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Simsek O, Vossough A. Fetal and postnatal neuroimaging of SUZ12-related overgrowth: Imagawa-matsumoto syndrome. J Neuroradiol 2024; 51:101210. [PMID: 38850627 DOI: 10.1016/j.neurad.2024.101210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Onur Simsek
- Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, United States.
| | - Arastoo Vossough
- Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, United States; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Righini A, Tortora M, Izzo G, Doneda C, Arrigoni F, Palumbo G, Parazzini C. Cutting-edge applications of fetal MR neuro-imaging in clinical routine: a pictorial essay. Neuroradiology 2023; 65:1813-1823. [PMID: 37910190 DOI: 10.1007/s00234-023-03242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
Over time, fetal MR neuro-imaging has undergone continuous improvement; presently, it plays a pivotal role in the diagnosis of an expanding array of complex neurological conditions. Within this pictorial essay, our focus will be exclusively directed towards those cutting-edge clinical applications, which currently yield valuable diagnostic insights on a single case basis. Specifically, the pictorial examples will center on some abnormal entities and their features at an earlier fetal stage.
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Affiliation(s)
- Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Mario Tortora
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Giana Izzo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Chiara Doneda
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Filippo Arrigoni
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | | | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
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Krajden Haratz K, Birnbaum R, Kidron D, Har-Toov J, Salemnick Y, Brusilov M, Malinger G. Malformation of cortical development with abnormal cortex: early ultrasound diagnosis between 14 and 24 weeks of gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:559-565. [PMID: 36484522 DOI: 10.1002/uog.26139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To describe neurosonographic findings diagnostic or highly suggestive of the presence of malformations of cortical development involving the cortex that may be identified before 24 weeks of gestation. METHODS This was a retrospective single-center study of fetuses referred for neurosonography, during 2012-2019, with an abnormal cortical or sulcation pattern diagnosed early in the mid trimester. Stored files were analyzed for demographic data, abnormal brain findings, non-central nervous system abnormalities, final diagnosis and postnatal outcome. RESULTS The study cohort included 20 fetuses, with a mean gestational age at diagnosis of 18.7 (range, 14.4-23.6) weeks, in 11 of which the diagnosis was made before 20 weeks of gestation. Reasons for referral were: midline anomaly (n = 7), ventriculomegaly (n = 4), infratentorial findings (n = 3), suspected malformation of cortical development (n = 3), 'abnormal brain' (n = 2) and skeletal dysplasia (n = 1). On neurosonography, both the sulcation pattern and the cortical layer were abnormal in four cases, only the sulcation pattern was considered abnormal in seven and only the cortical layer was abnormal in nine. Nineteen fetuses presented with associated central nervous system anomalies and six also had non-central nervous system malformations. One case was recurrent. Eighteen parents opted for termination of pregnancy, including one selective termination in a twin pregnancy, and two fetuses were liveborn. CONCLUSIONS Familiarity with fetal brain anatomy and its early sonographic landmarks allowed early diagnosis of malformations involving cortical development. These patients are likely to represent the most severe cases and all had associated malformations. The presence of an abnormal cortical layer and/or abnormal overdeveloped sulci appear to be early signs of malformation of cortical development. © 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)
- K Krajden Haratz
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Birnbaum
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Hospital, Kfar Saba, Israel
| | - J Har-Toov
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Salemnick
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Brusilov
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Malinger
- Fetal Neurology Clinic, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Complete agenesis of corpus callosum and unilateral cortical formation anomalies detected on fetal MR imaging: a phenotype strongly associated with the male fetuses. Eur Radiol 2023; 33:2258-2265. [PMID: 36264312 DOI: 10.1007/s00330-022-09173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In a previous study of classifying fetuses with cortical formation abnormalities (CFA) with fetal MR, we noticed a cluster of cases with unilateral CFA and complete agenesis of the corpus callosum (ACC). In this study, we provide a detailed morphological analysis of such fetuses using fetal MR to determine if there are indicators (such as the gender of the fetus) that could be used to delineate a genetic substrate of the phenotype in order to inform future studies. METHODS We have studied 45 fetuses with the unilateral CFA/ACC phenotype and analysed through an expert consensus panel the location and fine detail of the CFA and the associated findings such as associated anomalies, head size, and sex of the fetus. RESULTS The frontal lobe was significantly more frequently involved by CFA when compared with other lobes (p < 0.001) but no preference for the left or right hemisphere. CFA most often consisted of excessive/dysmorphic sulcation. The CFA/ACC phenotype was overwhelmingly more frequent in male fetuses (M:F 4.5:1-p < 0.0001). The most frequent associated findings were: ventriculomegaly (16/45 fetuses) and interhemispheric cysts (12/45 cases). CONCLUSIONS This report highlights the specific phenotype of unilateral CFA/ACC that is much more common in male fetuses. This finding provides a starting point to study possible sex-linked genetic abnormalities that underpin the unilateral CFA/ACC phenotype. KEY POINTS • We collected fetuses with unilateral cortical formation abnormality and callosal agenesis. • That distinctive neuroimaging phenotype has a strong male gender prevalence (over 80%). • This observation forms the basis of studies about outcomes and genetic substrates.
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Fileva N, Severino M, Tortora D, Ramaglia A, Paladini D, Rossi A. Second trimester fetal MRI of the brain: Through the ground glass. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:283-299. [PMID: 36785503 DOI: 10.1002/jcu.23423] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
Fetal MRI is an important tool for the prenatal diagnosis of brain malformations and is often requested after second-trimester ultrasonography reveals a possible abnormality. Despite the immature state of the fetal brain at this early stage, early suggestive signs of the presence of brain malformations can be recognized. To differentiate between the normal dynamics of the growing brain and the developing pathological conditions can be challenging and requires extensive knowledge of normal central nervous system developmental stages and their neuroradiological counterparts at those different stages. This article reviews the second-trimester appearances of some commonly encountered brain malformations, focusing on helpful tricks and subtle signs to aid in the diagnosis of such conditions as rhombencephalosynapsis, various causes of vermian rotation, molar tooth spectrum anomalies, diencephalic-mesencephalic junction dysplasia, ganglionic eminence anomalies, and the most common malformations of cortical development.
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Affiliation(s)
- Nevena Fileva
- Department of Radiology, Medical University of Sofia, Sofia, Bulgaria
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Scelsa B. Fetal Neurology: From Prenatal Counseling to Postnatal Follow-Up. Diagnostics (Basel) 2022; 12:diagnostics12123083. [PMID: 36553090 PMCID: PMC9776544 DOI: 10.3390/diagnostics12123083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Brain abnormalities detected in fetal life are being increasingly recognized. Child neurologists are often involved in fetal consultations, and specific fetal neurology training has been implemented in many countries. Pediatric neurologists are asked to examine the data available and to contribute to the definition of the long-term outcomes. Ventriculomegaly, posterior fossa malformations, and agenesis/dysgenesis of corpus callosum are among the most common reasons for antenatal neurological consultations. Fetuses with central nervous system and extra-CNS anomalies should ideally be managed in secondary/tertiary hospitals where obstetricians who are experts in fetal medicine and pediatric specialists are available. Obstetricians play a critical role in screening, performing detailed neurosonography, and referring to other specialists for additional investigations. Clinical geneticists are frequently asked to propose diagnostic tests and counsel complex fetal malformations whose phenotypes may differ from those during postnatal life. Advances in fetal MRI and genetic investigations can support the specialists involved in counseling. Nevertheless, data interpretation can be challenging, and it requires a high level of expertise in a multidisciplinary setting. Postnatally, child neurologists should be part of an integrated multidisciplinary follow-up, together with neonatologists and pediatricians. The neurodevelopmental outcomes should be assessed at least up to school age. Children should be evaluated with formal tests of their gross motor, cognitive, language, fine motor/visuo-perceptual skills, and their behavior. In this perspective, fetal neurology can be regarded as the beginning of a long journey which continues with a prolonged, structured follow-up, support to the families, and transition to adult life. A review of the most common conditions is presented, along with the long-term outcomes and a proposal of the neurodevelopmental follow-up of children with CNS malformation which are diagnosed in uterus.
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Affiliation(s)
- Barbara Scelsa
- Department of Pediatric Neurology and Psychiatry, V. Buzzi Children's Hospital, ASST-FBF-Sacco, via Castelvetro 32, 20154 Milan, Italy
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Aertsen M, Dymarkowski S, Vander Mijnsbrugge W, Cockmartin L, Demaerel P, De Catte L. Anatomical and diffusion-weighted imaging of brain abnormalities in third-trimester fetuses with cytomegalovirus infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:68-75. [PMID: 35018680 DOI: 10.1002/uog.24856] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In this study of cytomegalovirus (CMV)-infected fetuses with first-trimester seroconversion, we aimed to evaluate the detection of brain abnormalities using magnetic resonance imaging (MRI) and neurosonography (NSG) in the third trimester, and compare the grading systems of the two modalities. We also evaluated the feasibility of routine use of diffusion-weighted imaging (DWI) fetal MRI and compared the regional apparent diffusion coefficient (ADC) values between CMV-infected fetuses and presumed normal, non-infected fetuses in the third trimester. METHODS This was a retrospective review of MRI and NSG scans in fetuses with confirmed first-trimester CMV infection performed between September 2015 and August 2019. Brain abnormalities were recorded and graded using fetal MRI and NSG grading systems to compare the two modalities. To investigate feasibility of DWI, a four-point rating scale (poor, suboptimal, good, excellent) was applied to assess the quality of the images. Quantitative assessment was performed by placing a freehand drawn region of interest in the white matter of the frontal, parietal, temporal and occipital lobes and the basal ganglia, pons and cerebellum to calculate ADC values. Regional ADC measurements were obtained similarly in a control group of fetuses with negative maternal CMV serology in the first trimester, normal brain findings on fetal MRI and normal genetic testing. RESULTS Fifty-three MRI examinations of 46 fetuses with confirmed first-trimester CMV infection were included. NSG detected 24 of 27 temporal cysts seen on MRI scans, with a sensitivity of 78% and an accuracy of 83%. NSG did not detect abnormal gyration visible on two (4%) MRI scans. Periventricular calcifications were detected on two MRI scans compared with 10 NSG scans. While lenticulostriate vasculopathy was detected on 11 (21%) NSG scans, no fetus demonstrated this finding on MRI. MRI grading correlated significantly with NSG grading of brain abnormalities (P < 0.0001). Eight (15%) of the DWI scans in the CMV cohort were excluded from further analysis because of insufficient quality. The ADC values of CMV-infected fetuses were significantly increased in the frontal (both sides, P < 0.0001), temporal (both sides, P < 0.0001), parietal (left side, P = 0.0378 and right side, P = 0.0014) and occipital (left side, P = 0.0002 and right side, P < 0.0001) lobes and decreased in the pons (P = 0.0085) when compared with non-infected fetuses. The ADC values in the basal ganglia and the cerebellum were not significantly different in CMV-infected fetuses compared with normal controls (all P > 0.05). Temporal and frontal ADC values were higher in CMV-infected fetuses with more severe brain abnormalities compared to fetuses with mild abnormalities. CONCLUSIONS Ultrasound and MRI are complementary during the third trimester in the assessment of brain abnormalities in CMV-infected fetuses, with a significant correlation between the grading systems of the two modalities. On DWI in the third trimester, the ADC values in several brain regions are abnormal in CMV-infected fetuses compared with normal controls. Furthermore, they seem to correlate in the temporal area and, to a lesser extent, frontal area with the severity of brain abnormalities associated with CMV infection. Larger prospective studies are needed for further investigation of the microscopic nature of diffusion abnormalities and correlation of different imaging findings with postnatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Aertsen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - S Dymarkowski
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - L Cockmartin
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P Demaerel
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - L De Catte
- Division Woman and Child, Fetal Medicine Unit, Clinical Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium
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Righini A, Izzo G, Doneda C, Scelsa B, Parazzini C. School-Age Outcome of Fetuses with Isolated Complete Septum Pellucidum Agenesis at Prenatal Magnetic Resonance Imaging. Neuropediatrics 2022; 53:26-31. [PMID: 34404097 DOI: 10.1055/s-0041-1733985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To the best of our knowledge, there have not been studies to address the issue of long-term follow-up of patients with prenatal diagnosis of isolated complete septum pellucidum agenesis (SPA). The aim of this study was to acquire information about the school-age outcome of such patients as a resource for counseling parents receiving this prenatal finding. METHODS From a large fetal magnetic resonance (MR) database, we selected only those cases with isolated complete SPA as confirmed by two senior pediatric neuroradiologists in consensus; we then gathered information from the parents of those children who had reached the school age. RESULTS None among the 12 cases (mean age at follow-up: 8.7 years, range: 6-13 year) of the resulting final cohort presented visual or stature deficits; only one required special teaching assistance in school. All other 11 children resulted without any notable academic issue. CONCLUSION Our report may provide information of practical value about the school-age outcome of fetuses detected by prenatal MR imaging to carry isolated complete SPA.
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Affiliation(s)
- Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Giana Izzo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Chiara Doneda
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Barbara Scelsa
- Pediatric Neurology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
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The Role of Fetal Brain Magnetic Resonance Imaging in Current Fetal Medicine. J Belg Soc Radiol 2022; 106:130. [PMID: 36569393 PMCID: PMC9756908 DOI: 10.5334/jbsr.3000] [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: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
In open spina bifida we studied the use of MRI for the assessment of the posterior fossa and prevalence of supratentorial anomalies before and after in utero repair. New postprocessing techniques were applied to evaluate fetal brain development in this population compared to controls. In fetuses with congenital diaphragmatic hernia, we evaluated the brain development in comparison to controls. Diffusion weighted imaging was applied to study difference between fetuses with proven first trimester cytomegalovirus infection and controls. Finally, we investigated the value of third trimester fetal brain MRI after treatment for complicated monochorionic diamniotic pregnancies.
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Pogledic I, Schwartz E, Bobić-Rasonja M, Mitter C, Baltzer P, Gruber GM, Milković-Periša M, Haberler C, Bettelheim D, Kasprian G, Judaš M, Prayer D, Jovanov-Milošević N. 3T MRI signal intensity profiles and thicknesses of transient zones in human fetal brain at mid-gestation. Eur J Paediatr Neurol 2021; 35:67-73. [PMID: 34653829 DOI: 10.1016/j.ejpn.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
In this study we compare temporal lobe (TL) signal intensity (SI) profiles, along with the average thicknesses of the transient zones obtained from postmortem MRI (pMRI) scans and corresponding histological slices, to the frontal lobe (FL) SI and zone thicknesses, in normal fetal brains. The purpose was to assess the synchronization of the corticogenetic processes in different brain lobes. Nine postmortem human fetal brains without cerebral pathologies, from 19 to 24 weeks of gestation (GW) were analyzed on T2-weighted 3T pMRI, at the coronal level of the thalamus and basal ganglia. The SI profiles of the transient zones in the TL correlate well spatially and temporally to the signal intensity profile of the FL. During the examined period, in the TL, the intermediate and subventricular zone are about the size of the subplate zone (SP), while the superficial SP demonstrates the highest signal intensity. The correlation of the SI profiles and the distributions of the transient zones in the two brain lobes, indicates a time-aligned histogenesis during this narrow time window. The 3TpMRI enables an assessment of the regularity of lamination patterns in the fetal telencephalic wall, upon comparative evaluation of sizes of the transient developmental zones and the SI profiles of different cortical regions. A knowledge of normal vs. abnormal transient lamination patterns and the SI profiles is a prerequisite for further advancement of the MR diagnostic tools needed for early detection of developmental brain pathologies prenatally, especially mild white matter injuries such as lesions of TL due to prenatal cytomegalovirus infections, or cortical malformations.
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Affiliation(s)
- Ivana Pogledic
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090, Vienna, Austria
| | - Ernst Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090, Vienna, Austria
| | - Mihaela Bobić-Rasonja
- University of Zagreb, School of Medicine, Croatian Institute for Brain Research, Section for Developmental Neuroscience, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Šalata 12, 10000, Zagreb, Croatia; University of Zagreb, School of Medicine, Department of Biology, Šalata 3, 10000, Zagreb, Croatia
| | - Christian Mitter
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090, Vienna, Austria
| | - Pascal Baltzer
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090, Vienna, Austria
| | - Gerlinde Maria Gruber
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, 3500, Krems, Austria
| | - Marija Milković-Periša
- University Hospital Centre Zagreb, Department of Pathology and Cytology, Petrova 13, 10000, Zagreb, Croatia; University of Zagreb, School of Medicine, Institute of Pathology, Šalata 10, 10000 Zagreb, Croatia
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090, Vienna, Austria
| | - Dieter Bettelheim
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090, Vienna, Austria
| | - Miloš Judaš
- University of Zagreb, School of Medicine, Croatian Institute for Brain Research, Section for Developmental Neuroscience, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Šalata 12, 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
- University of Zagreb, School of Medicine, Croatian Institute for Brain Research, Section for Developmental Neuroscience, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Šalata 12, 10000, Zagreb, Croatia; University of Zagreb, School of Medicine, Department of Biology, Šalata 3, 10000, Zagreb, Croatia.
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Abstract
The importance of fetal magnetic resonance imaging (MRI) in the prenatal diagnosis of central nervous system (CNS) anomalies is rapidly increasing. Fetal MRI represents a third level examination usually performed, as early as 18-20 weeks of gestational age, when a second level (expert) neuro-ultrasonography (US) evaluation raises the suspicion of a CNS anomaly or when a genetic disorder is known. Compared to the US, MRI has the advantage to allow a better visualization and characterization of brain structures so to detect anomalies not visible in the US, thus resulting in relevant implications for parent counselling and pregnancy management. Moreover, the improvement of MRI technologies permits to obtain ultrafast sequences, which minimize the drawback of movement artifacts, and to perform advanced studies. This review aims at providing a practical guide for trainees and fellows who are approaching fetal MRI. In the first part, we provide information about indications, safety and protocols based on the state-of-the-art sequences, with a mention on the innovations related to the use of a 3T scanner. The second part is focused on the normal development of the human fetal brain related to its MR appearance, whose knowledge is essential to detect possible abnormalities. The last section briefly describes the most frequent abnormalities in the fetal brain and spine as depicted by MRI.
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Affiliation(s)
- Giulia Moltoni
- Neuroradiology Unit, NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Giacomo Talenti
- Neuroradiology Unit, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - Andrea Righini
- Neuroradiology Unit, Pediatric Radiology Department, Vittore Buzzi Children's Hospital, Milan, Italy
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The prevalence of brain lesions after in utero surgery for twin-to-twin transfusion syndrome on third-trimester MRI: a retrospective cohort study. Eur Radiol 2020; 31:4097-4103. [PMID: 33210202 DOI: 10.1007/s00330-020-07452-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 11/02/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Due to the increased risk of antenatal brain lesions, we offer a third-trimester magnetic resonance imaging (MRI) scan to all patients who underwent an in utero intervention for twin-twin transfusion syndrome (TTTS). However, the usefulness of such a policy has not been demonstrated yet. Therefore, we determined the prevalence of antenatal brain lesions detected on third-trimester MRI and the proportion of lesions detected exclusively on MRI. MATERIALS AND METHODS We conducted a retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS that underwent laser coagulation of the vascular anastomoses or fetal reduction by umbilical cord occlusion between 2010 and 2017. We reviewed the third-trimester MRI findings and compared those with the prenatal ultrasonography. RESULTS Of the 141 patients treated with laser coagulation and 17 managed by cord occlusion, 112/141 (79%) and 15/17 (88%) patients reached 28 weeks. Of those, 69/112 (62%) and 11/15 (73%) underwent an MRI between 28 and 32 weeks. After laser coagulation, MRI detected an antenatal brain lesion in 6 of 69 pregnancies (9%) or in 6 of 125 fetuses (5%). In 4 cases (67%), the lesion was detected only on MRI. In the 11 patients treated with cord occlusion, no brain lesions were diagnosed. CONCLUSION The prevalence of brain lesions detected by third-trimester MRI is higher compared to prenatal ultrasonography alone, making MRI a useful adjunct to detect antenatal brain lesions in twin pregnancies after in utero treatment for TTTS. KEY POINTS • In utero interventions for twin-to-twin transfusion syndrome (TTTS) do not prevent the occurrence of antenatal brain lesions. • Fetal magnetic resonance imaging (MRI) has high accuracy in detecting anomalies of cortical development and can be a useful adjunct to ultrasonography in diagnosing certain brain abnormalities. • After laser coagulation of the anastomoses for TTTS, third-trimester MRI diagnosed a brain lesion that was not detected earlier on ultrasound scan in 6% of pregnancies.
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Jezberova M, Kosutzka Z, Waczulikova I, Kolnikova M, Cunderlik A, Lehotska V. Agreement between prenatal ultrasound and 3.0T magnetic resonance imaging in the assessment of anomalies of the central nervous system: A single-center experience in Slovakia. Int J Gynaecol Obstet 2020; 152:365-373. [PMID: 32975312 DOI: 10.1002/ijgo.13388] [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: 04/07/2020] [Revised: 07/18/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the concordance of in-utero magnetic resonance imaging (MRI) findings at 3.0T in fetuses with suspect abnormalities of the central nervous system (CNS) on ultrasonography. METHODS A retrospective study was done on 222 pregnant women indicated for fetal MRI, with the examination performed within 2 weeks from indication. The inclusion criteria for patients were age 18 years or older with the fetus at 18 weeks of gestation or more. Fetal CNS pathologies were divided into six categories: ventriculomegaly; supratentorial midline abnormalities (ACC); supratentorial space-occupying lesions; abnormalities of the posterior fossa; destructive cerebral lesions; and cortical formation abnormalities (CFA). Chance-adjusted agreement was assessed using unweighted Cohen's kappa (κ). RESULTS The best agreement between ultrasound and MRI was observed in ventriculomegaly (κ=0.817; 95% confidence interval [CI] 0.76-0.88). There was only a moderate agreement in ACC (κ=0.483; 95% CI 0.35-0.61). CFA pathologies had a poor agreement between the modalities (κ=0.140; 95% CI -0.03 to 0.31). CONCLUSION Ultrasonography has good overall agreement with MRI in diagnosing fetal CNS anomalies. CFA had the most disagreement between ultrasound and MRI. The prognostic implication of these findings can be used for parental neuro-counseling but should be investigated further.
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Affiliation(s)
- Michaela Jezberova
- Department of Magnetic Resonance Imaging, Dr. Magnet Ltd., Bratislava, Slovakia
| | - Zuzana Kosutzka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Iveta Waczulikova
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
| | - Miriam Kolnikova
- Department of Pediatric Neurology, Comenius University Faculty of Medicine and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Anton Cunderlik
- Department of Obstetrics and Gynecology, Slovak Medical University Bratislava, Comenius University, Bratislava, Slovakia
| | - Viera Lehotska
- 2nd Radiology Department, Faculty of Medicine of Comenius University in Bratislava and St. Elizabeth's Cancer Institute Bratislava, Bratislava, Slovakia
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14
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Changes in appearance of cortical formation abnormalities in the foetus detected on sequential in utero MR imaging. Eur Radiol 2020; 31:1367-1377. [PMID: 32885300 DOI: 10.1007/s00330-020-07125-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/11/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We describe 64 foetuses with cortical formation abnormalities (CFA) who had two in utero magnetic resonance (iuMR) exams, paying particular detail to those in which the original classification of CFA category changed between the two studies. The goal was to attempt to quantify the value of third-trimester follow-up studies in CFA foetuses on second-trimester iuMR imaging. METHODS The 64 foetuses reviewed came from a CFA cohort of 374 foetuses reported in an earlier publication, which detailed a classification for foetal CFA. A consensus panel of senior paediatric neuroradiologists reviewed both studies, described any change in the category of CFA between them, and attempted to predict the possible clinical significance of any differences based on the combined clinical experience of the panel. RESULTS In 40/64 (62%) foetuses, the CFA description was the same on both studies. In 24/64 (38%) cases, there was a category change which included three foetuses without CFA on first examination, six foetuses where the difference involved change in laterality/symmetry, and in 15 cases the re-classification involved categorical change within the same group. Brain abnormalities other than CFA were present in 30/64 (47%) foetuses on the first study and in 33/64 (52%) on the second. We predicted that prognosis would have changed on the basis of the second study in 8% of cases, all indicating worse prognosis. CONCLUSIONS We have shown that the extra diagnostic and predicted prognostic yield justifies follow-up studies in the third trimester if a CFA is shown on the second-trimester iuMR imaging. KEY POINTS • Sixty-four foetuses with cortical formation abnormalities had two iuMR studies, for the vast majority the baseline in the second trimester and the sequential in the third. • In three foetuses, the cortical formation abnormality (CFA) was not visible on the first study. In a further 21 foetuses, the categorical description of the CFA changed between the two studies. Prognosis changed in 8% of the cases following the second iuMR study, and in all cases, the prognosis was worse. • Multiple iuMR studies provide information about the natural history of CFA; the extra diagnostic and predicted prognostic yield justifies follow-up studies.
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15
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Righini A, Genovese M, Parazzini C, Severino M, Scola E, Pinelli L, Conte G, Derrico I, Di Maurizio M, Talenti G, Mandefield L, Jarvis D, Palumbo G, Guerrini R, Rossi A, Triulzi F, Griffiths PD. Cortical formation abnormalities on foetal MR imaging: a proposed classification system trialled on 356 cases from Italian and UK centres. Eur Radiol 2020; 30:5250-5260. [PMID: 32405748 DOI: 10.1007/s00330-020-06899-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To formulate a classification system for foetal cortical formation abnormalities (CFAs) based on in utero magnetic resonance (iuMR) appearances and trial it in 356 cases. METHODS This retrospective study included all cases of foetal CFA diagnosed between 2000 and 2017 from seven centres in Italy and UK. All of the studies were reviewed by a panel of paediatric neuroradiologists experienced in iuMR with the aid of an algorithm designed to categorise the abnormalities. RESULTS Consensus expert review confirmed 356 foetuses with CFA and the first level of classification distinguished bilateral CFA (229/356-64%) from unilateral CFA (127/356-36%) cases with sub-classification of the bilateral cases into asymmetric (65/356-18%) and symmetric (164/356-46%) involvement. There was a statistically significant excess of foetuses with small head size, e.g. 17% of the cohort had a bi-parietal diameter < 3rd centile. There was a small but statistically significant excess of males in the cohort. Further categorisation was made on fine anatomical structure. CONCLUSIONS It is often not possible to classify foetal CFA using the principles and nomenclature used in paediatric neuroradiology. We have created a classification system for foetal CFA based on the analysis of 356 cases and believe that this will assist future research designed to correlate ante-natal and post-natal imaging features and understand the clinical sequelae of CFA described in utero. KEY POINTS • We describe a morphological classification system of foetal brain cortical formation abnormalities that can be used in clinical practice. • This classification system can be used in future research studies to evaluate the long-term imaging and clinical outcomes of foetal brain cortical formation abnormalities in 17- to 38-week gestational age range. • The practical value of the work is in providing a framework and language to look for imaging clues that may differentiate between different CFA in further studies.
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Affiliation(s)
- Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Maurilio Genovese
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Mariasavina Severino
- Neuroradiology Department, IRCCS-Gaslini Children's Research Hospital, Genoa, Italy
| | - Elisa Scola
- Neuroradiology Department, IRCCS-Fondazione Policlinco di Milano, Milan, Italy
| | - Lorenzo Pinelli
- Neuroradiology Department, Spedali Civili, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Giorgio Conte
- Neuroradiology Department, IRCCS-Fondazione Policlinco di Milano, Milan, Italy
| | - Ignazio Derrico
- Neuroradiology Department, University Hospital, Padua, Italy
| | | | - Giacomo Talenti
- Neuroradiology Department, University Hospital, Padua, Italy
| | - Laura Mandefield
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah Jarvis
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Giovanni Palumbo
- Neuroradiology Department, Spedali Civili, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer, Florence, Italy
| | - Andrea Rossi
- Neuroradiology Department, IRCCS-Gaslini Children's Research Hospital, Genoa, Italy
| | - Fabio Triulzi
- Neuroradiology Department, IRCCS-Fondazione Policlinco di Milano, Milan, Italy
| | - Paul D Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
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16
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Pogledic I, Schwartz E, Mitter C, Baltzer P, Milos RI, Gruber GM, Brugger PC, Hainfellner J, Bettelheim D, Langs G, Kasprian G, Prayer D. The Subplate Layers: The Superficial and Deep Subplate Can be Discriminated on 3 Tesla Human Fetal Postmortem MRI. Cereb Cortex 2020; 30:5038-5048. [PMID: 32377685 DOI: 10.1093/cercor/bhaa099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023] Open
Abstract
The subplate (SP) is a transient structure of the human fetal brain that becomes the most prominent layer of the developing pallium during the late second trimester. It is important in the formation of thalamocortical and cortico-cortical connections. The SP is vulnerable in perinatal brain injury and may play a role in complex neurodevelopmental disorders, such as schizophrenia and autism. Nine postmortem fetal human brains (19-24 GW) were imaged on a 3 Tesla MR scanner and the T2-w images in the frontal and temporal lobes were compared, in each case, with the histological slices of the same brain. The brains were confirmed to be without any brain pathology. The purpose of this study was to demonstrate that the superficial SP (sSP) and deep SP (dSP) can be discriminated on postmortem MR images. More specifically, we aimed to clarify that the observable, thin, hyperintense layer below the cortical plate in the upper SP portion on T2-weighted MR images has an anatomical correspondence to the histologically established sSP. Therefore, the distinction between the sSP and dSP layers, using clinically available MR imaging methodology, is possible in postmortem MRI and can help in the imaging interpretation of the fetal cerebral layers.
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Affiliation(s)
- Ivana Pogledic
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Ernst Schwartz
- Computational Imaging Research Lab, 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
| | - Pascal Baltzer
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Ruxandra-Iulia Milos
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerlinde Maria Gruber
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Peter C Brugger
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Dieter Bettelheim
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
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Prayer D, Paladini D, Deprest J. Current Controversies in Prenatal Diagnosis 1: Should MRI be performed on all fetuses with mild ventriculomegaly? Prenat Diagn 2019; 39:331-338. [PMID: 30614017 DOI: 10.1002/pd.5416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 12/18/2022]
Abstract
A ventricular diameter of 10 mm correlates with more than two standard deviations of the normal and hence is qualified as ventriculomegaly. The relevance of this is dependent on whether there are associated infectious, genetic, or structural problems. The chance for neurodevelopmental delay in isolated ventriculomegaly less than 15 mm is 7.9% (4.7-11.1), and less if it is unilateral. It can be further divided in mild (10-12) or moderate (13-15), though this is not widely accepted. As part of the workup, structural assessment today may include ultrasound or magnetic resonance imaging, or both. Discussants agreed that the diagnostic performance of both methods is as good as the expertise with which the images are acquired and interpreted. Discussants agreed that when the initial neurosonogram is normal, the likelihood of finding significant findings on MRI is low. Nevertheless, some anomalies may only be picked up or better worked out by fetal MRI. In utero follow-up is advocated, as progression may indicate a poorer outcome, and some conditions are only obvious late in pregnancy. Most benefit for future patients is expected from appropriate training in prenatal neuroimaging.
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Affiliation(s)
- Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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18
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Challenges in managing epilepsy associated with focal cortical dysplasia in children. Epilepsy Res 2018; 145:1-17. [DOI: 10.1016/j.eplepsyres.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022]
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Paradiso B, Simonato M, Thiene G, Lavezzi A. From fix to fit into the autoptic human brains. Eur J Histochem 2018; 62. [PMID: 30173504 PMCID: PMC6151333 DOI: 10.4081/ejh.2018.2944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/10/2018] [Indexed: 12/20/2022] Open
Abstract
Formalin-fixed, paraffinembedded (FFPE) human brain tissues are very often stored in formalin for long time. Formalin fixation reduces immunostaining, and the DNA/RNA extraction from FFPE brain tissue becomes suboptimal. At present, there are different protocols of fixation and several procedures and kits to extract DNA/RNA from paraffin embedding tissue, but a gold standard protocol remains distant. In this study, we analyzed four types of fixation systems and compared histo and immuno-staining. Based on our results, we propose a modified method of combined fixation in formalin and formic acid for the autoptic adult brain to obtain easy, fast, safe and efficient immunolabelling of long-stored FFPE tissue. In particular, we have achieved an improved preservation of cellular morphology and obtained success in postmortem immunostaining for NeuN. This nuclear antigen is an important marker for mapping neurons, for example, to evaluate the histopathology of temporal lobe epilepsy or to draw the topography of cardiorespiratory brainstem nuclei in sudden infant death syndrome (SIDS). However, NeuN staining is frequently faint or lost in postmortem human brain tissues. In addition, we attained Fluoro Jade C staining, a marker of neurodegeneration, and immunofluorescent staining for stem cell antigens in the postnatal human brain, utilizing custom fit fixation procedures.
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Affiliation(s)
- Beatrice Paradiso
- University of Milan, "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS Department of Biomedical, Surgical and Dental Sciences; Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua; Department of Medical Sciences, Section of Pharmacology and National Institute of Neuroscience, University of Ferrara.
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20
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Conte G, Righini A, Griffiths PD, Rustico M, Lanna M, Mackie FL, Pinelli L, Prefumo F, Persico N, Igra MS, Parazzini C, Doneda C, Fichera A, Ambrosi C, Kilby M, Severino M, Triulzi F, Rossi A, Skipper N. Brain-injured Survivors of Monochorionic Twin Pregnancies Complicated by Single Intrauterine Death: MR Findings in a Multicenter Study. Radiology 2018; 288:582-590. [PMID: 29688161 DOI: 10.1148/radiol.2018171267] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in co-twin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.
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Affiliation(s)
- Giorgio Conte
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Andrea Righini
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Paul D Griffiths
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Mariangela Rustico
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Mariano Lanna
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Fiona L Mackie
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Lorenzo Pinelli
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Federico Prefumo
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Nicola Persico
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Mark S Igra
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Cecilia Parazzini
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Chiara Doneda
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Anna Fichera
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Claudia Ambrosi
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Mark Kilby
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Mariasavina Severino
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Fabio Triulzi
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Andrea Rossi
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
| | - Nicholas Skipper
- From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.)
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Robinson AJ, Ederies MA. Fetal neuroimaging: an update on technical advances and clinical findings. Pediatr Radiol 2018; 48:471-485. [PMID: 29550864 DOI: 10.1007/s00247-017-3965-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/14/2017] [Accepted: 08/09/2017] [Indexed: 10/17/2022]
Abstract
This paper is based on a literature review from 2011 to 2016. The paper is divided into two main sections. The first section relates to technical advances in fetal imaging techniques, including fetal motion compensation, imaging at 3.0 T, 3-D T2-weighted MRI, susceptibility-weighted imaging, computed tomography, morphometric analysis, diffusion tensor imaging, spectroscopy and fetal behavioral assessment. The second section relates to clinical updates, including cerebral lamination, migrational anomalies, midline anomalies, neural tube defects, posterior fossa anomalies, sulcation/gyration and hypoxic-ischemic insults.
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Affiliation(s)
- Ashley J Robinson
- Sidra Medical and Research Center, Qatar Foundation, Education City North, Al Luqta Street, Doha, 26999, Qatar. .,Clinical Radiology, Weill-Cornell Medical College, New York, NY, USA.
| | - M Ashraf Ederies
- Sidra Medical and Research Center, Qatar Foundation, Education City North, Al Luqta Street, Doha, 26999, Qatar.,Clinical Radiology, Weill-Cornell Medical College, New York, NY, USA
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Manganaro L, Bernardo S, Antonelli A, Vinci V, Saldari M, Catalano C. Fetal MRI of the central nervous system: State-of-the-art. Eur J Radiol 2017; 93:273-283. [PMID: 28668426 DOI: 10.1016/j.ejrad.2017.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 12/17/2022]
Abstract
Prenatal ultrasonographic (US) examination is considered as the first tool in the assessment of fetal abnormalities. However, several large-scale studies point out that some malformations, in particular central nervous system (CNS) anomalies, are not well characterized through US. Therefore, the actual malformation severity is not always related to prenatal ultrasound (US) findings. Over the past 20 years, ultrafast Magnetic Resonance Imaging (MRI) has progressively increased as a prenatal 3rd level diagnostic technique with a good sensitivity, particularly for the study of fetal CNS malformations. In fact, CNS anomalies are the most common clinical indications for fetal MRI, representing about 80% of the total examinations. This review covers the recent literature on fetal brain MRI, with emphasis on techniques, safety and indications.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Silvia Bernardo
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Amanda Antonelli
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Valeria Vinci
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Matteo Saldari
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Carlo Catalano
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
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Manganaro L, Bernardo S, De Vito C, Antonelli A, Marchionni E, Vinci V, Saldari M, Di Meglio L, Giancotti A, Silvestri E, Catalano C, Pizzuti A. Role of fetal MRI in the evaluation of isolated and non-isolated corpus callosum dysgenesis: results of a cross-sectional study. Prenat Diagn 2017; 37:244-252. [PMID: 27992967 DOI: 10.1002/pd.4990] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/23/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE The aims of this study were to characterize isolated and non-isolated forms of corpus callosum dysgenesis (CCD) at fetal magnetic resonance imaging (MRI) and to identify early predictors of associated anomalies. METHODS We retrospectively analyzed 104 fetuses with CCD undergoing MRI between 2006 and 2016. Corpus callosum, cavum septi pellucidi, biometry, presence of ventriculomegaly, gyration anomalies, cranio-encephalic abnormalities and body malformations were evaluated. Results of genetic tests were also recorded. RESULTS At MRI, isolated CCD was 26.9%, the rest being associated to other abnormalities. In the isolated group, median gestational age at MRI was lower in complete agenesis than in hypoplasia (22 vs 28 weeks). In the group with additional findings, cortical dysplasia was the most frequently associated feature (P = 0.008), with a more frequent occurrence in complete agenesis (70%) versus other forms; mesial frontal lobes were more often involved than other cortical regions (P = 0.006), with polymicrogyria as the most frequent cortical malformation (40%). Multivariate analysis confirmed the association between complete agenesis and cortical dysplasia (odds ratio = 7.29, 95% confidence interval 1.51-35.21). CONCLUSIONS CCD is often complicated by other intra-cranial and extra-cranial findings (cortical dysplasias as the most prevalent) that significantly affect the postnatal prognosis. The present study showed CCD with associated anomalies as more frequent than isolated (73.1%). In isolated forms, severe ventriculomegaly was a reliable herald of future appearance of associated features. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Marchionni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.,Casa Sollievo della Sofferenza, Istituto Mendel, Rome, Italy
| | - Valeria Vinci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Saldari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Letizia Di Meglio
- Private Prenatal Diagnostic Centre 'Diagnostica ecografica Aniello Di Meglio s.r.l.', Naples, Italy
| | - Antonella Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, Sapienza, University of Rome, Rome, Italy
| | - Evelina Silvestri
- Surgical Pathology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.,Casa Sollievo della Sofferenza, Istituto Mendel, Rome, Italy
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Scagliotti V, Avagliano L, Gualtieri A, Graziola F, Doi P, Chalker J, Righini A, Korbonits M, Bulfamante G, Jacques TS, Massa V, Gaston-Massuet C. Histopathology and molecular characterisation of intrauterine-diagnosed congenital craniopharyngioma. Pituitary 2016; 19:50-6. [PMID: 26350256 DOI: 10.1007/s11102-015-0682-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Adamantinomatous craniopharyngiomas (aCPs) are complex epithelial neoplasms that arise from the progenitors of the pituitary gland. Although benign, these tumours can be locally aggressive invading vital neighbouring structures such as the hypothalamus, the cranial and optic nerves. Congenital forms of aCPs diagnosed during foetal development are very rare. The purpose of this article is to present with a histopathological and molecular characterisation of congenital craniopharyngioma. METHODS Here we report a case of in utero diagnosed aCP, detected at 21 weeks of gestation by ultrasound, visualised by MRI at 22 weeks and histologically diagnosed at 23 weeks. We provide with histopathological characterisation of rare form of congenital aCPs. RESULTS Detailed examination of the tumour reveals the classical histological hallmarks of aCPs with the presence of stellate reticulum, palisading epithelium, wet keratin and calcification deposits. The tumour demonstrated complete absence of all pituitary hormones and the absence of the neuroendocrine marker, synaptophysin. Immunohistochemistry against β-catenin revealed occasional cells with nuclear-β-catenin localisation and the presence of pituitary progenitors positive for SOX9 and SOX2. Targeted Sanger sequencing revealed no genetic variants in oncogenes CTNNB1 and BRAF, previously associated with CP. CONCLUSIONS In this article, we provide with in-depth molecular and histological characterisation of in utero aCP due to an unknown driving mutation that could represent a sub-cohort of congenital aCPs.
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Affiliation(s)
- Valeria Scagliotti
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Laura Avagliano
- Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudini, 8, 20142, Milan, Italy.
| | - Angelica Gualtieri
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Federica Graziola
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Patrizia Doi
- Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudini, 8, 20142, Milan, Italy.
| | - Jane Chalker
- Haematology, Cellular and Molecular Diagnostic Service, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Andrea Righini
- Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, 20142, Milan, Italy.
| | - Marta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Gaetano Bulfamante
- Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudini, 8, 20142, Milan, Italy.
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Institute of Child Health, University College London, London, UK.
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Valentina Massa
- Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudini, 8, 20142, Milan, Italy.
| | - Carles Gaston-Massuet
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Jansen AC, Robitaille Y, Honavar M, Mullatti N, Leventer RJ, Andermann E, Andermann F, Squier W. The histopathology of polymicrogyria: a series of 71 brain autopsy studies. Dev Med Child Neurol 2016; 58:39-48. [PMID: 26179148 DOI: 10.1111/dmcn.12840] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
AIM Polymicrogyria (PMG) is one of the most common forms of cortical malformation yet the mechanism of its development remains unknown. This study describes the histopathological aspects of PMG in a large series including a significant proportion of fetal cases. METHOD We have reviewed the neuropathology and medical records of 44 fetuses and 27 children and adults in whom the cortical architecture was focally or diffusely replaced by one or more festooning bands of neurons. RESULTS The pial surface of the brain overlying the polymicrogyric cortex was abnormal in almost 90% of cases irrespective of the aetiology. This accords with animal studies indicating the importance of the leptomeninges in cortical development. The aetiology of PMG was highly heterogeneous and there was no correlation between cortical layering patterns and aetiology. PMG was almost always associated with other brain malformations. INTERPRETATION The inclusion of many fetal cases has allowed us to examine the early developmental stages of PMG. The study indicates the significance of surface signals responsible for human corticogenesis and the complex interaction between genetic and environmental factors leading to this common endpoint of cortical maldevelopment.
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Affiliation(s)
- Anna C Jansen
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Brussels, Belgium.,Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Robitaille
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - Mrinalini Honavar
- Department of Clinical Neuropathology, King's College Hospital, Denmark Hill, London, UK.,Service of Anatomic Pathology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Nandini Mullatti
- Department of Clinical Neurophysiology, King's College Hospital, Denmark Hill, London, UK
| | - Richard J Leventer
- Department of Neurology, University Department of Pediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville, Vic., Australia
| | - Eva Andermann
- Neurogenetics Unit, Montreal Neurological Hospital and Institute, and Departments of Neurology & Neurosurgery and Human Genetics, McGill University, Montreal, QC, Canada
| | - Frederick Andermann
- Seizure Clinic, Montreal Neurological Hospital and Institute, and Departments of Neurology & Neurosurgery and Paediatrics, McGill University, Montreal, QC, Canada
| | - Waney Squier
- Department of Neuropathology, Oxford University John Radcliffe Hospital, Oxford, UK
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26
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Conte G, Parazzini C, Falanga G, Cesaretti C, Izzo G, Rustico M, Righini A. Diagnostic Value of Prenatal MR Imaging in the Detection of Brain Malformations in Fetuses before the 26th Week of Gestational Age. AJNR Am J Neuroradiol 2015; 37:946-51. [PMID: 26721771 DOI: 10.3174/ajnr.a4639] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/05/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In several countries, laws and regulations allow abortion for medical reasons within 24-25 weeks of gestational age. We investigated the diagnostic value of prenatal MR imaging for brain malformations within 25 weeks of gestational age. MATERIALS AND METHODS We retrospectively included fetuses within 25 weeks of gestational age who had undergone both prenatal and postnatal MR imaging of the brain between 2002 and 2014. Two senior pediatric neuroradiologists evaluated prenatal MR imaging examinations blinded to postnatal MR imaging findings. With postnatal MR imaging used as the reference standard, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the prenatal MR imaging in detecting brain malformations. RESULTS One-hundred nine fetuses (median gestational age at prenatal MR imaging: 22 weeks; range, 21-25 weeks) were included in this study. According to the reference standard, 111 malformations were detected. Prenatal MR imaging failed to detect correctly 11 of the 111 malformations: 3 midline malformations, 5 disorders of cortical development, 2 posterior fossa anomalies, and 1 vascular malformation. Prenatal MR imaging misdiagnosed 3 findings as pathologic in the posterior fossa. CONCLUSIONS The diagnostic value of prenatal MR imaging between 21 and 25 weeks' gestational age is very high, with limitations of sensitivity regarding the detection of disorders of cortical development.
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Affiliation(s)
- G Conte
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.) Department of Health Sciences (G.C.), University of Milan, Milan, Italy
| | - C Parazzini
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
| | - G Falanga
- Department of Biopathology and Medical and Forensic Biotechnologies (G.F.), Section of Radiological Sciences, University of Palermo, Palermo, Italy
| | - C Cesaretti
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
| | - G Izzo
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
| | - M Rustico
- Gynecology and Obstetrics (M.R.), Children's Hospital Vittore Buzzi, Milan, Italy
| | - A Righini
- From the Departments of Radiology and Neuroradiology (G.C., C.P., C.C., G.I., A.R.)
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27
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Weisstanner C, Kasprian G, Gruber GM, Brugger PC, Prayer D. MRI of the Fetal Brain. Clin Neuroradiol 2015; 25 Suppl 2:189-96. [PMID: 26063004 DOI: 10.1007/s00062-015-0413-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/12/2015] [Indexed: 12/17/2022]
Abstract
The purpose of this article is to provide an overview of the possibilities for fetal magnetic resonance imaging (MRI) in the evaluation of the fetal brain. For brain pathologies, fetal MRI is usually performed when an abnormality is detected by previous prenatal ultrasound, and is, therefore, an important adjunct to ultrasound. The most commonly suspected brain pathologies referred to fetal MRI for further evaluation are ventriculomegaly, missing corpus callosum, and abnormalities of the posterior fossa. We will briefly discuss the most common indications for fetal brain MRI, as well as recent advances.
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Affiliation(s)
- C Weisstanner
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - G Kasprian
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - G M Gruber
- Center of Anatomy and Cell Biology, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria
| | - P C Brugger
- Center of Anatomy and Cell Biology, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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28
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Kandula T, Fahey M, Chalmers R, Edwards A, Shekleton P, Teoh M, Clark J, Goergen SK. Isolated ventriculomegaly on prenatal ultrasound: what does fetal MRI add? J Med Imaging Radiat Oncol 2015; 59:154-62. [PMID: 25728263 DOI: 10.1111/1754-9485.12287] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/19/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cerebral ventriculomegaly is one of the most commonly detected fetal anomalies at the midtrimester ultrasound. Current evidence suggests that magnetic resonance imaging (MRI) is indicated when the isolated ventriculomegaly (IVM) on ultrasound is severe (>15 mm), but there is less agreement when IVM is mild or moderate (10-15 mm). The current study aimed to determine the frequency and nature of additional findings on MRI in IVM and their relationship to the severity of VM and gestational age. METHODS Data were gathered prospectively from all pregnant women with ultrasound-diagnosed IVM referred for MRI between November 2006 and February 2013. Cases with IVM and no other suspected cranial abnormality on a tertiary ultrasound performed at our institution, at or after 20 weeks gestation, were included. RESULTS Of the 59 fetuses with unilateral or bilateral IVM, additional findings were seen on MRI in 10 cases (17%) and half of these findings were identified in fetuses with mild IVM. Five of 40 (12.5%) fetuses with mild IVM had additional findings and 3/5 (60%) were potentially clinically significant. No additional abnormalities were identified in fetuses less than or equal to 24 weeks gestation with mild or moderate IVM. There was no statistically significant relationship between gestational age and additional findings on MRI in mild IVM. Callosal and septum pellucidum lesions, periventricular abnormalities and malformations of cortical development accounted for all of the significant additional findings. CONCLUSION This study helps to inform referral of pregnant women with a fetus who has IVM for prenatal MRI.
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Affiliation(s)
- Tejaswi Kandula
- Monash Childrens, Monash Health, Melbourne, Victoria, Australia
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29
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Egaña-Ugrinovic G, Sanz-Cortes M, Figueras F, Couve-Perez C, Gratacós E. Fetal MRI insular cortical morphometry and its association with neurobehavior in late-onset small-for-gestational-age fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:322-329. [PMID: 24616027 DOI: 10.1002/uog.13360] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/06/2014] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate insular cortical morphometry assessed by magnetic resonance imaging (MRI) in late-onset small-for-gestational-age (SGA) fetuses compared with controls, and its association with neurobehavioral outcomes. METHODS MRI was performed in 65 late-onset SGA and 59 normally-grown fetuses at 37 weeks' gestation. T2-weighted half Fourier acquisition single-shot turbo spin echo (HASTE) anatomical and diffusion-weighted images were acquired. Insular cortical thickness, volume and fractional anisotropy values were assessed, and asymmetry indices were constructed. At 42 weeks of age, a Neonatal Behavioral Assessment Scale (NBAS) test was performed on the SGA neonates. RESULTS Late-onset SGA fetuses had significantly thinner insular cortical thickness and smaller insular cortical volume than did controls. SGA fetuses also presented a more pronounced left asymmetry in the posterior cortex and significantly lower fractional anisotropy values in the left insula. Insular measurements in the SGA group were significantly correlated with neurobehavior as assessed by NBAS scores. CONCLUSIONS Insular cortical morphometry was significantly different in late-onset SGA fetuses and correlated with poorer neurobehavioral performance. These data support the impact of growth restriction on brain development and the potential value of cortical assessment as a biomarker of neurodevelopment in at-risk fetuses.
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Affiliation(s)
- G Egaña-Ugrinovic
- 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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30
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Cesaretti C, Spaccini L, Rustico M, Parazzini C, Doneda C, Re TJ, Righini A. Prenatal magnetic resonance imaging detection of temporal lobes and hippocampal anomalies in hypochondroplasia. Prenat Diagn 2014; 34:1015-7. [DOI: 10.1002/pd.4415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Claudia Cesaretti
- Radiology and Neuroradiology Department; Children's Hospital V. Buzzi; Milan Italy
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - Luigina Spaccini
- Obstetrics and Gynecology Department; Children's Hospital V. Buzzi; Milan Italy
| | - Mariangela Rustico
- Obstetrics and Gynecology Department; Children's Hospital V. Buzzi; Milan Italy
| | - Cecilia Parazzini
- Radiology and Neuroradiology Department; Children's Hospital V. Buzzi; Milan Italy
| | - Chiara Doneda
- Radiology and Neuroradiology Department; Children's Hospital V. Buzzi; Milan Italy
| | - Thomas J. Re
- Radiology Institute; University of Milan; Milan Italy
| | - Andrea Righini
- Radiology and Neuroradiology Department; Children's Hospital V. Buzzi; Milan Italy
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Abstract
Malformations of cortical development are common causes of developmental delay and epilepsy. Some patients have early, severe neurological impairment, but others have epilepsy or unexpected deficits that are detectable only by screening. The rapid evolution of molecular biology, genetics, and imaging has resulted in a substantial increase in knowledge about the development of the cerebral cortex and the number and types of malformations reported. Genetic studies have identified several genes that might disrupt each of the main stages of cell proliferation and specification, neuronal migration, and late cortical organisation. Many of these malformations are caused by de-novo dominant or X-linked mutations occurring in sporadic cases. Genetic testing needs accurate assessment of imaging features, and familial distribution, if any, and can be straightforward in some disorders but requires a complex diagnostic algorithm in others. Because of substantial genotypic and phenotypic heterogeneity for most of these genes, a comprehensive analysis of clinical, imaging, and genetic data is needed to properly define these disorders. Exome sequencing and high-field MRI are rapidly modifying the classification of these disorders.
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Affiliation(s)
- Renzo Guerrini
- Department of Neuroscience, Pharmacology and Child Health, Children's Hospital A Meyer and University of Florence, Florence, Italy; Stella Maris Foundation Research Institute, Pisa, Italy.
| | - William B Dobyns
- Departments of Pediatrics and Neurology, University of Washington, Seattle, WA, USA; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
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32
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Milesi G, Garbelli R, Zucca I, Aronica E, Spreafico R, Frassoni C. Assessment of human hippocampal developmental neuroanatomy by means of ex-vivo 7 T magnetic resonance imaging. Int J Dev Neurosci 2014; 34:33-41. [PMID: 24456808 DOI: 10.1016/j.ijdevneu.2014.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 11/17/2022] Open
Abstract
During development, the hippocampus undergoes numerous changes in its cell morphology and cyto- and myelo-architecture that begin during the fetal period and continue after birth. We investigated the developmental changes occurring in healthy fetal (20-32 gestational weeks) and post-natal human hippocampi (from 1 day to adulthood) by combining high-resolution 7 T magnetic resonance imaging (MRI) and histological and immunohistochemical analyses in order to compare variations in signal intensity with cyto- and myeloarchitectural organization. During fetal period the intensity of the T2-weighted images was related to the cell density and the subregions of Ammon's horn and dentate gyrus, characterized by densely packed neurons, were recognizable as hypointense areas. The inverse correlation between MRI signal intensity and cell density was visualized by line profile results. At the age of two post-natal weeks, the low MRI signal was still related to cell density, although thin myelinated fibers were observed in hypointense regions such as the alveus and stratum lacunosum-moleculare. The myelin content subsequently increases until the complete hippocampal myeloarchitecture is reached in adulthood. Comparison of the MRI findings and corresponding histological sections indicated that the differences in the T2-weighted images between the age of seven years and adulthood reflect the increasing density of myelinated fibers. These results provide useful information concerning the interpretation of MRI signals and the developmental changes visualized by in vivo MRI at lower field strengths, and may be used as a reference for the future use of high spatial resolution MRI in clinical practice.
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Affiliation(s)
- Gloria Milesi
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy
| | - Rita Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy
| | - Ileana Zucca
- Scientific Department, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center, The Netherlands; Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, The Netherlands; SEIN - Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy
| | - Carolina Frassoni
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy.
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Foresta C, Bertoldo A, Garolla A, Pizzol D, Mason S, Lenzi A, De Toni L. Human papillomavirus proteins are found in peripheral blood and semen Cd20+ and Cd56+ cells during HPV-16 semen infection. BMC Infect Dis 2013; 13:593. [PMID: 24341689 PMCID: PMC3878630 DOI: 10.1186/1471-2334-13-593] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/05/2013] [Indexed: 02/02/2023] Open
Abstract
Background Human papillomavirus (HPV) currently represents an important risk factor for cancer development and infertility in humans. Whilst binding of HPV to spermatozoa has been associated with male infertility, an investigation about the presence of HPV-DNA in non-spermatozoal semen cells is lacking. Previous findings documented the presence of HPV in peripheral blood leukocytes. The aim of this study was to investigate the expression of HPV markers in semen and blood leukocytes during HPV-16 infection. Methods A total of 32 subjects, 16 patients affected by HPV-16 semen infection and 16 controls, were evaluated in our andrological centre and enrolled in the study. Semen non-spermatozoal cells from all subjects were isolated and evaluated for the expression of HPV-16 markers (DNA and L1, E6 proteins) and further characterized for their molecular phenotype. Analogue determination was performed on peripheral blood mononuclear cells. Results The presence of HPV-DNA by FISH analysis in a round cell population from semen, confirmed to be CD45+ leukocytes, was observed. These HPV-DNA containing-cells also displayed HPV-16-E6 and HPV-16-L1 viral proteins and, upon further investigation, were found to be CD20+ and CD56+, likely phenotypes of B cells and natural killer cells (NK) respectively. In 25% of the patient group, a very small population of peripheral blood mononuclear cells was found to be positive for HPV-DNA via FISH. These cells displayed the CD20+ and CD56+ phenotype alike. None of the control subjects displayed HPV-DNA in either semen or peripheral blood. Conclusion Considering the role of CD20+ and CD56+ cell populations in the antiviral immune response, the detection of HPV markers on leukocytes may reflect the presence of virus particles within the endosomal compartment. However, the presence of HPV markers in circulating mononuclear cells raise concerns about the risk of developing cancers to distal organs.
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Affiliation(s)
- Carlo Foresta
- Department of Molecular Medicine and Centre for Human Reproduction Pathology, University of Padova, Via Gabelli 63, 35121, Padova, Italy.
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Chen J, Tsai V, Parker WE, Aronica E, Baybis M, Crino PB. Detection of human papillomavirus in human focal cortical dysplasia type IIB. Ann Neurol 2013; 72:881-92. [PMID: 23280839 DOI: 10.1002/ana.23795] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/25/2012] [Accepted: 10/26/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Focal cortical dysplasia type IIB (FCDIIB) is a sporadic developmental malformation of the cerebral cortex highly associated with pediatric epilepsy. Balloon cells (BCs) in FCDIIB exhibit constitutive activation of the mammalian target of rapamycin complex 1 (mTORC1) signaling pathway. Recently, the high-risk human papillomavirus type 16 oncoprotein E6 was identified as a potent activator of mTORC1 signaling. Here, we test the hypothesis that HPV16 E6 is present in human FCDIIB specimens. METHODS HPV16 E6 protein expression was assayed by immunohistochemistry in FCDIIB specimens (n = 50) and control brain specimens (n = 36). HPV16 E6 DNA was assayed by polymerase chain reaction (PCR) and in situ hybridization; HPV16 E6 mRNA was assayed by reverse transcriptase PCR. HPV16 E6 was transfected into fetal mouse brains by in utero electroporation to test the effects of E6 on cortical development. RESULTS HPV16 E6 protein was robustly expressed in all FCDIIB specimens in BCs, but not in regions without BCs or in control tissue specimens including normal brain, lymphoblasts, and fibroblasts, cortical tubers, and U87 glioma cells. E6 expression in FCDIIB colocalized with phosphoactivated S6 protein, a known mTORC1 substrate. HPV16 E6 DNA and mRNA were detected in representative specimens of FCDIIB but not control cortex, and were confirmed by sequencing. Transfection of E6 into fetal mouse brains caused a focal cortical malformation in association with enhanced mTORC1 signaling. INTERPRETATION Our results indicate a new association between HPV16 E6 and FCDIIB and demonstrate for the first time HPV16 E6 in the human brain. We propose a novel etiology for FCDIIB based on HPV16 E6 expression during fetal brain development.
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Affiliation(s)
- Julie Chen
- PENN Epilepsy Center and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19140, USA
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