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Murillo C, Eixarch E, Rueda C, Larroya M, Boada D, Grau L, Ponce J, Aldecoa V, Monterde E, Ferrero S, Andreu-Fernández V, Arca G, Oleaga L, Ros O, Hernández MP, Gratacós E, Palacio M, Cobo T. Evidence of brain injury in fetuses of mothers with preterm labor with intact membranes and preterm premature rupture of membranes. Am J Obstet Gynecol 2024:S0002-9378(24)00531-3. [PMID: 38685550 DOI: 10.1016/j.ajog.2024.04.025] [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: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers. OBJECTIVE This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator. STUDY DESIGN In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission. RESULTS Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non-intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8-37.6), 35.3 mm (interquartile range, 31.2-39.6), and 35.0 mm (interquartile range, 31.3-38.3), respectively (P=.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5-19.6), 17.2 mm (interquartile range, 16.0-18.9), and 17.1 mm (interquartile range, 15.7-19.0), respectively (P=.041). Second, they presented a lower corpus callosum area (0.72 mm2 [interquartile range, 0.59-0.81], 0.71 mm2 [interquartile range, 0.63-0.82], and 0.78 mm2 [interquartile range, 0.71-0.91], respectively; P=.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth-to-biparietal diameter ratios were 0.14 [interquartile range, 0.12-0.16], 0.14 [interquartile range, 0.13-0.16], and 0.16 [interquartile range, 0.15-0.17], respectively [P<.001], and the right parieto-occipital sulci depth ratios were 0.09 [interquartile range, 0.07-0.12], 0.11 [interquartile range, 0.09-0.14], and 0.11 [interquartile range, 0.09-0.14], respectively [P=.012]). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL [interquartile range, 6213.4-21,098.8], 8397.7 pg/mL [interquartile range, 3682.1-17,398.3], and 2393.7 pg/mL [interquartile range, 1717.1-3209.3], respectively; P<.001), protein S100B (2030.6 pg/mL [interquartile range, 993.0-4883.5], 1070.3 pg/mL [interquartile range, 365.1-1463.2], and 74.8 pg/mL [interquartile range, 44.7-93.7], respectively; P<.001), and glial fibrillary acidic protein (1.01 ng/mL [interquartile range, 0.54-3.88], 0.965 ng/mL [interquartile range, 0.59-2.07], and 0.24 mg/mL [interquartile range, 0.20-0.28], respectively; P=.002). CONCLUSION Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation.
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Affiliation(s)
- Clara Murillo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Claudia Rueda
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marta Larroya
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - David Boada
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Laia Grau
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Júlia Ponce
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Victoria Aldecoa
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Elena Monterde
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain. Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Silvia Ferrero
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Vicente Andreu-Fernández
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Biosanitary Research Institute, Valencian International University, Valencia, Spain
| | - Gemma Arca
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Olga Ros
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Maria Pilar Hernández
- Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain.
| | - Montse Palacio
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Teresa Cobo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
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Zhang Y. Prenatal ultrasound for the diagnosis of the agenesis of corpus callosum: a meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2228454. [PMID: 37365011 DOI: 10.1080/14767058.2023.2228454] [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: 05/26/2022] [Revised: 04/20/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Prenatal ultrasound has been regularly used as the screening tool for agenesis of corpus callosum (ACC) of the fetuses, which were mainly suspected on the basis of indirect signs rather than the visualization of the CC. However, the diagnostic accuracy of prenatal ultrasound for ACC, compared to the gold standard of postmortem diagnosis or postnatal images, is still unknown. This meta-analysis was performed to comprehensively evaluate the efficacy of prenatal ultrasound for the diagnosis of ACC. METHODS Studies evaluating the diagnostic accuracy of prenatal ultrasound for ACC compared to postmortem diagnosis or postnatal images were retrieved by searching PubMed, Embase, and Web of Science databases. Pooled sensitivity and specificity were calculated with a random-effects model. The diagnostic accuracy was measured by summarized area under the receiver operating characteristic (AUC) curve. RESULTS Twelve studies involving 544 fetuses with suspected anomalies of central nervous system were included, and 143 of them were with validated diagnosis of ACC. Pooled results showed that prenatal ultrasound has satisfying diagnostic efficacy for ACC, with the pooled sensitivity, specificity, positive and negative likelihood ratios of 0.72 (95% confidence interval [CI]: 0.39-0.91), 0.98 (95% CI: 0.79-1.00), 43.73 (95% CI: 3.42-558.74, and 0.29 (95% CI: 0.11-0.74), respectively. The pooled AUC was 0.94 (95% CI: 0.92-0.96), suggesting good diagnostic performance of prenatal ultrasound. Subgroup analysis according to the prenatal ultrasound procedures showed a better diagnostic efficacy of neurosonography than that of regular ultrasound screening (sensitivity: 0.84 versus 0.57, specificity: 0.98 versus 0.89, and AUC: 0.97 versus 0.78). CONCLUSIONS Prenatal ultrasound, particularly for the neurosonography, confers satisfying efficacy for the diagnosis of ACC.
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Affiliation(s)
- Yan Zhang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Griffiths PD, Bradburn M, Campbell MJ, Cooper CL, Embleton N, Graham R, Hart AR, Jarvis D, Kilby MD, Lie M, Mason G, Mandefield L, Mooney C, Pennington R, Robson SC, Wailoo A. MRI in the diagnosis of fetal developmental brain abnormalities: the MERIDIAN diagnostic accuracy study. Health Technol Assess 2020; 23:1-144. [PMID: 31538569 DOI: 10.3310/hta23490] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ultrasonography has been the mainstay of antenatal screening programmes in the UK for many years. Technical factors and physical limitations may result in suboptimal images that can lead to incorrect diagnoses and inaccurate counselling and prognostic information being given to parents. Previous studies suggest that the addition of in utero magnetic resonance imaging (iuMRI) may improve diagnostic accuracy for fetal brain abnormalities. These studies have limitations, including a lack of an outcome reference diagnosis (ORD), which means that improvements could not be assessed accurately. OBJECTIVES To assess the diagnostic impact, acceptability and cost consequence of iuMRI among fetuses with a suspected fetal brain abnormality. DESIGN A pragmatic, prospective, multicentre, cohort study with a health economics analysis and a sociological substudy. SETTING Sixteen UK fetal medicine centres. PARTICIPANTS Pregnant women aged ≥ 16 years carrying a fetus (at least 18 weeks' gestation) with a suspected brain abnormality detected on ultrasonography. INTERVENTIONS Participants underwent iuMRI and the findings were reported to their referring fetal medicine clinician. MAIN OUTCOME MEASURES Pregnancy outcome was followed up and an ORD from postnatal imaging or postmortem autopsy/imaging collected when available. Developmental data from the Bayley Scales of Infant Development and questionnaires were collected from the surviving infants aged 2-3 years. Data on the management of the pregnancy before and after the iuMRI were collected to inform the economic evaluation. Two surveys collected data on patient acceptability of iuMRI and qualitative interviews with participants and health professionals were undertaken. RESULTS The primary analysis consisted of 570 fetuses. The absolute diagnostic accuracies of ultrasonography and iuMRI were 68% and 93%, respectively [a difference of 25%, 95% confidence interval (CI) 21% to 29%]. The difference between ultrasonography and iuMRI increased with gestational age. In the 18-23 weeks group, the figures were 70% for ultrasonography and 92% for iuMRI (difference of 23%, 95% CI 18% to 27%); in the ≥ 24 weeks group, the figures were 65% for ultrasonography and 94% for iuMRI (difference of 29%, 95% CI 23% to 36%). Patient acceptability was high, with at least 95% of respondents stating that they would have iuMRI again in a similar situation. Health professional interviews suggested that iuMRI was acceptable to clinicians and that iuMRI was useful as an adjunct to ultrasonography, but not as a replacement. Across a range of scenarios, iuMRI resulted in additional costs compared with ultrasonography alone. The additional cost was consistently < £600 per patient and the cost per management decision appropriately changed was always < £3000. There is potential for reporting bias from the referring clinicians on the diagnostic and prognostic outcomes. Lower than anticipated follow-up rates at 3 years of age were observed. CONCLUSIONS iuMRI as an adjunct to ultrasonography significantly improves the diagnostic accuracy and confidence for the detection of fetal brain abnormalities. An evaluation of the use of iuMRI for cases of isolated microcephaly and the diagnosis of fetal spine abnormalities is recommended. Longer-term follow-up studies of children diagnosed with fetal brain abnormalities are required to fully assess the functional significance of the diagnoses. TRIAL REGISTRATION Current Controlled Trials ISRCTN27626961. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul D Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael J Campbell
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicholas Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ruth Graham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony R Hart
- Department of Perinatal and Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Deborah Jarvis
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Mark D Kilby
- Centre for Women's and Newborn Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust (Birmingham Health Partners), Birmingham, UK
| | - Mabel Lie
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Laura Mandefield
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cara Mooney
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebekah Pennington
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Allan Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Hassan E, Abdelgalil A, Torad F. Ultrasonographic examination of the normal caprine neonatal brain. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2020; 11:1-5. [PMID: 32537100 PMCID: PMC7282222 DOI: 10.30466/vrf.2019.91253.2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 04/17/2019] [Indexed: 11/09/2022]
Abstract
Ultrasonography is a safe, rapid, and non-invasive diagnostic tool that has been previously used for imaging infants and canine neonatal brains. The purpose of the present study was to describe the ultrasonographic appearance of the brain in clinically normal caprine neonates. Ultrasonographic examination was done on 12 day-old goat kids, transverse and sagittal transcranial scans were obtained through the frontal bone. Three image planes were recorded through transverse scans including plane I (level of the caudate nucleus), plane II (level of the rostral diencephalon) and plane III (level of the caudal diencephalon). Parallel post mortem examinations were done for two kids that died a day following examination due to accidental trauma by the dam. Reliable and repeatable ultrasonographic images of the goat kid’s brain were described based on the gross post mortem findings. The head of the caudate nucleus was taken as an anatomical landmark in the plane I where it appeared as a curved hyperechoic structure. In plane II, the longitudinal fissure with its characteristic umbrella-like structure was taken as a landmark, while in plane III, the laterally located hyperechoic hippocampus was taken as a landmark. Normal ultrasonographic examination of the caprine neonatal brain represented the basis for diagnosing congenital brain lesions as well as intracranial hemorrhage.
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Affiliation(s)
- Elham Hassan
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdelgalil
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Faisal Torad
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
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A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero. Eur Radiol 2016; 27:2367-2380. [PMID: 27655301 PMCID: PMC5408056 DOI: 10.1007/s00330-016-4563-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022]
Abstract
Objectives This systematic review was undertaken to define the diagnostic performance of in utero MR (iuMR) imaging when attempting to confirm, exclude or provide additional information compared with the information provided by prenatal ultrasound scans (USS) when there is a suspicion of foetal brain abnormality. Methods Electronic databases were searched as well as relevant journals and conference proceedings. Reference lists of applicable studies were also explored. Data extraction was conducted by two reviewers independently to identify relevant studies for inclusion in the review. Inclusion criteria were original research that reported the findings of prenatal USS and iuMR imaging and findings in terms of accuracy as judged by an outcome reference diagnosis for foetal brain abnormalities. Results 34 studies met the inclusion criteria which allowed diagnostic accuracy to be calculated in 959 cases, all of which had an outcome reference diagnosis determined by postnatal imaging, surgery or autopsy. iuMR imaging gave the correct diagnosis in 91 % which was an increase of 16 % above that achieved by USS alone. Conclusion iuMR imaging makes a significant contribution to the diagnosis of foetal brain abnormalities, increasing the diagnostic accuracy achievable by USS alone. Key points • Ultrasound is the primary modality for monitoring foetal brain development during pregnancy • iuMRI used together with ultrasound is more accurate for detecting foetal brain abnormalities • iuMR imaging is most helpful for detecting midline brain abnormalities • The moderate heterogeneity of reviewed studies may compromise findings
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Yang Z, Zuo XN, McMahon KL, Craddock RC, Kelly C, de Zubicaray GI, Hickie I, Bandettini PA, Castellanos FX, Milham MP, Wright MJ. Genetic and Environmental Contributions to Functional Connectivity Architecture of the Human Brain. Cereb Cortex 2016; 26:2341-2352. [PMID: 26891986 PMCID: PMC4830303 DOI: 10.1093/cercor/bhw027] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
One of the grand challenges faced by neuroscience is to delineate the determinants of interindividual variation in the comprehensive structural and functional connection matrices that comprise the human connectome. At present, this endeavor appears most tractable at the macroanatomic scale, where intrinsic brain activity exhibits robust patterns of synchrony that recapitulate core functional circuits at the individual level. Here, we use a classical twin study design to examine the heritability of intrinsic functional network properties in 101 twin pairs, including network activity (i.e., variance of a network's specific temporal fluctuations) and internetwork coherence (i.e., correlation between networks' specific temporal fluctuations). Five of 7 networks exhibited significantly heritable (23.3–65.2%) network activity, 6 of the 21 internetwork coherences were significantly heritable (25.6–42.0%), and 11 of the 21 internetwork coherences were significantly influenced by common environmental factors (18.0–47.1%). These results suggest that the source of interindividual variation in functional connectome has a modular architecture: individual modules represented by intrinsic connectivity networks are genetic controlled, while environmental factors influence the interplays between the modules. This work further provides network-specific hypotheses for discovery of the specific genetic and environmental factors influencing functional specialization and integration of the human brain.
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Affiliation(s)
- Zhi Yang
- Key Laboratory of Behavioral Sciences and MRI Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Xi-Nian Zuo
- Key Laboratory of Behavioral Sciences and MRI Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Katie L McMahon
- Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - R Cameron Craddock
- Child Mind Institute, New York, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Clare Kelly
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience at the NYU Child Study Center, New York, NY, USA
| | | | - Ian Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Peter A Bandettini
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - F Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience at the NYU Child Study Center, New York, NY, USA
| | - Michael P Milham
- Child Mind Institute, New York, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Margaret J Wright
- Genetic Epidemiology Laboratory, Queensland Institute of Medical Research, Brisbane, QLD, Australia
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van Doorn M, Oude Rengerink K, Newsum EA, Reneman L, Majoie CB, Pajkrt E. Added value of fetal MRI in fetuses with suspected brain abnormalities on neurosonography: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2015; 29:2949-61. [PMID: 26592136 DOI: 10.3109/14767058.2015.1109621] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the additional diagnostic value of fetal Magnetic Resonance Imaging (MRI) in fetuses with suspected brain abnormalities identified with advanced neurosonography (NS). METHODS A systematic literature search was performed for studies reporting on a comparison between diagnosis with NS and MRI, in fetuses suspected for brain abnormalities. Abnormalities detected on NS were compared with those detected on MRI as well as with postnatal imaging findings to assess the added value of fetal MRI. RESULTS We included 27 articles, reporting on 1184 cases in which NS and MRI diagnosis were compared. In 65% of cases [773/1184] fetal NS and fetal MRI diagnosis agreed completely. In 23% [312/1184], MRI showed additional or different pathology. In 8% [99/1184], MRI rejected the NS diagnosis with normal brain as conclusion. For 454 cases a comparison with postnatal imaging could be made. Compared to the postnatal diagnosis, fetal MRI diagnosis agreed completely in 80% [364/454] and fetal NS in 54% [243/454] (difference 27%, 95% CI 21-33%). Additional abnormalities were found on postnatal imaging in 36% [164/454] after NS and in 14% [61/454] after fetal MRI. CONCLUSIONS This meta-analysis shows that fetal MRI in addition to NS improves diagnostic accuracy in detecting brain abnormalities.
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Affiliation(s)
| | - Katrien Oude Rengerink
- b Department of Obstetrics and Gynecology , Academic Medical Center , Amsterdam , The Netherlands , and
| | - Esther A Newsum
- c Department of Radiology , Maastricht University Medical Center , Maastricht , The Netherlands
| | | | | | - Eva Pajkrt
- b Department of Obstetrics and Gynecology , Academic Medical Center , Amsterdam , The Netherlands , and
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Hassan EA, Torad FA, El-Tookhy OS, Shamaa AA. Canine neonatal transcranial ultrasonography from birth until closure of bregmatic fontanelle. Top Companion Anim Med 2015; 30:5-9. [PMID: 26041590 DOI: 10.1053/j.tcam.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/06/2015] [Accepted: 03/20/2015] [Indexed: 11/11/2022]
Abstract
Ultrasonography is a valuable diagnostic tool that has been used for diagnosis of neonatal brain diseases. The purpose of the present study was to describe the sequential ultrasonographic appearance of the normal canine neonatal brain from birth till closure of the bregmatic fontanelle. In total, 16 clinically normal neonates of mixed breed dogs were used. The bregmatic fontanelle was used as an acoustic window to record 5 transcranial scans (3 transverse, 1 sagittal, and 1 parasagittal scans) at 3, 10, 20, and 30 days of age. The appearance, echogenicity, and developmental differentiation of the structures within the cranium were described. Good images were obtained at 10 and 20 days of age. At 30 days of age, the obtained images presented poor details, as the fontanelle was small. Data obtained from this study represent the basis of brain ultrasound in neonates until 30 days of age, which could be beneficial in diagnosing congenital brain diseases.
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Affiliation(s)
- Elham A Hassan
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Cairo, Egypt.
| | - Faisal A Torad
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Cairo, Egypt
| | - Omar S El-Tookhy
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Cairo, Egypt
| | - Ashraf A Shamaa
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Cairo, Egypt
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9
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Egaña-Ugrinovic G, Savchev S, Bazán-Arcos C, Puerto B, Gratacós E, Sanz-Cortés M. Neurosonographic assessment of the corpus callosum as imaging biomarker of abnormal neurodevelopment in late-onset fetal growth restriction. Fetal Diagn Ther 2015; 37:281-8. [PMID: 25659952 DOI: 10.1159/000366160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore corpus callosum (CC) developmental differences by ultrasound in late-onset small fetuses compared with adequate for gestational age (AGA) controls. STUDY DESIGN Ninety four small (estimated fetal weight <10th centile) and 71 AGA fetuses were included. Small fetuses were further subdivided into fetal growth restriction (IUGR, n = 64) and small for gestational age (SGA, n = 30) based on poor perinatal outcome factors, that is, birth weight <3rd centile and/or abnormal cerebroplacental ratio and/or uterine artery Doppler. The entire cohort was scanned to assess CC by transvaginal neurosonography obtaining axial, coronal and midsagittal images. CC length, thickness, total area and the areas after a subdivision in 7 portions were evaluated by semiautomatic software. Furthermore, the weekly average growth of the CC in each study group was calculated and compared. RESULTS Small fetuses showed significantly shorter (small fetuses: 0.49 vs. AGA: 0.52; p < 0.01) and smaller CC (1.83 vs. 2.03; p < 0.01) with smaller splenium (0.47 vs. 0.55; p < 0.01) compared to controls. The CC growth rate was also reduced when compared to controls. Changes were more prominent in small fetuses with abnormal cerebroplacental Doppler suggesting fetal growth restriction. CONCLUSIONS Neurosonographic assessment of CC showed significantly altered callosal development, suggesting in-utero brain reorganization in small fetuses. This data support the potential value of CC assessment by US to monitor brain development in fetuses at risk.
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Affiliation(s)
- Gabriela Egaña-Ugrinovic
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), and University of Barcelona, Barcelona, Spain
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10
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Howe DT, Rankin J, Draper ES. Schizencephaly prevalence, prenatal diagnosis and clues to etiology: a register-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:75-82. [PMID: 21647999 DOI: 10.1002/uog.9069] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To establish the prevalence and antenatal diagnosis of schizencephaly in the UK. METHODS Data on schizencephaly were extracted from six regional congenital anomaly registers. RESULTS Thirty-eight cases of schizencephaly were identified in 2 567 165 livebirths and stillbirths, giving a total prevalence of 1.48/100 000 births (95% CI, 1.01-1.95). Eighteen (47% (95% CI, 31-63%)) of the 38 cases were identified antenatally. No affected fetus had an abnormal karyotype identified. A high proportion of cases of schizencephaly occurred in younger mothers: 63% were aged 24 years or less, significantly higher (P < 0.0001) than the corresponding proportion (26%) of mothers in England and Wales. The majority of cases were not identified until after 22 weeks of pregnancy. Additional anomalies associated with vascular disruption sequences were found in eight cases which had septo-optic dysplasia or absent septum pellucidum, one of which also had gastroschisis. CONCLUSIONS Schizencephaly occurs more frequently in the fetuses of younger mothers. It is often associated with septo-optic dysplasia, suggesting that the two conditions may share a common origin, arising as a result of destructive processes that cause changes in the brain which only become apparent on ultrasound in the second half of pregnancy.
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Affiliation(s)
- D T Howe
- Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton, UK.
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11
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Ting ET, Golomb MR. Grade IV fetal intracranial hemorrhage with good cognitive function. Pediatr Neurol 2010; 42:231-3. [PMID: 20159437 DOI: 10.1016/j.pediatrneurol.2009.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 09/24/2009] [Accepted: 10/12/2009] [Indexed: 11/26/2022]
Abstract
Fewer than 200 cases of prenatally diagnosed magnetic resonance imaging-confirmed fetal intracranial hemorrhage have been reported. Children surviving grade IV fetal intracranial hemorrhage usually manifest severe impairments, including mental retardation. We report on a child with a grade IV intracranial hemorrhage diagnosed by in utero ultrasound at 28 weeks of gestation, and confirmed by fetal magnetic resonance imaging at 29 weeks of gestation. At age 27 months, she has a ventriculoperitoneal shunt and exhibits hemiplegic cerebral palsy, but without seizures, and with normal cognitive function and excellent verbal ability. We discuss how perinatal care may have contributed to her good outcome.
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Affiliation(s)
- Erica T Ting
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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12
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Abstract
Prenatal ultrasound has concentrated on readily visible cerebral structures including head size, shape, ventricles, CSP (cavum septi pellucidi), cerebellar size/vermian presence and cisterna magna. However, apart from these easily visible structures it is important to evaluate the brain itself. Patients who initially appear to have mild isolated findings such as borderline ventriculomegaly in fact can have many more subtle findings that significantly alter prognosis and management that can be detected on detailed examination of the brain. There has been rapid evolution in imaging these foetuses, especially with neurosonography and MRI, and a revolution in understanding the underlying genetic and biochemical mechanisms. There is increasing emphasis to detect cortical abnormalities as early as possible. This article reviews development of the cerebral cortex, the classification, aetiologies and clinical manifestations of cortical disorders, normal and abnormal appearances at ultrasound and MRI, and approaches to investigation.
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Affiliation(s)
- Ants Toi
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.
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