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Fidon L, Aertsen M, Kofler F, Bink A, David AL, Deprest T, Emam D, Guffens F, Jakab A, Kasprian G, Kienast P, Melbourne A, Menze B, Mufti N, Pogledic I, Prayer D, Stuempflen M, Van Elslander E, Ourselin S, Deprest J, Vercauteren T. A Dempster-Shafer Approach to Trustworthy AI With Application to Fetal Brain MRI Segmentation. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2024; 46:3784-3795. [PMID: 38198270 DOI: 10.1109/tpami.2023.3346330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Deep learning models for medical image segmentation can fail unexpectedly and spectacularly for pathological cases and images acquired at different centers than training images, with labeling errors that violate expert knowledge. Such errors undermine the trustworthiness of deep learning models for medical image segmentation. Mechanisms for detecting and correcting such failures are essential for safely translating this technology into clinics and are likely to be a requirement of future regulations on artificial intelligence (AI). In this work, we propose a trustworthy AI theoretical framework and a practical system that can augment any backbone AI system using a fallback method and a fail-safe mechanism based on Dempster-Shafer theory. Our approach relies on an actionable definition of trustworthy AI. Our method automatically discards the voxel-level labeling predicted by the backbone AI that violate expert knowledge and relies on a fallback for those voxels. We demonstrate the effectiveness of the proposed trustworthy AI approach on the largest reported annotated dataset of fetal MRI consisting of 540 manually annotated fetal brain 3D T2w MRIs from 13 centers. Our trustworthy AI method improves the robustness of four backbone AI models for fetal brain MRIs acquired across various centers and for fetuses with various brain abnormalities.
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Mufti N, Aertsen M, Thomson D, De Vloo P, Demaerel P, Deprest J, Melbourne A, David AL. Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study. Acta Obstet Gynecol Scand 2024; 103:322-333. [PMID: 37984808 PMCID: PMC10823411 DOI: 10.1111/aogs.14711] [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: 06/16/2023] [Revised: 09/17/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Fetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines. MATERIAL AND METHODS We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB. RESULTS MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001). CONCLUSIONS There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - Michael Aertsen
- Department of RadiologyUniversity Hospitals Katholieke Universiteit (KU)LeuvenBelgium
| | - Dominic Thomson
- Pediatric Neurosurgery DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
| | - Phillippe De Vloo
- Department of NeurosurgeryUniversity Hospitals Katholieke Universiteit (KU)LeuvenBelgium
| | - Philippe Demaerel
- Department of RadiologyUniversity Hospitals Katholieke Universiteit (KU)LeuvenBelgium
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynecologyUniversity Hospitals Katholieke Universiteit (KU)LeuvenBelgium
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Anna L. David
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynecologyUniversity Hospitals Katholieke Universiteit (KU)LeuvenBelgium
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Kunpalin Y, Sichitiu J, Krishnan P, Blaser S, Kulkarni AV, Abbasi N, Ryan G, Shinar S, van Mieghem T. Simple prenatal imaging predictors for postnatal cerebrospinal fluid diversion surgery in fetuses undergoing in utero surgery for spina bifida. Prenat Diagn 2023; 43:1605-1613. [PMID: 37975651 DOI: 10.1002/pd.6453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To determine simple prenatal imaging parameters that can easily be acquired to predict the need for postnatal CSF diversion (PCD) surgery in fetuses undergoing open fetal surgery for open spina bifida (OSB). METHODS All fetuses with OSB that underwent open fetal surgery between June 2017 and June 2021 with available follow-up outcomes were included. Imaging parameters including clivus-supraocciput angle (CSA) on magnetic resonance imaging, transcerebellar diameter (TCD) and lateral ventricle size (Vp) on ultrasound (US), were collected pre- and postoperatively. The requirement for PCD surgery was determined at 1 year of age. The predictive strength of each parameter was determined by Receiver Operating Characteristic curve analysis. RESULTS Among 36 babies eligible for the analyses, 41.7% required PCD by one year of age. Pre-operative Vp (AUC 0.71; 95% confidence interval [CI] 0.54-0.88; p = 0.03), TCD (AUC 0.72; 95% CI 0.55-0.89; p = 0.02) and CSA (AUC 0.72; 95% CI 0.51-0.93; p = 0.04) were fair predictors for PCD surgery. After fetal surgery, TCD (AUC 0.93; 95% CI 0.83-1.00; p < 0.0001) and CSA (AUC 0.94; 95% CI 0.83-1.00; p = 0.0005) were outstanding predictors of PCD, whereas post-operative Vp was a fair predictor (AUC 0.71, 95% CI 0.54-0.88, p = 0.03). CONCLUSION Post-operative CSA and TCD were outstanding predictors for the need for PCD surgery.
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Affiliation(s)
- Yada Kunpalin
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Joanna Sichitiu
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Susan Blaser
- University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Nimrah Abbasi
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Shiri Shinar
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Tim van Mieghem
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
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Mufti N, Chappell J, Aertsen M, Ebner M, Fidon L, Deprest J, David AL, Melbourne A. Assessment of longitudinal brain development using super-resolution magnetic resonance imaging following fetal surgery for open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:707-720. [PMID: 37161647 PMCID: PMC10947002 DOI: 10.1002/uog.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Prenatal surgery is offered for selected fetuses with open spina bifida (OSB) to improve long-term outcome. We studied the effect of fetal OSB surgery on brain development using advanced magnetic resonance imaging (MRI) techniques to quantify the volume, surface area and shape of cerebral structures and to analyze surface curvature by means of parameters that correspond to gyrification. METHODS We compared MRI data from 29 fetuses with OSB before fetal surgery (mean gestational age (GA), 23 + 3 weeks) and at 1 and 6 weeks after surgery, with that of 36 GA-matched control fetuses (GA range, 21 + 2 to 36 + 2 weeks). Automated super-resolution reconstruction provided three-dimensional isotropic volumetric brain images. Unmyelinated white matter, cerebellum and ventricles were segmented automatically and refined manually, after which volume, surface area and shape parameter (volume/surface area) were quantified. Mathematical markers (shape index (SI) and curvedness) were used to measure gyrification. Parameters were assessed according to lesion type (myelomeningocele vs myeloschisis (MS)), postoperative persistence of hindbrain herniation (HH) and the presence of supratentorial anomalies, namely partial agenesis of the corpus callosum (pACC) and heterotopia (HT). RESULTS Growth in ventricular volume per week and change in shape parameter per week were higher at 6 weeks after surgery in fetuses with OSB compared with controls (median, 2500.94 (interquartile range (IQR), 1689.70-3580.80) mm3 /week vs 708.21 (IQR, 474.50-925.00) mm3 /week; P < 0.001 and 0.075 (IQR, 0.047-0.112) mm/week vs 0.022 (IQR, 0.009-0.042) mm/week; P = 0.046, respectively). Ventricular volume growth increased 6 weeks after surgery in cases with pACC (P < 0.001) and those with persistent HH (P = 0.002). During that time period, the change in unmyelinated white-matter shape parameter per week was decreased in OSB fetuses compared with controls (0.056 (IQR, 0.044-0.092) mm/week vs 0.159 (IQR, 0.100-0.247) mm/week; P = 0.002), particularly in cases with persistent HH (P = 0.011), MS (P = 0.015), HT (P = 0.022), HT with corpus callosum anomaly (P = 0.017) and persistent HH with corpus callosum anomaly (P = 0.007). At 6 weeks postoperatively, despite OSB fetuses having a lower rate of change in curvedness compared with controls (0.061 (IQR, 0.040-0.093) mm-1 /week vs 0.094 (IQR, 0.070-0.146) mm-1 /week; P < 0.001), reversing the trend seen at 1 week after surgery (0.144 (IQR, 0.099-0.236) mm-1 /week vs 0.072 (IQR, 0.059-0.081) mm-1 /week; P < 0.001), gyrification, as determined using SI, appeared to be increased in OSB fetuses overall compared with controls. This observation was more prominent in fetuses with pACC and those with severe ventriculomegaly (P-value range, < 0.001 to 0.006). CONCLUSIONS Following fetal OSB repair, volume, shape and curvedness of ventricles and unmyelinated white matter differed significantly compared with those of normal fetuses. Morphological brain changes after fetal surgery were not limited to effects on the circulation of cerebrospinal fluid. These observations may have implications for postnatal neurocognitive outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. Mufti
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - J. Chappell
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - M. Aertsen
- Department of RadiologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - M. Ebner
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - L. Fidon
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - J. Deprest
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - A. L. David
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
- National Institute for Health and Care Research University College London Hospitals Biomedical Research CentreLondonUK
| | - A. Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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Akbas H, Guven ESG, Guven S, Kizilirmak R, Albayrak M, Aydogan Z, Kul S. Evaluation of the height of the corpus callosum body region in fetal meningomyelocele malformation. J Gynecol Obstet Hum Reprod 2023; 52:102619. [PMID: 37295771 DOI: 10.1016/j.jogoh.2023.102619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings with the corpus callosum of healthy fetuses. METHODS In this study, fetal MRI examinations were performed on 44 fetal MMC malformation cases. As the control group, 34 fetal MRI examinations, which were anatomically normal, were evaluated retrospectively. In the study group, lateral ventricle diameter, the level and diameter of the MMC defect, and CC height were measured. In the control group, CC height and lateral ventricular diameter were measured. RESULTS The mean CC body height was 1.36 mm in the study group, and 2.48 mm in the control group. The height of the CC body region of the study population was inclined to be thinner compared with the control population (p<0.001). CONCLUSIONS The fact that the height of the CC body region was found to be thinner in fetal MRI in cases of MMC compared with normal fetuses suggests that various callosal anomalies are uncertain, investigation of additional callosal anomalies may be beneficial in the decision for the continuation of pregnancy, and termination or intrauterine surgery in cases with MMC. Further large case group studies are needed.
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Affiliation(s)
- Humeyra Akbas
- Department of Perinatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
| | | | - Suleyman Guven
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Rukiye Kizilirmak
- Department of Perinatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mehmet Albayrak
- Department of Perinatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Zeynep Aydogan
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sibel Kul
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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George E, MacPherson C, Pruthi S, Bilaniuk L, Fletcher J, Houtrow A, Gupta N, Glenn OA. Long-Term Imaging Follow-up from the Management of Myelomeningocele Study. AJNR Am J Neuroradiol 2023:ajnr.A7926. [PMID: 37385677 PMCID: PMC10337608 DOI: 10.3174/ajnr.a7926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Short-term results demonstrate that prenatal repair of a myelomeningocele is associated with a reduction in hydrocephalus and an increased likelihood of the reversal of Chiari II malformations compared with postnatal repair. The purpose of this study was to identify the long-term imaging findings at school age among subjects who underwent pre- versus postnatal repair of a myelomeningocele. MATERIALS AND METHODS A subset of subjects enrolled in the Management of Myelomeningocele Study who underwent either prenatal (n = 66) or postnatal (n = 63) repair of a lumbosacral myelomeningocele and had follow-up brain MR imaging at school age were included. The prevalence of posterior fossa features of Chiari II malformation and supratentorial abnormalities and the change in these findings from fetal to school-age MR imaging were compared between the 2 groups. RESULTS Prenatal repair of a myelomeningocele was associated with higher rates of normal location of fourth ventricle and lower rates of hindbrain herniation, cerebellar herniation, tectal beaking, brainstem distortion, and kinking at school age compared with postnatal repair (all P < .01). Supratentorial abnormalities, including corpus callosal abnormalities, gyral abnormalities, heterotopia, and hemorrhage, were not significantly different between the 2 groups (all P > .05). The rates of resolution of brainstem kinking, tectal beaking, cerebellar and hindbrain herniation, and normalization of fourth ventricle size from fetal to school age MR imaging were higher among the prenatal compared with postnatal surgery group (all, P < .02). CONCLUSIONS Prenatal repair of a myelomeningocele is associated with persistent improvement in posterior fossa imaging findings of Chiari II malformation at school age compared with postnatal repair.
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Affiliation(s)
- E George
- From the Departments of Radiology and Biomedical Imaging (E.G., O.A.G.)
| | - C MacPherson
- Biostatistics Center (C.M.), Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - S Pruthi
- Department of Radiology (S.P.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - L Bilaniuk
- Department of Radiology (L.B.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J Fletcher
- Department of Psychology (J.F.), University of Houston, Houston, Texas
| | - A Houtrow
- Department of Physical Medicine and Rehabilitation (A.H.), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - N Gupta
- Neurological Surgery (N.G.)
- Pediatrics (N.G.), University of California, San Francisco, San Francisco, California
| | - O A Glenn
- From the Departments of Radiology and Biomedical Imaging (E.G., O.A.G.)
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Ding X, Huang Z, Liu X, Lin L, Liu M, Yang J, Lu H. Value of three-dimensional volume contrast imaging C combined with magnetic resonance imaging for diagnosis of fetal cerebellar vermis and posterior cranial fossa. Am J Transl Res 2022; 14:7782-7791. [PMID: 36505303 PMCID: PMC9730120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the value of three-dimensional volume contrast imaging C (VCI-C) combined with magnetic resonance imaging (MRI) in the diagnosis of fetal posterior cranial cavity disease. METHODS This study retrospectively analyzed the imaging data of 100 pregnant women with diagnosed abnormal development of fetal cerebellar vermis or posterior cranial fossa in our hospital from January 2020 to February 2022. VCI-C combined with MRI was used to evaluate the morphology of fetal cerebellar vermis, and the display of primary fissures and secondary fissures. The angle between the brain stem and cerebellar vermis (BVA) and the angle between brain stem and cerebellar tentorium (BTA) were measured and compared through MRI images. RESULTS There was no significant difference between VCI-C and MRI in measuring the height, anteroposterior diameter, or area, BVA and BTA of fetal cerebellar vermis in the normal control group (P > 0.05). It can be considered that the two imaging methods are consistent in measuring the height, anteroposterior diameter and area, BVA, and BTA of the fetal cerebellar vermis in the normal control group. There was no significant difference between VCI-C and MRI in measuring the height, anterior posterior diameter and area, BVA, or BTA of the vermis in the group of fetal cerebellar vermis dysplasia (P > 0.05). The two imaging methods were comparable for all these measurements. CONCLUSION Combining three-dimensional VCI-Cwith MRI diagnosis, the median sagittal section of the cerebellar vermis can be observed, the morphologic structure of the vermis, and the anatomical structure of the posterior cranial fossa can be reflected stereoscopically. Quantitative indexes can be measured and calculated to evaluate the developmental abnormalities of the fetal cerebellar vermis and the lesions of the posterior cranial fossa. Their combined effect is better than that of a single application.
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Affiliation(s)
- Xiaojun Ding
- Department of Ultrasound Medicine, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Zhiping Huang
- Department of Ultrasound Medicine, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Xiaoyu Liu
- Department of Medical Imaging, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Lin Lin
- Department of Ultrasound Medicine, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Min Liu
- Department of Ultrasound Medicine, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Jie Yang
- Department of Ultrasound Medicine, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Huan Lu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Gannan Medical UniversityGanzhou 341000, Jiangxi, China
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Fidon L, Viola E, Mufti N, David AL, Melbourne A, Demaerel P, Ourselin S, Vercauteren T, Deprest J, Aertsen M. A spatio-temporal atlas of the developing fetal brain with spina bifida aperta. OPEN RESEARCH EUROPE 2022; 1:123. [PMID: 37645096 PMCID: PMC10445840 DOI: 10.12688/openreseurope.13914.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 08/31/2023]
Abstract
Background: Spina bifida aperta (SBA) is a birth defect associated with severe anatomical changes in the developing fetal brain. Brain magnetic resonance imaging (MRI) atlases are popular tools for studying neuropathology in the brain anatomy, but previous fetal brain MRI atlases have focused on the normal fetal brain. We aimed to develop a spatio-temporal fetal brain MRI atlas for SBA. Methods: We developed a semi-automatic computational method to compute the first spatio-temporal fetal brain MRI atlas for SBA. We used 90 MRIs of fetuses with SBA with gestational ages ranging from 21 to 35 weeks. Isotropic and motion-free 3D reconstructed MRIs were obtained for all the examinations. We propose a protocol for the annotation of anatomical landmarks in brain 3D MRI of fetuses with SBA with the aim of making spatial alignment of abnormal fetal brain MRIs more robust. In addition, we propose a weighted generalized Procrustes method based on the anatomical landmarks for the initialization of the atlas. The proposed weighted generalized Procrustes can handle temporal regularization and missing annotations. After initialization, the atlas is refined iteratively using non-linear image registration based on the image intensity and the anatomical land-marks. A semi-automatic method is used to obtain a parcellation of our fetal brain atlas into eight tissue types: white matter, ventricular system, cerebellum, extra-axial cerebrospinal fluid, cortical gray matter, deep gray matter, brainstem, and corpus callosum. Results: An intra-rater variability analysis suggests that the seven anatomical land-marks are sufficiently reliable. We find that the proposed atlas outperforms a normal fetal brain atlas for the automatic segmentation of brain 3D MRI of fetuses with SBA. Conclusions: We make publicly available a spatio-temporal fetal brain MRI atlas for SBA, available here: https://doi.org/10.7303/syn25887675. This atlas can support future research on automatic segmentation methods for brain 3D MRI of fetuses with SBA.
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Affiliation(s)
- Lucas Fidon
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, SE1 7EU, UK
| | - Elizabeth Viola
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, SE1 7EU, UK
| | - Nada Mufti
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, SE1 7EU, UK
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, WC1E 6DB, UK
| | - Anna L. David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, WC1E 6DB, UK
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, SE1 7EU, UK
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Sébastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, SE1 7EU, UK
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, SE1 7EU, UK
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, WC1E 6DB, UK
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
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Trigo L, Eixarch E, Bottura I, Dalaqua M, Barbosa AA, De Catte L, Demaerel P, Dymarkowski S, Deprest J, Lapa DA, Aertsen M, Gratacos E. Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:804-812. [PMID: 34396624 DOI: 10.1002/uog.23761] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine the prevalence of brain anomalies at the time of preoperative magnetic resonance imaging (MRI) assessment in fetuses eligible for prenatal open spina bifida (OSB) repair, and to explore the relationship between brain abnormalities and features of the spinal defect. METHODS This was a retrospective cross-sectional study, conducted in three fetal medicine centers, of fetuses eligible for OSB fetal surgery repair between January 2009 and December 2019. MRI images obtained as part of the presurgical assessment were re-evaluated by two independent observers, blinded to perinatal results, to assess: (1) the type and area of the defect and its anatomical level; (2) the presence of any structural central nervous system (CNS) anomaly and abnormal ventricular wall; and (3) fetal head and brain biometry. Binary regression analyses were performed and data were adjusted for type of defect, upper level of the lesion (ULL), gestational age (GA) at MRI and fetal medicine center. Multiple logistic regression analysis was performed in order to identify lesion characteristics and brain anomalies associated with a higher risk of presence of abnormal corpus callosum (CC) and/or heterotopia. RESULTS Of 115 fetuses included, 91 had myelomeningocele and 24 had myeloschisis. Anatomical level of the lesion was thoracic in seven fetuses, L1-L2 in 13, L3-L5 in 68 and sacral in 27. Median GA at MRI was 24.7 (interquartile range, 23.0-25.7) weeks. Overall, 52.7% of cases had at least one additional brain anomaly. Specifically, abnormal CC was observed in 50.4% of cases and abnormality of the ventricular wall in 19.1%, of which 4.3% had nodular heterotopia. Factors associated independently with higher risk of abnormal CC and/or heterotopia were non-sacral ULL (odds ratio (OR), 0.51 (95% CI, 0.26-0.97); P = 0.043), larger ventricular width (per mm) (OR, 1.23 (95% CI, 1.07-1.43); P = 0.005) and presence of abnormal cavum septi pellucidi (OR, 3.76 (95% CI, 1.13-12.48); P = 0.031). CONCLUSIONS Half of the fetuses assessed for OSB repair had an abnormal CC and/or an abnormal ventricular wall prior to prenatal repair. The likelihood of brain abnormalities was increased in cases with a non-sacral lesion and wider lateral ventricles. These findings highlight the importance of a detailed preoperative CNS evaluation of fetuses with OSB. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Trigo
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - I Bottura
- Fetal and Neonatal Therapy Group, Hospital Sabará, São Paulo, Brazil
| | - M Dalaqua
- Department of Radiology, Hospital Israelita Albert Einsten, São Paulo, Brazil
- School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, Brazil
| | - A A Barbosa
- Fetal and Neonatal Therapy Group, Hospital Sabará, São Paulo, Brazil
- School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, Brazil
| | - L De Catte
- Department of Radiology, UZ KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ KU Leuven, Leuven, Belgium
| | - P Demaerel
- Department of Radiology, UZ KU Leuven, Leuven, Belgium
| | - S Dymarkowski
- Department of Radiology, UZ KU Leuven, Leuven, Belgium
| | - J Deprest
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ KU Leuven, Leuven, Belgium
- Institute of Women's Health, University College London, London, UK
| | - D A Lapa
- Fetal Therapy Program, Hospital Israelita Albert Einsten, São Paulo, Brazil
- Department of Hospital Infantil Sabará, São Paulo, Brazil
| | - M Aertsen
- Department of Radiology, UZ KU Leuven, Leuven, Belgium
| | - E Gratacos
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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10
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Mufti N, Sacco A, Aertsen M, Ushakov F, Ourselin S, Thomson D, Deprest J, Melbourne A, David AL. What brain abnormalities can magnetic resonance imaging detect in foetal and early neonatal spina bifida: a systematic review. Neuroradiology 2022; 64:233-245. [PMID: 34792623 PMCID: PMC8789702 DOI: 10.1007/s00234-021-02853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound. METHODS Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible. RESULTS Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse. CONCLUSION MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Adalina Sacco
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Fred Ushakov
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Sebastian Ourselin
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Dominic Thomson
- Paediatric Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
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11
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Joyeux L, Basurto D, Bleeser T, Van der Veeken L, Vergote S, Kunpalin Y, Trigo L, Corno E, De Bie FR, De Coppi P, Ourselin S, Van Calenbergh F, Hooper SB, Rex S, Deprest J. Fetoscopic insufflation of heated-humidified carbon dioxide during simulated spina bifida repair is safe under controlled anesthesia in the fetal lamb. Prenat Diagn 2022; 42:180-191. [PMID: 35032031 DOI: 10.1002/pd.6093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/22/2021] [Accepted: 01/08/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the safety of Partial-Amniotic-Insufflation-of-heated-humidified-CO2 (hPACI) during fetoscopic spina bifida repair (fSB-repair). METHOD A simulated fSB-repair through an exteriorized uterus under hPACI was performed in 100-day fetal lambs (term = 145 days) under a laboratory anesthesia protocol (n = 5; group 1) which is known to induce maternal-fetal acidosis and hypercapnia. Since these may not occur clinically, we applied a clinical anesthesia protocol (n = 5; group 2), keeping maternal parameters within physiological conditions, that is, controlled maternal arterial carbon dioxide (CO2) pressure (pCO2 = 30 mmHg), blood pressure (≥67 mmHg), and temperature (37.1-39.8°C). Our superiority study used fetal pH as the primary outcome. RESULTS Compared to group 1, controlled anesthesia normalized fetal pH (7.23 ± 0.02 vs. 7.36 ± 0.02, p < 0.001), pCO2 (70.0 ± 9.1 vs. 43.0 ± 1.0 mmHg, p = 0.011) and bicarbonate (27.8 ± 1.1 vs. 24.0 ± 0.9 mmol/L, p = 0.071) at baseline. It kept them within clinically acceptable limits (pH ≥ 7.23, pCO2 ≤ 70 mmHg, bicarbonate ≤ 30 mm/L) for ≥120 min of hPACI as opposed to ≤30 min in group one. Fetal pO2 and lactate were comparable between groups and generally within normal range. Fetal brain histology demonstrated fewer apoptotic cells and higher neuronal density in the prefrontal cortex in group two. There was no difference in fetal membrane inflammation, which was mild. CONCLUSION Fetoscopic insufflation of heated-humidified CO2 during simulated fSB-repair through an exteriorized uterus can be done safely under controlled anesthesia.
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Affiliation(s)
- Luc Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - David Basurto
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Bleeser
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Van der Veeken
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Simen Vergote
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Yada Kunpalin
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, London, UK
| | - Lucas Trigo
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,BCNatal, Fetal Medicine Research Center, Hospital Clinic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Enrico Corno
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Felix R De Bie
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paolo De Coppi
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium.,Specialist Neonatal and Pediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals, NHS Trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Deprest
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, London, UK
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12
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The Role of Fetal Brain Magnetic Resonance Imaging in Current Fetal Medicine. J Belg Soc Radiol 2022; 106:130. [PMID: 36569393 PMCID: PMC9756908 DOI: 10.5334/jbsr.3000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
In open spina bifida we studied the use of MRI for the assessment of the posterior fossa and prevalence of supratentorial anomalies before and after in utero repair. New postprocessing techniques were applied to evaluate fetal brain development in this population compared to controls. In fetuses with congenital diaphragmatic hernia, we evaluated the brain development in comparison to controls. Diffusion weighted imaging was applied to study difference between fetuses with proven first trimester cytomegalovirus infection and controls. Finally, we investigated the value of third trimester fetal brain MRI after treatment for complicated monochorionic diamniotic pregnancies.
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13
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Jakab A, Payette K, Mazzone L, Schauer S, Muller CO, Kottke R, Ochsenbein-Kölble N, Tuura R, Moehrlen U, Meuli M. Emerging magnetic resonance imaging techniques in open spina bifida in utero. Eur Radiol Exp 2021; 5:23. [PMID: 34136989 PMCID: PMC8209133 DOI: 10.1186/s41747-021-00219-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become an essential diagnostic modality for congenital disorders of the central nervous system. Recent advancements have transformed foetal MRI into a clinically feasible tool, and in an effort to find predictors of clinical outcomes in spinal dysraphism, foetal MRI began to unveil its potential. The purpose of our review is to introduce MRI techniques to experts with diverse backgrounds, who are involved in the management of spina bifida. We introduce advanced foetal MRI postprocessing potentially improving the diagnostic work-up. Importantly, we discuss how postprocessing can lead to a more efficient utilisation of foetal or neonatal MRI data to depict relevant anatomical characteristics. We provide a critical perspective on how structural, diffusion and metabolic MRI are utilised in an endeavour to shed light on the correlates of impaired development. We found that the literature is consistent about the value of MRI in providing morphological cues about hydrocephalus development, hindbrain herniation or outcomes related to shunting and motor functioning. MRI techniques, such as foetal diffusion MRI or diffusion tractography, are still far from clinical use; however, postnatal studies using these methods revealed findings that may reflect early neural correlates of upstream neuronal damage in spinal dysraphism.
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Affiliation(s)
- Andras Jakab
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland. .,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.
| | - Kelly Payette
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Sonja Schauer
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland
| | | | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Ruth Tuura
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
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14
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Mufti N, Aertsen M, Ebner M, Fidon L, Patel P, Rahman MBA, Brackenier Y, Ekart G, Fernandez V, Vercauteren T, Ourselin S, Thomson D, De Catte L, Demaerel P, Deprest J, David AL, Melbourne A. Cortical spectral matching and shape and volume analysis of the fetal brain pre- and post-fetal surgery for spina bifida: a retrospective study. Neuroradiology 2021; 63:1721-1734. [PMID: 33934181 PMCID: PMC8460513 DOI: 10.1007/s00234-021-02725-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2021] [Indexed: 12/03/2022]
Abstract
Purpose A retrospective study was performed to study the effect of fetal surgery on brain development measured by MRI in fetuses with myelomeningocele (MMC). Methods MRI scans of 12 MMC fetuses before and after surgery were compared to 24 age-matched controls without central nervous system abnormalities. An automated super-resolution reconstruction technique generated isotropic brain volumes to mitigate 2D MRI fetal motion artefact. Unmyelinated white matter, cerebellum and ventricles were automatically segmented, and cerebral volume, shape and cortical folding were thereafter quantified. Biometric measures were calculated for cerebellar herniation level (CHL), clivus-supraocciput angle (CSO), transverse cerebellar diameter (TCD) and ventricular width (VW). Shape index (SI), a mathematical marker of gyrification, was derived. We compared cerebral volume, surface area and SI before and after MMC fetal surgery versus controls. We additionally identified any relationship between these outcomes and biometric measurements. Results MMC ventricular volume/week (mm3/week) increased after fetal surgery (median: 3699, interquartile range (IQR): 1651–5395) compared to controls (median: 648, IQR: 371–896); P = 0.015. The MMC SI is higher pre-operatively in all cerebral lobes in comparison to that in controls. Change in SI/week in MMC fetuses was higher in the left temporal lobe (median: 0.039, IQR: 0.021–0.054), left parietal lobe (median: 0.032, IQR: 0.023–0.039) and right occipital lobe (median: 0.027, IQR: 0.019–0.040) versus controls (P = 0.002 to 0.005). Ventricular volume (mm3) and VW (mm) (r = 0.64), cerebellar volume and TCD (r = 0.56) were moderately correlated. Conclusions Following fetal myelomeningocele repair, brain volume, shape and SI were significantly different from normal in most cerebral layers. Morphological brain changes after fetal surgery are not limited to hindbrain herniation reversal. These findings may have neurocognitive outcome implications and require further evaluation. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02725-8.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 1st Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK. .,School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.
| | - Michael Aertsen
- Department of Radiology, University Hospitals Katholieke Universiteit (KU), Leuven, Belgium
| | - Michael Ebner
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Lucas Fidon
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Premal Patel
- Radiology Department, Great Ormond Street Hospital for Children, London, UK
| | | | - Yannick Brackenier
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Gregor Ekart
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Virginia Fernandez
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Dominic Thomson
- Paediatric Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Luc De Catte
- Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Cluster 'Women and Child', Dept. Development and Regeneration, Biomedical Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Katholieke Universiteit (KU), Leuven, Belgium
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 1st Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.,Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Cluster 'Women and Child', Dept. Development and Regeneration, Biomedical Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 1st Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.,Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Cluster 'Women and Child', Dept. Development and Regeneration, Biomedical Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
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15
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Mckinnon K, Kendall GS, Tann CJ, Dyet L, Sokolska M, Baruteau KP, Marlow N, Robertson NJ, Peebles D, Srinivasan L. Biometric assessments of the posterior fossa by fetal MRI: A systematic review. Prenat Diagn 2020; 41:258-270. [PMID: 33251640 DOI: 10.1002/pd.5874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Posterior fossa abnormalities (PFAs) are commonly identified within routine screening and are a frequent indication for fetal magnetic resonance imaging (MRI). Although biometric measurements of the posterior fossa (PF) are established on fetal ultrasound and MRI, qualitative visual assessments are predominantly used to differentiate PFAs. OBJECTIVES This systematic review aimed to assess 2-dimensional (2D) biometric measurements currently in use for assessing the PF on fetal MRI to delineate different PFAs. METHODS The protocol was registered (PROSPERO ID CRD42019142162). Eligible studies included T2-weighted MRI PF measurements in fetuses with and without PFAs, including measurements of the PF, or other brain areas relevant to PFAs. RESULTS 59 studies were included - 6859 fetuses had 62 2D PF and related measurements. These included linear, area and angular measurements, representing measures of PF size, cerebellum/vermis, brainstem, and supratentorial measurements. 11 measurements were used in 10 or more studies and at least 1200 fetuses. These dimensions were used to characterise normal for gestational age, diagnose a range of pathologies, and predict outcome. CONCLUSION A selection of validated 2D biometric measurements of the PF on fetal MRI may be useful for identification of PFA in different clinical settings. Consistent use of these measures, both clinically and for research, is recommended.
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Affiliation(s)
- Katie Mckinnon
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Giles S Kendall
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Cally J Tann
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Leigh Dyet
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Institute for Women's Health, University College London, London, UK.,Medical Physics Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kelly Pegoretti Baruteau
- Institute for Women's Health, University College London, London, UK.,Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Nicola J Robertson
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Donald Peebles
- Institute for Women's Health, University College London, London, UK.,Obstetric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Latha Srinivasan
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
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Didier RA, Martin-Saavedra JS, Oliver ER, DeBari SE, Bilaniuk LT, Howell LJ, Moldenhauer JS, Adzick NS, Heuer GG, Coleman BG. Fetal Intraventricular Hemorrhage in Open Neural Tube Defects: Prenatal Imaging Evaluation and Perinatal Outcomes. AJNR Am J Neuroradiol 2020; 41:1923-1929. [PMID: 32943419 DOI: 10.3174/ajnr.a6745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/16/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Fetal imaging is crucial in the evaluation of open neural tube defects. The identification of intraventricular hemorrhage prenatally has unclear clinical implications. We aimed to explore fetal imaging findings in open neural tube defects and evaluate associations between intraventricular hemorrhage with prenatal and postnatal hindbrain herniation, postnatal intraventricular hemorrhage, and ventricular shunt placement. MATERIALS AND METHODS After institutional review board approval, open neural tube defect cases evaluated by prenatal sonography between January 1, 2013 and April 24, 2018 were enrolled (n = 504). The presence of intraventricular hemorrhage and gray matter heterotopia by both prenatal sonography and MR imaging studies was used for classification. Cases of intraventricular hemorrhage had intraventricular hemorrhage without gray matter heterotopia (n = 33) and controls had neither intraventricular hemorrhage nor gray matter heterotopia (n = 229). A total of 135 subjects with findings of gray matter heterotopia were excluded. Outcomes were compared with regression analyses. RESULTS Prenatal and postnatal hindbrain herniation and postnatal intraventricular hemorrhage were more frequent in cases of prenatal intraventricular hemorrhage compared with controls (97% versus 79%, 50% versus 25%, and 63% versus 12%, respectively). Increased third ventricular diameter, specifically >1 mm, predicted hindbrain herniation (OR = 3.7 [95% CI, 1.5-11]) independent of lateral ventricular size and prenatal intraventricular hemorrhage. Fetal closure (n = 86) was independently protective against postnatal hindbrain herniation (OR = 0.04 [95% CI, 0.01-0.15]) and postnatal intraventricular hemorrhage (OR = 0.2 [95% CI, 0.02-0.98]). Prenatal intraventricular hemorrhage was not associated with ventricular shunt placement. CONCLUSIONS Intraventricular hemorrhage is relatively common in the prenatal evaluation of open neural tube defects. Hindbrain herniation is more common in cases of intraventricular hemorrhage, but in association with increased third ventricular size. Fetal closure reverses hindbrain herniation and decreases the rate of intraventricular hemorrhage postnatally, regardless of the presence of prenatal intraventricular hemorrhage.
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Affiliation(s)
- R A Didier
- Department of Radiology (R.A.D., J.S.M-S., E.R.O., S.E.D., L.T.B., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - J S Martin-Saavedra
- Department of Radiology (R.A.D., J.S.M-S., E.R.O., S.E.D., L.T.B., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - E R Oliver
- Department of Radiology (R.A.D., J.S.M-S., E.R.O., S.E.D., L.T.B., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S E DeBari
- Department of Radiology (R.A.D., J.S.M-S., E.R.O., S.E.D., L.T.B., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L T Bilaniuk
- Department of Radiology (R.A.D., J.S.M-S., E.R.O., S.E.D., L.T.B., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - L J Howell
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Surgery (L.J.H., J.S.M., N.S.A., G.G.H.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J S Moldenhauer
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery (L.J.H., J.S.M., N.S.A., G.G.H.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - N S Adzick
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery (L.J.H., J.S.M., N.S.A., G.G.H.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - G G Heuer
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery (L.J.H., J.S.M., N.S.A., G.G.H.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - B G Coleman
- Department of Radiology (R.A.D., J.S.M-S., E.R.O., S.E.D., L.T.B., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Fetal Diagnosis and Treatment (R.A.D., E.R.O., S.E.D., L.T.B., L.J.H., J.S.M., N.S.A., G.G.H., B.G.C.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (R.A.D., E.R.O., L.T.B., J.S.M., N.S.A., G.G.H., B.G.C.), University of Pennsylvania, Philadelphia, Pennsylvania
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Ebner M, Wang G, Li W, Aertsen M, Patel PA, Aughwane R, Melbourne A, Doel T, Dymarkowski S, De Coppi P, David AL, Deprest J, Ourselin S, Vercauteren T. An automated framework for localization, segmentation and super-resolution reconstruction of fetal brain MRI. Neuroimage 2020; 206:116324. [PMID: 31704293 PMCID: PMC7103783 DOI: 10.1016/j.neuroimage.2019.116324] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/26/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022] Open
Abstract
High-resolution volume reconstruction from multiple motion-corrupted stacks of 2D slices plays an increasing role for fetal brain Magnetic Resonance Imaging (MRI) studies. Currently existing reconstruction methods are time-consuming and often require user interactions to localize and extract the brain from several stacks of 2D slices. We propose a fully automatic framework for fetal brain reconstruction that consists of four stages: 1) fetal brain localization based on a coarse segmentation by a Convolutional Neural Network (CNN), 2) fine segmentation by another CNN trained with a multi-scale loss function, 3) novel, single-parameter outlier-robust super-resolution reconstruction, and 4) fast and automatic high-resolution visualization in standard anatomical space suitable for pathological brains. We validated our framework with images from fetuses with normal brains and with variable degrees of ventriculomegaly associated with open spina bifida, a congenital malformation affecting also the brain. Experiments show that each step of our proposed pipeline outperforms state-of-the-art methods in both segmentation and reconstruction comparisons including expert-reader quality assessments. The reconstruction results of our proposed method compare favorably with those obtained by manual, labor-intensive brain segmentation, which unlocks the potential use of automatic fetal brain reconstruction studies in clinical practice.
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Affiliation(s)
- Michael Ebner
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Wenqi Li
- Nvidia, Cambridge, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Premal A Patel
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Rosalind Aughwane
- Institute for Women's Health, University College London, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tom Doel
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Steven Dymarkowski
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Paolo De Coppi
- Institute of Child Health, University College London, London, UK
| | - Anna L David
- Institute for Women's Health, University College London, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK; Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium; Institute for Women's Health, University College London, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Sébastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK; Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
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Prayer D, Deprest J. The use of MRI in fetal conditions amenable for antenatal management. Prenat Diagn 2020; 40:3-5. [PMID: 31860748 DOI: 10.1002/pd.5629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Development and Regeneration, Cluster Woman and Child, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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Nagaraj UD, Bierbrauer KS, Stevenson CB, Peiro JL, Lim FY, Habli MA, Kline-Fath BM. Prenatal and postnatal MRI findings in open spinal dysraphism following intrauterine repair via open versus fetoscopic surgical techniques. Prenat Diagn 2019; 40:49-57. [PMID: 31351017 DOI: 10.1002/pd.5540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study is to examine MRI findings of the brain and spine on prenatal and postnatal MRI following intrauterine repair of open spinal dysraphism (OSD) by open hysterotomy and fetoscopic approaches. MATERIALS AND METHODS This study is a single-center HIPAA-compliant and IRB-approved retrospective analysis of fetal MRIs with open spinal dysraphism from January 2011 through December 2018 that underwent subsequent prenatal repair of OSD. RESULTS Sixty-two patients met inclusion criteria: 47 underwent open repair, and 15 underwent fetoscopic repair, with an average gestational age of 22.6 ± 1.4 weeks at initial MRI. On postnatal MRI, spinal cord syrinx was seen in 34% (16/47) of patients undergoing open versus 33.3% (5/15) undergoing fetoscopic repair (P = 0.96). Postnatally, there was no significant difference in hindbrain herniation between the open versus fetoscopic repair groups (P = 0.28). Lateral ventricular size was significantly larger in the open (20.9 ± 6.7 mm) versus the fetoscopic repair (16.1 ± 4.9 mm) group (P = 0.01). CONCLUSION Though lateral ventricular size in the open repair group was larger than the fetoscopic repair group, this can likely be explained by initial selection criteria used for fetoscopic repair. Other postoperative imaging parameters on postnatal MRI were not significantly different between the two groups.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Karin S Bierbrauer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charles B Stevenson
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jose L Peiro
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Foong Yen Lim
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mounira A Habli
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Maternal-Fetal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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