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Chauhan NS, Nandolia K. Comparison of ultrasound and magnetic resonance imaging findings in evaluation of fetal congenital anomalies: A single-institution prospective observational study. Med J Armed Forces India 2023; 79:439-450. [PMID: 37441294 PMCID: PMC10334255 DOI: 10.1016/j.mjafi.2021.12.002] [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: 08/12/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to compare the ultrasound (USG) and fetal magnetic resonance imaging (MRI) findings in the evaluation of congenital fetal anomalies and to determine whether the management is changes significantly if MRI is combined with USG. Methods In this prospective observational cohort study, we performed fetal MRI in 90 consecutive cases of fetuses diagnosed or suspected as having congenital anomalies on a prior level II USG scan. We then compared the USG and MRI findings of each anomaly according to the diagnostic information yielded by each modality. Results Of 90 fetuses examined during 1 year study period, MRI and USG findings were equivalent in 13.3% of cases. MRI provided additional information in 68.8% cases, of which pregnancy management was changed in 5.6% cases. MRI provided additional information but did not change management in 63.3% of cases. USG provided additional information but did not change pregnancy management in 17.8% of cases. The difference was statistically significant with a p value of .000. Conclusion Fetal MRI is a significantly better modality than USG for detecting additional findings in anomalies of specific organ systems. Because of its high diagnostic yield for central nervous system (CNS) anomalies, it can be combined with USG for this subgroup. For non-CNS anomalies of genitourinary system, thorax, or in syndromic/complex malformations/conjoint twin pregnancy, it may be used as an adjunct to USG on a case to case basis. MRI has the potential to change the pregnancy management in few cases, but benefit is small to advocate a complete integration of MRI and USG for fetal anomaly scanning at present.
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Affiliation(s)
- Narvir Singh Chauhan
- Professor (Radiodiagnosis), Dr Rajendra Prasad Government Medical College, Tanda, Kangra, HP, India
| | - Khanak Nandolia
- Resident (Neuroradiology), AIIMS Rishikesh, Uttarakhand, India
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2
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Hawkins-Villarreal A, Moreno-Espinosa AL, Castillo K, Hahner N, Picone O, Mandelbrot L, Simon I, Gratacós E, Goncé A, Eixarch E. Brain cortical maturation assessed by magnetic resonance imaging in unaffected or mildly affected fetuses with cytomegalovirus infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:566-576. [PMID: 36349881 DOI: 10.1002/uog.26110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To assess by magnetic resonance imaging (MRI) the cortical maturation pattern in fetuses with cytomegalovirus (CMV) infection with mild or no abnormalities on ultrasound (US) and MRI, and to establish possible differences compared with healthy controls. METHODS This was a retrospective case-control study of consecutive pregnancies with a CMV-infected fetus undergoing prenatal MRI as a complementary diagnostic tool in two centers, and a control group of singleton low-risk pregnancies without fetal structural abnormalities, with normal fetal growth and with healthy newborns. CMV infection was confirmed by extraction of CMV-DNA from fetal and neonatal samples. Only fetuses with mild (mildly affected) or no (unaffected) neuroimaging abnormalities on US and MRI were included. MRI measurements of fetal parieto-occipital sulcus, cingulate sulcus and calcarine sulcus depth, Sylvian fissure depth and Sylvian fissure angles were performed and cortical development grading of specific cortical areas and sulci were assessed by one operator who was blinded to CMV infection status. Data were compared between controls and fetuses with CMV infection, using linear regression and non-parametric trend analysis. RESULTS Twenty-four CMV-infected fetuses (seven unaffected and 17 mildly affected) and 24 healthy controls that underwent fetal MRI between 27 and 36 weeks' gestation were included. Compared with controls, CMV-infected fetuses showed significantly larger median lateral ventricular width (right side, 7.8 (interquartile range (IQR), 5.9-9.9) mm vs 3.9 (IQR, 2.6-5.3) mm; left side, 7.5 (IQR, 6.0-10.9) mm vs 4.2 (IQR, 3.2-5.3) mm), significantly decreased parieto-occipital sulcus depth (right side, 12.6 (IQR, 11.3-13.5) mm vs 15.9 (IQR, 13.5-17.3) mm; left side, 12.3 (IQR, 10.6-13.5) mm vs 16.0 (IQR, 13.3-17.5) mm) and calcarine sulcus depth (right side, 15.4 (IQR, 14.4-16.3) mm vs 17.5 (IQR, 16.1-18.7) mm; left side, 14.6 (IQR, 14.1-15.6) mm vs 16.7 (IQR, 15.6-18.9) mm) (P < 0.001 for all). Compared with controls, CMV-infected fetuses also had significantly smaller upper (right side, 42.8° (IQR, 35.8-45.8°) vs 48.9° (IQR, 38.4-64.7°); left side, 40.9° (IQR, 34.2-45.8°) vs 48.2° (IQR, 41.9-60.7°)) and lower (right side, 41.6° (IQR, 34.4-49.2°) vs 48.9° (IQR, 40.6-60.9°); left side, 42.2° (IQR, 38.8-46.9°) vs 48.9° (IQR, 39.5-57.5°)) Sylvian fissure angles (P < 0.05 for all). In addition, the mildly affected CMV-infected fetuses had a significantly lower cortical development grading in the temporal and parietal areas, and the parieto-occipital and calcarine sulci compared with healthy fetuses (P < 0.05). These differences persisted when adjusting for gestational age, ipsilateral atrium width, fetal gender and when considering small-for-gestational age as a confounding factor. CONCLUSIONS Unaffected and mildly affected CMV-infected fetuses showed delayed cortical maturation compared with healthy controls. These results suggest that congenital CMV infection, even in non-severely affected fetuses that are typically considered of good prognosis, could be associated with altered brain cortical structure. Further research is warranted to better elucidate the correlation of these findings with neurodevelopmental outcomes. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Hawkins-Villarreal
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Fetal Medicine Service, Obstetrics Department, Hospital 'Santo Tomás', University of Panama, Panama City, Panama
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine
| | - A L Moreno-Espinosa
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Fetal Medicine Service, Obstetrics Department, Hospital 'Santo Tomás', University of Panama, Panama City, Panama
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine
| | - K Castillo
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - N Hahner
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - O Picone
- Department of Gynecology and Obstetrics, Hôpital Louis-Mourier, AP-HP, Féderation Hospitalo-Universitaire PREMA, Colombes, Paris, France
- Université Paris Cité, Paris, France
- Inserm IAME UMR1137, Paris, France
| | - L Mandelbrot
- Department of Gynecology and Obstetrics, Hôpital Louis-Mourier, AP-HP, Féderation Hospitalo-Universitaire PREMA, Colombes, Paris, France
- Université Paris Cité, Paris, France
- Inserm IAME UMR1137, Paris, France
| | - I Simon
- Department of Radiology, Hôpital Louis-Mourier, AP-HP, Colombes, France
| | - E Gratacós
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - A Goncé
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
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Boіagina BOD, Popadynets OH, Kolomiichenko YA. COMPARATIVE ANALYSIS OF THE PONS MORPHOMETRIC PARAMETERS ACCORDING TO THE DATA OF MRI IMAGES. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2023. [DOI: 10.29254/2077-4214-2022-4-167-281-284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Thill B. The fetal pain paradox. FRONTIERS IN PAIN RESEARCH 2023; 4:1128530. [PMID: 37025166 PMCID: PMC10072285 DOI: 10.3389/fpain.2023.1128530] [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: 12/20/2022] [Accepted: 02/21/2023] [Indexed: 04/08/2023] Open
Abstract
Controversy exists as to when conscious pain perception in the fetus may begin. According to the hypothesis of cortical necessity, thalamocortical connections, which do not form until after 24-28 weeks gestation, are necessary for conscious pain perception. However, anesthesiologists and neonatologists treat age-matched neonates as both conscious and pain-capable due to observable and measurable behavioral, hormonal, and physiologic indicators of pain. In preterm infants, these multimodal indicators of pain are uncontroversial, and their presence, despite occurring prior to functional thalamocortical connections, has guided the use of analgesics in neonatology and fetal surgery for decades. However, some medical groups state that below 24 weeks gestation, there is no pain capacity. Thus, a paradox exists in the disparate acknowledgment of pain capability in overlapping patient populations. Brain networks vary by age. During the first and second trimesters, the cortical subplate, a unique structure that is present only during fetal and early neonatal development, forms the first cortical network. In the third trimester, the cortical plate assumes this function. According to the subplate modulation hypothesis, a network of connections to the subplate and subcortical structures is sufficient to facilitate conscious pain perception in the fetus and the preterm neonate prior to 24 weeks gestation. Therefore, similar to other fetal and neonatal systems that have a transitional phase (i.e., circulatory system), there is now strong evidence for transitional developmental phases of fetal and neonatal pain circuitry.
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Guimaraes CVA, Dahmoush HM. Fetal Brain Anatomy. Neuroimaging Clin N Am 2022; 32:663-681. [PMID: 35843668 DOI: 10.1016/j.nic.2022.04.009] [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: 11/19/2022]
Abstract
"Fetal brain development has been well studied, allowing for an ample knowledge of the normal changes that occur during gestation. Imaging modalities used to evaluate the fetal central nervous system (CNS) include ultrasound and MRI. MRI is the most accurate imaging modality for parenchymal evaluation and depiction of developmental CNS anomalies. The depiction of CNS abnormalities in a fetus can only be accurately made when there is an understanding of its normal development. This article reviews the expected normal fetal brain anatomy and development during gestation. Additional anatomic structures seen on brain imaging sequences are also reviewed."
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Affiliation(s)
- Carolina V A Guimaraes
- Division Chief of Pediatric Radiology, Department of Radiology, University of North Carolina, School of Medicine, 2006 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7510, USA.
| | - Hisham M Dahmoush
- Department of Radiology, Stanford School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94304, USA
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Nagarajan L, Pisani F, Ghosh S. CARFS 7: A guide and proforma for reading a preterm neonate's EEG. Neurophysiol Clin 2022; 52:265-279. [PMID: 35718626 DOI: 10.1016/j.neucli.2022.05.002] [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: 01/28/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The important role of the EEG in preterm and term babies in investigating brain function and seizures, predicting outcomes, evaluating therapeutic interventions and decision-making is being increasingly acknowledged. Development of the brain in the last trimester of pregnancy results in rapid changes in the EEG patterns in this period. Acquiring and interpreting the EEG of a preterm baby can be challenging. The aim of this study was to develop a proforma titled CARFS7 (Continuity, Amplitude, Reactivity, Frequency, Synchrony, Symmetry, Sleep, Sharps, Shapes, Size and Seizures) to enable neurologists to read EEGs of premature babies with greater confidence, ease and accuracy and produce a report more easily repeatable and homogenous among operators. METHODS The CARFS7proforma was developed based on a literature review and the personal experience of the authors. The parameters of the EEG evaluated and scored in the proforma are Continuity, Amplitude, Reactivity/Variability, Frequency, Synchrony, Symmetry, Sleep, Sharps, Shapes/Patterns, Size and Seizures. We also assessed the interrater reliability of the proposed scoring system incorporated in the proforma. RESULTS CARFS7 proforma incorporates a number of parameters that help evaluate the preterm EEG. The interrater reliability of the proposed scoring system in the CARFS7proforma was high. CONCLUSIONS CARFS7 is a user friendly proforma for reading EEGs in the preterm infant. Interrater reliability using Cohen's k shows high agreement between two child neurologists who independently rated the EEGs of 25 premature babies using this proforma. CARFS7 has the potential to provide, accurate, reproducible and valuable information on brain function in the preterm infant in clinical practice.
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Affiliation(s)
- Lakshmi Nagarajan
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Nedlands, Australia; School of Medicine, University of Western Australia, Perth, Australia.
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Medicine & Surgery Department, Neuroscience Division, University of Parma, Parma, Italy
| | - Soumya Ghosh
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Nedlands, Australia; Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia
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Abstract
Fetal pain perception has important implications for fetal surgery, as well as for abortion. Current neuroscientific evidence indicates the possibility of fetal pain perception during the first trimester (<14 weeks gestation). Evidence for this conclusion is based on the following findings: (1) the neural pathways for pain perception via the cortical subplate are present as early as 12 weeks gestation, and via the thalamus as early as 7–8 weeks gestation; (2) the cortex is not necessary for pain to be experienced; (3) consciousness is mediated by subcortical structures, such as the thalamus and brainstem, which begin to develop during the first trimester; (4) the neurochemicals in utero do not cause fetal unconsciousness; and (5) the use of fetal analgesia suppresses the hormonal, physiologic, and behavioral responses to pain, avoiding the potential for both short- and long-term sequelae. As the medical evidence has shifted in acknowledging fetal pain perception prior to viability, there has been a gradual change in the fetal pain debate, from disputing the existence of fetal pain to debating the significance of fetal pain. The presence of fetal pain creates tension in the practice of medicine with respect to beneficence and nonmaleficence.
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8
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Romaniello R, Arrigoni F, De Salvo P, Bonaglia MC, Panzeri E, Bassi MT, Parazzini C, Righini A, Borgatti R. Long-term follow-up in a cohort of children with isolated corpus callosum agenesis at fetal MRI. Ann Clin Transl Neurol 2021; 8:2280-2288. [PMID: 34850608 PMCID: PMC8670314 DOI: 10.1002/acn3.51484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective This long‐term retrospective follow‐up study aimed to address the knowledge gap between prenatal diagnosis of complete isolated Agenesis of Corpus Callosum (cACC) at fetal MRI and postnatal neurodevelopmental outcome to improve prenatal counseling for parents. Methods Data on fetuses with isolated cACC from a single‐center MRI database built up in two decades were considered. Detailed postnatal clinical, neuropsychological evaluations were performed and descriptions of available neuroradiological and genetic data were provided. Results Following a detailed neuropsychological evaluation and a long‐term follow‐up, the subsequent results emerged: 38 school‐aged children (older than 6 years) of 50 (aged 2.5‐15 years) showed normal intellectual functions (50%), intellectual disability (21%), and borderline intelligence quotient (29%). Deficits in motor functions (58%), executive functions (37%), language (61%), memory abilities (58%), and academic performances (53%) were found. Twenty‐one percent of participants showed behavioral difficulties. Almost half of the participants underwent rehabilitation. Additional findings (21%) were detected at postnatal brain MRI, and a significant association between additional findings at postnatal imaging and abnormal neurodevelopmental outcome was observed. Interpretations This study supports the view that children with prenatal diagnosis of isolated cACC may present with several degrees of neurologic and neuropsychological impairment which become more evident only in their second decade of life. Postnatal MRI and detailed genetic analysis may add crucial information to prenatal data and substantially influence final judgment on the outcome and orient clinical management and counseling.
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Affiliation(s)
- Romina Romaniello
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Patrizia De Salvo
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Maria Clara Bonaglia
- Cytogenetics Laboratory, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Elena Panzeri
- Laboratory of Molecular Biology, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Maria Teresa Bassi
- Laboratory of Molecular Biology, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Cecilia Parazzini
- Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Andrea Righini
- Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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9
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Bobić-Rasonja M, Pogledić I, Mitter C, Štajduhar A, Milković-Periša M, Trnski S, Bettelheim D, Hainfellner JA, Judaš M, Prayer D, Jovanov-Milošević N. Developmental Differences Between the Limbic and Neocortical Telencephalic Wall: An Intrasubject Slice-Matched 3 T MRI-Histological Correlative Study in Humans. Cereb Cortex 2021; 31:3536-3550. [PMID: 33704445 DOI: 10.1093/cercor/bhab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
The purpose of the study was to investigate the interrelation of the signal intensities and thicknesses of the transient developmental zones in the cingulate and neocortical telencephalic wall, using T2-weighted 3 T-magnetic resonance imaging (MRI) and histological scans from the same brain hemisphere. The study encompassed 24 postmortem fetal brains (15-35 postconceptional weeks, PCW). The measurements were performed using Fiji and NDP.view2. We found that T2w MR signal-intensity curves show a specific regional and developmental stage profile already at 15 PCW. The MRI-histological correlation reveals that the subventricular-intermediate zone (SVZ-IZ) contributes the most to the regional differences in the MRI-profile and zone thicknesses, growing by a factor of 2.01 in the cingulate, and 1.78 in the neocortical wall. The interrelations of zone or wall thicknesses, obtained by both methods, disclose a different rate and extent of shrinkage per region (highest in neocortical subplate and SVZ-IZ) and stage (highest in the early second half of fetal development), distorting the zones' proportion in histological sections. This intrasubject, slice-matched, 3 T correlative MRI-histological study provides important information about regional development of the cortical wall, critical for the design of MRI criteria for prenatal brain monitoring and early detection of cortical or other brain pathologies in human fetuses.
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Affiliation(s)
- Mihaela Bobić-Rasonja
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, 10000 Zagreb, Croatia.,Department of Biology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivana Pogledić
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Mitter
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Andrija Štajduhar
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, 10000 Zagreb, Croatia.,Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Marija Milković-Periša
- University Hospital Centre Zagreb, Department of Pathology and Cytology, 10000 Zagreb, Croatia
| | - Sara Trnski
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Dieter Bettelheim
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Miloš Judaš
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Nataša Jovanov-Milošević
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, 10000 Zagreb, Croatia.,Department of Biology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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A Sparse Volume Reconstruction Method for Fetal Brain MRI Using Adaptive Kernel Regression. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6685943. [PMID: 33748279 PMCID: PMC7960018 DOI: 10.1155/2021/6685943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022]
Abstract
Slice-to-volume reconstruction (SVR) method can deal well with motion artifacts and provide high-quality 3D image data for fetal brain MRI. However, the problem of sparse sampling is not well addressed in the SVR method. In this paper, we mainly focus on the sparse volume reconstruction of fetal brain MRI from multiple stacks corrupted with motion artifacts. Based on the SVR framework, our approach includes the slice-to-volume 2D/3D registration, the point spread function- (PSF-) based volume update, and the adaptive kernel regression-based volume update. The adaptive kernel regression can deal well with the sparse sampling data and enhance the detailed preservation by capturing the local structure through covariance matrix. Experimental results performed on clinical data show that kernel regression results in statistical improvement of image quality for sparse sampling data with the parameter setting of the structure sensitivity 0.4, the steering kernel size of 7 × 7 × 7 and steering smoothing bandwidth of 0.5. The computational performance of the proposed GPU-based method can be over 90 times faster than that on CPU.
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11
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Jandeaux C, Kuchcinski G, Ternynck C, Riquet A, Leclerc X, Pruvo JP, Soto-Ares G. Biometry of the Cerebellar Vermis and Brain Stem in Children: MR Imaging Reference Data from Measurements in 718 Children. AJNR Am J Neuroradiol 2019; 40:1835-1841. [PMID: 31624120 DOI: 10.3174/ajnr.a6257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/21/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Objective and quantitative data to define cerebellar vermis and/or brain stem hypoplasia in children are lacking. Our aim was to provide MR imaging biometric references for the cerebellar vermis and brain stem from a large cohort of children with normal cerebellums. MATERIALS AND METHODS The MR imaging data were retrospectively selected from our hospital data base from January 1, 2014, to December 31, 2017. All MR imaging examinations of children between 1 day and 15 years of age, including midline sagittal sections, were included. Children with a clinical history or MR imaging abnormalities that may affect the posterior fossa were excluded. We manually measured four 2D parameters: vermian height, anterior-posterior diameter of the vermis, anterior-posterior diameter of the midbrain-pons junction, and anterior-posterior midpons diameter. The inter- and intraobserver agreement was evaluated. RESULTS Seven hundred eighteen children were included (372 boys and 346 girls), from 1 day to 15 years of age. Normal values (third to 97th percentiles) were provided for each parameter. The vermis parameters showed a rapid growth phase during the first year, a slower growth until the fifth year, and finally a near-plateau phase. The brain stem parameters showed more progressive growth. The intra- and interobserver agreement was excellent for all parameters. CONCLUSIONS We provide reference biometric data of the vermis and the brain stem using simple and reproducible measurements that are easy to use in daily practice. The relevance of these 2D measurements should be further validated in diseases associated with cerebellar abnormalities.
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Affiliation(s)
- C Jandeaux
- From the Departments of Neuroradiology (C.J., G.K., X.L., J.-P.P., G.S.-A.)
| | - G Kuchcinski
- From the Departments of Neuroradiology (C.J., G.K., X.L., J.-P.P., G.S.-A.)
| | | | - A Riquet
- Neuropediatrics (A.R.), Centre Hospitalier Universitaire Lille, Lille, France
| | - X Leclerc
- From the Departments of Neuroradiology (C.J., G.K., X.L., J.-P.P., G.S.-A.)
| | - J-P Pruvo
- From the Departments of Neuroradiology (C.J., G.K., X.L., J.-P.P., G.S.-A.)
| | - G Soto-Ares
- From the Departments of Neuroradiology (C.J., G.K., X.L., J.-P.P., G.S.-A.)
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12
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Lie MLS, Graham RH, Robson SC, Griffiths PD. MRI for Fetal Developmental Brain Abnormalities: Perspectives From the Pregnant Patient. QUALITATIVE HEALTH RESEARCH 2018; 28:1295-1307. [PMID: 29580171 DOI: 10.1177/1049732318764390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound is routinely used as a prenatal screening and diagnostic tool but has limitations. Some anomalies in the developing fetal brain can be difficult to detect, and in utero magnetic resonance imaging (iuMRI) is increasingly used as an adjunct to ultrasound. However, understandings of patient perspectives of iuMRI technology are still developing. Our qualitative study of 41 mothers who experienced iuMRI was embedded in a diagnostic accuracy trial and aimed to inform policy recommendations that might stem from the clinical findings. Our analysis suggests that iuMRI is seen as useful, offering valuable additional information and helping women make decisions about care options at a difficult time. However, patients' experiences demonstrated the uncertainty and anxiety associated with the prenatal diagnosis (PND) process relating to brain anomalies including the challenges of their embodied contributions. Our findings suggest more could be done to reduce the impact on pregnant women during an already difficult, anxious period.
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Affiliation(s)
- Mabel L S Lie
- 1 Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ruth H Graham
- 1 Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Paul D Griffiths
- 2 University of Sheffield, Sheffield, United Kingdom
- 3 Royal Hallamshire Hospital, Sheffield, United Kingdom
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Wang R, Dai G, Takahashi E. High Resolution MRI Reveals Detailed Layer Structures in Early Human Fetal Stages: In Vitro Study with Histologic Correlation. Front Neuroanat 2015; 9:150. [PMID: 26834575 PMCID: PMC4714631 DOI: 10.3389/fnana.2015.00150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/09/2015] [Indexed: 11/16/2022] Open
Abstract
An understanding of normal fetal brain development is essential in detecting the early onset of brain disorders. It is challenging to obtain high-quality images that show detailed local anatomy in the early fetal stages because the fetal brain is very small with rapidly-changing complex structures related to brain development, including neurogenesis, neuronal migration, and axonal elongation. Previous magnetic resonance imaging (MRI) studies detected three layers throughout the fetal cerebral wall that showed differences in MR contrasts at 10 gestational weeks (GW), which is one of the earliest ages studied using MRI. Contrary to the MRI studies, histological studies found more layers at this fetal age. The purpose of this work is to study the development of brain structures from an early fetal period to an early second trimester stage using ex vivo MRI and compare it to histology. Special attention was paid to laminar structures in the cerebral wall. T2-weighted imaging was performed on fetal brain specimens ranging from 10 GW to 18 GW on a 4.7 tesla MR scanner. We obtained standard grayscale as well as color-coded images using weighted red-green-blue scales, and compared them with the histological images. Our study confirmed laminar structure in the cerebral wall in all the fetal specimens studied. We found that MRI detected four layers within the cerebral wall as early as 10 GW during the early fetal period (10–13 GW). Early second trimester (15–18 GW) was characterized by the emergence of subplate structures and five layers within the cerebral wall. The color-coded images were more useful than the standard grayscale images in detecting the laminar structures. Scans with appropriate parameters from a high tesla MR scanner showed detailed laminar structures even through a very small and thin cerebral wall at 10 GW ex vivo. A combination of high-resolution structural imaging and color-coding processing with histological analysis may be a potential tool for studying detailed structures of typical developing fetal brains, as well as fetal brains with developmental disorders as references for clinical MRI.
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Affiliation(s)
- Rongpin Wang
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical SchoolBoston, MA, USA; Department of Radiology, Guizhou Provincial People's HospitalGuiyang, China
| | - Guangping Dai
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School Boston, MA, USA
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Evaluation and prevalence of major central nervous system malformations: a retrospective study. North Clin Istanb 2014; 1:78-83. [PMID: 28058307 PMCID: PMC5175067 DOI: 10.14744/nci.2014.84803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/12/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: Central nervous system (CNS) anomalies are the most common abnormalities of all malformations and can be diagnosed on routine prenatal ultrasonography (US). We aimed to find out fetal CNS anomaly rate in our clinic which is the referral center in the region. METHODS: This is a retrospective study of 15000 pregnant women who were scanned for routine obstetric follow-up from January 2012 to July 2013 in our referral center. We diagnosed CNS anomalies in 41 fetuses by using high resolution ultrasound unit with 3.5 MHz transabdominal and 6 MHz transvaginal transducers. RESULTS: CNS anomalies included 12 Chiari malformations, 2 Dandy-Walker malformations (DWM), 1 variant of Dandy-Walker syndrome (DWS), 3 iniencephalies, 15 anencephalies, 1 alobar holoprosencephaly, 2 isolated hydrocephalies, 3 hydrocephalies with cerebellar hypoplasia, 1 occipital encephalocele, 1 lumbosacral myelomeningocele accompanied with microcephaly. There were some associated anomalies in the groups that included club-foot deformities in 6 cases, ventricular septal defect (VSD) in 2 cases, polycystic kidney in 2 cases, scoliosis in 1 case, hypoplasic left ventricle in 1 case; alone atrium, single umbilical artery, echogenic focus, hydronephrosis and cleft lip and palate in the same case, and omphalocele in one. CONCLUSION: Prognosis and early detection of CNS abnormalities have become an important issue because the most serious complications of major CNS anomalies are disability and getting bedridden and this situation is inevitably related to health economy. On the other hand prognosis of the fetus and family counseling is another important issue. Parents should decide whether to continue their pregnancies or not.
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Biegon A, Hoffmann C. Quantitative magnetic resonance imaging of the fetal brain in utero: Methods and applications. World J Radiol 2014; 6:523-529. [PMID: 25170390 PMCID: PMC4147433 DOI: 10.4329/wjr.v6.i8.523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/24/2014] [Accepted: 06/11/2014] [Indexed: 02/07/2023] Open
Abstract
Application of modern magnetic resonance imaging (MRI) techniques to the live fetus in utero is a relatively recent endeavor. The relative advantages and disadvantages of clinical MRI relative to the widely used and accepted ultrasonographic approach are the subject of a continuing debate; however the focus of this review is on the even younger field of quantitative MRI as applied to non-invasive studies of fetal brain development. The techniques covered under this header include structural MRI when followed by quantitative (e.g., volumetric) analysis, as well as quantitative analyses of diffusion weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy and functional MRI. The majority of the published work reviewed here reflects information gathered from normal fetuses scanned during the 3rd trimester, with relatively smaller number of studies of pathological samples including common congenital pathologies such as ventriculomegaly and viral infection.
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Hergan B, Atar OD, Poretti A, Huisman TAGM. Serial fetal MRI for the diagnosis of Aicardi syndrome. Neuroradiol J 2013; 26:380-4. [PMID: 24007726 DOI: 10.1177/197140091302600403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/04/2013] [Indexed: 11/15/2022] Open
Abstract
Aicardi syndrome (AS) is defined by the triad of corpus callosum agenesis, chorioretinal "lacunae" and infantile spasms. Additional neuroimaging findings including migrational abnormalities are common. We report on serial neuroimaging findings of a female fetus with ventriculomegaly, corpus callosum agenesis and focal migrational abnormalities, suggestive of AS. Postnatal neuroimaging follow-up as well as ophthalmological evaluation and occurrence of infantile spasms confirmed the prenatally suspected diagnosis of AS. This case points out the key role of serial fetal magnetic resonance imaging (MRI) in detecting the full spectrum of pathologies associated with fetal ventriculomegaly. The associated neuroimaging findings may go undetected on prenatal ultrasound, but are important in terms of diagnosis and counseling of the parents. Additionally, this case emphasizes the importance of serial fetal MRI studies to more accurately delineate the progression of findings during brain development.
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Affiliation(s)
- B Hergan
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA - Medical University of Graz; Graz, Austria -
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Saleem SN. Fetal MRI: An approach to practice: A review. J Adv Res 2013; 5:507-23. [PMID: 25685519 PMCID: PMC4294280 DOI: 10.1016/j.jare.2013.06.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/25/2022] Open
Abstract
MRI has been increasingly used for detailed visualization of the fetus in utero as well as pregnancy structures. Yet, the familiarity of radiologists and clinicians with fetal MRI is still limited. This article provides a practical approach to fetal MR imaging. Fetal MRI is an interactive scanning of the moving fetus owed to the use of fast sequences. Single-shot fast spin-echo (SSFSE) T2-weighted imaging is a standard sequence. T1-weighted sequences are primarily used to demonstrate fat, calcification and hemorrhage. Balanced steady-state free-precession (SSFP), are beneficial in demonstrating fetal structures as the heart and vessels. Diffusion weighted imaging (DWI), MR spectroscopy (MRS), and diffusion tensor imaging (DTI) have potential applications in fetal imaging. Knowing the developing fetal MR anatomy is essential to detect abnormalities. MR evaluation of the developing fetal brain should include recognition of the multilayered-appearance of the cerebral parenchyma, knowledge of the timing of sulci appearance, myelination and changes in ventricular size. With advanced gestation, fetal organs as lungs and kidneys show significant changes in volume and T2-signal. Through a systematic approach, the normal anatomy of the developing fetus is shown to contrast with a wide spectrum of fetal disorders. The abnormalities displayed are graded in severity from simple common lesions to more complex rare cases. Complete fetal MRI is fulfilled by careful evaluation of the placenta, umbilical cord and amniotic cavity. Accurate interpretation of fetal MRI can provide valuable information that helps prenatal counseling, facilitate management decisions, guide therapy, and support research studies.
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Affiliation(s)
- Sahar N Saleem
- Department of Radiology, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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