dept. of Fetal Medicine, Birmingham Women's Hospital, Metchley Park rd.Edgbaston, Birmingham, West Midlands, B15 2TG, United Kingdom of Great Britain and Northern Ireland
| | - E R Maher
- University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - R Wapner
- Obstetrics and Gynecology, Columbia University Medical Centerm, New York, United States
| | - J Giordano
- MFM, Columbia University, 3959 Broadway, New York, 10032, United States
| | - L S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health, UCL Great Ormond Street Institute of Child Health.30 Guilford Street, WC1N 1EH, London, United Kingdom of Great Britain and Northern Ireland
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Clinical Applications of Fetal MRI in the Brain. Diagnostics (Basel) 2022; 12:diagnostics12030764. [PMID: 35328317 PMCID: PMC8947742 DOI: 10.3390/diagnostics12030764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Fetal magnetic resonance imaging (MRI) has become a widely used tool in clinical practice, providing increased accuracy in prenatal diagnoses of congenital abnormalities of the brain, allowing for more accurate prenatal counseling, optimization of perinatal management, and in some cases fetal intervention. In this article, a brief description of how fetal ultrasound (US) and fetal MRI are used in clinical practice will be followed by an overview of the most common reasons for referral for fetal MRI of the brain, including ventriculomegaly, absence of the cavum septi pellucidi (CSP) and posterior fossa anomalies.
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Alluhaybi AA, Altuhaini K, Ahmad M. Fetal Ventriculomegaly: A Review of Literature. Cureus 2022; 14:e22352. [PMID: 35223331 PMCID: PMC8860673 DOI: 10.7759/cureus.22352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/05/2022] Open
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Deopujari C, Mohanty C, Agrawal H, Jain S, Chawla P. A comparison of Adult and Pediatric Hydrocephalus. Neurol India 2022; 69:S395-S405. [PMID: 35102995 DOI: 10.4103/0028-3886.332283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hydrocephalus is a common clinical problem encountered in neurosurgical practice. With greater subspecialisation, pediatric neurosurgery has emerged as a special discipline in several countries. However, in the developing world, which inhabits a large pediatric population, a limited number of neurosurgeons manage all types of hydrocephalus across all ages. There are some essential differences in pediatric and adult hydrocephalus. The spectrum of hydrocephalus of dysgenetic origin in a neonate and that of normal pressure hydrocephalus of the old age has a completely different strategy of management. Endoscopic third ventriculostomy outcomes are known to be closely associated with age at presentation and surgery. Efficacy of alternative pathways of CSF absorption also differs according to age. Managing this disease in various age groups is challenging because of these differences in etiopathology, tempo of the disease, modalities of investigations and various treatment protocols as well as prognosis.
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Affiliation(s)
- Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences; B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences; B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | | | - Sonal Jain
- B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Pawan Chawla
- B J Wadia Hospital for Children, Mumbai, Maharashtra, India
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Yin X, Zhao X, Lu L, Zhang L, Xing Q, Yuan R, Niu Z, Zhang L. Fetal magnetic resonance imaging of lumbar spine development in vivo: a retrospective study. Childs Nerv Syst 2022; 38:2113-2118. [PMID: 35972535 PMCID: PMC9617832 DOI: 10.1007/s00381-022-05645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study is to describe MR imaging appearances of the fetal lumbar spine in vivo at different gestational ages (GAs). METHODS This retrospective study was approved by the Third Affiliated Hospital of Zhengzhou University. We collected MR images and clinical data of 93 fetuses in our hospital. All the MR images were obtained by 3-T MR. All had the mid-sagittal plane of steady state free precession sequence (Trufi) of the lumbar spine, which could show the lumbar vertebra and conus medullaris (CM). Regression analysis was made between GA and heights of lumbar vertebral body ossification center (LVBOC), lengths of LVBOC, and heights of intervertebral gap (IVG). RESULTS There were good linear correlations between the heights of LVBOC and GA (P < 0.001), lengths of LVBOC and GA (P < 0.001), and heights of IVG and GA (P < 0.001). CONCLUSION We showed the different development of each LVBOC and IVG which caused the difference of the shape of LVBOC and IVG.
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Affiliation(s)
- Xing Yin
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Xin Zhao
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liying Zhang
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingna Xing
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Yuan
- grid.412719.8Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhijun Niu
- grid.412719.8Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Zhang
- grid.412719.8Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Start AO, Ryan GA, Cathcart B, Hughes H, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Colleran G, McParland P, McAuliffe FM. Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort. Prenat Diagn 2021; 42:109-117. [PMID: 34870870 DOI: 10.1002/pd.6072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/12/2021] [Accepted: 10/07/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Severe fetal ventriculomegaly (VM) is defined as an enlargement of the atria of the lateral cerebral ventricles (Vp) of greater than 15 mm. While it is well established that it confers significant risk of morbidity and mortality to the neonate, there is limited information pertaining to the caesarean delivery rates and the obstetric management of these complex cases. The aim of this study was twofold: firstly, to determine survival rates in fetuses with severe VM, and secondly to determine the caesarean delivery rates in continuing pregnancies. We explore the obstetric challenges associated with these difficult cases. METHODS This was a prospective observational study of patients with antenatal severe VM, attending the Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland, from 1st January 2011 to 31st July 2020. Data were obtained from the hospital database and those with severe VM (Vp > 15 mm) were identified. The rates of chromosomal abnormalities, the survival rates and the caesarean delivery (CD) rates for the overall group were then determined. The data were then further sub-divided into two groups: 1. Vp < 20 mm and 2. Vp > 20 mm, and the results compared. Statistical analysis was performed using the Chi-Square test. RESULTS A total of N = 95 pregnancies with severe VM were included for analysis, of which additional structural abnormalities on ultrasound were apparent in 67/95 (70.5%) and 28/95 (29.5%) had isolated severe VM. Chromosomal abnormalities were diagnosed in 15/95 (15.8%) of cases, with (2/28) 7.1% in the isolated SVM group versus (13/67) 19.4% in the non-isolated SVM group. The overall survival rate (excluding TOP) was 53/74 (71.6%), with 20/23 (86.9%) in the isolated SVM group. The overall CD rate was 47/72 (65.3%), which was significantly higher than the CD for the hospital during the same time period of 25.4% (P < 0.01). The data were subdivided into Vp < 20 and Vp > 20 and those with a Vp > 20 had higher rates of additional intracranial findings on ultrasound (Vp < 20 13/41 (31.7%) versus Vp > 20 32/54 (59.3%) (P < 0.05)) and macrocrania (Vp < 20 14/41 (34.1%) versus Vp > 20 35/54 (64.8%) (P < 0.05)). No significant difference was observed in the overall survival or CD rates between the two groups. CONCLUSION In conclusion this study reports significant fetal morbidity and mortality with severe VM with high CD rates observed in this cohort. Significant challenges exist in relation to the obstetric management and counseling of parents regarding an often uncertain neonatal prognosis. In continuing pregnancies with significant macrocrania delivery plans should be individualized to improve neonatal outcomes where possible and minimize harm to the mother.
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Affiliation(s)
- Alex O Start
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Gillian A Ryan
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Barbara Cathcart
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Heather Hughes
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Shane Higgins
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Siobhan Corcoran
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Jennifer Walsh
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Stephen Carroll
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Rhona Mahony
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Darach Crimmins
- Neurosurgery Department, Children's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - John Caird
- Neurosurgery Department, Children's University Hospital, Dublin, Ireland
| | - Gabrielle Colleran
- UCD School of Medicine, University College Dublin, Dublin, Ireland.,Radiology Department, The National Maternity Hospital, Dublin, Ireland
| | - Peter McParland
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
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Di Mascio D, Khalil A, Pilu G, Rizzo G, Caulo M, Liberati M, Giancotti A, Lees C, Volpe P, Buca D, Oronzi L, D'Amico A, Tinari S, Stampalija T, Fantasia I, Pasquini L, Masini G, Brunelli R, D'Ambrosio V, Muzii L, Manganaro L, Antonelli A, Ercolani G, Ciulla S, Saccone G, Maruotti GM, Carbone L, Zullo F, Olivieri C, Ghi T, Frusca T, Dall'Asta A, Visentin S, Cosmi E, Forlani F, Galindo A, Villalain C, Herraiz I, Sileo FG, Mendez Quintero O, Salsi G, Bracalente G, Morales-Roselló J, Loscalzo G, Pellegrino M, De Santis M, Lanzone A, Parazzini C, Lanna M, Ormitti F, Toni F, Murru F, Di Maurizio M, Trincia E, Garcia R, Bennike Bjørn Petersen O, Neerup L, Sandager P, Prefumo F, Pinelli L, Mappa I, Acuti Martellucci C, Flacco ME, Manzoli L, Giangiordano I, Nappi L, Scambia G, Berghella V, D'Antonio F. Role of prenatal magnetic resonance imaging in fetuses with isolated severe ventriculomegaly at neurosonography: A multicenter study. Eur J Obstet Gynecol Reprod Biol 2021; 267:105-110. [PMID: 34773875 DOI: 10.1016/j.ejogrb.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to report the rate of additional anomalies detected exclusively at prenatal magnetic resonance imaging (MRI) in fetuses with isolated severe ventriculomegaly undergoing neurosonography. METHOD Multicenter, retrospective, cohort study involving 20 referral fetal medicine centers in Italy, United Kingdom, Spain and Denmark. Inclusion criteria were fetuses affected by isolated severe ventriculomegaly (≥15 mm), defined as ventriculomegaly with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on ultrasound. In all cases, a multiplanar assessment of fetal brain as suggested by ISUOG guidelines on fetal neurosonography had been performed. The primary outcome was the rate of additional CNS anomalies detected exclusively at fetal MRI within two weeks from neurosonography. Subgroup analyses according to gestational age at MRI (<vs ≥ 24 weeks of gestation) and the laterality of ventriculomegaly (unilateral vs bilateral) were also performed. Univariate and multivariate logistic regression analysis was used to analyze the data. RESULTS 187 fetuses with a prenatal diagnosis of isolated severe ventriculomegaly on neurosonography were included in the analysis. Additional structural anomalies were detected exclusively at prenatal MRI in 18.1% of cases. When considering the type of anomaly, malformations of cortical development were detected on MRI in 32.4% cases, while midline or acquired (hypoxemic/hemorrhagic) lesions were detected in 26.5% and 14.7% of cases, respectively. There was no difference in the rate of additional anomalies when stratifying the analysis according to either gestational age at MRI or laterality of the lesion. At multivariate logistic regression analysis, the presence of additional anomalies only found at MRI was significantly higher in bilateral compared versus unilateral ventriculomegaly (OR: 4.37, 95% CI 1.21-15.76; p = 0.04), while neither maternal body mass index, age, severity of ventricular dilatation, interval between ultrasound and MRI, nor gestational age at MRI were associated with the likelihood of detecting associated anomalies at MRI. CONCLUSION The rate of associated anomalies detected exclusively at prenatal MRI in fetuses with isolated severe ventriculomegaly is lower than previously reported, but higher compared to isolated mild and moderate ventriculomegaly. Fetal MRI should be considered as a part of the prenatal assessment of fetuses presenting with isolated severe ventriculomegaly at neurosonography.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
| | - Gianluigi Pilu
- Unit of Obstetrics, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy; Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. D'Annunzio" University of Chieti, Italy
| | - Marco Liberati
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Christoph Lees
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Danilo Buca
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Ludovica Oronzi
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Alice D'Amico
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Tinari
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Lucia Pasquini
- Fetal Medicine Unit, Department for Women and Children Health, AOU Careggi, Florence, Italy
| | - Giulia Masini
- Fetal Medicine Unit, Department for Women and Children Health, AOU Careggi, Florence, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Amanda Antonelli
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Giada Ercolani
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Sandra Ciulla
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | | | - Tullio Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Italy
| | - Andrea Dall'Asta
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Italy
| | - Silvia Visentin
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Erich Cosmi
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Francesco Forlani
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Filomena Giulia Sileo
- Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom; Department of Biochemical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Ginevra Salsi
- Unit of Obstetrics, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Gabriella Bracalente
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Osp. Cà Foncello Treviso, Italy
| | - José Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría Obstetricia y Ginecología, Universidad de Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría Obstetricia y Ginecología, Universidad de Valencia, Spain
| | - Marcella Pellegrino
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco De Santis
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Università di Milano, Italy
| | - Mariano Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Children's Hospital, V. Buzzi Università di Milano, Italy
| | - Francesca Ormitti
- Department of Radiology - Azienda Ospedaliera Universitaria di Parma, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche UOC Neuroradiologia, Bologna, Italy
| | - Flora Murru
- Unit of Paediatric Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Italy
| | | | - Elena Trincia
- UOC Neuroradiologia, Osp. Cà Foncello Treviso, Italy
| | - Raquel Garcia
- Complejo Hospitalario Universitario Insular - Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Olav Bennike Bjørn Petersen
- Center for Fetal Medicine and Ultrasound, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lisa Neerup
- Center for Fetal Medicine and Ultrasound, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Puk Sandager
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Lorenzo Pinelli
- Neuroradiology Unit, Pediatric Neuroradiology Section, ASST Spedali Civili, Brescia, Italy
| | - Ilenia Mappa
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | - Ilaria Giangiordano
- Department of Child and Adolescent Neuropsychiatry, Local Health Unit of Avezzano-Sulmona-L'Aquila, Sulmona, Italy
| | - Luigi Nappi
- Fetal Medicine Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giovanni Scambia
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA
| | - Francesco D'Antonio
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy.
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Diagnosis, management, and neurodevelopmental outcomes of fetal hydrocephalus: an observational prospective study. Childs Nerv Syst 2021; 37:3777-3784. [PMID: 34510257 DOI: 10.1007/s00381-021-05213-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
The etiology of fetal hydrocephalus is complex, and the outcome of fetal neurodevelopment after birth is also different. The purpose of this study is to conduct anti-infection of hydrocephalus fetuses with non-specific infection, and observe their neurodevelopment after birth, so as to provide clinical basis for further guidance and management of fetal hydrocephalus. Eighteen single pregnant women with fetal hydrocephalus confirmed by intrapartum ultrasonography in the Second Xiangya Hospital between July 1, 2019, and December 1, 2020, were included. Pelvis MRI, NITP, amniotic fluid/umbilical cord blood puncture, infection index, TORCH, and other examinations were completed during pregnancy. If the patient's infection index is elevated, the second-generation cephalosporin will be used for anti-infection therapy, and the development of fetal hydrocephalus, growth, and neurodevelopment after birth will be observed. Fetal hydrocephalus subsided in 3 cases (25%, 95% CI [0%, 53.7%]) remained stable in 6 cases (50%, 95% CI [16.8%, 83.2%]), progressed in 2 cases (16.7%, 95% CI [0%, 41.4%]), and terminated pregnancy in 1 case (8.7% [0%, 26.7%]). Of the 6 untreated patients, pregnancy was terminated in 3 (50%), hydrocephalus remained stable in 2 (33.3%), and spontaneous resolution in 1 case (16.7%). Fourteen patients delivered successfully, including 11 children with no obvious abnormalities in growth and development, 1 with mild growth retardation and 2 with moderate growth retardation. Anti-infective therapy in the case of non-specific infection or maternal infection can partially prevent the progression of hydrocephalus.
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Guo D, He D, Shen Q, Lin N, He S, Dai Y, Li Y, Xu L, Wu X. Comprehensive Assessment of Fetal Bilateral Ventriculomegaly Based on Genetic Disorders, Cytomegalovirus Infection, Extra Prenatal Imaging and Pregnancy Outcomes in a Tertiary Referral Center. Int J Gen Med 2021; 14:7719-7728. [PMID: 34764685 PMCID: PMC8577530 DOI: 10.2147/ijgm.s335011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This retrospective study aimed to systematically evaluate the genetic disorders, cytomegalovirus (CMV) infection, extra ultrasound findings and outcomes of fetuses with bilateral ventriculomegaly (BVM). Methods Data from pregnancies with fetal BVM were obtained between 2014 and 2020. The cases were divided into groups of isolated bilateral ventriculomegaly (IBVM) and non-isolated bilateral ventriculomegaly (NIBVM) according to the presence of extra prenatal imaging. Subgroups of mild, moderate, and severe were determined according to lateral ventricle widths. The NIBVM group was further classified into pregnancies with soft markers, non-structural abnormalities, and structural abnormalities. Results A total of 353 pregnancies were enrolled, including 153 cases of IBVM and 200 cases of NIBVM. Conventional karyotyping was performed on 192 samples, and 15 cases of numerical abnormalities and 3 cases of unbalanced structural abnormalities were identified. Chromosomal microarray analysis (CMA) was concurrently performed on 108 of them and revealed additional 5 cases (4.7%) of copy number variants with clinical significance. CMV DNA testing was performed on 154 of the 192 cases that underwent invasive prenatal diagnosis, and a positive result was found in 2 (1.3%) cases. In the IBVM group, the percentage of favorable prognosis in the mild, moderate and severe pregnancies were 94.4%, 79.2%, and 4.8%, respectively, and the termination of pregnancy (TOP) rates were 4.6%, 20.8%, and 85.7%, respectively. In both the mild and moderate NIBVM, the TOP rates progressively increased and the favorable prognosis survival rates progressively decreased relative to the soft markers, non-structural abnormalities, and structural abnormalities, respectively. Approximately 94.1% of severe NIBVM ended in termination. Conclusion Genetic disorders and fetal infection are important etiology of BVM. CMA is highly recommended for genetic disorders’ evaluation. Pregnancies with severe BVM always ended in TOP, while in mild-to-moderate NIBVM, prenatal imaging by ultrasound and/or MRI plays important roles in the pregnancy outcomes.
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Affiliation(s)
- Danhua Guo
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Deqin He
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Qingmei Shen
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Shuqiong He
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Yifang Dai
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Ying Li
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Xiaoqing Wu
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China.,Department of Laboratory Medicine, Fujian Medical University, Fuzhou, 350002, Fujian, People's Republic of China
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Meyer R, Bar-Yosef O, Barzilay E, Radinsky I, Segal CK, Ziv-Baran T, Shani H, Levin G, Katorza E. The Significance of Fetal Brain Ventricular Asymmetry Without Dilation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2413-2419. [PMID: 33427340 DOI: 10.1002/jum.15626] [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: 09/28/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Fetal brain non-dilated ventricular asymmetry (NDVA) is a common finding on prenatal ultrasound exams. However, the optimal prenatal management in these cases remains unknown. We aimed to evaluate the benefit of prenatal genetic and magnetic resonance imaging (MRI) exams performed in cases of fetal NDVA detected on ultrasound. METHODS A historical cohort study from a tertiary medical center. Singleton pregnancies with fetal brain NDVA diagnosed on ultrasound were included. We defined ventricular asymmetry as a difference of ≥2.0 mm between the lateral ventricles and ventricular dilation as ventricular width of >10.0 mm. Outcomes were evaluated with genetic exams (karyotype and chromosomal microarray analysis [CMA]) and fetal brain MRI. RESULTS During the study period, there were 145 cases diagnosed with NDVA on ultrasound that comprised the cohort study. The rate of abnormal karyotype was 1.8% (1/56) and of abnormal CMA was 10% (3/30). The rate of minor additional CNS findings did not differ between ultrasound and MRI (3.4 versus 2.8%, respectively, p = .74). No major additional fetal brain findings were detected on MRI performed after ultrasound. CONCLUSIONS In cases diagnosed with NDVA on ultrasound, no significant additional anomalies were detected on fetal brain MRI. The rate of abnormal genetic tests was relatively high and warrants further studies.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Omer Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Pediatric Neurology Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Igal Radinsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Chen Key Segal
- School of Medicine, Semmelweis University, Budapest, Hungary
| | - Tomer Ziv-Baran
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Hagit Shani
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eldad Katorza
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Prabhu M, Kuller JA, Biggio JR, Biggio JR. Society for Maternal-Fetal Medicine Consult Series #57: Evaluation and management of isolated soft ultrasound markers for aneuploidy in the second trimester: (Replaces Consults #10, Single umbilical artery, October 2010; #16, Isolated echogenic bowel diagnosed on second-trimester ultrasound, August 2011; #17, Evaluation and management of isolated renal pelviectasis on second-trimester ultrasound, December 2011; #25, Isolated fetal choroid plexus cysts, April 2013; #27, Isolated echogenic intracardiac focus, August 2013). Am J Obstet Gynecol 2021; 225:B2-B15. [PMID: 34171388 DOI: 10.1016/j.ajog.2021.06.079] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Soft markers were originally introduced to prenatal ultrasonography to improve the detection of trisomy 21 over that achievable with age-based and serum screening strategies. As prenatal genetic screening strategies have greatly evolved in the last 2 decades, the relative importance of soft markers has shifted. The purpose of this document is to discuss the recommended evaluation and management of isolated soft markers in the context of current maternal serum screening and cell-free DNA screening options. In this document, "isolated" is used to describe a soft marker that has been identified in the absence of any fetal structural anomaly, growth restriction, or additional soft marker following a detailed obstetrical ultrasound examination. In this document, "serum screening methods" refers to all maternal screening strategies, including first-trimester screen, integrated screen, sequential screen, contingent screen, or quad screen. The Society for Maternal-Fetal Medicine recommends the following approach to the evaluation and management of isolated soft markers: (1) we do not recommend diagnostic testing for aneuploidy solely for the evaluation of an isolated soft marker following a negative serum or cell-free DNA screening result (GRADE 1B); (2) for pregnant people with no previous aneuploidy screening and isolated echogenic intracardiac focus, echogenic bowel, urinary tract dilation, or shortened humerus, femur, or both, we recommend counseling to estimate the probability of trisomy 21 and a discussion of options for noninvasive aneuploidy screening with cell-free DNA or quad screen if cell-free DNA is unavailable or cost-prohibitive (GRADE 1B); (3) for pregnant people with no previous aneuploidy screening and isolated thickened nuchal fold or isolated absent or hypoplastic nasal bone, we recommend counseling to estimate the probability of trisomy 21 and a discussion of options for noninvasive aneuploidy screening through cell-free DNA or quad screen if cell-free DNA is unavailable or cost-prohibitive or diagnostic testing via amniocentesis, depending on clinical circumstances and patient preference (GRADE 1B); (4) for pregnant people with no previous aneuploidy screening and isolated choroid plexus cysts, we recommend counseling to estimate the probability of trisomy 18 and a discussion of options for noninvasive aneuploidy screening with cell-free DNA or quad screen if cell-free DNA is unavailable or cost-prohibitive (GRADE 1C); (5) for pregnant people with negative serum or cell-free DNA screening results and an isolated echogenic intracardiac focus, we recommend no further evaluation as this finding is a normal variant of no clinical importance with no indication for fetal echocardiography, follow-up ultrasound imaging, or postnatal evaluation (GRADE 1B); (6) for pregnant people with negative serum or cell-free DNA screening results and isolated fetal echogenic bowel, urinary tract dilation, or shortened humerus, femur, or both, we recommend no further aneuploidy evaluation (GRADE 1B); (7) for pregnant people with negative serum screening results and isolated thickened nuchal fold or absent or hypoplastic nasal bone, we recommend counseling to estimate the probability of trisomy 21 and discussion of options for no further aneuploidy evaluation, noninvasive aneuploidy screening through cell-free DNA, or diagnostic testing via amniocentesis, depending on clinical circumstances and patient preference (GRADE 1B); (8) for pregnant people with negative cell-free DNA screening results and isolated thickened nuchal fold or absent or hypoplastic nasal bone, we recommend no further aneuploidy evaluation (GRADE 1B); (9) for pregnant people with negative serum or cell-free DNA screening results and isolated choroid plexus cysts, we recommend no further aneuploidy evaluation, as this finding is a normal variant of no clinical importance with no indication for follow-up ultrasound imaging or postnatal evaluation (GRADE 1C); (10) for fetuses with isolated echogenic bowel, we recommend an evaluation for cystic fibrosis and fetal cytomegalovirus infection and a third-trimester ultrasound examination for reassessment and evaluation of growth (GRADE 1C); (11) for fetuses with an isolated single umbilical artery, we recommend no additional evaluation for aneuploidy, regardless of whether results of previous aneuploidy screening were low risk or testing was declined. We recommend a third-trimester ultrasound examination to evaluate growth and consideration of weekly antenatal fetal surveillance beginning at 36 0/7 weeks of gestation (GRADE 1C); (12) for fetuses with isolated urinary tract dilation A1, we recommend an ultrasound examination at ≥32 weeks of gestation to determine if postnatal pediatric urology or nephrology follow-up is needed. For fetuses with urinary tract dilation A2-3, we recommend an individualized follow-up ultrasound assessment with planned postnatal follow-up (GRADE 1C); (13) for fetuses with isolated shortened humerus, femur, or both, we recommend a third-trimester ultrasound examination for reassessment and evaluation of growth (GRADE 1C).
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Li X, Wang Q. Magnetic Resonance Imaging (MRI) Diagnosis of Fetal Corpus Callosum Abnormalities and Follow-up Analysis. J Child Neurol 2021; 36:1017-1026. [PMID: 34250854 DOI: 10.1177/08830738211016253] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We analyzed the magnetic resonance imaging (MRI) manifestations of fetal corpus callosum abnormalities and discussed their prognosis based on the results of postnatal follow up. METHODS One hundred fifty-five fetuses were diagnosed with corpus callosum abnormalities by MRI at our hospital from 2004 to 2019. Gesell Development Scales were used to evaluate the prognosis of corpus callosum abnormalities after birth. RESULTS Corpus callosum abnormalities were diagnosed in 149 fetuses from singleton pregnancies, and 6 pairs of twins, 1 in each pair is a corpus callosum abnormality. Twenty-seven cases (27/155) were lost to follow up, whereas 128 cases (128/155) were followed up. Of these, 101 cases were induced for labor, whereas 27 cases were born naturally. Among the 27 cases of corpus callosum abnormality after birth, 22 cases were from singleton pregnancies (22/27). Moreover, 1 twin from each of 5 pairs of twins (5/27) demonstrated corpus callosum abnormalities. The average Gesell Development Scale score was 87.1 in 19 cases of agenesis of the corpus callosum and 74.9 in 3 cases of hypoplasia of the corpus callosum. Among the 5 affected twins, 2 had severe neurodevelopmental delay, 2 had mild neurodevelopmental delay, and 1 was premature and died. CONCLUSION The overall prognosis of agenesis of the corpus callosum is good in singleton pregnancies. Hypoplasia of the corpus callosum is often observed with other abnormalities, and the development quotient of hypoplasia of the corpus callosum is lower compared with agenesis of the corpus callosum. Corpus callosum abnormalities may occur in one twin, in whom the risk may be increased.
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Affiliation(s)
- Xu Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiology, Anhui Provincial Children's Hospital, Hefei, Anhui Province, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Pang B, Pan JJ, Li Q, Zhang X. Accuracy of ultrasonography in diagnosis of fetal central nervous system malformation. World J Clin Cases 2021; 9:8027-8034. [PMID: 34621859 PMCID: PMC8462195 DOI: 10.12998/wjcc.v9.i27.8027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/03/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prenatal examination is an important measure for the screening and diagnosis of fetal malformations.
AIM To investigate the accuracy of ultrasonography in the diagnosis of fetal central nervous system (CNS) malformations.
METHODS One hundred and thirteen pregnant women suspected of having fetal CNS malformations were examined at our hospital from December 2018 to October 2020 using two-dimensional ultrasonography and three-dimensional ultrasonography, respectively.
RESULTS According to the pathological results, there were 79 cases of CNS malformations and 34 cases of non-CNS malformations among the 113 pregnant women suspected of having fetal CNS malformation. Fifty-one cases of CNS malformation and 26 cases of non-CNS malformation were detected by two-dimensional ultrasonography, and 73 cases of CNS malformation and 30 cases of non-CNS malformation were detected by three-dimensional ultrasonography. The diagnostic sensitivity (92.41%) and accuracy (91.15%) of three-dimensional ultrasonography were higher than those of two-dimensional ultrasonography (64.56% and 68.14%, respectively) (P = 0.000). The specificity of three-dimensional ultrasonography (88.24%) was higher than that of two-dimensional ultrasonography (76.47%); however, the difference was not significant (P = 0.203).
CONCLUSION Three-dimensional ultrasonography has high application value in the diagnosis of fetal CNS malformations. In addition, the image quality is clear, and the diagnostic sensitivity and accuracy are high.
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Affiliation(s)
- Bo Pang
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Jing-Jing Pan
- Department of Neurosurgery, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Qin Li
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Xia Zhang
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
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