Critical Growth Processes for the Midfacial Morphogenesis in the Early Prenatal Period

3D atlas of the human fetal chondrocranium in the middle trimester

The chondrocranium provides the key initial support for the fetal brain, jaws and cranial sensory organs in all vertebrates. The patterns of shaping and growth of the chondrocranium set up species-specific development of the entire craniofacial complex. The 3D development of chondrocranium have been studied primarily in animal model organisms, such as mice or zebrafish. In comparison, very little is known about the full 3D human chondrocranium, except from drawings made by anatomists many decades ago. The knowledge of human-specific aspects of chondrocranial development are essential for understanding congenital craniofacial defects and human evolution. Here advanced microCT scanning was used that includes contrast enhancement to generate the first 3D atlas of the human fetal chondrocranium during the middle trimester (13 to 19 weeks). In addition, since cartilage and bone are both visible with the techniques used, the  endochondral ossification of cranial base was mapped since this region is so critical for brain and jaw growth. The human 3D models are published as a scientific resource for human development.

Normal human craniofacial growth and development from 0 to 4 years

Knowledge of human craniofacial growth (increase in size) and development (change in shape) is important in the clinical treatment of a range of conditions that affects it. This study uses an extensive collection of clinical CT scans to investigate craniofacial growth and development over the first 48 months of life, detail how the cranium changes in form (size and shape) in each sex and how these changes are associated with the growth and development of various soft tissues such as the brain, eyes and tongue and the expansion of the nasal cavity. This is achieved through multivariate analyses of cranial form based on 3D landmarks and semi-landmarks and by analyses of linear dimensions, and cranial volumes. The results highlight accelerations and decelerations in cranial form changes throughout early childhood. They show that from 0 to 12 months, the cranium undergoes greater changes in form than from 12 to 48 months. However, in terms of the development of overall cranial shape, there is no significant sexual dimorphism in the age range considered in this study. In consequence a single model of human craniofacial growth and development is presented for future studies to examine the physio-mechanical interactions of the craniofacial growth.

Imaging fetal anatomy

Due to advancements in ultrasound techniques, the focus of antenatal ultrasound screening is moving towards the first trimester of pregnancy. The early first trimester however remains in part, a 'black box', due to the size of the developing embryo and the limitations of contemporary scanning techniques. Therefore there is a need for images of early anatomical developmental to improve our understanding of this area. By using new imaging techniques, we can not only obtain better images to further our knowledge of early embryonic development, but clear images of embryonic and fetal development can also be used in training for e.g. sonographers and fetal surgeons, or to educate parents expecting a child with a fetal anomaly. The aim of this review is to provide an overview of the past, present and future techniques used to capture images of the developing human embryo and fetus and provide the reader newest insights in upcoming and promising imaging techniques. The reader is taken from the earliest drawings of da Vinci, along the advancements in the fields of in utero ultrasound and MR imaging techniques towards high-resolution ex utero imaging using Micro-CT and ultra-high field MRI. Finally, a future perspective is given about the use of artificial intelligence in ultrasound and new potential imaging techniques such as synchrotron radiation-based CT to increase our knowledge regarding human development.

Application of geometric morphometrics for facial congenital anomaly studies

The face is a small complex three-dimensional (3D) structure composed of various bones and essential organs. Congenital anomalies of those organs represent various deformities; therefore, their quantification has been challenging. Linear measurements, such as lengths or angles between landmarks, called conventional morphometrics, have been used to quantify their phenotypes usually using 2D images, such as photographs or X-ray images. During analysis, geometric information, which refers to the relative position of each structure, is lost. Geometric morphometrics (GM) uses shape configurations, including anatomical landmarks, which can retain geometric information throughout analysis and can help visualize the results, making it tremendously advantageous compared to conventional methods. Morphometric studies investigate variations within groups, identification of group differences, simulation of the ontogeny, or association with specific organs or genetic disorders, and GM can be applied to these purposes using multivariate statistical methods. The calculation of high-dimensional data is usually required and has prevented GM from becoming a major morphometric method. However, recent developments in computer technology and software have enabled us to perform it easily with ordinary home computers, and the number of morphometric studies applying GM for facial congenital anomalies has been increasing recently. In this article, we introduce the concept and application of GM and review previous morphometric studies with GM regarding congenital facial anomalies.

The first 3D analysis of the sphenoid morphogenesis during the human embryonic period

The sphenoid has a complicated shape, and its morphogenesis during early development remains unknown. We aimed to elucidate the detailed morphogenesis of the sphenoid and to visualize it three-dimensionally using histological section (HS) and phase-contrast X-ray CT (PCX-CT). We examined 54 specimens using HS and 57 specimens using PCX-CT, and summarized the initial morphogenesis of the sphenoid during Carnegie stage (CS) 17 to 23. The 3D models reconstructed using PCX-CT demonstrated that some neural foramina have the common process of "neuro-advanced" formation and revealed that shape change in the anterior sphenoid lasts longer than that of the posterior sphenoid, implying that the anterior sphenoid may have plasticity to produce morphological variations in the human face. Moreover, we measured the cranial base angle (CBA) in an accurate midsagittal section acquired using PCX-CT and found that the CBA against CS was largest at CS21. Meanwhile, CBA against body length showed no striking peak, suggesting that the angulation during the embryonic period may be related to any developmental events along the progress of stages rather than to a simple body enlargement. Our study elucidated the normal growth of the embryonic sphenoid, which has implications for the development and evolution of the human cranium.

A 3D analysis of growth trajectory and integration during early human prenatal facial growth

Significant shape changes in the human facial skeleton occur in the early prenatal period, and understanding this process is critical for studying a myriad of congenital facial anomalies. However, quantifying and visualizing human fetal facial growth has been challenging. Here, we applied quantitative geometric morphometrics (GM) to high-resolution magnetic resonance images of human embryo and fetuses, to comprehensively analyze facial growth. We utilized non-linear growth estimation and GM methods to assess integrated epigenetic growth between masticatory muscles and associated bones. Our results show that the growth trajectory of the human face in the early prenatal period follows a curved line with three flexion points. Significant antero-posterior development occurs early, resulting in a shift from a mandibular prognathic to relatively orthognathic appearance, followed by expansion in the lateral direction. Furthermore, during this time, the development of the zygoma and the mandibular ramus is closely integrated with the masseter muscle.

Maternal Folic Acid Deficiency Is Associated to Developing Nasal and Palate Malformations in Mice

Craniofacial development requires extremely fine-tuned developmental coordination of multiple specialized tissues. It has been evidenced that a folate deficiency (vitamin B9), or its synthetic form, folic acid (FA), in maternal diet could trigger multiple craniofacial malformations as oral clefts, tongue, or mandible abnormalities. In this study, a folic acid-deficient (FAD) diet was administered to eight-week-old C57/BL/6J female mouse for 2-16 weeks. The head symmetry, palate and nasal region were studied in 24 control and 260 experimental fetuses. Our results showed a significant reduction in the mean number of fetuses per litter according to maternal weeks on FAD diet (p < 0.01). Fetuses were affected by cleft palate (3.8%) as well as other severe congenital abnormalities, for the first time related to maternal FAD diet, as head asymmetries (4.6%), high arched palate (3.5%), nasal septum malformed (7.3%), nasopharynx duct shape (15%), and cilia and epithelium abnormalities (11.2% and 5.8%). Dysmorphologies of the nasal region were the most frequent, appearing at just four weeks following a maternal FAD diet. This is the first time that nasal region development is experimentally related to this vitamin deficiency. In conclusion, our report offers novel discoveries about the importance of maternal folate intake on midface craniofacial development of the embryos. Moreover, the longer the deficit lasts, the more serious the consequent effects appear to be.

Novel imaging techniques to study postmortem human fetal anatomy: a systematic review on microfocus-CT and ultra-high-field MRI

Background

MRI and CT have been extensively used to study fetal anatomy for research and diagnostic purposes, enabling minimally invasive autopsy and giving insight in human fetal development. Novel (contrast-enhanced) microfocus CT (micro-CT) and ultra-high-field (≥ 7.0 T) MRI (UHF-MRI) techniques now enable micron-level resolution that combats the disadvantages of low-field MRI and conventional CT. Thereby, they might be suitable to study fetal anatomy in high detail and, in time, contribute to the postmortem diagnosis of fetal conditions.

Objectives

(1) To systematically examine the usability of micro-CT and UHF-MRI to study postmortem human fetal anatomy, and (2) to analyze factors that govern success at each step of the specimen preparation and imaging.

Method

MEDLINE and EMBASE were systematically searched to identify publications on fetal imaging by micro-CT or UHF-MRI. Scanning protocols were summarized and best practices concerning specimen preparation and imaging were enumerated.

Results

Thirty-two publications reporting on micro-CT and UHF-MRI were included. The majority of the publications focused on imaging organs separately and seven publications focused on whole body imaging, demonstrating the possibility of visualization of small anatomical structures with a resolution well below 100 μm. When imaging soft tissues by micro-CT, the fetus should be stained by immersion in Lugol’s staining solution.

Conclusion

Micro-CT and UHF-MRI are both excellent imaging techniques to provide detailed images of gross anatomy of human fetuses. The present study offers an overview of the current best practices when using micro-CT and/or UHF-MRI to study fetal anatomy for clinical and research purposes.

Key Points

• Micro-CT and UHF-MRI can both be used to study postmortem human fetal anatomy for clinical and research purposes.

• Micro-CT enables high-resolution imaging of fetal specimens in relatively short scanning time. However, tissue staining using a contrast solution is necessary to enable soft-tissue visualization.

• UHF-MRI enables high-resolution imaging of fetal specimens, without the necessity of prior staining, but with the drawback of long scanning time.

Electronic supplementary material

The online version of this article (10.1007/s00330-019-06543-8) contains supplementary material, which is available to authorized users.