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Hung SC, Dahmoush H, Lee HJ, Chen HC, Guimaraes CV. Prenatal Imaging of Supratentorial Fetal Brain Malformation. Magn Reson Imaging Clin N Am 2024; 32:395-412. [PMID: 38944430 DOI: 10.1016/j.mric.2024.03.002] [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] [Indexed: 07/01/2024]
Abstract
This review article provides a comprehensive overview of fetal MR imaging in supratentorial cerebral malformations. It emphasizes the importance of fetal MR imaging as an adjunct diagnostic tool used alongside ultrasound, improving the detection and characterization of prenatal brain abnormalities. This article reviews a spectrum of cerebral malformations, their MR imaging features, and the clinical implications of these findings. Additionally, it outlines the growing importance of fetal MR imaging in the context of perinatal care.
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Affiliation(s)
- Sheng-Che Hung
- Division of Neuroradiology, Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA; Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Hisham Dahmoush
- Division of Pediatric Neuroradiology, Department of Radiology, Stanford School of Medicine, Stanford, CA, USA
| | - Han-Jui Lee
- Division of Neuroradiology, Department of Radiology, Taipei Veterans General Hospital, Taiwan; National Yang Ming Chiao Tung University, Taiwan
| | - Hung-Chieh Chen
- National Yang Ming Chiao Tung University, Taiwan; Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Carolina V Guimaraes
- Division of Pediatric Radiology, Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
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Desnous B, Carles G, Riccardi F, Stremler N, Baravalle M, El-Louali F, Testud B, Milh M. Diffuse interstitial lung disease in a male fetus with periventricular nodular heterotopia and filamin A mosaic variant. Prenat Diagn 2024; 44:364-368. [PMID: 38148030 DOI: 10.1002/pd.6505] [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: 10/02/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Most periventricular nodular heterotopias (PNHs) are associated with a mutation in the filamin A (FLNA) gene in Xq28. This condition is associated with cardiovascular malformations, connective tissue abnormalities, epilepsy, and intellectual deficiency of varying severity. MATERIALS AND METHODS We report a new FLNA gene mutation in a male patient associated with PNH and diffuse interstitial lung disease. RESULTS A 23-year-old woman was referred at 31 gestational weeks to evaluate a suspected mega cisterna magna and ventricular septal defect with atrioventricular valve alignment in a male fetus. The fetal magnetic resonance imaging showed PNH associated with corpus callosum dysgenesis and a mega cisterna magna. At 2 months of age, the infant was diagnosed with severe respiratory distress with hypoxemia. A chest CT scan demonstrated a diffuse interstitial lung pattern with emphysema, multiple atelectasis foci, and signs of pulmonary hypertension. Rapid worsening led to his death at 4 months. Targeted sequencing of the FLNA gene identified a de novo hemizygous variant in 75% mosaic in lymphocyte cells, resulting in incomplete FLNA function loss. DISCUSSION & CONCLUSION On the diagnosis of antenatal PNH, the possibility of such lung involvement should be considered in the prognostic evaluation during prenatal counseling.
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Affiliation(s)
- Beatrice Desnous
- Pediatric Neurology Department, Timone Enfant, APHM, Marseille, France
| | - Guillaume Carles
- Pediatric Cardiology Department, Timone Enfant, APHM, Marseille, France
| | | | - Nathalie Stremler
- Pediatric Pneumology Department, Timone Enfant, APHM, Marseille, France
| | - Melissa Baravalle
- Pediatric Pneumology Department, Timone Enfant, APHM, Marseille, France
| | - Fedouah El-Louali
- Pediatric Cardiology Department, Timone Enfant, APHM, Marseille, France
| | - Benoit Testud
- Neuroradiology Department, Timone Enfant, APHM, Marseille, France
- Aix-Marseille University, CNRS, CRMBM, UMR 7339, Marseille, France
- APHM La Timone, CEMEREM, Marseille, France
| | - Mathieu Milh
- Pediatric Neurology Department, Timone Enfant, APHM, Marseille, France
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Loft Nagel J, Jønch AE, Nguyen NTTN, Bygum A. Phenotypic manifestations in FLNA-related periventricular nodular heterotopia: a case report and review of the literature. BMJ Case Rep 2022; 15:e247268. [PMID: 35414575 PMCID: PMC9006829 DOI: 10.1136/bcr-2021-247268] [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] [Accepted: 03/29/2022] [Indexed: 11/03/2022] Open
Abstract
Periventricular nodular heterotopia (PVNH) is an X-linked disease caused by loss-of-function variants in the filamin A (FLNA) gene. FLNA-PVNH is a heterogeneous disorder, and the phenotype is associated with neurological and non-neurological features including cardiovascular, gastrointestinal, pulmonary, haematological, cutaneous and skeletal manifestations. No clear definition of the FLNA-PVNH phenotype has been established, but the patients are predominantly females with seizures, cardiovascular manifestations, and normal intelligence or mild intellectual disability. Herein, we describe a PVNH patient diagnosed with a novel heterozygous missense variant in FLNA after an atypical presentation of deep vein thrombosis and thrombocytopenia. Clinical evaluation found hypermobility, cardiovascular and skin manifestations. Moreover, we conducted a literature review of 186 FLNA-PVNH patients to describe the phenotypic spectrum. In conclusion, our patient highlights the importance of thorough clinical evaluation to identify manifestations in this very heterogeneous disorder. The phenotypic review may guide clinicians in the assessment and follow-up of FLNA-PVNH patients.
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Affiliation(s)
- Julie Loft Nagel
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Aia Elise Jønch
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Nina T T N Nguyen
- Department of Neuroradiology, Odense University Hospital, Odense, Denmark
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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[Prenatal ultrasound prognostic of myelomeningocele at the era of fetal surgery]. ACTA ACUST UNITED AC 2021; 49:617-629. [PMID: 34020095 DOI: 10.1016/j.gofs.2021.05.003] [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: 11/11/2020] [Indexed: 11/21/2022]
Abstract
Myelomeningocele (MMC) is a severe congenital condition responsible for motor and sensory impairments of the lower limbs, incontinence and cognitive impairment. Its screening, sometimes as early as the first trimester, is one of the major goals of modern prenatal care, supported by the emergence of prenatal surgery that results in a significant improvement in motor function, ambulation and ventriculoperitoneal shunt rate in patients undergoing in-utero surgery. From screening to pre- and post-operative prognostic evaluation, prenatal ultrasound is now an essential tool in the antenatal management of this condition. Using the multi planar and three-dimensional modes, it can be used to assess the vertebral level of MMC, which remains the key antenatal prognostic marker for motor function and ambulation, incontinence and the need for a ventriculo-peritoneal shunt. A careful and systematic ultrasound examination also makes it possible to assess the severity and progression of ventriculomegaly, to search for associated cerebral, spinal cord or vertebral anomalies, or to rule out exclusion criteria for in-utero surgery such as severe kyphosis or serious cortical anomalies. New tools from post-natal evaluation, such as the "metameric" ultrasound assessment of lower limb mobility, appear to be promising either for the initial examination or after in-utero surgery. Ultrasonography, associated with fetal MRI, cytogenetic and next generation sequencing, now allows a highly customized prognostic evaluation of these fetuses affected by MMC and provides the parents with the best possible information on the expected benefits and limitations of fetal surgery.
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Maurice P, Garel J, Garel C, Dhombres F, Friszer S, Guilbaud L, Maisonneuve E, Ducou Le Pointe H, Blondiaux E, Jouannic JM. New insights in cerebral findings associated with fetal myelomeningocele: a retrospective cohort study in a single tertiary centre. BJOG 2020; 128:376-383. [PMID: 32112473 DOI: 10.1111/1471-0528.16185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate cerebral anomalies other than Chiari type 2 malformation in fetuses with myelomeningocele (MMC). DESIGN A retrospective cohort study in a single tertiary centre. SETTING A review of associated cerebral anomalies in cases with prenatal diagnosis of myelomeningocele. POPULATION Seventy cases of fetal myelomeningocele. METHODS Ultrasound and MRI images were blindly reviewed. Postnatal imaging and results of the postmortem results were also reviewed. The association between cerebral anomalies and the following ultrasound findings was measured: level of the defect, ventriculomegaly, microcephaly and fetal talipes. MAIN OUTCOME MEASURES A microcephaly was observed in 32/70 cases (46%) and a ventriculomegaly was observed in 39/70 cases (56%). Other cerebral anomalies were diagnosed in 47/70 (67%). RESULTS Other cerebral anomalies were represented by 42/70 cases with abnormal CC (60%), 8/70 cases with perinodular heterotopia (PNH; 11%), 2/70 cases with abnormal gyration (3%). MRI performed only in fetal surgery cases confirmed the ulltrasound findings in all cases and provided additional findings in two cases (PNH). Risk ratios of fetal cerebral anomalies associated with MMC did not reach significance for microcephaly, ventriculomegaly, talipes or the level of the defect There was an overall good correlation between pre- and postnatal findings with a Kappa value of 0.79 [95% CI 0.57-1] and 82% agreement. CONCLUSION Fetal brain anomalies other than Chiari type 2 malformation are frequently observed in fetuses with myelomeningocele, predominantly represented by CC anomalies. Whether these associated cerebral anomalies have an impact on selecting cases eligible for fetal surgery needs further evaluation. TWEETABLE ABSTRACT Fetal cerebral anomalies other than Chiari type 2 malformation, microcephaly, and ventriculomegaly may be associated with MMC in up to 67% of the cases.
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Affiliation(s)
- P Maurice
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - J Garel
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - C Garel
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - F Dhombres
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - S Friszer
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - L Guilbaud
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - E Maisonneuve
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - H Ducou Le Pointe
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - E Blondiaux
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - J-M Jouannic
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
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Van den Veyver IB. Prenatally diagnosed developmental abnormalities of the central nervous system and genetic syndromes: A practical review. Prenat Diagn 2019; 39:666-678. [PMID: 31353536 DOI: 10.1002/pd.5520] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022]
Abstract
Developmental brain abnormalities are complex and can be difficult to diagnose by prenatal imaging because of the ongoing growth and development of the brain throughout pregnancy and the limitations of ultrasound, often requiring fetal magnetic resonance imaging as an additional tool. As for all major structural congenital anomalies, amniocentesis with chromosomal microarray and a karyotype is the first-line recommended test for the genetic work-up of prenatally diagnosed central nervous system (CNS) abnormalities. Many CNS defects, especially neuronal migration defects affecting the cerebral and cerebellar cortex, are caused by single-gene mutations in a large number of different genes. Early data suggest that prenatal diagnostic exome sequencing for fetal CNS defects will have a high diagnostic yield, but interpretation of sequencing results can be complex. Yet a genetic diagnosis is important for prognosis prediction and recurrence risk counseling. The evaluation and management of such patients is best done in a multidisciplinary team approach. Here, we review general principles of the genetic work-up for fetuses with CNS defects and review categories of genetic causes of prenatally diagnosed CNS phenotypes.
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