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Righini A, Tortora M, Izzo G, Doneda C, Arrigoni F, Palumbo G, Parazzini C. Cutting-edge applications of fetal MR neuro-imaging in clinical routine: a pictorial essay. Neuroradiology 2023; 65:1813-1823. [PMID: 37910190 DOI: 10.1007/s00234-023-03242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
Over time, fetal MR neuro-imaging has undergone continuous improvement; presently, it plays a pivotal role in the diagnosis of an expanding array of complex neurological conditions. Within this pictorial essay, our focus will be exclusively directed towards those cutting-edge clinical applications, which currently yield valuable diagnostic insights on a single case basis. Specifically, the pictorial examples will center on some abnormal entities and their features at an earlier fetal stage.
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Affiliation(s)
- Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Mario Tortora
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Giana Izzo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Chiara Doneda
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Filippo Arrigoni
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | | | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
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O'Keefe H, Shenfine R, Brown M, Beyer F, Rankin J. Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy. BMJ Open 2023; 13:e064774. [PMID: 36609326 PMCID: PMC9827258 DOI: 10.1136/bmjopen-2022-064774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/04/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of non-invasive or minimally invasive autopsy techniques in deaths under 1 year of age. DESIGN This is a systematic review of diagnostic test accuracy. The protocol is registered on PROSPERO. PARTICIPANTS Deaths from conception to one adjusted year of age. SEARCH METHODS MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), the Cochrane Library, Scopus and grey literature sources were searched from inception to November 2021. DIAGNOSTIC TESTS Non-invasive or minimally invasive diagnostic tests as an alternative to traditional autopsy. DATA COLLECTION AND ANALYSIS Studies were included if participants were under one adjusted year of age, with index tests conducted prior to the reference standard.Data were extracted from eligible studies using piloted forms. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted following the Synthesis without Meta-Analysis guidelines. Vote counting was used to assess the direction of effect. MAIN OUTCOME MEASURES Direction of effect was expressed as percentage of patients per study. FINDINGS We included 54 direct evidence studies (68 articles/trials), encompassing 3268 cases and eight index tests. The direction of effect was positive for postmortem ultrasound and antenatal echography, although with varying levels of success. Conversely, the direction of effect was against virtual autopsy. For the remaining tests, the direction of effect was inconclusive.A further 134 indirect evidence studies (135 articles/trials) were included, encompassing 6242 perinatal cases. The addition of these results had minimal impact on the direct findings yet did reveal other techniques, which may be favourable alternatives to autopsy.Seven trial registrations were included but yielded no results. CONCLUSIONS Current evidence is insufficient to make firm conclusions about the generalised use of non-invasive or minimally invasive autopsy techniques in relation to all perinatal population groups.PROSPERO registration numberCRD42021223254.
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Affiliation(s)
- Hannah O'Keefe
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebekka Shenfine
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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3
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Congenital Brain Malformations: An Integrated Diagnostic Approach. Semin Pediatr Neurol 2022; 42:100973. [PMID: 35868725 DOI: 10.1016/j.spen.2022.100973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Congenital brain malformations are abnormalities present at birth that can result from developmental disruptions at various embryonic or fetal stages. The clinical presentation is nonspecific and can include developmental delay, hypotonia, and/or epilepsy. An informed combination of imaging and genetic testing enables early and accurate diagnosis and management planning. In this article, we provide a streamlined approach to radiologic phenotyping and genetic evaluation of brain malformations. We will review the clinical workflow for brain imaging and genetic testing with up-to-date ontologies and literature references. The organization of this article introduces a streamlined approach for imaging-based etiologic classification into malformative, destructive, and migrational abnormalities. Specific radiologic ontologies are then discussed in detail, with correlation of key neuroimaging features to embryology and molecular pathogenesis.
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Mahalingam HV, Rangasami R, Seshadri S, Suresh I. Imaging spectrum of posterior fossa anomalies on foetal magnetic resonance imaging with an algorithmic approach to diagnosis. Pol J Radiol 2021; 86:e183-e194. [PMID: 33828631 PMCID: PMC8018271 DOI: 10.5114/pjr.2021.105014] [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: 03/24/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Posterior fossa abnormalities are one of the most common indications for performing foetal magnetic resonance imaging (FMRI). Ultrasonography is the initial imaging modality for assessment of foetal posterior fossa. Abnormal findings on ultrasonography warrant further evaluation with FMRI because it offers excellent soft-tissue contrast resolution and multiplanar capabilities. The neurological prognosis of different posterior fossa anomalies varies widely. FMRI plays a crucial role in confirming the diagnosis, assessing the prognosis, and counselling patients regarding continuation of pregnancy and possible post-natal developmental outcome. In this review we present the imaging spectrum of posterior fossa anomalies that readers can encounter in practice, highlight salient points in favour of each diagnosis, and provide a simplified algorithmic approach to reach the final diagnosis.
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Affiliation(s)
- Harsha Vardhan Mahalingam
- Department of Radiology, Sri Ramachandra Medical College and Research Institute (SRMC & RI), Chennai, India
| | - Rajeswaran Rangasami
- Department of Radiology, Sri Ramachandra Medical College and Research Institute (SRMC & RI), Chennai, India
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Magnetic resonance imaging of the brainstem in children, part 1: imaging techniques, embryology, anatomy and review of congenital conditions. Pediatr Radiol 2021; 51:172-188. [PMID: 33496830 DOI: 10.1007/s00247-020-04953-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/10/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Part 1 of this series of two articles describes conventional and advanced MRI techniques that are useful for evaluating brainstem pathologies. In addition, it provides a review of the embryology, normal progression of myelination, and clinically and radiologically salient imaging anatomy of the normal brainstem. Finally, it discusses congenital diseases of the brainstem with a focus on distinctive imaging features that allow for differentiating pathologies. Part 2 of this series of two articles includes discussion of neoplasms; infections; and vascular, demyelinating, toxic and metabolic, and miscellaneous disease processes affecting the brainstem. The ultimate goal of this pair of articles is to empower the radiologist to add clinical value in the care of pediatric patients with brainstem pathologies.
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Srivastava R, Morneau-Jacob FD. Teaching NeuroImages: The curious case of the brainstem kink. Neurology 2019; 92:e1933-e1934. [PMID: 30988092 DOI: 10.1212/wnl.0000000000007320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ratika Srivastava
- From the Department of Pediatrics (R.S.), Division of Neurology, Faculty of Medicine & Dentistry, Edmonton Clinic Health Academy, University of Alberta (F.-D.M.-J.), Edmonton, Canada.
| | - Francois-Dominique Morneau-Jacob
- From the Department of Pediatrics (R.S.), Division of Neurology, Faculty of Medicine & Dentistry, Edmonton Clinic Health Academy, University of Alberta (F.-D.M.-J.), Edmonton, Canada
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7
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Haratz KK, Lerman-Sagie T. Prenatal diagnosis of brainstem anomalies. Eur J Paediatr Neurol 2018; 22:1016-1026. [PMID: 30448280 DOI: 10.1016/j.ejpn.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
Prenatal diagnosis of brainstem anomalies is important due to the usually associated neurodevelopmental impairment and genetic implications. The extreme developmental changes that the brainstem and cerebellum undergo during fetal life pose a challenge for the characterization and definition of the different malformations. The present review aims to demonstrate the normal development of the fetal brainstem and to present the main features required for diagnosis of its anomalies according to available data in the medical literature.
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Affiliation(s)
- Karina Krajden Haratz
- Fetal Neurology Clinic, Ultrasound in Ob-Gyn Unit, Wolfson Medical Center, Holon, Israel; Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tally Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in Ob-Gyn Unit, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
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8
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Geva R, Dital A, Ramon D, Yarmolovsky J, Gidron M, Kuint J. Brainstem as a developmental gateway to social attention. J Child Psychol Psychiatry 2017; 58:1351-1359. [PMID: 28504308 DOI: 10.1111/jcpp.12746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Evolution preserves social attention due to its key role in supporting survival. Humans are attracted to social cues from infancy, but the neurobiological mechanisms for the development of social attention are unknown. An evolutionary-based, vertical-hierarchical theoretical model of self-regulation suggests that neonatal brainstem inputs are key for the development of well-regulated social attention. METHODS Neonates born preterm (N = 44, GA 34 w.) were recruited and diagnosed at birth as a function of their auditory brainstem evoked responses (ABR). Participants enrolled in a prospective 8-year-long, double-blind, follow-up study comparing participants with brainstem dysfunctions and well-matched controls. Groups had comparable fetal, neonatal, and familial characteristics. Methods incorporated EEG power analysis and gaze tracking during the Attention Network Test (ANT, four cue types, and two targets) and a Triadic Gaze Engagement task (TGE, three social cue levels). RESULTS Results showed that neonatal brainstem compromise is related to long-term changes in Alpha- and Theta-band power asymmetries (p < .034, p < .016, respectively), suggesting suppressed bottom-up input needed to alert social attention. Gaze tracking indicated dysregulated arousal-modulated attention (p < .004) and difficulty in gaze engagement to socially neutral compared to nonsocial cues (p < .012). CONCLUSIONS Integrating models of Autism and cross-species data with current long-term follow-up of infants with discrete neonatal brainstem dysfunction suggests neonatal brainstem input as a gateway for bottom-up regulation of social attention.
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Affiliation(s)
- Ronny Geva
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.,The Gonda Multidisciplinary Brain Research Center Bar Ilan University, Ramat Gan, Israel
| | - Ayelet Dital
- The Gonda Multidisciplinary Brain Research Center Bar Ilan University, Ramat Gan, Israel
| | - Dan Ramon
- Psychology Department, Ashkelon College, Ashkelon, Israel
| | - Jessica Yarmolovsky
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.,The Gonda Multidisciplinary Brain Research Center Bar Ilan University, Ramat Gan, Israel
| | - Maor Gidron
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.,The Gonda Multidisciplinary Brain Research Center Bar Ilan University, Ramat Gan, Israel
| | - Jacob Kuint
- Neonatology Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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Abstract
Ultrasound and magnetic resonance imaging are the two imaging modalities used in the assessment of the fetus. Ultrasound is the primary imaging modality, whereas magnetic resonance is used in cases of diagnostic uncertainty. Both techniques have advantages and disadvantages and therefore they are complementary. Standard axial ultrasound views of the posterior fossa are used for routine scanning for fetal anomalies, with additional orthogonal views directly and indirectly obtainable using three-dimensional ultrasound techniques. Magnetic resonance imaging allows not only direct orthogonal imaging planes, but also tissue characterization, for example to search for blood breakdown products. We review the nomenclature of several posterior fossa anomalies using standardized criteria, and we review cerebellar abnormalities based on an etiologic classification.
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11
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Lacalm A, Nadaud B, Massoud M, Putoux A, Gaucherand P, Guibaud L. Prenatal diagnosis of cobblestone lissencephaly associated with Walker-Warburg syndrome based on a specific sonographic pattern. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:117-122. [PMID: 26315758 DOI: 10.1002/uog.15735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 06/04/2023]
Abstract
We report a specific sonographic cerebral pattern of cobblestone lissencephaly (CL) that has not been described previously. This pattern was encountered in four index cases and allowed prenatal diagnosis of CL associated with Walker-Warburg syndrome. The pattern included both an outer echogenic band with reduced pericerebral space, corresponding to an infra- and supratentorial extracortical layer of neuroglial overmigration on pathological examination, and a 'Z'-shaped appearance of the brainstem. This pattern was found as early as 14 weeks' gestation in one of our cases.
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Affiliation(s)
- A Lacalm
- Département d'Imagerie Pédiatrique et Fœtale, Hôpital Femme Mère Enfant, Lyon-Bron, France
| | - B Nadaud
- Laboratoire de Pathologie, Hôpital Femme Mère Enfant, Lyon-Bron, France
| | - M Massoud
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant, Lyon-Bron, France
| | - A Putoux
- Département de Génétique, Hôpital Femme Mère Enfant, Lyon-Bron, France
| | - P Gaucherand
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant, Lyon-Bron, France
| | - L Guibaud
- Département d'Imagerie Pédiatrique et Fœtale, Hôpital Femme Mère Enfant, Lyon-Bron, France
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant, Lyon-Bron, France
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12
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Leibovitz Z, Shkolnik C, Haratz KK, Malinger G, Shapiro I, Lerman-Sagie T. Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 2: application of nomograms to fetuses with posterior fossa malformations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:581-587. [PMID: 24478245 DOI: 10.1002/uog.13312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To apply fetal midbrain (MB) and hindbrain (HB) nomograms, developed using three-dimensional multiplanar sonographic reconstruction (3D-MPR) in the mid-sagittal cranial plane, to fetuses with known posterior fossa malformations. METHODS In this retrospective study we examined sonographic volumes obtained by sagittal acquisition in 43 fetuses diagnosed with posterior fossa abnormalities and evaluated in the mid-sagittal cranial plane, using 3D-MPR, the following: MB parameters tectal length (TL) and anteroposterior midbrain diameter (APMD), and HB parameters anteroposterior pons diameter (APPD), superoinferior vermian diameter (SIVD) and anteroposterior vermian diameter (APVD). Fetuses were grouped, according to malformation, into eight categories: cobblestone malformation complex (CMC, n = 3), Chiari-II malformation (C-II, n = 7), pontocerebellar hypoplasia (PCH, n = 2), rhombencephalosynapsis (RES, n = 4), Dandy-Walker malformation (n = 8), vermian dysgenesis (VD, n = 7), persistent Blake's pouch cyst (n = 6) and megacisterna magna (n = 6). In each case and for each subgroup, the MB-HB biometric parameters and their z-scores were evaluated with reference to our new nomograms. RESULTS The new MB-HB nomograms were able to identify the brainstem and vermian anomalies and differentiate fetuses with MB-HB malformations from those with isolated enlarged posterior fossa cerebrospinal fluid spaces. Use of the nomograms enabled detection of an elongated tectum in fetuses with CMC, C-II and RES, and a flattened pontine belly in cases of CMC, PCH and VD. In the fetuses with VD, the nomograms enabled division into three distinctive groups: (1) those with small SIVD and APVD, (2) those with normal SIVD but small APVD, and (3) those with small SIVD but normal APVD. CONCLUSIONS Application of our new reference data, that for the first time include the MB, enables accurate diagnosis of brain malformations affecting the MB and HB and makes possible novel characterization of previously described features of posterior fossa anomalies.
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Affiliation(s)
- Z Leibovitz
- Unit of Fetal Neurology and Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
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Abstract
Fetal magnetic resonance imaging (MRI) is used with increasing frequency as a complementary imaging modality to ultrasound (US) in prenatal diagnosis. Fetal MRI displays the fetal, uterine, and extrauterine anatomy in ways that allow confirmation of normal anatomy and the diagnosis of pathological entities that were formerly very difficult to detect prenatally. Comparison of US views with standard orthogonal plane MR images reinforces the understanding of fetal anatomy as visualized with US. Technological advances in US equipment have allowed the recent description of subtle fetal anatomical structures. Similarly, knowledge of the MRI appearances of pathological conditions has opened opportunities for the sonographic diagnosis of entities such as brainstem malformations and alterations in the normal transient laminar pattern that occur during development of the fetal cerebrum. Fetal MRI can confirm suspicious US findings and thus add confidence in a particular prenatal diagnosis before performing invasive and interventional procedures. Specific MRI sequences can be used to add information about the chemical composition of fetal structures, such as fat, blood, and meconium. Dynamic MRI sequences have increased understanding of gestational age-dependent behavior, and assist the sonographer in assessment of fetal structural anomalies that cause abnormal movement and behavior. The technological ability of US to demonstrate very small structures complements the lower resolution of fetal MR images, whereas the ability of MR to visualize the whole fetus improves the limited views necessitated by US. Therefore, both US and fetal MRI have complementary strengths and weaknesses that can be used to full advantage in prenatal diagnosis.
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14
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Saleem SN. Fetal magnetic resonance imaging (MRI): a tool for a better understanding of normal and abnormal brain development. J Child Neurol 2013; 28:890-908. [PMID: 23644716 DOI: 10.1177/0883073813486296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Knowledge of the anatomy of the developing fetal brain is essential to detect abnormalities and understand their pathogenesis. Capability of magnetic resonance imaging (MRI) to visualize the brain in utero and to differentiate between its various tissues makes fetal MRI a potential diagnostic and research tool for the developing brain. This article provides an approach to understand the normal and abnormal brain development through schematic interpretation of fetal brain MR images. MRI is a potential screening tool in the second trimester of pregnancies in fetuses at risk for brain anomalies and helps in describing new brain syndromes with in utero presentation. Accurate interpretation of fetal MRI can provide valuable information that helps genetic counseling, facilitates management decisions, and guides therapy. Fetal MRI can help in better understanding the pathogenesis of fetal brain malformations and can support research that could lead to disease-specific interventions.
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Affiliation(s)
- Sahar N Saleem
- Department of Radiology, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
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15
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Howe DT, Rankin J, Draper ES. Schizencephaly prevalence, prenatal diagnosis and clues to etiology: a register-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:75-82. [PMID: 21647999 DOI: 10.1002/uog.9069] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To establish the prevalence and antenatal diagnosis of schizencephaly in the UK. METHODS Data on schizencephaly were extracted from six regional congenital anomaly registers. RESULTS Thirty-eight cases of schizencephaly were identified in 2 567 165 livebirths and stillbirths, giving a total prevalence of 1.48/100 000 births (95% CI, 1.01-1.95). Eighteen (47% (95% CI, 31-63%)) of the 38 cases were identified antenatally. No affected fetus had an abnormal karyotype identified. A high proportion of cases of schizencephaly occurred in younger mothers: 63% were aged 24 years or less, significantly higher (P < 0.0001) than the corresponding proportion (26%) of mothers in England and Wales. The majority of cases were not identified until after 22 weeks of pregnancy. Additional anomalies associated with vascular disruption sequences were found in eight cases which had septo-optic dysplasia or absent septum pellucidum, one of which also had gastroschisis. CONCLUSIONS Schizencephaly occurs more frequently in the fetuses of younger mothers. It is often associated with septo-optic dysplasia, suggesting that the two conditions may share a common origin, arising as a result of destructive processes that cause changes in the brain which only become apparent on ultrasound in the second half of pregnancy.
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Affiliation(s)
- D T Howe
- Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton, UK.
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16
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Dhouib A, Blondiaux E, Moutard ML, Billette de Villemeur T, Chalard F, Jouannic JM, Ducou le Pointe H, Garel C. Correlation between pre- and postnatal cerebral magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:170-178. [PMID: 21240911 DOI: 10.1002/uog.8937] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of fetal cerebral magnetic resonance imaging (MRI) on a large cohort and to compare pre- and postnatal MRI data. METHODS This prospective study included all cases referred to our unit for fetal cerebral MRI examination between June 2006 and December 2009 and which underwent at least one postnatal MRI examination. Cases in which there was termination of pregnancy, fetal death or stillbirth were excluded. The pre- and postnatal diagnoses established by MRI were compared and divided into five subgroups: same diagnosis on pre- and postnatal MRI (Group 1); same diagnosis but different appearance related to the natural course of the disease (Group 2); different diagnosis (related to limitations of fetal MRI) (Group 3); same diagnosis but with additional findings discovered on postnatal MRI examination (Group 4); or same diagnosis but different appearance related to the natural course of the disease (as in Group 2) and associated with additional findings discovered on postnatal MRI examination (Group 5). The prognostic impact of a possible disagreement between pre- and postnatal findings was evaluated. RESULTS One hundred fetuses were included. Fetal MRI was performed at a mean gestational age of 33 (range, 24-39) weeks and postnatal MRI at a mean age of 3.5 months. There were 53 cases classified as Group 1, 32 in Group 2, four in Group 3, 10 in Group 4 and one in Group 5. Thus, in 15 cases (Groups 3-5), there were discrepancies between pre- and postnatal findings (mostly related to corpus callosum anatomy, cortical and migration disorders). The discrepancy was judged to have a prognostic impact in 9/15 cases. Two postnatal MRI examinations were performed in eight cases, in one of which the second examination showed subependymal heterotopia which were not detectable on the first examination. CONCLUSION Pre- and postnatal MRI data showed good agreement in 85% of cases. There was disagreement with a prognostic impact in 9% of cases.
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Affiliation(s)
- A Dhouib
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Service de Radiologie, Paris, France
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17
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Posterior fossa malformations: main features and limits in prenatal diagnosis. Pediatr Radiol 2010; 40:1038-45. [PMID: 20432023 DOI: 10.1007/s00247-010-1617-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 01/06/2010] [Indexed: 12/11/2022]
Abstract
Posterior fossa (PF) malformations are commonly observed during prenatal screening. Their understanding requires knowledge of the main steps of PF development and knowledge of normal patterns in US and MR imaging. The vast majority of PF malformations can be strongly suspected by acquiring a midline sagittal slice and a transverse slice and by systematically scrutinizing the elements of the PF: cerebellar vermis, hemispheres, brainstem, fourth ventricle, PF fluid spaces and tentorium. Analysis of cerebellar echogenicity and biometry is also useful. This review explains how to approach the diagnosis of the main PF malformations by performing these two slices and answering six key questions about the elements of the PF. The main imaging characteristics of PF malformations are also reviewed.
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18
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Abstract
Prenatal ultrasound has concentrated on readily visible cerebral structures including head size, shape, ventricles, CSP (cavum septi pellucidi), cerebellar size/vermian presence and cisterna magna. However, apart from these easily visible structures it is important to evaluate the brain itself. Patients who initially appear to have mild isolated findings such as borderline ventriculomegaly in fact can have many more subtle findings that significantly alter prognosis and management that can be detected on detailed examination of the brain. There has been rapid evolution in imaging these foetuses, especially with neurosonography and MRI, and a revolution in understanding the underlying genetic and biochemical mechanisms. There is increasing emphasis to detect cortical abnormalities as early as possible. This article reviews development of the cerebral cortex, the classification, aetiologies and clinical manifestations of cortical disorders, normal and abnormal appearances at ultrasound and MRI, and approaches to investigation.
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Affiliation(s)
- Ants Toi
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.
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19
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Guibaud L. Contribution of fetal cerebral MRI for diagnosis of structural anomalies. Prenat Diagn 2009; 29:420-33. [PMID: 19156685 DOI: 10.1002/pd.2171] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
More than 20 years after its introduction, magnetic resonance imaging (MRI) is now considered a useful complementary tool in the imaging work-up of fetal brain structural anomalies, but its real contribution in neuro-fetal imaging is still controversial. Our purpose is to present an overview of the most valuable indications of fetal cerebral MRI in current practice as guided by dedicated ultrasound analysis. On the basis of a review of the literature and our personal experience, we underline herein the real complementarities between these two techniques in different clinical or imaging settings and show how MRI adds significant information compared with ultrasound, especially in the late second and third trimesters. We assess the interest of using MRI from a technical point of view (complete and extensive anatomical analysis, analysis of developmental and pathological processes) and from a practical point of view in different imaging and clinical settings.
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Affiliation(s)
- Laurent Guibaud
- Imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon I, 59, Boulevard Pinel, 69677 Lyon-Bron, France.
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20
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Malinger G, Lev D, Lerman-Sagie T. The fetal cerebellum. Pitfalls in diagnosis and management. Prenat Diagn 2009; 29:372-80. [DOI: 10.1002/pd.2196] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Strigini F, Valleriani A, Cecchi M, Ghirri P, Aiello C, Bertini E, Cioni G, Battini R. Prenatal ultrasound and magnetic resonance imaging features in a fetus with Walker-Warburg syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:363-365. [PMID: 19222032 DOI: 10.1002/uog.6300] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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22
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Pugash D, Brugger PC, Bettelheim D, Prayer D. Prenatal ultrasound and fetal MRI: the comparative value of each modality in prenatal diagnosis. Eur J Radiol 2008; 68:214-26. [PMID: 18790583 DOI: 10.1016/j.ejrad.2008.06.031] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 06/23/2008] [Indexed: 11/24/2022]
Abstract
Fetal MRI is used with increasing frequency as an adjunct to ultrasound (US) in prenatal diagnosis. In this review, we discuss the relative value of both prenatal US and MRI in evaluating fetal and extra-fetal structures for a variety of clinical indications. Advantages and disadvantages of each imaging modality are addressed. In summary, MRI has advantages in demonstrating pathology of the brain, lungs, complex syndromes, and conditions associated with reduction of amniotic fluid. At present, US is the imaging method of choice during the first trimester, and in the diagnosis of cardiovascular abnormalities, as well as for screening. In some conditions, such as late gestational age, increased maternal body mass index, skeletal dysplasia, and metabolic disease, neither imaging method may provide sufficient diagnostic information.
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Affiliation(s)
- Denise Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada.
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23
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Affiliation(s)
- Catherine Garel
- Service de Radiologie Pédiatrique, Hôpital d'Enfants Armand-Trousseau, 26-28 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France.
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24
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Affiliation(s)
- Tim Jaspan
- B Floor, Imaging Centre, University Hospital, Nottingham, NG7 2UH, UK.
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25
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Robinson AJ, Blaser S, Toi A, Chitayat D, Halliday W, Pantazi S, Gundogan M, Laughlin S, Ryan G. The Fetal Cerebellar Vermis. Ultrasound Q 2007; 23:211-23. [PMID: 17805192 DOI: 10.1097/ruq.0b013e31814b162c] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fetal magnetic resonance provides a new tool in the imaging of the posterior fossa and is proving useful in cases that are difficult to assess sonographically by allowing further assessment of the fourth ventricle, cisterna magna, and vermian growth and development. We describe various criteria with which to evaluate vermian growth, including vermian biometry and the relationship between the superior and inferior lobes. We demonstrate 2 markers of normal vermian development: the primary fissure and fastigial point. We illustrate the tegmento-vermian angle, "closure" of the fourth ventricle, and communication of the fourth ventricle with the basal cisterns during development and in several disorders. We correlate those features with the expected embryological course of development and illustrate identification of these features and associated abnormalities of the posterior fossa, brain stem, and central nervous system in mid-trimester scans of fetuses with abnormal development. Correlation with contemporaneous ultrasound examinations is demonstrated.
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Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, Vancouver V6H 3V4, Canada.
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26
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Prayer D, Brugger P, Kasprian G. The Pediatric Posterior Fossa: Fetal MRI. Neuroradiol J 2007; 20:403-9. [DOI: 10.1177/197140090702000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 07/23/2007] [Indexed: 11/17/2022] Open
Affiliation(s)
- D. Prayer
- Department of Neuroradiology, University Clinics of Radiodiagnostics, Vienna, Austria
| | - P.C. Brugger
- Center for Anatomy and Cell Biology, Vienna, Austria
| | - G. Kasprian
- Department of Conservative and Childhood Radiology, University Clinics of Radiodiagnostics Medical University; Vienna, Austria
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27
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Bibliography. Current world literature. Maternal-fetal medicine. Curr Opin Obstet Gynecol 2007; 19:196-201. [PMID: 17353689 DOI: 10.1097/gco.0b013e32812142e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Abstract
Ultrasonography is the primary prenatal screening modality used in the evaluation of the fetus and the maternal pelvis. However, fetal MR imaging plays a complementary role to prenatal ultrasound in the evaluation of the fetus with suspected abnormalities. MR imaging's role includes confirming or excluding possible lesions, defining their full extent, aiding in their characterization, and demonstrating other associated abnormalities. As newer techniques such as diffusion imaging, MR spectroscopy, and functional studies are used more widely, it is hoped that additional information will be made available by this modality to physicians evaluating and taking care of fetuses.
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Affiliation(s)
- Rosalind B Dietrich
- Department of Radiology, University of California, San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA.
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