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Lerman-Sagie T, Prayer D, Stöcklein S, Malinger G. Fetal cerebellar disorders. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:3-23. [PMID: 29891067 DOI: 10.1016/b978-0-444-64189-2.00001-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The embryologic development of the cerebellum extends over a long time period, thus making it vulnerable to a broad spectrum of malformations and disruptions. Knowledge of the main steps of fetal posterior fossa development; the normal imaging patterns at different stages of embryogenesis; the large spectrum of cerebellar malformations; and their clinical presentations enables diagnosis and precise counseling of parents. Sonography is the most important imaging method for the screening of cerebellar malformations since it is noninvasive, widely available, and safe for both mother and child. The ultrasonographic approach for the evaluation of the fetal posterior fossa is based on the classic transabdominal visualization of axial planes with addition when indicated of a more comprehensive, multiplanar transvaginal or transfundal approach, including coronal and sagittal imaging planes. Fetal magnetic resonance imaging (MRI) has become an adjunct to prenatal ultrasound since the 1980s. Good-quality images have been obtained thanks to the implementation of fast and ultrafast MRI sequences. Fetal MRI has higher-contrast resolution than prenatal sonography and may contribute to the differentiation of normal from abnormal tissue. Both prenatal neurosonography and fetal MRI enable accurate prenatal diagnosis of most posterior fossa anomalies.
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Affiliation(s)
- Tally Lerman-Sagie
- Fetal Neurology Clinic, Prenatal Ultrasound Unit, Department of Obstetrics and Gynecology, and Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.
| | - Daniella Prayer
- Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Sophia Stöcklein
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gustavo Malinger
- Fetal Neurology Clinic, Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv, Israel
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Bernardo S, Vinci V, Saldari M, Servadei F, Silvestri E, Giancotti A, Aliberti C, Porpora MG, Triulzi F, Rizzo G, Catalano C, Manganaro L. Dandy-Walker Malformation: is the 'tail sign' the key sign? Prenat Diagn 2015; 35:1358-64. [PMID: 26448595 DOI: 10.1002/pd.4705] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/22/2015] [Accepted: 10/02/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aims to demonstrate the value of the 'tail sign' in the assessment of Dandy-Walker malformation. METHODS A total of 31 fetal magnetic resonance imaging (MRI), performed before 24 weeks of gestation after second-line ultrasound examination between May 2013 and September 2014, were examined retrospectively. All MRI examinations were performed using a 1.5 Tesla magnet without maternal sedation. RESULTS Magnetic resonance imaging diagnosed 15/31 cases of Dandy-Walker malformation, 6/31 of vermian partial caudal agenesis, 2/31 of vermian hypoplasia, 4/31 of vermian malrotation, 2/31 of Walker-Warburg syndrome, 1/31 of Blake pouch cyst and 1/31 of rhombencephalosynapsis. All data were compared with fetopsy results, fetal MRI after the 30th week or postnatal MRI; the follow-up depended on the maternal decision to terminate or continue pregnancy. In our review study, we found the presence of the 'tail sign'; this sign was visible only in Dandy-Walker malformation and Walker-Warburg syndrome. CONCLUSION The 'tail sign' could be helpful in the difficult differential diagnosis between Dandy-Walker, vermian malrotation, vermian hypoplasia and vermian partial agenesis.
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Affiliation(s)
- Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Valeria Vinci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Saldari
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Evelina Silvestri
- Surgical Pathology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Aliberti
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynecological Sciences Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabio Triulzi
- UOC Neuroradiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università Tor Vergata, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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Frick N, Fazelnia C, Kanzian K, Hitzl W, Fischer T, Forstner R, Bogner G. The Reliability of Fetal MRI in the Assessment of Brain Malformations. Fetal Diagn Ther 2014; 37:93-101. [DOI: 10.1159/000363652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/10/2014] [Indexed: 11/19/2022]
Abstract
Objectives: To assess the inter- and intraobserver reliability of different fetal MRI measurements in cases of fetal brain malformations and to examine the concordance between ultrasonography (US) and MRI findings. Methods: Fetal brain MRIs and US findings of 56 pregnant women were retrieved from the institutional database. Standardized fetal brain MRI measurements were performed by 4 observers, and the inter- and intraobserver reliability was determined. Additionally, US and MRI findings were retrospectively compared. Results: The interobserver intraclass correlation coefficient (ICC) was above 0.9 for the cerebellum and posterior horn of the lateral ventricle. The measurements regarding the third ventricle (0.50), the fourth ventricle (0.58), and the corpus callosum (0.63) showed poor reliability. Overall, the intraobserver reliability was greater than the interobserver reliability. US and MRI findings were discordant in 29% of the cases with MRI rendering an extended diagnosis in 18%, a change of diagnosis in 3.6%, and excluding pathological findings suspected on US in 7.1%. Conclusions: Fetal MRI is a valuable complement to US in the investigation of fetal brain malformations. The reliability of most parameters was high, except for the measurements of the third and fourth ventricles and the corpus callosum.
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Robinson AJ. Inferior vermian hypoplasia--preconception, misconception. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:123-136. [PMID: 24497418 DOI: 10.1002/uog.13296] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, 4480 Oak Street, Vancouver, V6H 3V4, Canada.
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Leibovitz Z, Haratz KK, Malinger G, Shapiro I, Pressman C. Fetal posterior fossa dimensions: normal and anomalous development assessed in mid-sagittal cranial plane by three-dimensional multiplanar sonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:147-153. [PMID: 23671019 DOI: 10.1002/uog.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 04/19/2013] [Accepted: 05/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To construct nomograms of the dimensions of the fetal posterior fossa (PF), assessed in the mid-sagittal plane in the second and third trimesters, and to assess how measurements from fetuses with PF abnormalities deviate from our normal ranges. METHODS This was a prospective cross-sectional study of 378 healthy fetuses in low-risk singleton pregnancies between 15 and 35 weeks. PF size was evaluated in the mid-sagittal plane of the fetal head using three-dimensional multiplanar reconstruction (3D-MPR). The borders of the PF were defined from the clivus to the tentorium (clivotentorial distance, CTD) and from the occipital bone to the level of the upper mesencephalic edge (tecto-occipital distance, TOD), and the posterior fossa area (PFA) and perimeter (PFP) were assessed. Growth charts were produced. Thirty-nine fetuses diagnosed with PF malformations were analyzed by calculating the z-scores of PFA, PFP, TOD and CTD, relative to the developed nomograms. RESULTS Of the 378 healthy fetuses initially included, there were 281 with adequate visualization of the PF borders; i.e. PF mid-sagittal plane morphometry was feasible in 74.3% of cases. There was a linear relationship between each of PFA, PFP, TOD and CTD, and gestational age, with Pearson correlation coefficients of 0.97, 0.97, 0.96 and 0.95, respectively (P < 0.001 for each). Chiari II malformation (CM-II) and Dandy-Walker malformation (DWM) were associated with the greatest difference in PF size compared with normal; PFA z-scores exceeded 2.6 in all five DWM cases and were below -2.66 in all 11 CM-II cases. CONCLUSIONS Sonographic evaluation of fetal PF size in the mid-sagittal plane is feasible. Our constructed nomograms provide reference data that may be helpful when evaluating PF congenital malformations.
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Affiliation(s)
- Z Leibovitz
- Division of Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
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Araujo Júnior E, Martins WP, Rolo LC, Pires CR, Zanforlin Filho SM. Normative data for fetal cisterna magna length measurement between 18 and 24 weeks of pregnancy. Childs Nerv Syst 2014; 30:9-12. [PMID: 24122018 DOI: 10.1007/s00381-013-2298-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine normative data for fetal cisterna magna length (CML) measurement in a Brazilian population. METHODS This was a retrospective cross-sectional study on 3,862 normal singleton pregnancies between the 18th and 24th weeks of pregnancy. Fetal CML was measured in the axial plane of the fetal head, at lateral ventricle level, including the cavum septum pellucidum, thalamus, third ventricle, and transverse cerebellar diameter. The anteroposterior measurement was made between the posterior border of the cerebellar vermis and the internal face of the occipital bone. To assess the correlation between CML and gestational age (GA), polynomial equations were calculated, with adjustments using determination coefficient (R2). RESULTS The mean CML ranged from 4.29±0.93 mm at 18 to 18+6 weeks to 5.58±1.23 mm at 24 to 24+6 weeks of pregnancy. There was a good correlation between CML and GA, best represented by a linear equation: CML=0.535+0.208*GA (R2=0.084). CONCLUSION We established normative data for fetal CML in the second trimester of pregnancy, in a large Brazilian population.
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Ghi T, Contro E, De Musso F, Farina A, Conturso R, Bonasoni P, Salsi G, Youssef A, Rizzo N, Pilu G. Normal morphometry of fetal posterior fossa at midtrimester: brainstem-tentorium angle and brainstem-vermis angle. Prenat Diagn 2012; 32:440-3. [DOI: 10.1002/pd.3834] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tullio Ghi
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Elena Contro
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Francesca De Musso
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Antonio Farina
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | | | - Paola Bonasoni
- Pathology Unit; Arcispedale S.Maria Nuova; Reggio Emilia; Italy
| | - Ginevra Salsi
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Aly Youssef
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Gianluigi Pilu
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
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Chapman T, Matesan M, Weinberger E, Bulas DI. Digital atlas of fetal brain MRI. Pediatr Radiol 2010; 40:153-62. [PMID: 19774370 DOI: 10.1007/s00247-009-1411-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 07/31/2009] [Accepted: 08/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fetal MRI can be performed in the second and third trimesters. During this time, the fetal brain undergoes profound structural changes. Interpretation of appropriate development might require comparison with normal age-based models. Consultation of a hard-copy atlas is limited by the inability to compare multiple ages simultaneously. OBJECTIVE To provide images of normal fetal brains from weeks 18 through 37 in a digital format that can be reviewed interactively. This will facilitate recognition of abnormal brain development. MATERIALS AND METHODS T2-W images for the atlas were obtained from fetal MR studies of normal brains scanned for other indications from 2005 to 2007. Images were oriented in standard axial, coronal and sagittal projections, with laterality established by situs. Gestational age was determined by last menstrual period, earliest US measurements and sonogram performed on the same day as the MR. The software program used for viewing the atlas, written in C#, permits linked scrolling and resizing the images. Simultaneous comparison of varying gestational ages is permissible. RESULTS Fetal brain images across gestational ages 18 to 37 weeks are provided as an interactive digital atlas and are available for free download from http://radiology.seattlechildrens.org/teaching/fetal_brain . CONCLUSION Improved interpretation of fetal brain abnormalities can be facilitated by the use of digital atlas cataloging of the normal changes throughout fetal development. Here we provide a description of the atlas and a discussion of normal fetal brain development.
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Affiliation(s)
- Teresa Chapman
- Seattle Children's Hospital, Department of Radiology, MS R-5417, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Tepper R, Kidron D, Hershkovitz R. Sonographic measurements of the fetal fastigium between 20 and 40 weeks' gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1657-1661. [PMID: 19933479 DOI: 10.7863/jum.2009.28.12.1657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to establish a new reference angle chart for fastigial biometric measurements throughout gestation in normal singleton pregnancies. METHODS A prospective cohort study was designed. A total of 505 pregnant women between 20 and 40 weeks' gestation were included in the study. Excluded were those with multiple pregnancies, congenital anomalies, abnormal karyotypes, and polyhydramnios or oligohydramnios. Transvaginal or transabdominal sonography was performed in the midsagittal plane of the brain. RESULTS The angle of the fastigium was found to be 30 degrees to 60 degrees throughout pregnancy. These data were found to be constant during the progression of pregnancy without any significant changes. CONCLUSIONS Fastigial measurements throughout pregnancy are presented. Its angle is constant throughout pregnancy. Evaluation of the fastigium may assist in cases of subtle posterior fossa anomalies.
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Affiliation(s)
- Ronnie Tepper
- Department of Obstetrics and Gynecology, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Kfar-Saba, Israel
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