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Davutoglu EA, Arica G, Sahin NE, Ucar AK, Adaletli I, Vural ZM, Madazli R. Clinical characteristics and perinatal outcome of fetuses with ventriculomegaly. Arch Gynecol Obstet 2024; 310:2065-2071. [PMID: 38926203 PMCID: PMC11393207 DOI: 10.1007/s00404-024-07599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To assess the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections, and perinatal outcomes of fetuses with ventriculomegaly (VM), also to evaluate the role of fetal magnetic resonance imaging (MRI) in detecting associated intracranial anomalies. METHODS Retrospective cohort study of 149 prenatally diagnosed pregnancies with fetal VM. VM was classified as mild (Vp = 10-12 mm), moderate (Vp = 12.1-15 mm), and severe (Vp > 15 mm). Fetal MRI was performed to 97 pregnancies. RESULTS The incidences of an associated CNS, non-CNS, chromosomal anomaly, genetic abnormality and fetal infection were 42.3%, 11.4%, 6.1%, 2.1% and 1.3%, respectively. Fetal MRI identified additional CNS anomalies in 6.7% of cases, particularly in severe VM. The incidences of perinatal outcomes were 18.8% termination of pregnancy, 4% intrauterine and 8.1% neonatal or infant death. The rates of fetuses alive at > 12 months of age with neurological morbidity were 2.6%, 11.1% and 76.9% for mild, moderate and severe isolated VM, respectively. CONCLUSION The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. Mild to moderate isolated VM generally have favorable outcomes. Fetal MRI is particularly valuable in fetuses with isolated severe VM.
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Affiliation(s)
- Ebru Alici Davutoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey
| | - Gorkem Arica
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey
| | - Nazli Ece Sahin
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Department of Pediatric Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Pediatric Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zekeriyya Mehmet Vural
- Department of Neonatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Riza Madazli
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
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2
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Zhang X, Chen Z, Li Y, Xie C, Liu Z, Wu Q, Kuang M, Yan R, Wu F, Liu H. Volume development changes in the occipital lobe gyrus assessed by MRI in fetuses with isolated ventriculomegaly correlate with neurological development in infancy and early childhood. J Perinatol 2024; 44:1178-1185. [PMID: 38802655 DOI: 10.1038/s41372-024-02012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE This study was to systematically assess the occipital lobe gray and white matter volume of isolated ventriculomegaly (IVM) fetuses with MRI and to follow up the neurodevelopment of participants. METHOD MRI was used to evaluate 37 IVM fetuses and 37 control fetuses. The volume of gray and white matter in each fetal occipital gyrus was manually segmented and compared, and neurodevelopment was followed up and assessed in infancy and early childhood. RESULT Compared with the control group, the volume of gray matter in occipital lobe increased in the IVM group, and the incidence of neurodevelopmental delay increased. CONCLUSION We tested the hypothesis that prenatal diagnosis IVM represents a biological marker for development in fetal occipital lobe. Compared with the control group, the IVM group showed differences in occipital gray matter development and had a higher risk of neurodevelopmental delay.
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Affiliation(s)
- Xin Zhang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Zhaoji Chen
- Department of Radiology, Hexian Memorial Hospital of PanYu District, Guangzhou, China
| | - Yuchao Li
- Department of Radiology, Longhua District People's Hospital, Shenzhen, China
| | - Chenxin Xie
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Zhenqing Liu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Qianqian Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Minwei Kuang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Ren Yan
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Fan Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
| | - Hongsheng Liu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
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3
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Agarwal S, Venkatesan C, Vollmer B, Scelsa B, Lemmon ME, Pardo AC, Mulkey SB, Tarui T, Dadhwal V, Scher M, Hart AR, Gano D. Fetal Cerebral Ventriculomegaly: A Narrative Review and Practical Recommendations for Pediatric Neurologists. Pediatr Neurol 2024; 156:119-127. [PMID: 38761643 DOI: 10.1016/j.pediatrneurol.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/19/2024] [Indexed: 05/20/2024]
Abstract
Fetal cerebral ventriculomegaly is one of the most common fetal neurological disorders identified prenatally by neuroimaging. The challenges in the evolving landscape of conditions like fetal cerebral ventriculomegaly involve accurate diagnosis and how best to provide prenatal counseling regarding prognosis as well as postnatal management and care of the infant. The purpose of this narrative review is to discuss the literature on fetal ventriculomegaly, including postnatal management and neurodevelopmental outcome, and to provide practice recommendations for pediatric neurologists.
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Affiliation(s)
- Sonika Agarwal
- Division of Neurology & Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Charu Venkatesan
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brigitte Vollmer
- Faculty of Medicine, Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Barbara Scelsa
- Department of Pediatric Neurology, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Monica E Lemmon
- Department of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Andrea C Pardo
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Departments of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Division of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Tomo Tarui
- Division of Pediatric Neurology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vatsla Dadhwal
- Professor, Maternal Fetal Medicine, Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mark Scher
- Emeritus Full Professor Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anthony R Hart
- Department of Paediatric Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dawn Gano
- Department of Neurology & Pediatrics, University of California San Francisco, San Francisco, California
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Cortes-Albornoz MC, Bedoya MA, Choi JJ, Jaimes C. MR insights into fetal brain development: what is normal and what is not. Pediatr Radiol 2024; 54:635-645. [PMID: 38416183 DOI: 10.1007/s00247-024-05890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Fetal brain development is a complex, rapid, and multi-dimensional process that can be documented with MRI. In the second and third trimesters, there are predictable developmental changes that must be recognized and differentiated from disease. This review delves into the key biological processes that drive fetal brain development, highlights normal developmental anatomy, and provides a framework to identify pathology. We will summarize the development of the cerebral hemispheres, sulci and gyri, extra-axial and ventricular cerebrospinal fluid, and corpus callosum and illustrate the most common abnormal findings in the clinical setting.
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Affiliation(s)
- Maria Camila Cortes-Albornoz
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Pediatric Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jungwhan John Choi
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Pediatric Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Cavalheiro S, da Costa MDS, Barbosa MM, Suriano IC, Ottaiano AC, de Andrade Lourenção Freddi T, Ferreira NPFD, Kusano CU, Dastoli PA, Nicácio JM, Sarmento SGP, Moron AF. Fetal neurosurgery. Childs Nerv Syst 2023; 39:2899-2927. [PMID: 37606832 DOI: 10.1007/s00381-023-06109-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
Among fetal surgical procedures, neurosurgery stands out due to the number of cases and the possibility of developing new procedures that can be performed in the fetal period. To perform fetal neurosurgical procedures, there is a need for specialized centers that have experts in the diagnosis of fetal pathologies and a highly complex obstetrics service with specialized maternal-fetal teams associated with a pediatric neurosurgery center with expertise in the diverse pathologies of the fetus and the central nervous system that offers multidisciplinary follow-up during postnatal life. Services that do not have these characteristics should refer their patients to these centers to obtain better treatment results. It is essential that the fetal neurosurgical procedure be performed by a pediatric neurosurgeon with extensive experience, as he will be responsible for monitoring these patients in the postnatal period and for several years. The objective of this manuscript is to demonstrate the diagnostic and treatment possibilities, in the fetal period, of some neurosurgical diseases such as hydrocephalus, tumors, occipital encephalocele, and myelomeningocele.
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Affiliation(s)
- Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
| | - Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil.
| | | | - Italo Capraro Suriano
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
| | - Ana Carolina Ottaiano
- Diagnostic Imaging Department, Neuroradiology Subdivision, Hospital do Coração, São Paulo, SP, Brazil
- Teleimaging, São Paulo, SP, Brazil
| | - Tomás de Andrade Lourenção Freddi
- Diagnostic Imaging Department, Neuroradiology Subdivision, Hospital do Coração, São Paulo, SP, Brazil
- Teleimaging, São Paulo, SP, Brazil
| | - Nelson Paes Fortes Diniz Ferreira
- Diagnostic Imaging Department, Neuroradiology Subdivision, Hospital do Coração, São Paulo, SP, Brazil
- Teleimaging, São Paulo, SP, Brazil
| | - Cid Ura Kusano
- Department of Fetal Medicine, Hosptial e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Patricia Alessandra Dastoli
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
| | - Jardel Mendonça Nicácio
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, São Paulo, SP, 04024-002, Brazil
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Whitehead MT, Limperopoulos C, Schlatterer SD, Mulkey SB, Fraser JL, du Plessis AJ. Hippocampal rotation is associated with ventricular atrial size. Pediatr Radiol 2023; 53:1941-1950. [PMID: 37183230 DOI: 10.1007/s00247-023-05687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Fetal ventriculomegaly is a source of apprehension for expectant parents and may present prognostic uncertainty for physicians. Accurate prenatal counseling requires knowledge of its cause and associated findings as the differential diagnosis is broad. We have observed an association between ventriculomegaly and incomplete hippocampal inversion. OBJECTIVE To determine whether ventricular size is related to incomplete hippocampal inversion. MATERIALS AND METHODS We retrospectively evaluated pre- and postnatal brain MRIs in normal subjects (mean GA, 31 weeks; mean postnatal age, 27 days) and patients with isolated ventriculomegaly (mean GA, 31 weeks; mean postnatal age, 68 days) at a single academic medical center. Lateral ventricular diameter, multiple qualitative and quantitative markers of hippocampal inversion, and evidence of intraventricular hemorrhage were documented. RESULTS Incomplete hippocampal inversion and ventricular size were associated in both normal subjects (n=51) and patients with ventriculomegaly (n=32) (P<0.05). Severe ventriculomegaly was significantly associated with adverse clinical outcome in postnatal (P=0.02) but not prenatal (P=0.43) groups. In all additional cases of isolated ventriculomegaly, clinical outcome was normal over the time of assessment (mean 1±1.9 years; range 0.01 to 10 years). CONCLUSION Lateral ventricular atrial diameter and incomplete hippocampal inversion are associated. Less hippocampal inversion correlates with larger atria. For every 1-mm increase in fetal ventricular size, the odds of incomplete hippocampal inversion occurring increases by a factor of 1.6 in normal controls and 1.4 in patients with ventriculomegaly.
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Affiliation(s)
- Matthew T Whitehead
- Department of Neuroradiology, Children's National Hospital, Washington, DC, USA.
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA.
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Radiology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Catherine Limperopoulos
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Sarah D Schlatterer
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Jamie L Fraser
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
| | - Adre J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA
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7
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Hadjidekov G, Haynatzki G, Chaveeva P, Nikolov M, Masselli G, Rossi A. Concordance between US and MRI Two-Dimensional Measurement and Volumetric Segmentation in Fetal Ventriculomegaly. Diagnostics (Basel) 2023; 13:diagnostics13061183. [PMID: 36980491 PMCID: PMC10047855 DOI: 10.3390/diagnostics13061183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
We provide a study comparison between two-dimensional measurement and volumetric (3D) segmentation of the lateral ventricles and brain structures in fetuses with isolated and non-isolated ventriculomegaly with 3D virtual organ computer-aided analysis (VOCAL) ultrasonography vs. magnetic resonance imaging (MRI) analyzed with 3D-Slicer software. In this cross-sectional study, 40 fetuses between 20 and 38 gestational weeks with various degrees of ventriculomegaly were included. A total of 71 ventricles were measured with ultrasound (US) and with MRI. A total of 64 sonographic ventricular volumes, 80 ventricular and 40 fetal brain MR volumes were segmented and analyzed using both imaging modalities by three observers. Sizes and volumes of the ventricles and brain parenchyma were independently analyzed by two radiologists, and interobserver correlation of the results with 3D fetal ultrasound data was performed. The semiautomated rotational multiplanar 3D VOCAL technique was performed for ultrasound volumetric measurements. Results were compared to manually extracted ventricular and total brain volumes in 3D-Slicer. Segmentation of fetal brain structures (cerebral and cerebellar hemispheres, brainstem, ventricles) performed independently by two radiologists showed high interobserver agreement. An excellent agreement between VOCAL and MRI volumetric and two-dimensional measurements was established, taking into account the intraclass correlation coefficients (ICC), and a Bland-Altman plot was established. US and MRI are valuable tools for performing fetal brain and ventricular volumetry for clinical prognosis and patient counseling. Our datasets could provide the backbone for further construction of quantitative normative trajectories of fetal intracranial structures and support earlier detection of abnormal brain development and ventriculomegaly, its timing and progression during gestation.
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Affiliation(s)
- George Hadjidekov
- Department of Radiology, University Hospital Lozenetz, Koziak 1 Str., 1407 Sofia, Bulgaria
- Department of Physics, Biophysics and Radiology, Faculty of Medicine, Sofia University "St Kliment Ohridski", 1504 Sofia, Bulgaria
| | - Gleb Haynatzki
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Petya Chaveeva
- Department of Fetal Medicine, Shterev Hospital, 1330 Sofia, Bulgaria
| | - Miroslav Nikolov
- Department of Theoretical Electrical Engineering, Technical University, 1156 Sofia, Bulgaria
| | - Gabriele Masselli
- Radiology Department, Umberto 1 Hospital Sapienza University, 00161 Rome, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
- Department of Health Sciences, University of Genoa, 16126 Genoa, Italy
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Prayer D, Malinger G, De Catte L, De Keersmaecker B, Gonçalves LF, Kasprian G, Laifer-Narin S, Lee W, Millischer AE, Platt L, Prayer F, Pugash D, Salomon LJ, Sanz Cortes M, Stuhr F, Timor-Tritsch IE, Tutschek B, Twickler D, Raine-Fenning N. ISUOG Practice Guidelines (updated): performance of fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:278-287. [PMID: 36722431 PMCID: PMC10107509 DOI: 10.1002/uog.26129] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 05/03/2023]
Affiliation(s)
- D Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L De Catte
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L F Gonçalves
- Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - S Laifer-Narin
- Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - A-E Millischer
- Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - F Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - D Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada
| | - L J Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Paris, France
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - F Stuhr
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU Grossmann School of Medicine, New York, NY, USA
| | - B Tutschek
- Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Prenatal Zurich, Zürich, Switzerland
| | - D Twickler
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Raine-Fenning
- Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK; Nurture Fertility, The Fertility Partnership, Nottingham, UK
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Raafat M, Hosny SM, Sheta GA, Talaat SH, Ali EA. Role of fetal MRI to diagnose abnormal cerebral ventricular system and associated fetal brain anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Abnormal cerebral ventricular system is one of the most common clinical indications for fetal MRI, mainly to detect other associated abnormalities that can be occult on prenatal ultrasonography. Although using ultrasound can identify most anomalies, MRI is known to be superior in identifying CNS anomalies as it has higher contrast resolution for brain parenchymal assessment added to the fact of being less affected by fetal positioning, oligohydramnios, maternal obesity, and reverberation artifacts. Fetal brain ventriculomegaly is defined as atrial width of > 10 mm on sonography, measured in the axial plane, at the level of the frontal horns, cavum septi pellucidi, and glomus of the choroid plexus perpendicular to the long axis of the lateral ventricle. One of the most important factors determining the fetal neurological outcome is the presence and severity of additional CNS anomalies that are better clarified by MRI. The aim of this study is to establish the role of fetal MRI in detecting the association between abnormal cerebral ventricular system and other CNS anomalies, correlation with the severity of ventriculomegaly and ventricle asymmetry.
Results
Thirty pregnancies with fetal brain abnormal ventricular system were included in this study, 5 cases with isolated corpus callosum (CC) agenesis (16.666%); 2 cases with cystic lesions [one interhemispheric and the other dorsal] (6.666%) both associated with CC agenesis; 1 case with alobar holoprosencephaly (3.333%) associated with CC agenesis; 2 cases with semi-lobar holoprosencephaly (6.666%) [associated with CC agenesis and one of them is also associated with lissencephaly]; 3 cases with Dandy–Walker Malformation (DWM) (10%) [2 isolated and 1 associated with CC agenesis]; 3 cases with Dandy–Walker Variants (DWV) (10%) [1 isolated and 2 associated with CC agenesis]; 2 cases with Joubert syndrome (6.666%); 1 case isolated lissencephaly (3.333%); 4 cases of obstructive ventriculomegaly (13.333%) (1 of which associated with CC agenesis); 1 case of Arnold Chiari malformation type II (3.333%) associated with CC agenesis; 2 cases with meningoceles (6.666%) (occipital and parieto-occipital); 1 case with Mega cisterna Magna (3.333%); 1 case with anencephaly (3.333%); 1 case with right hemimegalencephaly (3.333%) (associated with frontal meningocele and CC agenesis); and 1 case with grade IV germinal matrix hemorrhage (3.333%). The pregnancies resulted in 20 births (66.66%), 2 died directly after birth (6.66%), 5 terminations (16.66%), and 3 intrauterine fetal deaths (IUFD) (10%). We found that the frequency of associated CNS anomalies was strongly related to the width of the ventricle. The association between CNS findings and ventricle width was particularly evident in sever ventriculomegaly. The greater the width of the ventricular system, the more the risk of associated CNS anomalies. Only one case showed diffusion restriction and was diagnosed to be of hemorrhagic nature. The relation between symmetry and degree of ventriculomegaly was found to be statistically insignificant (P = 0.115). Assessment of different fetal brain congenital anomalies was not significantly affected by the using of DWI sequence as it is a functional modality rather than being a tool for assessment of anatomical gross abnormalities.
Conclusions
Fetal MRI is an important adjuvant to US in cases of ventriculomegaly particularly those associated with complex CNS anomalies. The association between CNS findings and ventricular dilatation was particularly evident in sever ventriculomegaly. The greater the width of the ventricular system, the more the risk of associated CNS anomalies. Fetal MRI may also be helpful in doubtful cases that could be misdiagnosed as ventriculomegaly including holoprosencephaly, hydranencephaly, porencephaly, and various supratentorial cystic lesions. DWI confirms the diagnosis of hemorrhage.
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Ganor Paz Y, Levinsky D, Rosen H, Barzilay E. Feasibility of Fetal Proximal Lateral Cerebral Ventricle Measurement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2933-2938. [PMID: 35293635 DOI: 10.1002/jum.15978] [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: 11/29/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Measuring the posterior horn of the lateral ventricle in the fetus during ultrasound scans may be challenging. We aimed to examine this measurement feasibility, in relation to gestational age. METHODS A cross-sectional study was conducted, including nonanomalous fetuses, in which both lateral ventricles measured less than 10 mm during anomaly scans. The measurements were performed according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines. Success rate of measuring both ventricles was assessed at different gestational ages. Association between lateral ventricle width with contralateral ventricle width, gender, gestational age, and fetal head position were assessed. RESULTS A total of 156 cases were recruited. The lateral ventricle distal to the probe was measured in all cases. In 10 cases proximal lateral ventricle could not be adequately measured (failed proximal ventricle measurement group). In 146 scans both ventricle measurements were available. All 10 cases of failed proximal ventricle measurement were in third trimester (30-38 weeks). Success rate of measurement of both ventricles was 100%, 96.2%, 71.4%, and 37.5% for gestational week 14-29, 30-32, 33-35, and 36-38, respectively (P <.001). Proximal lateral ventricle width was strongly associated with the distal ventricle width (B = 0.422, 95% confidence interval 0.29, 0.555, P <.001), but not with head position, fetal gender, or gestational age. CONCLUSIONS Measurement of the proximal lateral ventricle is feasible in most cases, even during late third trimester scans. Efforts should be made to visualize both ventricles in every evaluation of the fetal brain.
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Affiliation(s)
- Yael Ganor Paz
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Affiliated with Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Denis Levinsky
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Affiliated with Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hadar Rosen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Affiliated with Ben Gurion University of the Negev, Beer Sheva, Israel
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11
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Meyer R, Bar-Yosef O, Barzilay E, Radinsky I, Segal CK, Ziv-Baran T, Shani H, Levin G, Katorza E. The Significance of Fetal Brain Ventricular Asymmetry Without Dilation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2413-2419. [PMID: 33427340 DOI: 10.1002/jum.15626] [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: 09/28/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Fetal brain non-dilated ventricular asymmetry (NDVA) is a common finding on prenatal ultrasound exams. However, the optimal prenatal management in these cases remains unknown. We aimed to evaluate the benefit of prenatal genetic and magnetic resonance imaging (MRI) exams performed in cases of fetal NDVA detected on ultrasound. METHODS A historical cohort study from a tertiary medical center. Singleton pregnancies with fetal brain NDVA diagnosed on ultrasound were included. We defined ventricular asymmetry as a difference of ≥2.0 mm between the lateral ventricles and ventricular dilation as ventricular width of >10.0 mm. Outcomes were evaluated with genetic exams (karyotype and chromosomal microarray analysis [CMA]) and fetal brain MRI. RESULTS During the study period, there were 145 cases diagnosed with NDVA on ultrasound that comprised the cohort study. The rate of abnormal karyotype was 1.8% (1/56) and of abnormal CMA was 10% (3/30). The rate of minor additional CNS findings did not differ between ultrasound and MRI (3.4 versus 2.8%, respectively, p = .74). No major additional fetal brain findings were detected on MRI performed after ultrasound. CONCLUSIONS In cases diagnosed with NDVA on ultrasound, no significant additional anomalies were detected on fetal brain MRI. The rate of abnormal genetic tests was relatively high and warrants further studies.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Omer Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Pediatric Neurology Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Igal Radinsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Chen Key Segal
- School of Medicine, Semmelweis University, Budapest, Hungary
| | - Tomer Ziv-Baran
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Hagit Shani
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eldad Katorza
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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12
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Krishnan V, Sharma A, Ramamurthy R, Elayedatt R, Ramamurthy BS. Prenatal Ventriculomegaly - Diagnosis, Prognostication and Management. Neurol India 2021; 69:S305-S312. [PMID: 35102981 DOI: 10.4103/0028-3886.332280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fetal ventriculomegaly (VM) refers to the abnormal enlargement of one or more ventricles of the brain in-utero. The enlargement may or may not be related to ventricular obstruction and increased intracranial pressure; therefore, the term "hydrocephalus" is not used. VM is diagnosed usually in the mid-trimester when the atrial diameter (AD) of the lateral ventricle is more than 10 mm on one or both sides. A thorough workup is then required to identify the cause as the etiology is diverse. Fetal magnetic resonance imaging (MRI) may yield additional information. Serial ultrasound follow-up would be required to assess its progression with advancing gestation. The prognosis and long-term outcomes greatly depend upon the etiology, the severity at diagnosis, progression, and associations. This article reviews the definitions, diagnosis, and workup of fetal VM, discusses follow-up protocols and prognosis, and examines the role of fetal therapy, including fetoscopic surgery in its prenatal management.
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Affiliation(s)
- Vivek Krishnan
- Fetal Medicine and Perinatology, Amrita Centre of Excellence in Fetal Care, AMRITA Institute of Medical Sciences, Kochi, Kerala, India
| | - Akshatha Sharma
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Rinshi Elayedatt
- Fetal Medicine and Perinatology, Amrita Centre of Excellence in Fetal Care, AMRITA Institute of Medical Sciences, Kochi, Kerala, India
| | - B S Ramamurthy
- Srinivasa Ultrasound Scanning Centre, Bangalore, Karnataka, India
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13
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Fried S, Gafner M, Jeddah D, Gosher N, Hoffman D, Ber R, Mayer A, Katorza E. Correlation between 2D and 3D Fetal Brain MRI Biometry and Neurodevelopmental Outcomes in Fetuses with Suspected Microcephaly and Macrocephaly. AJNR Am J Neuroradiol 2021; 42:1878-1883. [PMID: 34385141 DOI: 10.3174/ajnr.a7225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Definitions of fetal microcephaly and macrocephaly are debatable. A better understanding of their long-term prognoses would help guide parental education and counseling. This study aimed to explore the correlation between 2D and 3D fetal brain MR imaging biometry results and the long-term neurodevelopmental outcomes. MATERIALS AND METHODS This analysis is a historical cohort study. Fetal brain biometry was measured on 2D and 3D MR imaging using a volumetric MR imaging semiautomated algorithm. We measured and assessed the following brain structures: the supratentorial brain volume and cerebellar volume and cerebellar volume/supratentorial brain volume ratio, in addition to commonly used 2D brain MR imaging biometric variables, including occipitofrontal diameter, biparietal diameter, and transcerebellar diameter. Microcephaly was defined as ≤ 3rd percentile; and macrocephaly, as ≥ 97th percentile, corresponding to -2 SDs and +2 SDs. The neurodevelopmental outcome of this study cohort was evaluated using the Vineland-II Adaptive Behavior Scales, and the measurements were correlated to the Vineland standard scores. RESULTS A total of 70 fetuses were included. No significant correlation was observed between the Vineland scores and either the supratentorial brain volume, cerebellar volume, or supratentorial brain volume/cerebellar volume ratio in 3D or 2D MR imaging measurements, after correction for multiple comparisons. No differences were found among fetuses with macrocephaly, normocephaly, or microcephaly regarding the median Vineland standard scores. CONCLUSIONS Provided there is normal brain structure on MR imaging, the developmental milestone achievements in early years are unrelated to 2D and 3D fetal brain MR imaging biometry, in the range of measurements depicted in this study.
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Affiliation(s)
- S Fried
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology (S.F., E.K.), Sheba Medical Center, Tel-Hashomer, Israel
| | - M Gafner
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Pediatrics B (M.G.), Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - D Jeddah
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
| | - N Gosher
- Hadassah Medical School (N.G.), The Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Hoffman
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
| | - R Ber
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
| | - A Mayer
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Diagnostic Radiology (A.M.), Sheba Medical Center, Tel-Hashomer, Israel
| | - E Katorza
- From the Sackler School of Medicine (S.F., M.G., D.J., D.H., R.B., A.M., E.K.), Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology (S.F., E.K.), Sheba Medical Center, Tel-Hashomer, Israel
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14
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Alata M, González-Vega A, Piazza V, Kleinert-Altamirano A, Cortes C, Ahumada-Juárez JC, Eguibar JR, López-Juárez A, Hernandez VH. Longitudinal Evaluation of Cerebellar Signs of H-ABC Tubulinopathy in a Patient and in the taiep Model. Front Neurol 2021; 12:702039. [PMID: 34335454 PMCID: PMC8317997 DOI: 10.3389/fneur.2021.702039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
Hypomyelination with atrophy of the basal ganglia and cerebellum (H-ABC) is a central neurodegenerative disease due to mutations in the tubulin beta-4A (TUBB4A) gene, characterized by motor development delay, abnormal movements, ataxia, spasticity, dysarthria, and cognitive deficits. Diagnosis is made by integrating clinical data and radiological signs. Differences in MRIs have been reported in patients that carry the same mutation; however, a quantitative study has not been performed so far. Our study aimed to provide a longitudinal analysis of the changes in the cerebellum (Cb), corpus callosum (CC), ventricular system, and striatum in a patient suffering from H-ABC and in the taiep rat. We correlated the MRI signs of the patient with the results of immunofluorescence, gait analysis, segmentation of cerebellum, CC, and ventricular system, performed in the taiep rat. We found that cerebellar and callosal changes, suggesting a potential hypomyelination, worsened with age, in concomitance with the emergence of ataxic gait. We also observed a progressive lateral ventriculomegaly in both patient and taiep, possibly secondary to the atrophy of the white matter. These white matter changes are progressive and can be involved in the clinical deterioration. Hypomyelination with atrophy of the basal ganglia and cerebellum (H-ABC) gives rise to a spectrum of clinical signs whose pathophysiology still needs to be understood.
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Affiliation(s)
| | - Arturo González-Vega
- Department of Chemical, Electronic and Biomedical Engineering, Division of Sciences and Engineering, University of Guanajuato, Guanajuato, Mexico
| | | | | | - Carmen Cortes
- Behavioral Neurophysiology Lab, Institute of Physiology, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Juan C Ahumada-Juárez
- Behavioral Neurophysiology Lab, Institute of Physiology, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Jose R Eguibar
- Behavioral Neurophysiology Lab, Institute of Physiology, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.,Research Office, Vicerrectory of Research and Postgraduate Studies, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Alejandra López-Juárez
- Department of Chemical, Electronic and Biomedical Engineering, Division of Sciences and Engineering, University of Guanajuato, Guanajuato, Mexico
| | - Victor H Hernandez
- Department of Chemical, Electronic and Biomedical Engineering, Division of Sciences and Engineering, University of Guanajuato, Guanajuato, Mexico
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15
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Barzilay E, Fux A, Nezer M, Berkenstadt M, Bar-Yosef O, Katorza E. The added value of third trimester fetal brain MRI in cases of isolated ventriculomegaly. J Matern Fetal Neonatal Med 2021; 35:6759-6763. [PMID: 33969781 DOI: 10.1080/14767058.2021.1922379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the added value of third trimester fetal brain MRI, performed in one tertiary referral center, in cases of isolated ventriculomegaly as established by a dedicated multiplanar neurosonography. METHODS Fetal brain MRI scans performed in a single tertiary center during a 3-year period were assessed for possible inclusion. Only cases diagnosed with ventriculomegaly without additional findings in a neurosonography preceding the MRI were included. Fetal MRI was performed at a median gestational of 32 weeks (IQR 31-34 weeks). RESULTS A total of 68 cases met the inclusion criteria. Of them, in four cases MRI identified additional findings including three cases of intraventricular hemorrhage and one case of cortical infarction. The overall rate of MRI-findings in the study population was (5.9%, 95% CI 2.3-14.2%). No additional findings were detected in cases of mild ventriculomegaly, 6.1% in moderate and 25% in severe ventriculomegaly. The combined rate of additional findings in mild to moderate ventriculomegaly was 3.3% (95%CI 0.9-11.4%). CONCLUSIONS MRI was able to detect additional findings in 5.9% of cases with seemingly isolated ventriculomegaly after a dedicated neurosonography. The severity of ventriculomegaly is associated with a higher chance of detecting abnormalities in fetal brain MRI.
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Affiliation(s)
- Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Arik Fux
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Meirav Nezer
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Berkenstadt
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
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16
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Sun G, Jing B, Zhou F, Liu H, Liu L, Chen J, Hou X. Neurodevelopmental outcomes in mild and moderate isolated ventriculomegaly originating in utero. J Matern Fetal Neonatal Med 2021; 35:6691-6698. [PMID: 33944669 DOI: 10.1080/14767058.2021.1919869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the differences in outcomes between mild and moderate isolated ventriculomegaly (IVM). METHODS We conducted a prospective cohort study on 94 fetuses with IVM and evaluated the neurodevelopmental outcomes at 12 months of age using the ASQ-3 and BSID-I neurodevelopmental assessment tools. Progression of VM was defined as an increase in the width of the ventricular by at least 3 mm during sequential ultrasound monitoring. The population was divided into two groups according to ventricular width: mild (10-12 mm) and moderate (12.1-15 mm), which were further evaluated for VM progression in utero separately. RESULTS Neurodevelopmental assessments at 12 months were the main form of evaluations. Neurodevelopmental impairment (NDI) was defined as a mental development index (MDI) or psychomotor development index (PDI) < 85. There were no significant differences in NDI values between the mild and moderate groups (p = .155). Compared with the non-in utero progression group (7.6%), the rate of NDI was significantly higher (p = .004) in the group with progression (33.3%). Using linear regression and correlation, no negative correlation was found between the maximum value of atrial diameter (AD) in utero and the PDI (r = -0.021, p = .914) or MDI (r = -0.073, p = .703) score. However, the maximum change in the AD in utero was negatively correlated with both PDI (r = -0.460, p = .011) and MDI (r=-0.422, p = .020) scores. CONCLUSION There were likely no differences in neurodevelopmental outcomes between mild and moderate IVM. In fetuses with mild to moderate VM, intrauterine progression may be a poor prognostic factor for neurodevelopmental outcomes.
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Affiliation(s)
- Guoyu Sun
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Baihua Jing
- Department of Obstetrics & Gynecology, Peking University First Hospital, Beijing, China
| | - Faliang Zhou
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongyan Liu
- Department of Obstetrics & Gynecology, Peking University First Hospital, Beijing, China
| | - Lili Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Junya Chen
- Department of Obstetrics & Gynecology, Peking University First Hospital, Beijing, China
| | - Xinlin Hou
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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17
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Cerebrospinal fluid NCAM-1 concentration is associated with neurodevelopmental outcome in post-hemorrhagic hydrocephalus of prematurity. PLoS One 2021; 16:e0247749. [PMID: 33690655 PMCID: PMC7946285 DOI: 10.1371/journal.pone.0247749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Efforts directed at mitigating neurological disability in preterm infants with intraventricular hemorrhage (IVH) and post hemorrhagic hydrocephalus (PHH) are limited by a dearth of quantifiable metrics capable of predicting long-term outcome. The objective of this study was to examine the relationships between candidate cerebrospinal fluid (CSF) biomarkers of PHH and neurodevelopmental outcomes in infants undergoing neurosurgical treatment for PHH. STUDY DESIGN Preterm infants with PHH were enrolled across the Hydrocephalus Clinical Research Network. CSF samples were collected at the time of temporizing neurosurgical procedure (n = 98). Amyloid precursor protein (APP), L1CAM, NCAM-1, and total protein (TP) were compared in PHH versus control CSF. Fifty-four of these PHH subjects underwent Bayley Scales of Infant Development-III (Bayley-III) testing at 15-30 months corrected age. Controlling for false discovery rate (FDR) and adjusting for post-menstrual age (PMA) and IVH grade, Pearson's partial correlation coefficients were used to examine relationships between CSF proteins and Bayley-III composite cognitive, language, and motor scores. RESULTS CSF APP, L1CAM, NCAM-1, and TP were elevated in PHH over control at temporizing surgery. CSF NCAM-1 was associated with Bayley-III motor score (R = -0.422, p = 0.007, FDR Q = 0.089), with modest relationships noted with cognition (R = -0.335, p = 0.030, FDR Q = 0.182) and language (R = -0.314, p = 0.048, FDR Q = 0.194) scores. No relationships were observed between CSF APP, L1CAM, or TP and Bayley-III scores. FOHR at the time of temporization did not correlate with Bayley-III scores, though trends were observed with Bayley-III motor (p = 0.0647 and R = -0.2912) and cognitive scores (p = 0.0506 and R = -0.2966). CONCLUSION CSF NCAM-1 was associated with neurodevelopment in this multi-institutional PHH cohort. This is the first report relating a specific CSF protein, NCAM-1, to neurodevelopment in PHH. Future work will further investigate a possible role for NCAM-1 as a biomarker of PHH-associated neurological disability.
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18
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Mirsky DM, Stence NV, Powers AM, Dingman AL, Neuberger I. Imaging of fetal ventriculomegaly. Pediatr Radiol 2020; 50:1948-1958. [PMID: 33252761 DOI: 10.1007/s00247-020-04880-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/18/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Fetal ventriculomegaly is the most common central nervous system abnormality detected by prenatal imaging. It has a high association with other anomalies. Etiologies and prognoses for fetal ventriculomegaly range from normal outcomes to significant neurodevelopmental sequelae. In this paper, we review the development, terminology, pathogenesis, imaging and prognosis of fetal ventriculomegaly.
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Affiliation(s)
- David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA.
| | - Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Andria M Powers
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Andra L Dingman
- Division of Child Neurology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA
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19
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Zvi E, Shemer A, Toussia-Cohen S, Zvi D, Bashan Y, Hirschfeld-Dicker L, Oselka N, Amitai MM, Ezra O, Bar-Yosef O, Katorza E. Fetal Exposure to MR Imaging: Long-Term Neurodevelopmental Outcome. AJNR Am J Neuroradiol 2020; 41:1989-1992. [PMID: 32912871 DOI: 10.3174/ajnr.a6771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Very few studies have investigated long-term neurodevelopment of children exposed to MR imaging antenatally. Thus, the purpose of our study was to evaluate long-term neurodevelopmental outcomes of children exposed to MR imaging during pregnancy. MATERIALS AND METHODS We conducted a historical prospective cohort study in a single tertiary medical center. Women exposed to 1.5T noncontrast MR imaging for maternal or fetal indications were matched to unexposed controls. Long-term neurodevelopmental outcomes were evaluated of their children, 2.5 to 6 years of age, according to the Vineland-II Adaptive Behavior Scale. The Vineland-II Adaptive Behavior Scale assesses communication, daily living skills, socialization, and motor skills. A composite score summarizes these 4 domains. RESULTS A total of 131 exposed women matched our inclusion criteria and were included in the study group, and 771 unexposed women, in the control group. No difference was identified in the Vineland-II Adaptive Behavior Scale composite score between the children of the study and control groups (mean, 110.79 versus 108.18; P = .098). Differences were also not observed between the children of the 2 groups in 3 of the 4 questionnaire domains: communication (108.84 versus 109.10; P = .888), daily living skills (109.51 versus 108.28; P = .437), and motor skills (105.09 versus 104.42; P = .642). However, the socialization score was favorable for the study group (112.98 versus 106.47; P < .001). CONCLUSIONS Exposure to 1.5T noncontrast MR imaging during pregnancy had no harmful effects on long-term neurodevelopmental outcomes. This study contributes to understanding the safety of MR imaging during pregnancy.
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Affiliation(s)
- E Zvi
- From the Antenatal Diagnostic Unit (E.Z., S.t.-C., O.E., E.K.)
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - A Shemer
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - S Toussia-Cohen
- From the Antenatal Diagnostic Unit (E.Z., S.t.-C., O.E., E.K.)
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - D Zvi
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - Y Bashan
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - L Hirschfeld-Dicker
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - N Oselka
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - M-M Amitai
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, and Department of Diagnostic Radiology (M.-M.A.), Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - O Ezra
- From the Antenatal Diagnostic Unit (E.Z., S.t.-C., O.E., E.K.)
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
| | - O Bar-Yosef
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Unit (O.B.-Y.), Sheba Medical Center, Ramat-Gan, Israel
| | - E Katorza
- From the Antenatal Diagnostic Unit (E.Z., S.t.-C., O.E., E.K.)
- Sackler School of Medicine (E.Z., A.S., S.t.-C., D.Z., Y.B., L.H.-d., N.O., M.-M.A., O.E., O.B.-Y., E.K.), Tel Aviv University, Tel Aviv, Israel
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20
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Abstract
OBJECTIVES To review the current imaging techniques available for the evaluation of the fetal brain. FINDINGS Ultrasound remains the initial screening modality with routine scanning typically performed at 18-20 weeks gestation. When a central nervous system (CNS) abnormality is noted by ultrasound, MRI is increasingly being used to further clarify findings. Fetal MRI has the unique ability to provide high detailed anatomical information of the entire human fetus with high contrast resolution. This technique has grown due to the development of rapid single shot image acquisition sequences, improvement of motion correction strategies and optimizing shimming techniques. CONCLUSIONS The assessment of fetal CNS anomalies continues to improve. Advanced MRI techniques have allowed for further delineation of CNS anomalies and have become a cornerstone in the assessment of fetal brain well-being. Those interpreting fetal studies need to be familiar with the strengths and limitations of each exam and be sensitive to the impact discussing findings can have regarding perinatal care and delivery planning. Collaboration with neurologists, neurosurgeons, geneticists, counselors, and maternal fetal specialists are key in providing the best care to the families we treat.
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Affiliation(s)
- Agustin M Cardenas
- Department of Radiology, Children's of Alabama University of Alabama at Birmingham
| | - Matthew T Whitehead
- Department of Radiology, Children's of Alabama University of Alabama at Birmingham
| | - Dorothy I Bulas
- Department of Radiology, Children's of Alabama University of Alabama at Birmingham; George Washington School of Medicine, Washington, DC.
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21
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Thorup E, Jensen LN, Bak GS, Ekelund CK, Greisen G, Jørgensen DS, Hellmuth SG, Wulff C, Petersen OB, Pedersen LH, Tabor A. Neurodevelopmental disorder in children believed to have isolated mild ventriculomegaly prenatally. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:182-189. [PMID: 30168217 DOI: 10.1002/uog.20111] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/12/2018] [Accepted: 08/08/2018] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To estimate the prevalence of specific neurodevelopmental disorders in children believed to have isolated mild ventriculomegaly (IMV) prenatally in the second trimester of pregnancy, in order to optimize the counseling process. METHODS This was a nationwide registry-based study including all singleton pregnancies that had first- and second-trimester ultrasound scans in the period 1st January 2008 to 1st October 2014, identified in the Danish Fetal Medicine Database and local clinical databases in Denmark. All fetuses diagnosed prenatally with IMV (measurement of the atrium of the lateral ventricles, 10.0-15.0 mm) between 18 and 22 weeks' gestation were followed up in national patient registers until the age of 2-7 years. Information was obtained on the diagnoses of intellectual disability, cerebral palsy, autism spectrum disorder, epilepsy and impaired psychomotor development. Neurodevelopmental disorders were compared between those with postnatally confirmed IMV and a reference population of children in the same age range. RESULTS Of a cohort of 292 046 fetuses, 133 were found to have apparent IMV on the second-trimester scan for fetal malformations. In 11 cases, long-term follow-up was not possible owing to termination of pregnancy, spontaneous miscarriage, neonatal death or loss to follow-up. Of the 122 liveborn children followed up until 2-7 years, 15 were identified as having an additional abnormality while 107 were confirmed postnatally to have IMV. Of these 107 children, the diagnosis of a neurodevelopmental disorder was registered in six (5.6%), corresponding to an odds ratio of 2.64 (95% CI, 1.16-6.02), as compared with the reference population. The diagnoses were autism spectrum disorder, epilepsy and impaired psychomotor development. None of these 107 children was diagnosed with intellectual disability or cerebral palsy. CONCLUSIONS Our results show that a confirmed diagnosis of IMV was associated with an increased risk of a neurodevelopmental disorder, as compared with the reference population, but the absolute risk was low and there were no cases of intellectual disability or cerebral palsy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Thorup
- Copenhagen University Hospital, Rigshospitalet, Center of Fetal Medicine, Copenhagen, Denmark
- University of Copenhagen, Faculty of Medicine and Health Sciences, Copenhagen, Denmark
| | - L N Jensen
- Copenhagen University Hospital, Rigshospitalet, Center of Fetal Medicine, Copenhagen, Denmark
| | - G S Bak
- Odense University Hospital, Fetal Medicine Unit, Department of Obstetrics and Gynecology, Odense, Denmark
| | - C K Ekelund
- Copenhagen University Hospital, Rigshospitalet, Center of Fetal Medicine, Copenhagen, Denmark
| | - G Greisen
- University of Copenhagen, Faculty of Medicine and Health Sciences, Copenhagen, Denmark
- Copenhagen University Hospital, Rigshospitalet, Department of Neonatology, Copenhagen, Denmark
| | - D S Jørgensen
- Copenhagen University Hospital, Rigshospitalet, Center of Fetal Medicine, Copenhagen, Denmark
| | - S G Hellmuth
- University of Copenhagen, Faculty of Medicine and Health Sciences, Copenhagen, Denmark
| | - C Wulff
- Copenhagen University Hospital, Rigshospitalet, Center of Fetal Medicine, Copenhagen, Denmark
| | - O B Petersen
- Aarhus University Hospital, Department of Obstetrics and Gynecology, Aarhus, Denmark
- Aarhus University Hospital, Department of Clinical Medicine, Aarhus, Denmark
| | - L H Pedersen
- Aarhus University Hospital, Department of Obstetrics and Gynecology, Aarhus, Denmark
- Aarhus University Hospital, Department of Clinical Medicine, Aarhus, Denmark
| | - A Tabor
- Copenhagen University Hospital, Rigshospitalet, Center of Fetal Medicine, Copenhagen, Denmark
- University of Copenhagen, Faculty of Medicine and Health Sciences, Copenhagen, Denmark
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22
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Van den Veyver IB. Prenatally diagnosed developmental abnormalities of the central nervous system and genetic syndromes: A practical review. Prenat Diagn 2019; 39:666-678. [PMID: 31353536 DOI: 10.1002/pd.5520] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022]
Abstract
Developmental brain abnormalities are complex and can be difficult to diagnose by prenatal imaging because of the ongoing growth and development of the brain throughout pregnancy and the limitations of ultrasound, often requiring fetal magnetic resonance imaging as an additional tool. As for all major structural congenital anomalies, amniocentesis with chromosomal microarray and a karyotype is the first-line recommended test for the genetic work-up of prenatally diagnosed central nervous system (CNS) abnormalities. Many CNS defects, especially neuronal migration defects affecting the cerebral and cerebellar cortex, are caused by single-gene mutations in a large number of different genes. Early data suggest that prenatal diagnostic exome sequencing for fetal CNS defects will have a high diagnostic yield, but interpretation of sequencing results can be complex. Yet a genetic diagnosis is important for prognosis prediction and recurrence risk counseling. The evaluation and management of such patients is best done in a multidisciplinary team approach. Here, we review general principles of the genetic work-up for fetuses with CNS defects and review categories of genetic causes of prenatally diagnosed CNS phenotypes.
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23
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Meyer R, Bar-Yosef O, Barzilay E, Hoffman D, Toussia-Cohen S, Zvi E, Achiron R, Katorza E. Neurodevelopmental outcome of fetal isolated ventricular asymmetry without dilation: a cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:467-472. [PMID: 29607569 DOI: 10.1002/uog.19065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/10/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Fetal isolated ventricular asymmetry (IVA) is a relatively common finding in pregnancy, but data regarding its effect on neurodevelopmental outcome are scarce and founded principally on ultrasound-based studies. The purpose of this study was to assess the neurodevelopmental outcome of IVA cases in a magnetic resonance imaging (MRI)-based study. METHODS Cases referred for fetal brain MRI as part of the assessment of IVA without ventriculomegaly (lateral ventricular atrial diameter ≤ 10 mm), identified during routine ultrasound examination, were assessed for possible inclusion. Asymmetry was defined as a difference in width of ≥ 2 mm between the two lateral ventricles. Forty-three cases were included in the study group and compared with a control group of 94 normal cases without IVA. Children were assessed at ages 13-74 months using the Vineland-II Adaptive Behavior Scales (VABS-II). RESULTS VABS-II scores were within normal range. There was no significant difference in composite VABS-II score between the study and control groups (106.5 vs 108.0; P = 0.454). VABS-II scores did not differ between the groups when matched for gender and age at VABS-II interview (109.6 in study group vs 107.8 in control group; P = 0.690). CONCLUSION In cases of IVA without ventriculomegaly on MRI, neurodevelopmental test scores were normal and did not differ from cases without IVA. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - O Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Pediatric Neurology Unit, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - E Barzilay
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - D Hoffman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - S Toussia-Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - E Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - E Katorza
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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24
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Fishel-Bartal M, Watad H, Hoffmann C, Achiron R, Barzilay E, Katorza E. Fetal brain MRI in polyhydramnios: is it justified? J Matern Fetal Neonatal Med 2018; 32:3986-3992. [PMID: 29865922 DOI: 10.1080/14767058.2018.1480605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Despite meticulous investigation of polyhydramnios cases, in many of these cases, congenital anomalies are detected only after birth. The aim of our study was to explore the contribution of fetal brain MRI to the detection of CNS anomalies in cases of polyhydramnios. Materials and methods: This was retrospective cohort study on fetuses referred for the investigation of polyhydramnios at a single tertiary center. All fetuses underwent a detailed sonographic anatomical scan and a fetal brain MRI. Isolated and nonisolated polyhydramnios were differentiated according to associated anomalies. MRI findings were compared between the groups. Results: A total of 46 fetuses were included in the study. Brain anomalies were detected in ultrasound in 12 (26%) cases while MRI detected brain anomalies in 23 (50%) cases. MRI detected more anomalies in fetuses with nonisolated compared to isolated polyhydramnios (62.9% and 31.6%, respectively, p = .019). Conclusions: Fetal brain MRI may contribute to the evaluation of fetuses with polyhydramnios. The clinical value and cost-effectiveness of MRI use in the routine work-up of polyhydramnios should be assessed in future studies.
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Affiliation(s)
- Michal Fishel-Bartal
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Hadel Watad
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Chen Hoffmann
- Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Reuven Achiron
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eran Barzilay
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eldad Katorza
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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25
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Single-Shot Version of FLAIR Sequence in the Detection of Intraventricular Anomalies: Preliminary Experience in Fetal MR Imaging. J Comput Assist Tomogr 2018; 42:487-491. [PMID: 29287023 DOI: 10.1097/rct.0000000000000701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate single-shot (ss) FLAIR sequence in the detection of intraventricular anomalies in a series of fetuses showing mild-moderate ventriculomegaly at ultrasound. SUBJECTS AND METHODS Fetuses with mild-moderate isolated ventriculomegaly, which underwent MR imaging between 2003 and 2014 were considered eligible. Fetuses were examined by standard MR protocol and ss-FLAIR sequence, tailored for snapshot imaging. Two paediatric neuroradiologists evaluated MR images. RESULTS 542 cases were selected. MR imaging was performed at mean 26 weeks of gestation. ss-FLAIR sequence detected intraventricular findings, consistent with cysts in 10 cases. In 3/10 intraventricular cysts were also evident on ss-FSE T2 and FSE T1-weighted images. In no case diffusion weighted imaging was able to detect cyst. No cyst was highlighted on ss-FSE-T2 and FSE-T1-weighted images, without being visible also on ss-FLAIR. CONCLUSION ss-FLAIR sequence may be useful to detect intraventricular anomalies especially when fetal position or maternal obesity prevents adequate visualization by ultrasound.
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26
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Li X, Ba M, Ng KP, Mathotaarachchi S, Pascoal TA, Rosa-Neto P, Gauthier S. Characterizing biomarker features of cognitively normal individuals with ventriculomegaly. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 10:12-21. [PMID: 29159265 PMCID: PMC5678356 DOI: 10.1016/j.dadm.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The clinical significance of ventriculomegaly in cognitively normal elderly individuals remains unclear. METHODS We selected cognitively normal individuals (n = 425) from the Alzheimer's Disease Neuroimaging Initiative database and calculated Evans index (EI) based on the ratio of the frontal horn and skull diameter. We defined ventriculomegaly as EI ≥ 0.30, and the participants were stratified into EI ≥ 0.30 group and EI < 0.30 group. Neuropsychological, imaging, and fluid biomarker profiles between the two groups were then compared using regression models. RESULTS A total of 96 (22.5%) individuals who had ventriculomegaly performed worse on the cognitive tests; showed smaller hippocampal volume but larger caudate, cingulate, and paracentral gyrus volumes; and displayed lower positron emission tomography [18F]fluorodeoxyglucose standardized uptake value ratio but higher amyloid burden represented by higher [18F]florbetapir standardized uptake value ratio and lower cerebrospinal fluid amyloid β 1-42 levels compared to those without ventriculomegaly. DISCUSSION Asymptomatic ventriculomegaly might be an early imaging signature of preclinical Alzheimer's disease and/or normal pressure hydrocephalus.
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Affiliation(s)
- Xiaofeng Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Maowen Ba
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical University, Shandong, PR China
| | - Kok Pin Ng
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Sulantha Mathotaarachchi
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Tharick A. Pascoal
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Pedro Rosa-Neto
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Serge Gauthier
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
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27
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Bar-Yosef O, Barzilay E, Dorembus S, Achiron R, Katorza E. Neurodevelopmental outcome of isolated ventriculomegaly: a prospective cohort study. Prenat Diagn 2017; 37:764-768. [DOI: 10.1002/pd.5078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 05/20/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Omer Bar-Yosef
- Pediatric Neurology Unit; Sheba Medical Center; Ramat-Gan Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv-Yafo Israel
| | - Eran Barzilay
- Sackler School of Medicine; Tel Aviv University; Tel Aviv-Yafo Israel
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat-Gan Israel
| | - Sara Dorembus
- Sackler School of Medicine; Tel Aviv University; Tel Aviv-Yafo Israel
| | - Reuven Achiron
- Sackler School of Medicine; Tel Aviv University; Tel Aviv-Yafo Israel
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat-Gan Israel
| | - Eldad Katorza
- Sackler School of Medicine; Tel Aviv University; Tel Aviv-Yafo Israel
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat-Gan Israel
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28
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Severino M, Righini A, Tortora D, Pinelli L, Parazzini C, Morana G, Accorsi P, Capra V, Paladini D, Rossi A. MR Imaging Diagnosis of Diencephalic-Mesencephalic Junction Dysplasia in Fetuses with Developmental Ventriculomegaly. AJNR Am J Neuroradiol 2017; 38:1643-1646. [PMID: 28596193 DOI: 10.3174/ajnr.a5245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Abstract
Diencephalic-mesencephalic junction dysplasia is a rare malformation characterized by a poorly defined junction between the diencephalon and the mesencephalon, associated with a characteristic butterfly-like contour of the midbrain (butterfly sign). This condition may be variably associated with other brain malformations, including callosal abnormalities and supratentorial ventricular dilation, and is a potential cause of developmental hydrocephalus. Here, we have reported 13 fetuses with second-trimester obstructive ventriculomegaly and MR features of diencephalic-mesencephalic junction dysplasia, correlating the fetal imaging with available pathology and/or postnatal data. The butterfly sign can be clearly detected on axial images on fetal MR imaging, thus allowing for the prenatal diagnosis of diencephalic-mesencephalic junction dysplasia, with possible implications for the surgical management of hydrocephalus and parental counseling.
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Affiliation(s)
- M Severino
- From the Neuroradiology Unit (M.S., D.T., G.M., A. Rossi)
| | - A Righini
- Radiology and Neuroradiology Department (A. Righini, C.P.), Ospedale dei Bambini V Buzzi, Milano, Italy
| | - D Tortora
- From the Neuroradiology Unit (M.S., D.T., G.M., A. Rossi)
| | | | - C Parazzini
- Radiology and Neuroradiology Department (A. Righini, C.P.), Ospedale dei Bambini V Buzzi, Milano, Italy
| | - G Morana
- From the Neuroradiology Unit (M.S., D.T., G.M., A. Rossi)
| | - P Accorsi
- Neuropsychiatry Units (P.A.), Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - V Capra
- Genetic Unit, Department of Neurosurgery (V.C.)
| | - D Paladini
- Fetal Medicine and Surgery Unit (D.P.), Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- From the Neuroradiology Unit (M.S., D.T., G.M., A. Rossi)
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