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Fortin O, Christoffel K, Shoaib AB, Venkatesan C, Cilli K, Schroeder JW, Alves C, Ganetzky RD, Fraser JL. Fetal Brain MRI Abnormalities in Pyruvate Dehydrogenase Complex Deficiency. Neurology 2024; 103:e209728. [PMID: 39102617 DOI: 10.1212/wnl.0000000000209728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pyruvate dehydrogenase complex deficiency (PDCD) is a disorder of mitochondrial metabolism that is caused by pathogenic variants in multiple genes, including PDHA1. Typical neonatal brain imaging findings have been described, with a focus on malformative and encephaloclastic features. Fetal brain MRI in PDCD has not been comprehensively described. The aims of this study were (1) to further characterize the fetal brain MRI findings in PDCD using comprehensive fetal imaging and genetic testing and (2) to determine whether markers of diagnosis of PDCD could be identified on prenatal imaging. METHODS Fetuses with a diagnosis of PDCD related to a genetic etiology that had undergone fetal MRI were included. Fetuses were identified retrospectively from local databases of 4 fetal diagnostic clinics within tertiary pediatric health care centers. Electronic medical records were reviewed retrospectively: demographics, maternal and pregnancy history, fetal outcomes, and neonatal outcomes (if available) were reviewed and recorded. Fetal and neonatal imaging reports were reviewed; source fetal and neonatal brain MRI scans were reviewed by a single pediatric neuroradiologist (J.W.S.) for consistency. Genetic testing strategies and results including variant type, zygosity, inheritance pattern, and pathogenicity were recorded. Deidentified data were combined and reported descriptively. RESULTS A total of 10 fetuses with a diagnosis of PDCD were included. 8 fetuses had corpus callosum dysgenesis, 6 had an abnormal gyration pattern, 10 had reduced brain volumes, and 9 had cystic lesions. 1 fetus had intraventricular hemorrhages. 1 fetus had a midbrain malformation with aqueductal stenosis and severe hydrocephalus. 6 fetuses imaged in the second trimester had cystic lesions involving the ganglionic eminences (GEs) while GE cysts were not present in the 4 fetuses imaged in the third trimester. DISCUSSION Fetuses with PDCD have similar brain MRI findings to neonates described in the literature, although some of these findings are subtle early in pregnancy. Additional features, such as cystic lesions of the GEs, are noted in the second trimester in fetuses with PDCD. These may represent an early diagnostic marker of PDCD, although more data are needed to validate this association. Early diagnosis of PDCD using fetal MRI may inform genetic counseling, pregnancy decision making, and neonatal care planning.
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Affiliation(s)
- Olivier Fortin
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kelsey Christoffel
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Abdullah B Shoaib
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Charu Venkatesan
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kate Cilli
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jason W Schroeder
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Cesar Alves
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rebecca D Ganetzky
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jamie L Fraser
- From the Zickler Family Prenatal Pediatrics Institute (O.F., K. Christoffel, K. Cilli, J.L.F.), Department of Radiology (J.W.S.), Rare Disease Institute (J.L.F.), and Center for Genetic Medicine Research (J.L.F.), Children's National Hospital, Washington, DC; Departments of Neurology and Rehabilitation Medicine (K. Christoffel), Radiology (J.W.S.), and Pediatrics (J.L.F.), George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics (A.B.S.) and Neurology (A.B.S.), University of Texas Southwestern Medical Center, Dallas; Division of Neurology (C.V.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.V.), University of Cincinnati College of Medicine, OH; Department of Radiology (C.A.), Boston Children's Hospital, MA; Division of Human Genetics (R.D.G.), Children's Hospital of Philadelphia; and Department of Pediatrics (R.D.G.), University of Pennsylvania Perelman School of Medicine, Philadelphia
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Fortin O, Christoffel K, Shoaib A, Venkatesan C, Cilli K, Schroeder JW, Alves C, Ganetzky RD, Fraser JL. Characteristic Fetal Brain MRI Abnormalities in Pyruvate Dehydrogenase Complex Deficiency. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.08.24303574. [PMID: 38645225 PMCID: PMC11030481 DOI: 10.1101/2024.04.08.24303574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Pyruvate dehydrogenase complex deficiency (PDCD) is a disorder of mitochondrial metabolism that is caused by pathogenic variants in multiple genes, including PDHA1. Typical neonatal brain imaging findings in PDCD have been described, with a focus on malformative features and chronic encephaloclastic changes. However, fetal brain MRI imaging in confirmed PDCD has not been comprehensively described. We sought to demonstrate the prenatal neurological and systemic manifestations of PDCD determined by comprehensive fetal imaging and genomic sequencing. All fetuses with a diagnosis of genetic PDCD who had undergone fetal MRI were included in the study. Medical records, imaging data, and genetic testing results were reviewed and reported descriptively. Ten patients with diagnosis of PDCD were included. Most patients had corpus callosum dysgenesis, abnormal gyration pattern, reduced brain volumes, and periventricular cystic lesions. One patient had associated intraventricular hemorrhages. One patient had a midbrain malformation with aqueductal stenosis and severe hydrocephalus. Fetuses imaged in the second trimester were found to have enlargement of the ganglionic eminences with cystic cavitations, while those imaged in the third trimester had germinolytic cysts. Fetuses with PDCD have similar brain MRI findings to neonates described in the literature, although some of these findings may be subtle early in pregnancy. Additional features, such as cystic cavitations of the ganglionic eminences, are noted in the second trimester in fetuses with PDCD, and these may represent a novel early diagnostic marker for PDCD. Using fetal MRI to identify these radiological hallmarks to inform prenatal diagnosis of PDCD may guide genetic counseling, pregnancy decision-making, and neonatal care planning.
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Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children’s National Hospital, Washington, District of Columbia, USA, 20010
| | - Kelsey Christoffel
- Zickler Family Prenatal Pediatrics Institute, Children’s National Hospital, Washington, District of Columbia, USA, 20010
- Department of Neurology and Rehabilitation Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA, 20052
| | - Abdullah Shoaib
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA, 75235
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA, 75235
| | - Charu Venkatesan
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA, 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA, 45221
| | - Kate Cilli
- Zickler Family Prenatal Pediatrics Institute, Children’s National Hospital, Washington, District of Columbia, USA, 20010
| | - Jason W. Schroeder
- Department of Radiology, Children’s National Hospital, Washington, District of Columbia, USA, 20010
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA, 20052
| | - Cesar Alves
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - Rebecca D. Ganetzky
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, 19104
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, 19104
| | - Jamie L. Fraser
- Zickler Family Prenatal Pediatrics Institute, Children’s National Hospital, Washington, District of Columbia, USA, 20010
- Rare Disease Institute, Children’s National Hospital, Washington, District of Columbia, USA, 20010
- Center for Genetic Medicine Research, Children’s National Hospital, Washington, District of Columbia, USA, 20010
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Yao Y, Wang G, Lan Q, Li T, Wang Y, Ma B. Prenatal diagnosis of hemimegalencephaly via transabdominal and transvaginal ultrasonography: a case description. Quant Imaging Med Surg 2024; 14:3231-3234. [PMID: 38617140 PMCID: PMC11007497 DOI: 10.21037/qims-23-1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/04/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Yanwu Yao
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Gang Wang
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Qiong Lan
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Tiangang Li
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Yixuan Wang
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Bin Ma
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
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Shinar S, Chitayat D, Shannon P, Blaser S. Fetal macrocephaly: Pathophysiology, prenatal diagnosis and management. Prenat Diagn 2023; 43:1650-1661. [PMID: 38009873 DOI: 10.1002/pd.6473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
Macrocephaly means a large head and is defined as a head circumference (HC) above the 98th percentile or greater than +2SD above the mean for gestational age. Macrocephaly can be primary and due to increased brain tissue (megalocephaly), which in most cases is familial and benign or secondary. The latter may be due to various causes, including but not limited to communicating or non-communicating hydrocephalus, cerebral edema, focal and pericerebral increased fluid collections, thickened calvarium and brain tumors. Megalocephaly can be syndromic or non-syndromic. In the former, gyral and structural CNS anomalies are common. It is important to exercise caution when considering a diagnosis of megalocephaly due to limitations in the accuracy of HC measurement, lack of nomograms for specific populations, inconsistencies between prenatal and postnatal HC growth curves and progression over time. The degree of macrocephaly is important, with mild macrocephaly ≤2.5SD carrying a good prognosis, especially when one of the parents has macrocephaly and normal development. Cases in which the patient history and/or physical exam are positive or when parental HC are normal are more worrisome and warrant a neurosonogram, fetal MRI and genetic testing to better delineate the underlying etiology and provide appropriate counseling.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Contro E, Volpe N, Larcher L, Dall'Asta A, Penas Da Costa MA, Vairo G, Di Pasquo E, Giorgini I, Ghi T. Normal and abnormal appearance of fetal ganglionic eminence on second-trimester three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:398-404. [PMID: 37099497 DOI: 10.1002/uog.26229] [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: 01/22/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To describe the appearance and size of the ganglionic eminence (GE) in normal fetuses on midtrimester three-dimensional (3D) neurosonography and to report on the association between GE alterations (cavitation or enlargement) and malformation of cortical development (MCD). METHODS This was a prospective multicenter cohort study of normal fetuses and a retrospective analysis of pathological cases with MCD. From January 2022 to June 2022, patients attending our tertiary centers for an expert fetal brain scan were recruited for the purpose of the study. A 3D volume of the fetal head, starting from the sagittal plane, was acquired in apparently normal fetuses using a transabdominal or transvaginal approach. Stored volume datasets were then evaluated independently by two expert operators. Two measurements (longitudinal diameter and transverse diameter) of the GE in the coronal view were obtained twice by each operator. Intra- and interobserver measurement variation was calculated. Reference ranges for GE measurements were calculated in the normal population. A previously stored volume dataset of 60 cases with MCD was also analyzed independently by the two operators using the same method in order to assess if GE abnormalities (cavitation or enlargement) were present. Postnatal follow-up was obtained in all cases. RESULTS In the study period, 160 normal fetuses between 19 and 22 weeks of gestation were included in the study. The GE was visible in the coronal plane on 3D neurosonography in 144 (90%) cases and was not clearly visible in the remaining 16 (10%) cases. The intra- and interobserver agreement was almost perfect for the longitudinal diameter, with an intraclass correlation coefficient (ICC) of 0.90 (95% CI, 0.83-0.93) and 0.90 (95% CI, 0.86-0.92), respectively, and substantial for the transverse diameter, with an ICC of 0.80 (95% CI, 0.70-0.87) and 0.64 (95% CI, 0.53-0.72), respectively. A retrospective analysis of 50 cases with MCD in the second trimester showed that GE enlargement was present in 12 cases and GE cavitation was present in four cases. CONCLUSIONS Systematic assessment of the GE in fetuses at 19-22 weeks of gestation is feasible on 3D neurosonography, with good reproducibility in normal cases. Cavitation or enlargement of the GE can be demonstrated in fetuses with MCD. © 2023 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)
- E Contro
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - N Volpe
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Larcher
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - A Dall'Asta
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - M A Penas Da Costa
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Vairo
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - E Di Pasquo
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - I Giorgini
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Orsola University Hospital of Bologna, IRCCS AOUB, Bologna, Italy
| | - T Ghi
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Stuempflen M, Taymourtash A, Kienast P, Schmidbauer VU, Schwartz E, Mitter C, Binder J, Prayer D, Kasprian G. Ganglionic eminence: volumetric assessment of transient brain structure utilizing fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:405-413. [PMID: 37099530 DOI: 10.1002/uog.26232] [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: 01/30/2023] [Revised: 03/27/2023] [Accepted: 04/15/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To provide quantitative magnetic resonance imaging (MRI) super-resolution-based three-dimensional volumetric reference data on the growth dynamics of the ganglionic eminence (GE) relative to cortical and total fetal brain volumes (TBV). METHODS This was a retrospective study of fetuses without structural central nervous system anomalies or other confounding comorbidities that were referred for fetal MRI. Super-resolution reconstructions of 1.5- and 3-Tesla T2-weighted images were generated. Semiautomatic segmentation of TBV and cortical volume and manual segmentation of the GE were performed. Cortical volume, TBV and GE volume were quantified and three-dimensional reconstructions were generated to visualize the developmental dynamics of the GE. RESULTS Overall, 120 fetuses that underwent 127 MRI scans at a mean gestational age of 27.23 ± 4.81 weeks (range, 20-37 weeks) were included. In the investigated gestational-age range, GE volume ranged from 74.88 to 808.75 mm3 and was at its maximum at 21 gestational weeks, followed by a linear decrease (R2 = 0.559) throughout the late second and third trimesters. A pronounced reduction in GE volume relative to cortical volume and TBV occurred in the late second trimester, with a decline in this reduction observed in the third trimester (R2 = 0.936 and 0.924, respectively). Three-dimensional rendering allowed visualization of a continuous change in the shape and size of the GE throughout the second and third trimesters. CONCLUSIONS Even small compartments of the fetal brain, which are not easily accessible by standardized two-dimensional modalities, can be assessed precisely by super-resolution processed fetal MRI. The inverse growth dynamics of GE volume compared with TBV and cortical volume reflects the transitory nature and physiological involution of this (patho-)physiologically important brain structure. The normal development and involution of the GE is mandatory for normal cortical development. Pathological changes of this transient organ precede impairment of cortical structures, and their detection may allow an earlier diagnosis of such anomalies. © 2023 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)
- M Stuempflen
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A Taymourtash
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - P Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - V U Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - E Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - C Mitter
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - J Binder
- Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - G Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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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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Tian D, Izumi SI. Transcranial Magnetic Stimulation and Neocortical Neurons: The Micro-Macro Connection. Front Neurosci 2022; 16:866245. [PMID: 35495053 PMCID: PMC9039343 DOI: 10.3389/fnins.2022.866245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022] Open
Abstract
Understanding the operation of cortical circuits is an important and necessary task in both neuroscience and neurorehabilitation. The functioning of the neocortex results from integrative neuronal activity, which can be probed non-invasively by transcranial magnetic stimulation (TMS). Despite a clear indication of the direct involvement of cortical neurons in TMS, no explicit connection model has been made between the microscopic neuronal landscape and the macroscopic TMS outcome. Here we have performed an integrative review of multidisciplinary evidence regarding motor cortex neurocytology and TMS-related neurophysiology with the aim of elucidating the micro–macro connections underlying TMS. Neurocytological evidence from animal and human studies has been reviewed to describe the landscape of the cortical neurons covering the taxonomy, morphology, circuit wiring, and excitatory–inhibitory balance. Evidence from TMS studies in healthy humans is discussed, with emphasis on the TMS pulse and paradigm selectivity that reflect the underlying neural circuitry constitution. As a result, we propose a preliminary neuronal model of the human motor cortex and then link the TMS mechanisms with the neuronal model by stimulus intensity, direction of induced current, and paired-pulse timing. As TMS bears great developmental potential for both a probe and modulator of neural network activity and neurotransmission, the connection model will act as a foundation for future combined studies of neurocytology and neurophysiology, as well as the technical advances and application of TMS.
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Affiliation(s)
- Dongting Tian
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine, Sendai, Japan
- *Correspondence: Dongting Tian,
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine, Sendai, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Shin-Ichi Izumi,
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Goergen SK, Alibrahim E, Christie J, Dobrotwir A, Fahey M, Fender L, Frawley K, Manikkam SA, Pinner JR, Sinnott S, Romaniello R, Sandaradura SA, Taylor J, Vasudevan A, Righini A. The Fetus with Ganglionic Eminence Abnormality: Head Size and Extracranial Sonographic Findings Predict Genetic Diagnoses and Postnatal Outcomes. AJNR Am J Neuroradiol 2021; 42:1528-1534. [PMID: 33958329 DOI: 10.3174/ajnr.a7131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ganglionic eminence abnormalities on fetal MR imaging are associated with cerebral malformations. Their presumed genetic basis and associated postnatal outcomes remain largely unknown. We aimed to elucidate these through a multicenter study. MATERIALS AND METHODS Between January 2010 and June 2020, seven hospitals in 2 countries performing fetal MR imaging examinations identified fetal MR imaging studies demonstrating ganglionic eminence enlargement, cavitation, or both. Cases with no genetic diagnosis, no whole exome sequencing, or no outcome of a liveborn child were excluded. Head size was classified as large (fronto-occipital diameter > 95th centile), small (fronto-occipital diameter <5th centile), or normal. RESULTS Twenty-two fetuses with ganglionic eminence abnormalities were identified. Of 8 with large heads, 2 were diagnosed with MTOR mutations; 1 with PIK3CA mutation-producing megalencephaly, polymicrogyria, polydactyly, hydrocephalus (MPPH) syndrome; 3 with TSC mutations; 1 with megalencephaly capillary malformation syndrome; and 1 with hemimegalencephaly. Cardiac rhabdomyoma was present prenatally in all cases of TSC; mutation postaxial polydactyly accompanied megalencephaly capillary malformation and MPPH. Of 12 fetuses with small heads, 7 had TUBA1A mutations, 1 had a TUBB3 mutation, 2 had cobblestone lissencephaly postnatally with no genetic diagnosis, 1 had a PDHA1 mutation, and 1 had a fetal akinesia dyskinesia sequence with no pathogenic mutation on trio whole exome sequencing. One of the fetuses with a normal head size had an OPHN1 mutation with postnatal febrile seizures, and the other had peri-Sylvian polymicrogyria, seizures, and severe developmental delay but no explanatory mutation on whole exome sequencing. CONCLUSIONS Fetal head size and extracranial prenatal sonographic findings can refine the phenotype and facilitate genetic diagnosis when ganglionic eminence abnormality is diagnosed with MR imaging.
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Affiliation(s)
- S K Goergen
- From the Monash Imaging (S.K.G.), Monash Health, Victoria, Australia .,Departments of Imaging and Surgery (S.K.G.), School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - E Alibrahim
- Department of Radiology (E.A., A.D.), Royal Women's Hospital, Parkville, Victoria, Australia
| | - J Christie
- PRP Imaging (J.C.), Sydney, New South Wales, Australia
| | - A Dobrotwir
- Department of Radiology (E.A., A.D.), Royal Women's Hospital, Parkville, Victoria, Australia
| | - M Fahey
- Department of Paediatrics (M.F.), School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Neurogenetics Unit (M.F.), Monash Health, Victoria, Australia
| | - L Fender
- Department of Radiology (L.F.), King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - K Frawley
- Department of Medical Imaging and Nuclear Medicine (K.F., S.A.M.), Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - S A Manikkam
- Department of Medical Imaging and Nuclear Medicine (K.F., S.A.M.), Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - J R Pinner
- Centre for Clinical Genetics (J.R.P.), Sydney Children's Hospital, Sydney, New South Wales, Australia.,University of New South Wales (J.R.P.), Sydney, Australia
| | - S Sinnott
- SO + GI Scan I-MED Radiology (S.S.), Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - R Romaniello
- Child Neuropsychiatry and Neurorehabilitation Department (R.R.), Scientific Institute Eugenio Medea, La Nostra Famiglia, Bosiso Parini, Lecco, Italy
| | - S A Sandaradura
- Discipline of Child and Adolescent Health (S.A.S.), Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia.,Department of Clinical Genetics (S.A.S.), Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - J Taylor
- Department of Radiology (J.T.), Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - A Vasudevan
- Department of Clinical Genetics (A.V.), Royal Women's Hospital, Parkville, Victoria, Australia
| | - A Righini
- Department of Pediatric Radiology and Neuroradiology (A.R.), Vittore Buzzi Children's Hospital, Milan, Italy
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