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Whitehead MT, Barkovich MJ, Sidpra J, Alves CA, Mirsky DM, Öztekin Ö, Bhattacharya D, Lucato LT, Sudhakar S, Taranath A, Andronikou S, Prabhu SP, Aldinger KA, Haldipur P, Millen KJ, Barkovich AJ, Boltshauser E, Dobyns WB, Mankad K. Refining the Neuroimaging Definition of the Dandy-Walker Phenotype. AJNR Am J Neuroradiol 2022; 43:1488-1493. [PMID: 36137655 PMCID: PMC9575531 DOI: 10.3174/ajnr.a7659] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The traditionally described Dandy-Walker malformation comprises a range of cerebellar and posterior fossa abnormalities with variable clinical severity. We aimed to establish updated imaging criteria for Dandy-Walker malformation on the basis of cerebellar development. MATERIALS AND METHODS In this multicenter study, retrospective MR imaging examinations from fetuses and children previously diagnosed with Dandy-Walker malformation or vermian hypoplasia were re-evaluated, using the choroid plexus/tela choroidea location and the fastigial recess shape to differentiate Dandy-Walker malformation from vermian hypoplasia. Multiple additional measures of the posterior fossa and cerebellum were also obtained and compared between Dandy-Walker malformation and other diagnoses. RESULTS Four hundred forty-six examinations were analyzed (174 fetal and 272 postnatal). The most common diagnoses were Dandy-Walker malformation (78%), vermian hypoplasia (14%), vermian hypoplasia with Blake pouch cyst (9%), and Blake pouch cyst (4%). Most measures were significant differentiators of Dandy-Walker malformation from non-Dandy-Walker malformation both pre- and postnatally (P < .01); the tegmentovermian and fastigial recess angles were the most significant quantitative measures. Posterior fossa perimeter and vascular injury evidence were not significant differentiators pre- or postnatally (P > .3). The superior posterior fossa angle, torcular location, and vermian height differentiated groups postnatally (P < .01), but not prenatally (P > .07). CONCLUSIONS As confirmed by objective measures, the modern Dandy-Walker malformation phenotype is best defined by inferior predominant vermian hypoplasia, an enlarged tegmentovermian angle, inferolateral displacement of the tela choroidea/choroid plexus, an obtuse fastigial recess, and an unpaired caudal lobule. Posterior fossa size and torcular location should be eliminated from the diagnostic criteria. This refined phenotype may help guide future study of the numerous etiologies and varied clinical outcomes.
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Affiliation(s)
- M T Whitehead
- From the Department of Radiology (M.T.W.)
- Prenatal Pediatrics Institute (M.T.W.), Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences (M.T.W.), Washington DC
- Division of Neuroradiology (M.T.W., C.A.A., S.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, Perelman School of Medicine (M.T.W., S.A), University of Pennsylvania, Philadelphia, Pennsylvania
| | - M J Barkovich
- Department of Radiology and Biomedical Imaging (M.J.B., A.J.B.) University of California, San Francisco, San Francisco, California
- Neuroradiology Section (M.J.B., A.J.B.), University of California, San Francisco-Benioff Children's Hospital, San Francisco, California
| | - J Sidpra
- Developmental Biology and Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - C A Alves
- Division of Neuroradiology (M.T.W., C.A.A., S.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - D M Mirsky
- Department of Radiology (D.M.M.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Ö Öztekin
- Department of Neuroradiology (Ö.Ö.), Bakırçay University, Çiğli Education and Research Hospital, İzmir, Turkey
| | - D Bhattacharya
- Department of Neuroradiology (D.B.), Royal Victoria Hospital, Belfast, UK
| | - L T Lucato
- Division of Diagnostic Neuroradiology (L.T.L.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S Sudhakar
- Department of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - A Taranath
- Department of Medical Imaging (A.T.), Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Faculty of Medicine (A.T.), University of Adelaide, Adelaide, South Australia, Australia
| | - S Andronikou
- Division of Neuroradiology (M.T.W., C.A.A., S.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, Perelman School of Medicine (M.T.W., S.A), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S P Prabhu
- Department of Neuroradiology (S.P.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K A Aldinger
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
| | - P Haldipur
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
| | - K J Millen
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- University of Washington School of Medicine (K.J.M.), Seattle, Washington
| | - A J Barkovich
- Department of Radiology and Biomedical Imaging (M.J.B., A.J.B.) University of California, San Francisco, San Francisco, California
- Neuroradiology Section (M.J.B., A.J.B.), University of California, San Francisco-Benioff Children's Hospital, San Francisco, California
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital, Zürich, Switzerland
| | - W B Dobyns
- Department of Genetics and Metabolism (W.B.D.), Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - K Mankad
- Developmental Biology and Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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Whitehead MT, Vezina G, Schlatterer SD, Mulkey SB, du Plessis AJ. Taenia-tela choroidea complex and choroid plexus location help distinguish Dandy-Walker malformation and Blake pouch cysts. Pediatr Radiol 2021; 51:1457-1470. [PMID: 33783580 DOI: 10.1007/s00247-021-04991-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/13/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dandy-Walker malformation and Blake pouch cysts can have overlapping imaging features. The choroid plexus and associated taenia-tela choroidea complex are displaced inferolaterally in Dandy-Walker malformation and below the vermis in Blake pouch cysts. OBJECTIVE To determine the normal fetal and postnatal MR appearance of the choroid plexus and taenia-tela choroidea complex, and whether their location can help distinguish Dandy-Walker malformation from Blake pouch cysts. MATERIALS AND METHODS In this retrospective study, we evaluated brain MR exams from normal-appearing fetuses (gestational age 19-38 weeks) and infants, fetal and postnatal exams in Blake pouch cysts and Dandy-Walker malformation, and ambiguous cases equivocal for mild Dandy-Walker malformation and Blake pouch cysts. We documented choroid plexus and the taenia-tela choroidea complex location and axial and sagittal angles in each case. Then we contrasted and compared the original and updated fetal diagnoses based on taenia-tela choroidea complex and choroid plexus positions. RESULTS The choroid plexus location and the taenia-tela choroidea complex location and angles varied significantly among normal exams, Blake pouch cyst exams and Dandy-Walker malformation exams (P<0.01). Dandy-Walker malformation showed inferolateral displacement of the taenia-tela choroidea complex and choroid plexus distant from the vermis. Adding the taenia-tela choroidea complex and choroid plexus into the assessment improved diagnostic accuracy, especially in ambiguous cases. CONCLUSION The location of the taenia-tela choroidea complex and choroid plexus provided additional diagnostic neuroimaging clues that could be used in conjunction with other conventional findings to distinguish Dandy-Walker malformation and Blake pouch cysts. Normal, Blake pouch cyst, and Dandy-Walker malformation cases differed with regard to taenia-tela choroidea complex and choroid plexus position. Inferolateral taenia-tela choroidea complex displacement distant from the vermian margin was characteristic of Dandy-Walker malformation.
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Affiliation(s)
- Matthew T Whitehead
- Department of Neuroradiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA. .,Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA. .,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Gilbert Vezina
- Department of Neuroradiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.,Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, 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
| | - 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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