1
|
Gafner M, Haddad L, Gupta R, Leibovitz Z, Zilberman Ron I, Ben-Sira L, Libzon S, Gindes L, Boltshauser E, Lerman-Sagie T. Hydrocephalus associated with a molar tooth sign: A distinct subtype of Joubert syndrome. Dev Med Child Neurol 2024; 66:948-957. [PMID: 38247023 DOI: 10.1111/dmcn.15845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
Hydrocephalus is rarely described in Joubert-Boltshauser syndrome (JBTS). The aim of this study was to investigate whether this association is a chance occurrence or potentially signifies a new phenotypic subtype. The databases of Wolfson Medical Center, Sourasky Medical Center, and EB's personal collection were reviewed. Records from an additional family were obtained from RG. The patients' medical records, prenatal ultrasounds, and magnetic resonance imaging were assessed. In addition, we reviewed the medical literature for the association of ventriculomegaly/hydrocephalus (VM/HC) in JBTS. Only seven cases (from five families) were found with prenatal onset of VM/HC, diagnosed during the second trimester; three pregnancies were terminated, one was stillborn and three were born, of which one died within a week, and another died at the age of 6 years. Additional central nervous system findings included dysgenesis of the corpus callosum, delayed sulcation, polymicrogyria, and pachygyria. We found 16 publications describing 54 patients with JBTS and VM/HC: only five were diagnosed at birth and three were diagnosed prenatally. Hydrocephalus is extremely rare in JBTS. The recurrence of this association, reported in several publications in multiple family members, suggests that it might represent a new phenotypic subtype of JBTS possibly associated with specific genes or variants. Further genetic studies are needed to confirm this hypothesis. WHAT THIS PAPER ADDS: The association of fetal hydrocephalus with Joubert-Boltshauser syndrome (JBTS) is very rare but not a chance association. This association represents a new phenotypic subtype of JBTS possibly linked to specific genes or variants.
Collapse
Affiliation(s)
- Michal Gafner
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leila Haddad
- Foetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
| | - Rachna Gupta
- Sunehri Devi Hospital, Sonipat, India
- Indraprastha Apollo Hospital, New Delhi, India
| | - Zvi Leibovitz
- Obstetrics & Gynecology Ultrasound Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion- Israel Institute, Haifa, Israel
| | | | - Liat Ben-Sira
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Radiology Unit, Sourasky Medical Center, Tel Aviv, Israel
| | - Stephanie Libzon
- Pediatric Radiology Unit, Sourasky Medical Center, Tel Aviv, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - Liat Gindes
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Foetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Obstetrics & Gynecology Ultrasound Unit, Wolfson Medical Center, Haifa, Israel
| | - Eugen Boltshauser
- Pediatric Neurology (Emeritus), Children's University, Zürich, Switzerland
| | - Tally Lerman-Sagie
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Foetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| |
Collapse
|
2
|
Olson IR, Hoffman LJ, Jobson KR, Popal HS, Wang Y. Little brain, little minds: The big role of the cerebellum in social development. Dev Cogn Neurosci 2023; 60:101238. [PMID: 37004475 PMCID: PMC10067769 DOI: 10.1016/j.dcn.2023.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Seminal work in the 1990's found alterations in the cerebellum of individuals with social disorders including autism spectrum disorder and schizophrenia. In neurotypical populations, distinct portions of the posterior cerebellum are consistently activated in fMRI studies of social cognition and it has been hypothesized that the cerebellum plays an essential role in social cognition, particularly in theory of mind. Here we review the lesion literature and find that the effect of cerebellar damage on social cognition is strongly linked to the age of insult, with dramatic impairments observed after prenatal insult, strong deficits observed after childhood damage, and mild and inconsistent deficits observed following damage to the adult cerebellum. To explain the developmental gradient, we propose that early in life, the forward model dominates cerebellar computations. The forward model learns and uses errors to help build schemas of our interpersonal worlds. Subsequently, we argue that once these schemas have been built up, the inverse model, which is the foundation of automatic processing, becomes dominant. We provide suggestions for how to test this, and also outline directions for future research.
Collapse
Affiliation(s)
- Ingrid R Olson
- Department of Psychology and Neuroscience, Temple University, Philadephia PA, USA.
| | - Linda J Hoffman
- Department of Psychology and Neuroscience, Temple University, Philadephia PA, USA
| | - Katie R Jobson
- Department of Psychology and Neuroscience, Temple University, Philadephia PA, USA
| | - Haroon S Popal
- Department of Psychology and Neuroscience, Temple University, Philadephia PA, USA
| | - Yin Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| |
Collapse
|
3
|
Huang LX, Lu XG, Liu JX, Xu L, Shang N, Guo L, OuYang YC. Case report and a brief review: Analysis and challenges of prenatal imaging phenotypes and genotypes in Joubert syndrome. Front Genet 2022; 13:1038274. [DOI: 10.3389/fgene.2022.1038274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Prenatal imaging phenotypes and genotypes were analyzed in 13 cases prenatally diagnosed with Joubert syndrome (JS), all of which underwent magnetic resonance imaging (MRI), ultrasound, and genetic testing. Prenatal MRI diagnosed 10 cases as JS with a typical molar tooth sign (MTS), while prenatal ultrasound diagnosed or suspiciously diagnosed 11 cases as JS with typical or mild MTS in 10 cases. Mutations in JS-related genes and other prenatal JS imaging phenotypes were identified in 10 cases, including OFD1 in two cases [cerebellar vermis (CV) absence, posterior fossa dilation, ventriculomegaly, polydactyly, malformations of cortical development (MCD), and persistent left superior vena cava], TMEM67 in two cases (CV absence, polydactyly, hyperechoic kidneys or polycystic kidneys, posterior fossa dilation, and ventriculomegaly), CC2D2A in two cases (CV absence, polydactyly, MCD, agenesis of the corpus callosum, encephalocele and hydrocephalus, ventriculomegaly, and posterior fossa dilation), RPGRIP1L in one case (CV absence), TCTN3 in one case (CV absence, polydactyly, MCD, and posterior fossa dilation), CEP290 in one case (CV absence and polycystic kidney), and NPHP1 in one case (CV absence). The prenatal diagnosis of JS presents a number of challenges, including the variants of unknown significance, the lack of functional assessment in prenatal imaging, unclear phenotype–genotype relationships in prenatal evaluation, and the incorrect identification of the JS hallmark, the MTS, in prenatal imaging, especially on ultrasound. Although combined MRI, ultrasound, and exome sequencing could help improve the prenatal diagnosis of JS, there still exist significant challenges.
Collapse
|
4
|
Birnbaum R, Barzilay R, Brusilov M, Acharya P, Malinger G, Krajden Haratz K. Early second-trimester three-dimensional transvaginal neurosonography of fetal midbrain and hindbrain: normative data and technical aspects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:317-324. [PMID: 34002885 DOI: 10.1002/uog.23691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To provide a detailed description of the sonographic appearance and development of various fetal structures of the midbrain and hindbrain (MBHB) during the early second trimester, and to evaluate the impact of the frequency of the transvaginal sonography (TVS) transducer on the early recognition of these structures. METHODS This was a retrospective analysis of three-dimensional volumetric datasets of the MBHB from apparently normal fetuses at 14-19 gestational weeks, acquired by TVS in the midsagittal view through the posterior fontanelle. Using a multiplanar approach, we measured the tectal thickness and length, aqueductal thickness, tegmental thickness and width and height of the Blake's pouch (BP) neck. In addition, we assessed the existence of early vermian fissures, the linear shape of the brainstem and the components of the fastigium. The correlation between gestational age according to last menstrual period and sonographic measurements of MBHB structures was evaluated using Pearson's correlation (r). A subanalysis was performed to assess the performance of a 5-9-MHz vs a 6-12-MHz TVS transducer in visualizing the MBHB structures in the early second trimester. RESULTS Sixty brain volumes were included in the study, obtained at a mean gestational age of 16.2 weeks (range, 14.1-19.0 weeks), with a transverse cerebellar diameter range of 13.0-19.8 mm. We found a strong correlation between gestational age and all MBHB measurements, with the exception of the tectal, tegmental and aqueductal thicknesses, for which the correlation was moderate. There was good-to-excellent intraobserver and moderate-to-good interobserver correlation for most MBHB measurements. We observed that the BP neck was patent in all fetuses between 14 and 18 weeks with decreasing diameter, and that the aqueductal thickness was significantly smaller at ≥ 18 weeks compared with at < 16 weeks. The early vermian fissures and the linear shape of the brainstem were present in all fetuses from 14 weeks. We found that, in the early second trimester, the horizontal arm of the presumed 'fastigium' evolves from the fourth ventricular choroid plexus and not the posterior vermis, indicating that this is not the fastigium. Standard- and high-resolution TVS transducers performed similarly in the assessment of MBHB anatomy. CONCLUSION Detailed early second-trimester assessment of the MBHB is feasible by transvaginal neurosonography and provides reference data which may help in the early detection of brain pathology involving the MBHB. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- R Birnbaum
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Barzilay
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - M Brusilov
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Acharya
- Paras Advanced Center for Fetal Medicine, Ahmedabad, India
| | - G Malinger
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Krajden Haratz
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
5
|
Salsi G, Volpe G, Montaguti E, Fanelli T, Toni F, Maffei M, Votino C, Pompilii E, Pilu G, Volpe P. Isolated Upward Rotation of the Fetal Cerebellar Vermis (Blake's Pouch Cyst) Is a Normal Variant: An Analysis of 111 Cases. Fetal Diagn Ther 2021; 48:485-492. [PMID: 34182549 DOI: 10.1159/000516807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of the study was to provide more detailed data about fetal isolated upward rotation of the cerebellar vermis rotation (Blake's pouch cyst) in particular regarding pregnancy outcome. METHODS This is a retrospective study of all cases of fetal isolated upward rotation of the cerebellar vermis (URCV) diagnosed in 3 referral centers in Italy from January 2009 to November 2019. Whenever possible, prenatal magnetic resonance imaging (MRI) was performed and a fetal karyotype was obtained. A detailed follow-up was obtained by consultation of medical records, interview with the parents, and the pediatricians. RESULTS Our study population included 111 patients with a prenatal diagnosis of isolated URCV made at a median gestational age of 21 weeks +3 days (interquartile range (IQR) 21 + 0-22 + 2). The median brain stem-vermis (BV) angle was 27° (IQR 24-29°). In 37.9% of the cases, a regression of the finding with restoration of normal anatomy was noted at a follow-up scan or at postnatal checks. A BV angle of 25° or less predicted regression with a probability in excess of 90%. MRI was performed in utero or at birth in 101 patients and always confirmed sonographic diagnosis. Fetal CGH array and/or karyotype was available in 97 cases and was always normal, but in 1 case. A postnatal follow-up was available in 102 infants (mean 7 months, range 0-10 years of age) and documented a normal neurologic development in all the cases. CONCLUSIONS Isolated URCV is most likely a normal variant of fetal anatomy without clinical consequences, at least at an early follow-up. A BV angle of 25° or less predicts intrauterine regression of the finding, but the outcome is good in all the cases. When a confident sonographic diagnosis is made, MRI is not mandatory. The risk of a chromosomal anomaly in these cases is probably low.
Collapse
Affiliation(s)
- Ginevra Salsi
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy
| | - Grazia Volpe
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST, Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Elisa Montaguti
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy
| | - Tiziana Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UDC Neuroradiologia, Bologna, Italy
| | - Monica Maffei
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UDC Neuroradiologia, Bologna, Italy
| | - Carmela Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Eva Pompilii
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy.,Gynepro Medical, Bologna, Italy
| | - Gianluigi Pilu
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| |
Collapse
|
6
|
Schlatterer SD, Sanapo L, du Plessis AJ, Whitehead MT, Mulkey SB. The Role of Fetal MRI for Suspected Anomalies of the Posterior Fossa. Pediatr Neurol 2021; 117:10-18. [PMID: 33607354 DOI: 10.1016/j.pediatrneurol.2021.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Posterior fossa anomalies can be diagnostic dilemmas during the fetal period. The prognosis for different diagnoses of the posterior fossa varies widely. We investigated whether fetal magnetic resonance imaging (MRI) and prenatal neurology consultation led to an alternate prognosis for fetuses referred due to concern for a fetal posterior fossa anomaly and concordance between pre- and postnatal diagnoses. METHODS This is a retrospective study of cases referred to the Prenatal Pediatrics Institute at Children's National Hospital from January 2012 to June 2018 due to concern for posterior fossa anomaly. Each encounter was scored for change in prognosis based upon clinical and fetal MRI report. Postnatal imaging was compared with prenatal imaging when available. RESULTS In total, 180 cases were referred for fetal posterior fossa anomalies based on outside obstetric ultrasound and had both fetal MRI and a neurology consultation. Fetal MRI and neurology consultation resulted in a change in fetal prognosis in 70% of cases. The most common referral diagnosis in our cohort was Dandy-Walker continuum, but it was not often confirmed by fetal MRI. In complex cases, posterior fossa diagnosis and prognosis determined by fetal MRI impacted choices regarding pregnancy management. Postnatal imaging was obtained in 57 (47%) live-born infants. Fetal and postnatal prognoses were similar in 60%. CONCLUSIONS Fetal diagnosis affects pregnancy management decisions. The fetal-postnatal imaging agreement of 60% highlights the conundrum of balancing the timing of fetal MRI to provide the most accurate diagnosis of the posterior fossa abnormalities in time to make pregnancy management decisions.
Collapse
Affiliation(s)
- Sarah D Schlatterer
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Laura Sanapo
- Women's Medicine Collaborative-Division of Research, The Miriam Hospital, Providence, Rhode Island; Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adre J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matthew T Whitehead
- Department of Neuroradiology, Children's National Hospital, Washington, District of Columbia; Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| |
Collapse
|
7
|
Prenatal Ultrasonographic Molar Tooth Sign: Case Reports and Review of Literature. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:476-484. [PMID: 32870591 DOI: 10.1002/uog.22145] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G.Gaslini, Genoa, Italy
| | - K K Haratz
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Monteagudo
- Carnegie Imaging for Women, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G L Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
| |
Collapse
|
9
|
Milani HJF, Barreto EQDS, Araujo Júnior E, Peixoto AB, Nardozza LMM, Moron AF. Ultrasonographic evaluation of the fetal central nervous system: review of guidelines. Radiol Bras 2019; 52:176-181. [PMID: 31210692 PMCID: PMC6561375 DOI: 10.1590/0100-3984.2018.0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Central nervous system malformations constitute the second most common group of
anomalies in fetuses. Such malformations have assumed clinical importance
because of their association with high rates of perinatal morbidity and
mortality. Therefore, it is extremely important to assess the fetal central
nervous system during the prenatal period, in order to identify any changes in
its development and thereby gain sufficient information to advise parents about
pregnancy follow-up, options for fetal therapy, and the timing/type of delivery,
as well as the postnatal treatment and prognosis. The objective of this review
was to describe the ultrasonographic evaluation of the fetal central nervous
system as per the guidelines of the International Society of Ultrasound in
Obstetrics and Gynecology.
Collapse
Affiliation(s)
- Hérbene José Figuinha Milani
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Enoch Quindere de Sá Barreto
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | | | - Antonio Fernandes Moron
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| |
Collapse
|
10
|
Abstract
Prenatal imaging of the central nervous system has proven to be essential in the detection of anomalies to guide counseling and intrauterine and postnatal therapies. However, understanding the appearance of normal is important because the fetal brain changes dramatically during the pregnancy. In this review, normal imaging of the brain with ultrasound and MR imaging is discussed. The initial section stresses techniques for both modalities. The second section describes ultrasound and MR landmarks in a normal fetal brain.
Collapse
Affiliation(s)
- Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| |
Collapse
|
11
|
Diagnosis of Joubert Syndrome 10 in a Fetus with Suspected Dandy-Walker Variant by WES: A Novel Splicing Mutation in OFD1. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4032543. [PMID: 30581852 PMCID: PMC6276521 DOI: 10.1155/2018/4032543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/09/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022]
Abstract
Joubert syndrome (JBTS) is a clinically and genetically heterogeneous group of ciliary diseases. To date, 34 subtypes of JBTS have been classified due to different causative genes or extra clinical features. Most of them are autosomal recessive, while only the subtype 10 (JBTS10) is a quite rare X-linked recessive disorder caused by OFD1 mutations with few reports. In this study, by using whole exome sequencing (WES), a novel OFD1 splicing mutation (c.2488+2T>C) was identified in a male fetus with suspected Dandy-Walker variant (DWV) and syndactyly, for whom abnormal karyotype and pathogenic CNV have been excluded. This mutation was inherited from the mother who has experienced two similar pregnancies before. An abnormal skipping of exon 18 in OFD1 mRNA was confirmed by RT-PCR and sequencing. Result from quantitative RT-PCR also showed that total OFD1 mRNA in the index fetus was significantly lower than the control. After a combined analysis of genetic testing results and genotype-phenotype correlations, the novel mutation c.2488+2T>C in OFD1 was considered to be the genetic cause for the affected fetus. Thus the diagnosis should be JBTS10 rather than the primary clinical diagnosis of DWV. We report the first prenatal case of JBTS10 in Chinese population, which not only helps the family to predict recurrence risks for future pregnancies but also provides more information for understanding such a rare disease. The results also present evidence that WES is an effective method in prenatal diagnosis for those fetuses with Joubert syndrome.
Collapse
|
12
|
Xie JX, You JH, Chen XK, Su YM, Liu JR, Su SS, Hou M, Lv GR. Three-dimensional sonographic minute structure analysis of fetal cerebellar vermis development and malformations: utilizing volume contrast imaging. J Med Ultrason (2001) 2018; 46:113-122. [PMID: 30291575 DOI: 10.1007/s10396-018-0906-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To obtain three-dimensional ultrasonic (3D US) structural details and biometrics of the fetal cerebellar vermis and evaluate the value of developmental and malformation identification. METHODS The 3D US minute structure of the fetal cerebellar vermis in mid-sagittal view was detected in normal fetuses (n = 438; 16-41 weeks). Biometric sizes were measured to establish the stage-specific norms and reproducibility analysis. Additionally, 28 fetuses with suspected abnormal posterior fossa contents were assessed to analyze the clinical value. RESULTS The minute structure of normal fetuses, including cerebellar vermis contours and the fastigial recess of the fourth ventricle, were visible around Week 19. The main lobules and fissures were apparent around Week 22, and all nine lobules, fissures, and the fourth ventricle were clearly displayed by Week 28. Cerebellar vermis biometric sizes (anterior-posterior length, cranio-caudal length, circumference, and surface area (SA)) grew in a linear fashion with high reliability, especially SA measurements (for intraclass, ICC 0.989, 95% CI (0.980-0.994); for interclass, ICC 0.992, 95% CI (0.984-0.996)). On the middle sagittal section of 3D US, the SA reduced at least 50% in the Dandy-Walker group with no recognizable cerebellar vermis structures showing. The SA in vermian hypoplasia malformation reduced during [Formula: see text] to 50% with the primary/secondary fissures absent or partly absent and arborization of the lobules reduced. That would be an important diagnosis and antidiastole clue. Combined with minute structural observation, sonographic diagnoses were accurate in 88% of cases. CONCLUSION Minute structures obtained by 3D US were clinically useful in the evaluation of cerebellar vermis development and cerebellar vermis malformations.
Collapse
Affiliation(s)
- Jing-Xian Xie
- Department of Obstetrics and Gynecology, Xiamen Maternity and Child Health Care Hospital, Xiamen, 361000, Fujian, People's Republic of China
| | - Jian-Hong You
- Department of Ultrasound, Zhongshan Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Xiao-Kang Chen
- Department of Ultrasound, Children's Hospital of Fudan University Xiamen Branch, Xiamen Children's Hospital, Xiamen, 361000, Fujian, People's Republic of China
| | - Yi-Ming Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Jin-Rong Liu
- Department of Ultrasound, Guangzhou Women and Children Medical Center, Guangzhou, 510000, People's Republic of China
| | - Shan-Shan Su
- Department of Ultrasound, The Second Clinical Medical College of Fujian Medical University, Quanzhou, 362000, Fujian, People's Republic of China
| | - Min Hou
- Department of Ultrasound, Affiliated Hospital of Hebei University, Baoding, 071000, People's Republic of China
| | - Guo-Rong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian, People's Republic of China.
- , Quanzhou, People's Republic of China.
| |
Collapse
|
13
|
Wüest A, Surbek D, Wiest R, Weisstanner C, Bonel H, Steinlin M, Raio L, Tutschek B. Enlarged posterior fossa on prenatal imaging: differential diagnosis, associated anomalies and postnatal outcome. Acta Obstet Gynecol Scand 2017; 96:837-843. [DOI: 10.1111/aogs.13131] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 03/07/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Anja Wüest
- Department of Obstetrics and Gynecology; Inselspital; University of Bern; Bern Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology; Inselspital; University of Bern; Bern Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - Christian Weisstanner
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - Harald Bonel
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - Maja Steinlin
- Division of Pediatric Neurology; Inselspital; University of Bern; Bern Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology; Inselspital; University of Bern; Bern Switzerland
| | - Boris Tutschek
- Prenatal Zürich; Zürich Switzerland
- Medical Faculty; Heinrich Heine University; Düsseldorf Germany
| |
Collapse
|
14
|
Buke B, Canverenler E, İpek G, Canverenler S, Akkaya H. Diagnosis of Joubert syndrome via ultrasonography. J Med Ultrason (2001) 2016; 44:197-202. [DOI: 10.1007/s10396-016-0751-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/26/2016] [Indexed: 01/25/2023]
|
15
|
Abstract
The human cerebellum has a protracted development that makes it vulnerable to a broad spectrum of developmental disorders including malformations and disruptions. Starting from 19 to 20 weeks of gestation, prenatal magnetic resonance imaging (MRI) can reliably study the developing cerebellum. Pre- and postnatal neuroimaging plays a key role in the diagnostic work-up of congenital cerebellar abnormalities. Diagnostic criteria for cerebellar malformations and disruptions are based mostly on neuroimaging findings. The diagnosis of a Dandy-Walker malformation is based on the presence of hypoplasia, elevation, and counterclockwise upward rotation of the cerebellar vermis and cystic dilatation of the fourth ventricle, which extends posteriorly filling out the posterior fossa. For the diagnosis of Joubert syndrome, the presence of the molar tooth sign (thickened, elongated, and horizontally orientated superior cerebellar peduncles and an abnormally deep interpeduncular fossa) is needed. The diagnostic criteria of rhombencephalosynapsis include a complete or partial absence of the cerebellar vermis and continuity of the cerebellar hemispheres across the midline. Unilateral cerebellar hypoplasia is defined by the complete aplasia or hypoplasia of one cerebellar hemisphere. Familiarity with these diagnostic criteria as well as the broad spectrum of additional neuroimaging findings is important for a correct pre- and postnatal diagnosis. A correct diagnosis is essential for management, prognosis, and counseling of the affected children and their family.
Collapse
|
16
|
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.
Collapse
|
17
|
Gezer C, Ekin A, Sinem Gezer N, Solmaz U, Ozeren M. Quantitative Evaluation of the Fetal Cerebellar Vermis Using the Median View on Two-Dimensional Ultrasound. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e34870. [PMID: 27703661 PMCID: PMC5037970 DOI: 10.5812/iranjradiol.34870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022]
Abstract
Background Evaluation of the cerebellum and vermis is one of the integral parts of the fetal cranial anomaly screening. Objectives The aim of this study was to create a nomogram for fetal vermis measurements between 17 and 30 gestational weeks. Patients and Methods This prospective study was conducted on 171 volunteer pregnant women between March 2013 and December 2014. Measurements of the fetal cerebellar vermis diameters in the sagittal plane were performed by two-dimensional transabdominal ultrasonography. Results Optimal median planes were obtained in 117 of the cases. Vermian diameters as a function of gestational age were expressed by regression equations and the correlation coefficients were found to be highly statistically significant (P < 0.001). The normal mean (± standard deviation) for each gestational week was also defined. Conclusion This study presents the normal range of the two-dimensional fetal vermian measurements between 17 and 30 gestational weeks. In the absence of a three-dimensional ultrasonography, two-dimensional ultrasonography could also be used confidently with more time and effort.
Collapse
Affiliation(s)
- Cenk Gezer
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
- Corresponding author: Cenk Gezer, Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey. Tel: +90-5325239130, E-mail:
| | - Atalay Ekin
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Naciye Sinem Gezer
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ulas Solmaz
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Ozeren
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
18
|
Cignini P, Giorlandino M, Brutti P, Mangiafico L, Aloisi A, Giorlandino C. Reference Charts for Fetal Cerebellar Vermis Height: A Prospective Cross-Sectional Study of 10605 Fetuses. PLoS One 2016; 11:e0147528. [PMID: 26812238 PMCID: PMC4727931 DOI: 10.1371/journal.pone.0147528] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/27/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To establish reference charts for fetal cerebellar vermis height in an unselected population. METHODS A prospective cross-sectional study between September 2009 and December 2014 was carried out at ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy. Of 25203 fetal biometric measurements, 12167 (48%) measurements of the cerebellar vermis were available. After excluding 1562 (12.8%) measurements, a total of 10605 (87.2%) fetuses were considered and analyzed once only. Parametric and nonparametric quantile regression models were used for the statistical analysis. In order to evaluate the robustness of the proposed reference charts regarding various distributional assumptions on the ultrasound measurements at hand, we compared the gestational age-specific reference curves we produced through the statistical methods used. Normal mean height based on parametric and nonparametric methods were defined for each week of gestation and the regression equation expressing the height of the cerebellar vermis as a function of gestational age was calculated. Finally the correlation between dimension/gestation was measured. RESULTS The mean height of the cerebellar vermis was 12.7mm (SD, 1.6mm; 95% confidence interval, 12.7-12.8mm). The regression equation expressing the height of the CV as a function of the gestational age was: height (mm) = -4.85+0.78 x gestational age. The correlation between dimension/gestation was expressed by the coefficient r = 0.87. CONCLUSION This is the first prospective cross-sectional study on fetal cerebellar vermis biometry with such a large sample size reported in literature. It is a detailed statistical survey and contains new centile-based reference charts for fetal height of cerebellar vermis measurements.
Collapse
Affiliation(s)
- Pietro Cignini
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| | - Maurizio Giorlandino
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| | - Pierpaolo Brutti
- Department of Statistics, Sapienza University of Rome, Rome, Italy
| | - Lucia Mangiafico
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| | - Alessia Aloisi
- Department of Obstetrics and Gynecology, Campus Biomedico University of Rome, Rome, Italy
| | - Claudio Giorlandino
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| |
Collapse
|
19
|
Differential diagnosis of ventriculomegaly and brainstem kinking on fetal MRI. Brain Dev 2016; 38:103-8. [PMID: 26013959 DOI: 10.1016/j.braindev.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/05/2015] [Accepted: 05/10/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fetal ventriculomegaly is a common and frequently leading neuroimaging finding in complex brain malformations. Here we report on pre- and postnatal neuroimaging findings in three fetuses with prenatal ventriculomegaly and brainstem kinking. We aim to identify key neuroimaging features that may allow the prenatal differentiation between diseases associated with fetal ventriculomegaly and brainstem kinking. METHODS All pre- and postnatal magnetic resonance imaging (MRI) data were qualitatively evaluated for infra- and supratentorial abnormalities. Data about clinical features and genetic findings were collected from clinical histories. RESULTS In all three patients, fetal MRI showed ventriculomegaly and brainstem kinking. In two patients, postnatal MRI also showed supratentorial migration abnormalities and eye abnormalities were found. In these children, the diagnosis of α-dystroglycanopathy was genetically confirmed. In the third patient, basal ganglia had an abnormal shape on MRI suggesting a tubulinopathy. CONCLUSION The differential diagnosis of prenatal ventriculomegaly and brainstem kinking includes α-dystroglycanopathies, X-linked hydrocephalus due to mutations in L1CAM, and tubulinopathies. The prenatal differentiation between these diseases may be difficult. The presence of ocular abnormalities on prenatal neuroimaging may favor α-dystroglycanopathies, while dysplastic basal ganglia may suggest a tubulinopathy. However, in some patients the final differentiation between these diseases is possible only postnatally.
Collapse
|
20
|
The Midline Sagittal View of Fetal Brain: Moving from 3D to 2D. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
21
|
Karl K, Heling KS, Chaoui R. Fluid Area Measurements in the Posterior Fossa at 11-13 Weeks in Normal Fetuses and Fetuses with Open Spina Bifida. Fetal Diagn Ther 2015; 37:289-93. [DOI: 10.1159/000365989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022]
Abstract
Objectives: To measure the area of the intracranial translucency (IT) (syn: 4th ventricle) and the future cisterna magna (CM) in normal fetuses and to compare with fetuses with open spina bifida. Patients: In the midsagittal plane of the face of 220 fetuses between 11 and 13 weeks' gestation, the areas of the IT and CM were measured and the sum, defined as the posterior fossa fluid (PFF) area was calculated. Reference ranges were constructed in relation to the crown-rump length. The study group consisted of 21 fetuses with open spina bifida and showed in all cases a single pocket of fluid in the posterior fossa. Fetuses with no fluid in the fossa were excluded. This PFF-area was measured and compared with the reference range of the IT-area and the PFF-area of normal fetuses and Z-scores were calculated. Results: In normal fetuses, a significant increase of the IT-, the CM- and the PFF-area was found as a sign of the expanding posterior fossa. The mean PFF-area increased from 8.55 to 29.72 mm2 in the observation period. Fetuses with open spina bifida had reduced fluid in the posterior fossa with values ranging between 2.39 and 5.08 mm2 and significantly lower Z-scores. Conclusions: Fetuses with open spina bifida have an abnormally small posterior fossa at 11-13 weeks' and in cases where the cerebrospinal fluid is still present, the fluid area in the midsagittal plane is reduced when compared to normal fetuses. Area fluid assessment can be an additional useful measurement in suspicious cases for open spina bifida in early gestation.
Collapse
|
22
|
Chapman T, Mahalingam S, Ishak GE, Nixon JN, Siebert J, Dighe MK. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: Part 1, normal anatomy and classification of anomalies. Clin Imaging 2015; 39:1-8. [DOI: 10.1016/j.clinimag.2014.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
|
23
|
Ritner JA, Frates MC. Fetal CNS: a systematic approach. Radiol Clin North Am 2014; 52:1253-64. [PMID: 25444104 DOI: 10.1016/j.rcl.2014.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prenatal sonography is routinely used to evaluate fetal biometry and anatomy between 16 and 20 weeks. Ventriculomegaly is easily seen on these routine views and is commonly associated with numerous intracranial anomalies. Although ventriculomegaly can be isolated, it should always prompt a detailed search to evaluate for an underlying cause. Using a systematic approach to evaluate the intracranial structures can help the clinician arrive at a correct diagnosis for many abnormalities of central nervous system.
Collapse
Affiliation(s)
- Julie A Ritner
- Department of Ultrasound, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Mary C Frates
- Department of Ultrasound, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
24
|
Meng X, Xie L. Quantitative evaluation of fetal brainstem-vermis and brainstem-tentorium angles by three-dimensional ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2076-2081. [PMID: 24996575 DOI: 10.1016/j.ultrasmedbio.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine reference values and ranges for brainstem-vermis (BV) angle and brainstem-tentorium (BT) angle and to assess the correlation among these angles, fetal gender and gestational age (GA) in 221 fetuses between 20 and 37 wk. The angles of the BV and BT were measured on the mid-sagittal view of the fetal head in normally developed Chinese fetuses. The ultrasound measurements, the fetal gender and the GA were collected for statistical analysis. Rank sum test revealed no significant differences in the measurements of the BV and the BT angles with respect to gender (all p > 0.05). Spearman rank correlation analysis showed no GA effect on the BV and the BT angles with correlation coefficients (r) of 0.05 (p > 0.05) and 0.09 (p > 0.05). The 95% reference ranges of the BV and the BT angles were 8.7° (4.5°-18.0°) and 28.0° (21.3°-43.8°), respectively. The newly established reference ranges may facilitate differential diagnosis of fetuses with suspected posterior fossa anomalies in the second and third trimesters.
Collapse
Affiliation(s)
- Xinyue Meng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Limei Xie
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
25
|
Plunk MR, Chapman T. The fundamentals of fetal MR imaging: Part 1. Curr Probl Diagn Radiol 2014; 43:331-46. [PMID: 25060713 DOI: 10.1067/j.cpradiol.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
Congenital malformations detected in any fetal system using ultrasound may be further evaluated with magnetic resonance imaging (MRI) to improve counseling, to plan deliveries appropriately, and sometimes to enable fetal interventions. In this first half of a 2-part review, the history and safety factors regarding fetal MRI, as well as the practical aspects of image acquisition, are discussed. In addition, as central nervous system anomalies are most commonly and best evaluated using fetal MRI, challenging central nervous system anomalies, such as fetal ventriculomegaly, posterior anomalies, and neural tube defects, detected using prenatal ultrasound are also reviewed with a focus on the fundamental implications of these diagnoses.
Collapse
Affiliation(s)
- Matthew R Plunk
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Teresa Chapman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Department of Radiology, Seattle Children׳s Hospital, Seattle, WA.
| |
Collapse
|
26
|
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.
| |
Collapse
|
27
|
Contro E, Volpe P, De Musso F, Muto B, Ghi T, De Robertis V, Pilu G. Open fourth ventricle prior to 20 weeks' gestation: a benign finding? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:154-158. [PMID: 24151160 DOI: 10.1002/uog.13227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/12/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the role of the brainstem-vermis (BV) angle in the diagnosis of fetal posterior fossa abnormalities at 15-18 weeks' gestation. METHODS We examined retrospectively three-dimensional (3D) ultrasound volumes acquired at 15-18 gestational weeks in fetuses with normal posterior fossa (controls) and in those with cystic posterior fossa. Whether the fourth ventricle appeared open posteriorly in axial views was noted and the BV angle was measured. A detailed follow-up was obtained in all cases. RESULTS Of the 139 controls, 46 cases were excluded because of inadequate quality of the 3D volumes. Of the 93 remaining normal fetuses, 84 (90.3%) had a closed fourth ventricle and a BV angle < 20°, whereas 9/93 (9.7%) had an open fourth ventricle and a BV angle between 20° and 37°. The study group of 11 fetuses included seven with Dandy-Walker malformation and four with Blake's pouch cyst. In abnormal cases as a whole, the BV angle was significantly increased compared with that in controls (P < 0.0001). However, fetuses with Blake's pouch cyst and normal fetuses with an open fourth ventricle had strikingly similar sonograms: the BV angle was between 20° and 37° and the fourth ventricle appeared open only when viewed using a more steeply angulated scanning plane than that of the standard transcerebellar plane; in fetuses with Dandy-Walker malformation the fourth ventricle was widely open posteriorly, even in the standard transcerebellar view, and the BV angle was > 45°, significantly increased compared both with that in normal fetuses (P < 0.0001) and with that in fetuses with Blake's pouch cyst (P = 0.004). CONCLUSION An open fourth ventricle is found in about 10% of normal fetuses at 15-18 weeks' gestation. Measurement of the BV angle is useful in such cases, as a value ≥ 45° is associated with a very high risk of severe posterior fossa malformation.
Collapse
Affiliation(s)
- E Contro
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | |
Collapse
|
28
|
Tarui T, Limperopoulos C, Sullivan NR, Robertson RL, du Plessis AJ. Long-term developmental outcome of children with a fetal diagnosis of isolated inferior vermian hypoplasia. Arch Dis Child Fetal Neonatal Ed 2014; 99:F54-8. [PMID: 23964086 PMCID: PMC4570471 DOI: 10.1136/archdischild-2013-304054] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Isolated inferior vermian hypoplasia (iiVH) is one of the most common fetal cerebellar anomalies presenting for fetal neurological counselling with controversial postnatal neurodevelopmental outcome. In the present study, we characterised the long-term neurodevelopmental outcome of prenatally diagnosed iiVH at school age. DESIGN AND PATIENTS We prospectively followed 20 children with fetal MRI diagnosis of iiVH including their postnatal MRI result and developmental outcome at school age (mean 6.1 years±1.9 years SD) using a comprehensive age-appropriate developmental testing battery, which encompassed cognitive, language, social and behavioural domains. Parental stress level and socioeconomic status were also evaluated. RESULTS All children with postnatally confirmed iiVH had a normal neurodevelopmental outcome. A subgroup of children (2/20) who demonstrated cognitive delays and behavioural impairments had more extensive cerebellar malformation. Despite a normal developmental outcome, the parents of children with postnatally confirmed iiVH had higher parental stress compared with those parents whose children had normal postnatal MRI. CONCLUSIONS Children with postnatally confirmed iiVH show age appropriate functioning at school age. Postnatal MRI is important to confirm the diagnosis of iiVH and to exclude associated anomalies that impact neurodevelopmental outcome. A diagnosis of iiVH is associated with persistent elevated parental stress despite normal developmental outcomes in these children suggesting the need for ongoing parental support.
Collapse
Affiliation(s)
- Tomo Tarui
- Pediatric Neurology, Department of Pediatrics, Floating Hospital for Children, Tufts University School of Medicine, Boston, Massachusetts, USA,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine Limperopoulos
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA,Department of Fetal and Transitional Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Nancy R Sullivan
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard L Robertson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adre J du Plessis
- Department of Fetal and Transitional Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
29
|
Bornstein E, Goncalves Rodríguez JL, Álvarez Pavón EC, Quiroga H, Or D, Divon MY. First-trimester sonographic findings associated with a Dandy-Walker malformation and inferior vermian hypoplasia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1863-1868. [PMID: 24065268 DOI: 10.7863/ultra.32.10.1863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report 2 cases in which first-trimester measurements of the intracranial translucency and the brain stem-to-occipital bone diameter were markedly enlarged. This finding was thought to represent an abnormal fourth ventricle-cisterna magna complex. Subsequently, the diagnoses of a Dandy-Walker malformation with partial vermian agenesis in 1 case and inferior vermian hypoplasia in the other were established and confirmed by either postmortem autopsy or postnatal magnetic resonance imaging. These cases suggest that evaluation of the fourth ventricle-cisterna magna complex, by measuring the intracranial translucency or brain stem-to-occipital bone diameter may identify some cases with structural malformations of the cerebellum as early as the first trimester.
Collapse
Affiliation(s)
- Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, North Shore-LIJ, 130 E 77th St, New York, NY 10075 USA.
| | | | | | | | | | | |
Collapse
|
30
|
Gandolfi Colleoni G, Contro E, Carletti A, Ghi T, Campobasso G, Rembouskos G, Volpe G, Pilu G, Volpe P. Prenatal diagnosis and outcome of fetal posterior fossa fluid collections. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:625-631. [PMID: 22173885 DOI: 10.1002/uog.11071] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the accuracy of fetal imaging in differentiating between diagnoses involving posterior fossa fluid collections and to investigate the postnatal outcome of affected infants. METHODS This was a retrospective study of fetuses with posterior fossa fluid collections, carried out between 2001 and 2010 in two referral centers for prenatal diagnosis. All fetuses underwent multiplanar neurosonography. Parents were also offered fetal magnetic resonance imaging (MRI) and karyotyping. Prenatal diagnosis was compared with autopsy or postnatal MRI findings and detailed follow-up was attempted by consultation of medical records and interview with parents and pediatricians. RESULTS During the study period, 105 fetuses were examined, at a mean gestational age of 24 (range, 17-28) weeks. Sonographic diagnoses (Blake's pouch cyst, n = 32; megacisterna magna, n = 27; Dandy-Walker malformation, n = 26; vermian hypoplasia, n = 17; cerebellar hypoplasia, n = 2; arachnoid cyst, n = 1) were accurate in 88% of the 65 cases in which confirmation was possible. MRI proved more informative than ultrasound in only 1/51 cases. Anatomic anomalies and/or chromosomal aberrations were found in 43% of cases. Blake's pouch cysts and megacisterna magna underwent spontaneous resolution in utero in one third of cases and over 90% of survivors without associated anomalies had normal developmental outcome at 1-5 years. Isolated Dandy-Walker malformation and vermian hypoplasia were associated with normal developmental outcome in only 50% of cases. CONCLUSION Prenatal neurosonography and MRI are similarly accurate in the categorization of posterior fossa fluid collections from mid gestation. Blake's pouch cyst and megacisterna magna are risk factors for associated anomalies but when isolated have an excellent prognosis, with a high probability of intrauterine resolution and normal intellectual development in almost all cases. Conversely, Dandy-Walker malformation and vermian hypoplasia, even when they appear isolated antenatally, are associated with an abnormal outcome in half of cases.
Collapse
Affiliation(s)
- G Gandolfi Colleoni
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Tan S, Ipek A. Detailed ultrasound screening in the second trimester: pictorial essay of normal fetal anatomy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:280-300. [PMID: 22508380 DOI: 10.1002/jcu.21918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 02/21/2012] [Indexed: 05/31/2023]
Abstract
Today, ultrasound is the main diagnostic tool in the prenatal detection of congenital abnormalities. Therefore, ultrasound examination should be offered to all pregnant women. A detailed sonographic examination of the fetus is usually performed between 18 and 22 weeks of pregnancy. The accurate recognition of normal fetal anatomy is very important for the detection of both minor and major defects. The purpose of this pictorial essay is to show fetal anatomic structures, which have to be examined between the 18(th) and 22(nd) weeks of pregnancy, and present their standard measurements systematically and thoroughly in accordance with sonographically obtained ideal sections.
Collapse
Affiliation(s)
- Sinan Tan
- Department of Radiology, Ataturk Research and Education Hospital, Ankara, Turkey
| | | |
Collapse
|
32
|
O'Connor SC, Rooks VJ, Smith AB. Magnetic resonance imaging of the fetal central nervous system, head, neck, and chest. Semin Ultrasound CT MR 2012; 33:86-101. [PMID: 22264906 DOI: 10.1053/j.sult.2011.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnetic resonance imaging (MRI) has become an important tool in the assessment of fetal anomalies. Although ultrasound remains the modality of choice for screening, MRI offers several advantages that permit optimal characterization of anomalies in certain situations. Accurate recognition and characterization of fetal anomalies guides decisions about pregnancy management and coordination of postnatal care. This article will briefly review safety and practical aspects of fetal MRI. We will then provide a concise summary of the most common indications for fetal MRI, and discuss the differential diagnosis and role of MRI in assessment of fetal brain, head, neck, spine, and chest anomalies.
Collapse
Affiliation(s)
- Stephen C O'Connor
- Department of Radiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA. Stephen.o'
| | | | | |
Collapse
|
33
|
Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A. One case of increased intracranial translucency during the first trimester associated with the Dandy-Walker variant. Prenat Diagn 2012; 32:602-3. [DOI: 10.1002/pd.3868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 11/10/2022]
|
34
|
Guibaud L, Larroque A, Ville D, Sanlaville D, Till M, Gaucherand P, Pracros JP, Portes V. Prenatal diagnosis of ‘isolated’ Dandy-Walker malformation: imaging findings and prenatal counselling. Prenat Diagn 2012; 32:185-93. [DOI: 10.1002/pd.3828] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Anne Larroque
- Département d'Imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant; Université Claude Bernard Lyon I; Lyon; France
| | - Dorothée Ville
- Département de Neuropédiatrie, Hôpital Femme Mère Enfant; Université Claude Bernard Lyon I; Lyon; France
| | | | - Marianne Till
- Laboratoire de Cytogénétique Constitutionnelle, Hôpital Femme Mère Enfant; Université Claude Bernard Lyon I; Lyon; France
| | - Pascal Gaucherand
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant; Université Claude Bernard Lyon I; Lyon; France
| | - Jean-Pierre Pracros
- Département d'Imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant; Université Claude Bernard Lyon I; Lyon; France
| | | |
Collapse
|
35
|
|
36
|
Patek KJ, Kline-Fath BM, Hopkin RJ, Pilipenko VV, Crombleholme TM, Spaeth CG. Posterior fossa anomalies diagnosed with fetal MRI: Associated anomalies and neurodevelopmental outcomes. Prenat Diagn 2012; 32:75-82. [DOI: 10.1002/pd.2911] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kyla J. Patek
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Beth M. Kline-Fath
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Robert J. Hopkin
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Valentina V. Pilipenko
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Timothy M. Crombleholme
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Christine G. Spaeth
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| |
Collapse
|
37
|
Prenatal diagnosis of partial trisomy 3q resulting from t(3;14) in a fetus with multiple anomalies including vermian hypoplasia. Gene 2012; 498:237-41. [PMID: 22366303 DOI: 10.1016/j.gene.2012.01.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 01/19/2012] [Accepted: 01/25/2012] [Indexed: 11/22/2022]
Abstract
While genetic origin of Dandy-Walker complex has not yet fully elucidated, the complex has been known to be associated with structural and chromosomal abnormalities. A partial trisomy 3q was also identified in patients with DWC. 3q duplication syndrome is defined as duplications of large parts of 3q, especially 3q21-qter. Most cases with 3q duplication are diagnosed postnatally and the patients show typical features including various facial dysmorphisms, congenital heart defects, genitourinary malformations, and mental and growth retardation. Here we report a 28 year old nulliparous woman who was referred from the infertility clinic at 21 gestational weeks. Fetal ultrasonographic examination showed various abnormal findings including a ventricular septal defect, hydrocephalus, and hypoplasia of the cerebellar vermis. Fetal chromosome analysis was initially reported as 46,XY,der(14)(?::p11.2→qter). Array CGH followed by FISH allowed precise characterization of the der(14) chromosome and the initial karyotype of the fetus had been changed to 46,XY,add(14)(p11).ish der(14)t(3;14)(q26.1;p11)(tel3q+).arr 3q26.1q29(166249469-199288361)x3. Though further studies are required, gene clusters rather than a single gene might be responsible for the clinical features of the Dandy-Walker complex.
Collapse
|
38
|
Bertucci E, Gindes L, Mazza V, Re C, Lerner-Geva L, Achiron R. Vermian biometric parameters in the normal and abnormal fetal posterior fossa: three-dimensional sonographic study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1403-1410. [PMID: 21968492 DOI: 10.7863/jum.2011.30.10.1403] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purposes of this study were to describe a 3-dimensional sonographic technique for evaluation of the fetal vermis and to compare vermian biometric parameters in fetuses with a normal and an abnormal posterior fossa. METHODS A prospective study was conducted from 2006 through 2008 on 12 fetuses with an abnormal posterior fossa and 73 healthy control fetuses from 18 to 35 weeks' gestation. Three-dimensional scans of the fetal head were performed in the axial plane, using static volume contrast imaging in the C-plane. The vermian perimeter, cross-sectional area, and superoinferior diameter were measured and compared between abnormal and normal fetuses using the Wilcoxon nonparametric test. Linear regression analysis was used to describe trends of the vermis during gestation. The z scores for perimeter, cross-sectional area, and superoinferior diameter measurements in the abnormal posterior fossa group in each 2-week interval were calculated. RESULTS Twelve fetuses with an abnormal posterior fossa were recruited: 3 with a Blake pouch cyst, 1 vermian cyst, 1 enlarged cisterna magna, 2 Dandy-Walker malformation, 4 partial vermian agenesis, and 1 hemicerebellar hypoplasia. The vermian cross-sectional area was reduced significantly in the fetuses with an abnormal posterior fossa compared with the control fetuses starting at 18 to 19 weeks' gestation (P = .01); the mean vermian superoinferior diameter was lower only from 22 to 23 weeks (P = .01); and the mean vermian perimeter was decreased from 28-29 weeks' gestation (P = .03). Linear regression analysis of the parameters showed that fetuses with an abnormal posterior fossa had a statistically significantly lower growth rate than control fetuses during gestation (P < .001). CONCLUSIONS Measurements of the cross-sectional area were more useful than those of the perimeter and superoinferior diameter in distinguishing between fetuses with a normal and an abnormal posterior fossa during the early stages of gestation.
Collapse
Affiliation(s)
- Emma Bertucci
- Prenatal Medicine Unit, Department of Obstetrics and Gynecology, Modena Hospital, Modena and Reggio Emilia University, Largo del Pozzo 71, 41123 Modena, Italy.
| | | | | | | | | | | |
Collapse
|
39
|
Parisi MA. Clinical and molecular features of Joubert syndrome and related disorders. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2010; 151C:326-40. [PMID: 19876931 DOI: 10.1002/ajmg.c.30229] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Joubert syndrome (JBTS; OMIM 213300) is a rare, autosomal recessive disorder characterized by a specific congenital malformation of the hindbrain and a broad spectrum of other phenotypic findings that is now known to be caused by defects in the structure and/or function of the primary cilium. The complex hindbrain malformation that is characteristic of JBTS can be identified on axial magnetic resonance imaging and is known as the molar tooth sign (MTS); other diagnostic criteria include intellectual disability, hypotonia, and often, abnormal respiratory pattern and/or abnormal eye movements. In addition, a broad spectrum of other anomalies characterize Joubert syndrome and related disorders (JSRD), and may include retinal dystrophy, ocular coloboma, oral frenulae and tongue tumors, polydactyly, cystic renal disease (including cystic dysplasia or juvenile nephronophthisis), and congenital hepatic fibrosis. The clinical course can be variable, but most children with this condition survive infancy to reach adulthood. At least eight genes cause JSRD, with some genotype-phenotype correlations emerging, including the association between mutations in the MKS3 gene and hepatic fibrosis characteristic of the JSRD subtype known as COACH syndrome. Several of the causative genes for JSRD are implicated in other ciliary disorders, such as juvenile nephronophthisis and Meckel syndrome, illustrating the close association between these conditions and their overlapping clinical features that reflect a shared etiology involving the primary cilium.
Collapse
Affiliation(s)
- Melissa A Parisi
- Center for Developmental Biology and Perinatal Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Boulevard, Bethesda, MD 20892-7510, USA.
| |
Collapse
|
40
|
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.
Collapse
Affiliation(s)
- Ronnie Tepper
- Department of Obstetrics and Gynecology, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Kfar-Saba, Israel
| | | | | |
Collapse
|
41
|
Monteagudo A, Timor-Tritsch IE. Normal sonographic development of the central nervous system from the second trimester onwards using 2D, 3D and transvaginal sonography. Prenat Diagn 2009; 29:326-39. [PMID: 19003788 DOI: 10.1002/pd.2146] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The developmental changes of the fetal central nervous system (CNS) during the second and third trimesters, specifically the brain, relate mostly to changes in size. However, other changes do occur in the fetal brain during the second and third trimester such as: the union of the cerebellar hemispheres, development of the corpus callosum (CC), and increasing complexity of the cerebral cortex. These changes follow a well-defined developmental timeline recognizable by sonography. The fetal neuroscan can be divided into a 'basic scan' which is performed transabdominally and a 'targeted Exam or neurosonogram' which uses a multiplanar approach, which preferably should be performed transvaginally. During the 'basic scan', several brain structures are imaged in addition to obtaining important biometric measurements. The 'neurosonogram' is a more extensive or detailed fetal study during which the emphasis is on the addition of coronal and sagittal planes. The easiest way to obtain these planes, if the fetus is in a cephalic presentation, is the transvaginal route. Three-dimensional (3D) sonography should, if possible, be performed transvaginally using the multiplanar approach. An added benefit of 3D sonography is the ability to display and render the volume in a variety of ways which may enhance the detection of pathology.
Collapse
Affiliation(s)
- Ana Monteagudo
- Division of Obstetrical and Gynecological Ultrasound, Department of Obstetrics and Gynecology, Professor of Obstetrics and Gynecology, NYU School of Medicine, 530 First Avenue NB9N26, New York, NY 10016, USA.
| | | |
Collapse
|
42
|
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]
|
43
|
Zalel Y, Yagel S, Achiron R, Kivilevich Z, Gindes L. Three-dimensional ultrasonography of the fetal vermis at 18 to 26 weeks' gestation: time of appearance of the primary fissure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1-8. [PMID: 19106349 DOI: 10.7863/jum.2009.28.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to establish the normality of the fetal vermis, ie, the time of appearance of the primary fissure, as well as its measurements between 18 and 26 weeks' gestation, using 3-dimensional (3D) ultrasonography. METHODS A prospective cross-sectional study of normal singleton pregnancies was conducted. Examinations were performed with high-resolution transabdominal ultrasonography using the axial plane in 173 fetuses between 18 and 26 weeks' gestation. Postprocessing measurements of the fetal vermis were done with 4-dimensional software using static volume contrast imaging and tomographic ultrasound imaging in the C-plane. Detection of the primary fissure was evaluated in all cases, and the time of appearance was documented. RESULTS Adequate vermis measurements were obtained in 173 fetuses. Vermian length as a function of gestational age was expressed by regression equations, and the correlation coefficients were found to be highly statistically significant (P < .001). The normal mean +/- 2 SD for each gestational week was defined. The primary fissure was observed at 24 weeks' gestation in all cases, at 22 weeks in 94% of cases, and as early as 18 weeks in 40%. CONCLUSIONS This 3D study documents the appearance of the primary fissure and presents the normal range of vermian measurements, confirming normal development of the fetal vermis starting as early as 18 weeks' gestation. It also shows an easy method for visualizing the vermis with 3D ultrasonography at every gestational week regardless of fetal presentation.
Collapse
Affiliation(s)
- Yaron Zalel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel.
| | | | | | | | | |
Collapse
|
44
|
LAVANYA T, COHEN M, GANDHI SV, FARRELL T, WHITBY EH. A case of a Dandy–Walker variant: the importance of a multidisciplinary team approach using complementary techniques to obtain accurate diagnostic information. Br J Radiol 2008; 81:e242-5. [DOI: 10.1259/bjr/77399621] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
45
|
Tao G, Yew D, Gu T, Liu S, Ma Z, Zhan X, Cheng L, Li C. Sex-related differences in the anteroposterior diameter of the foetal cisterna magna. Clin Radiol 2008; 63:1015-8. [DOI: 10.1016/j.crad.2008.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 02/19/2008] [Accepted: 02/17/2008] [Indexed: 11/17/2022]
|
46
|
How accurately does current fetal imaging identify posterior fossa anomalies? AJR Am J Roentgenol 2008; 190:1637-43. [PMID: 18492918 DOI: 10.2214/ajr.07.3036] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The first objective of our study was to describe the prevalence and spectrum of posterior fossa anomalies over 5 years in a major fetal care center where the referral diagnosis (by fetal sonography) was investigated by fetal MRI and, if confirmed, by postnatal MRI if possible. The second objective was to assess the accuracy with which fetal MRI predicts postnatal MRI findings in this population. MATERIALS AND METHODS We retrospectively identified all cases of suspected fetal posterior fossa anomalies referred to our center from 2002 through 2006. We reviewed maternal, fetal, neonatal, and follow-up records of all cases and fetal and early postnatal imaging studies. RESULTS Of the 90 cases of suspected fetal posterior fossa anomalies (by fetal sonography) referred over the study period, 60 (67%) were confirmed by fetal MRI. Of 42 live-born infants, 39 (93%) underwent postnatal MRI. There was complete agreement in fetal and postnatal MRI diagnoses in 23 infants (59%). In 16 cases (41%), fetal and postnatal MRI diagnoses disagreed; postnatal MRI excluded fetal MRI diagnoses in six cases (15%) and revealed additional anomalies in 10 cases (26%). CONCLUSION Although a valuable adjunct to fetal sonography in cases of suspected posterior fossa anomaly, current fetal MRI, particularly in early gestation, has limitations in accurately predicting postnatal MRI abnormalities. Advancing the accuracy of MRI for the diagnosis of posterior fossa anomalies will require greater understanding of normal brain development and improved tissue resolution of fetal MRI. During the interim, our findings strongly support the need for postnatal MRI follow-up in cases with suspected posterior fossa anomalies by fetal MRI.
Collapse
|
47
|
McAuliffe F, Chitayat D, Halliday W, Keating S, Shah V, Fink M, Nevo O, Ryan G, Shannon P, Blaser S. Rhombencephalosynapsis: prenatal imaging and autopsy findings. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:542-548. [PMID: 18409180 DOI: 10.1002/uog.5318] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Rhombencephalosynapsis is a rare, but increasingly recognized, brain malformation characterized by congenital fusion of the cerebellar hemispheres and absence of the vermis. Rhombencephalosynapsis is associated with significant developmental delay, seizures and involuntary head movements. We report four cases, with correlation of prenatal and postnatal imaging and autopsy findings. METHODS Over a 2-year period, four cases of rhombencephalosynapsis were diagnosed in the perinatal period, three in one center and one in another center. The clinical cases were reviewed, and correlation was made between the prenatal and postnatal imaging and autopsy findings where available. RESULTS All cases presented initially with ventriculomegaly on prenatal ultrasound examination. Subsequent magnetic resonance imaging (MRI) established the diagnosis in two cases and postnatal MRI established the diagnosis in a further two cases. Autopsy was available and confirmed the diagnosis in two cases. In one case the pregnancy was terminated, two infants died in the neonatal period and one died in infancy. CONCLUSIONS The cases in this perinatal series of rhombencephalosynapsis showed a very poor prognosis. The presence of ventriculomegaly on prenatal ultrasound imaging should alert the physician to consider rhombencephalosynapsis in the differential diagnosis. MRI appears to be the imaging modality of choice in establishing the diagnosis.
Collapse
Affiliation(s)
- F McAuliffe
- University College Dublin School of Medicine and Medical Science, Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
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.
Collapse
Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, Vancouver V6H 3V4, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
OBJECTIVES Recognize posterior fossa anomalies on ultrasound and magnetic resonance imaging and appreciate imaging pitfalls that may lead to misdiagnosis. MATERIALS AND METHODS Cases are presented to illustrate normal development and various anomalies. Postnatal studies and autopsy are used for correlation with prenatal imaging. RESULTS Normal anatomy and anomalies are demonstrated. Pitfalls such as cystic hygroma, pseudomasses, and use of nonstandard scan planes are illustrated. CONCLUSIONS Recognizing normal developing structures is an important component of performing fetal ultrasound. Documentation of the cerebellum, vermis, and cisterna magna are required for posterior fossa evaluation in any American Institute of Ultrasound in Medicine-certified practice. Normal variations are common, and understanding the anatomy is vital to avoid misdiagnosis and to accurately characterize abnormalities.
Collapse
Affiliation(s)
- Karen Y Oh
- Department of Radiology, University of Utah Hospital, SOM 1A71, 30 N 1900 E, Salt Lake City, UT 84132, USA.
| | | | | | | |
Collapse
|
50
|
Harper T, Fordham LA, Wolfe HM. The fetal dandy walker complex: associated anomalies, perinatal outcome and postnatal imaging. Fetal Diagn Ther 2007; 22:277-81. [PMID: 17369695 DOI: 10.1159/000100790] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compares the diagnostic accuracy of prenatal ultrasound with postnatal imaging and evaluates for associated fetal anomalies and their impact on immediate neonatal outcome in fetal Dandy Walker complex (DWC). METHODS Cases of fetal DWC diagnosed in a single ultrasound unit from January 2000 through July 2004 were reviewed for associated fetal anomalies, fetal karyotype, immediate neonatal outcome and postnatal head imaging. RESULTS A total of 55 fetuses with DWC were identified. Of liveborn cases, postnatal imaging confirmed prenatal intracranial findings in 50% of Dandy Walker variant (DWV) and 100% of Dandy Walker malformation (DWM), with additional central nervous system findings noted in 21% of all cases. Additional fetal anomalies were seen in 26/40 (65%) cases of DWV and 15/15 (100%) cases of DWM. Immediate neonatal survival was predicted by karyotype and associated fetal anomalies. CONCLUSION The sonographic diagnosis of fetal DWM is accurate. Significant discrepancies exist in prenatal and postnatal diagnosis of DWV. Comprehensive fetal ultrasound and karyotype should be offered for all fetuses with DWC. Postnatal imaging should be performed on all fetal DWC.
Collapse
MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/pathology
- Amniocentesis
- Aneuploidy
- Central Nervous System/abnormalities
- Central Nervous System/pathology
- Cranial Fossa, Posterior/abnormalities
- Cranial Fossa, Posterior/pathology
- Dandy-Walker Syndrome/diagnosis
- Dandy-Walker Syndrome/embryology
- Dandy-Walker Syndrome/genetics
- Dandy-Walker Syndrome/pathology
- Echocardiography, Doppler, Color
- Female
- Gestational Age
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/embryology
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/pathology
- Humans
- Karyotyping
- Magnetic Resonance Imaging
- Predictive Value of Tests
- Pregnancy
- Prenatal Diagnosis/methods
- Retrospective Studies
- Tomography, X-Ray Computed
- Ultrasonography, Prenatal
Collapse
Affiliation(s)
- Terry Harper
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 27599, USA
| | | | | |
Collapse
|