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Garel J, Rossi A, Blondiaux E, Cassart M, Hoffmann C, Garel C. Prenatal imaging of the normal and abnormal spinal cord: recommendations from the Fetal Task Force of the European Society of Paediatric Radiology (ESPR) and the European Society of Neuroradiology (ESNR) Pediatric Neuroradiology Committee. Pediatr Radiol 2024; 54:548-561. [PMID: 37803194 DOI: 10.1007/s00247-023-05766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
Spinal dysraphisms are amenable to diagnosis in utero. The prognosis and the neonatal management of these conditions differ significantly depending on their types, mainly on the distinction between open and closed defects. A detailed evaluation not only of the fetal spine, but also of the brain, skull, and lower limbs is essential in allowing for the right diagnosis. In this article, recommendations from the Fetal Task Force of the European Society of Paediatric Radiology (ESPR) and the European Society of Neuroradiology (ESNR) Pediatric Neuroradiology Committee will be presented. The aim of this paper is to review the imaging features of the normal and abnormal fetal spinal cord, to clarify the prenatal classification of congenital spinal cord anomalies and to provide guidance in their reporting.
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Affiliation(s)
- Juliette Garel
- Department of Radiology, Sainte-Justine University Hospital, University of Montreal, Montreal, QC, H3T 1C5, Canada.
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Eléonore Blondiaux
- Department of Radiology, Médecine Sorbonne Université, APHP, DMU DIAMENT, GRC Images, Paris, France
| | - Marie Cassart
- Department of Radiology and Fetal Medicine, Iris South Hospitals, 63 Rue J. Paquot, 1050, Brussels, Belgium
| | - Chen Hoffmann
- Department of Radiology, Tel Hashomer Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catherine Garel
- Department of Radiology, Hôpital d'Enfants Armand-Trousseau, AP-HP, Paris, France
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, Paris, France
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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 Obstet Gynecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bekiesinska-Figatowska M, Sobieraj P, Pasieczna M, Szymkiewicz-Dangel J. Early Diagnosis of Tuberous Sclerosis Complex: Prenatal Diagnosis. AJNR Am J Neuroradiol 2023; 44:1070-1076. [PMID: 37536734 PMCID: PMC10494953 DOI: 10.3174/ajnr.a7952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/25/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE Strong emphasis has been placed recently on early (4 postnatal months) detection of tuberous sclerosis complex and the introduction of antiepileptic treatment before seizure onset. This objective can be achieved prenatally: Cardiac rhabdomyomas and the major diagnostic tuberous sclerosis complex sign are detected during fetal ultrasound, and prenatal MR imaging allows detection of cerebral major manifestations: cortical tubers, subependymal nodules, and subependymal giant cell astrocytomas. MATERIALS AND METHODS We retrospectively reviewed 50 fetuses with ultrasound-detected cardiac tumors at 19-36 gestational weeks (median, 31 weeks). MR imaging with the use of 1.5T scanners was performed at 24-37 gestational weeks (median, 34 weeks). RESULTS In 11 fetuses (22%), cardiac tumors remained the only criterion. In remaining 39 fetuses (78%), MR imaging revealed a prenatal diagnosis of tuberous sclerosis complex, having shown an additional 1-3 major criteria: subependymal nodules in all cases (39/39 = 100.0%), subependymal giant cell astrocytomas in 6 (6/39 = 15.4%), and cortical tubers in 24 (24/39 = 61.5%). Radial migration lines and cerebellar tuber, not published so far, were shown in 1 case each. CONCLUSIONS A schedule of proper care of children with tuberous sclerosis complex can be established during the perinatal period due to education of women to report for mandatory ultrasound examinations during pregnancy, the good quality of ultrasound, and referral to MR imaging if a cardiac tumor is depicted on ultrasound. Gynecologists and pediatric cardiologists performing fetal ultrasound and radiologists performing prenatal MR imaging are a key to early diagnosis of tuberous sclerosis complex in many cases.
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Affiliation(s)
- M Bekiesinska-Figatowska
- From the Department of Diagnostic Imaging (M.B.-F., P.S.), Institute of Mother and Child, Warsaw, Poland
| | - P Sobieraj
- From the Department of Diagnostic Imaging (M.B.-F., P.S.), Institute of Mother and Child, Warsaw, Poland
| | - M Pasieczna
- Second Department of Obstetrics and Gynecology (M.P.), Medical University of Warsaw, Warsaw, Poland
| | - J Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies (J.S.-D.), Centre of Postgraduate Medical Education, Warsaw, Poland
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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 Obstet Gynecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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EROĞLU Y, AĞLAMIŞ S. Gri Cevher Heterotopisi Bulunan Pediatrik Hastaların Manyetik Rezonans Görüntüleme Bulguları ve Eşlik Eden Malformasyonların Değerlendirilmesi. KSÜ Tıp Fak Der 2022. [DOI: 10.17517/ksutfd.1023811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: The aim of the present study is to classify gray matter heterotopias according to magnetic resonance imaging findings and to define the accompanying malformations.
Methods: Images of all pediatric patients who were detected to have heterotopia in brain magnetic resonance imaging between January 2012 and June 2020 were retrospectively evaluated. The type, location of heterotopia, and accompanying cerebral anomalies were analyzed.
Results: A total of 42 patients, 22 male, and 20 female, with a mean age of 7.80 ± 4.53 years (2-16 years) with gray matter heterotopia were included in the study. Of the patients, 33 (78.6%) had subependymal, 7 (16.7%) had subcortical, and 2 (4.7%) had band heterotopia. Twenty-four patients had epilepsy.
Conclusion: The sub ependymal heterotopias were frequently located in the trigon region of the lateral ventricles. All subcortical heterotopias were in the frontal and unifocal locations. Band heterotopias were located bilaterally and subcortically in a symmetrical fashion in the cerebral hemisphere. The main accompanying anomalies were ventriculomegaly, Arnold-Chiari malformation, and corpus callosum agenesis. Considering the neurological developments of pediatric patients, it is important to identify the type of heterotopia and accompanying anomalies for patient management.
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Affiliation(s)
- Yeşim EROĞLU
- Firat University School of Medicine, Department of Radiology, Elazig
| | - Serpil AĞLAMIŞ
- Firat University School of Medicine, Department of Radiology, Elazig
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Nagaraj UD, Venkatesan C, Bierbrauer KS, Kline-Fath BM. Value of pre- and postnatal magnetic resonance imaging in the evaluation of congenital central nervous system anomalies. Pediatr Radiol 2022; 52:802-816. [PMID: 34232351 DOI: 10.1007/s00247-021-05137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Fetal MRI and neonatal MRI of the central nervous system (CNS) are complementary tools that can help to accurately counsel and direct the management of children with anomalies of the central nervous system. Postnatal MRI can add to fetal MRI by allowing for monitoring of changes in the severity of disease, better delineation of a suspected prenatal anomaly, evaluation for secondary pathologies related to the primary diagnosis, and surgical management direction. In this review we discuss the roles of fetal and neonatal MRI in the diagnosis and treatment of congenital anomalies of the CNS through a series of case examples and how both are important in patient management.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Charu Venkatesan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karin S Bierbrauer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurosurgery, 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, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Aertsen M. The Role of Fetal Brain Magnetic Resonance Imaging in Current Fetal Medicine. J Belg Soc Radiol 2022; 106:130. [PMID: 36569393 DOI: 10.5334/jbsr.3000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Sepulveda F, Sepulveda W. Prenatal intracranial hypotension syndrome: new insights into the mechanisms of fenestration of septi pellucidi and ventriculomegaly in fetuses with open spinal dysraphism. J Matern Fetal Neonatal Med 2021; 35:6981-6987. [PMID: 34074204 DOI: 10.1080/14767058.2021.1932808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To study the prevalence of abnormalities of the septi pellucidi (SP) in a cohort of fetuses with open spinal dysraphism (OSD) and to determine whether this condition is secondary to obstructive ventriculomegaly and, therefore, part of the natural history of prenatal intracranial hypotension (PICH) syndrome. METHODS Magnetic resonance imaging (MRI) studies from fetuses with OSD were analyzed. The SP were assessed using axial and coronal T2-weighted images of the fetal brain and classified as intact, partially absent, or completely absent. Additionally, the correlation between the presence or absence of the SP and the size of the lateral ventricles, degree of cerebellar tonsillar herniation, collapse of the fourth ventricle, and interpeduncular angle was investigated. RESULTS A total of 32 fetuses with OSD were studied. Mean gestational age at the time of the fetal MRI was 25.5 ± 3.9 weeks (range, 19-35) and mean ventricular size was 16.2 ± 4.2 mm (range, 8-26). Twenty-three (71.9%) fetuses had cerebellar tonsillar herniation. The IPA was completely collapsed in 23 cases (71.9%), reduced in seven (21.9%), and unreadable in two (6.3%). Twenty (62.5%) fetuses presented with intact SP, 10 (31.3%) with partially absent SP (incomplete fenestration), and two (6.3%) with completely absent SP (complete fenestration). Fenestration of the SP correlated significantly with the degree of ventriculomegaly (Pearson's correlation coefficient =0.459; p = .01). However, there was no correlation with the IPA, collapse of the fourth ventricle, and cerebellar tonsillar herniation. CONCLUSIONS More than one-third of the fetuses with OSD had fenestration of the SP. The most probable etiology is increased intraventricular pressure leading to local necrosis of the SP. As fenestration of the SP is a secondary event associated with PICH syndrome, this condition should not be considered a contraindication for intrauterine repair of the spinal defect. Instead, it should be seen as an indicator of the severity of the intraventricular pressure.
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Affiliation(s)
- Francisco Sepulveda
- Department of Neuroradiology, Institute of Neurosurgery 'Dr. Asenjo', National Health Service, Santiago, Chile.,FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Waldo Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Choi JJ, Yang E, Soul JS, Jaimes C. Fetal magnetic resonance imaging: supratentorial brain malformations. Pediatr Radiol 2020; 50:1934-1947. [PMID: 33252760 DOI: 10.1007/s00247-020-04696-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Abstract
Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence of events that occurs during prenatal brain development; this includes familiarity with the processes of hemispheric cleavage, formation of interhemispheric commissures, neuro-glial proliferation and migration, and cortical folding. Disruption of these processes results in malformations observed on fetal MRI including holoprosencephaly, callosal agenesis, heterotopic gray matter, lissencephaly and other malformations of cortical development (focal cortical dysplasia, polymicrogyria). The radiologist should also be familiar with findings that have high association with specific conditions affecting the central nervous system or other organ systems. This review summarizes and illustrates common patterns of supratentorial brain malformations and emphasizes aspects that are important to patient care.
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Affiliation(s)
- Jungwhan John Choi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Janet S Soul
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
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12
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Nagaraj UD, Kline-Fath BM. Imaging of open spinal dysraphisms in the era of prenatal surgery. Pediatr Radiol 2020; 50:1988-98. [PMID: 33252764 DOI: 10.1007/s00247-020-04734-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/15/2020] [Accepted: 05/20/2020] [Indexed: 01/24/2023]
Abstract
Over the last decade fetal surgery to repair open spinal dysraphisms has become an acceptable and in some cases desirable alternative to the traditional method of postnatal closure. Fetal MRI is an essential part of the workup in these patients, not only to select the appropriate candidates for fetal surgery but also to guide prenatal counseling and perinatal management. In this article we review current surgical techniques for prenatal repair, relevant imaging findings in the era of fetal surgery, and expected imaging findings of the brain and spine in the fetal and postnatal periods.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Aertsen M, Verduyckt J, De Keyzer F, Vercauteren T, Van Calenbergh F, De Catte L, Dymarkowski S, Demaerel P, Deprest J. Reliability of MR Imaging-Based Posterior Fossa and Brain Stem Measurements in Open Spinal Dysraphism in the Era of Fetal Surgery. AJNR Am J Neuroradiol 2018; 40:191-198. [PMID: 30591508 DOI: 10.3174/ajnr.a5930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/06/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Fetal MR imaging is part of the comprehensive prenatal assessment of fetuses with open spinal dysraphism. We aimed to assess the reliability of brain stem and posterior fossa measurements; use the reliable measurements to characterize fetuses with open spinal dysraphism versus what can be observed in healthy age-matched controls; and document changes in those within 1 week after prenatal repair. MATERIALS AND METHODS Retrospective evaluation of 349 MR imaging examinations took place, including 274 in controls and 52 in fetuses with open spinal dysraphism, of whom 23 underwent prenatal repair and had additional early postoperative MR images. We evaluated measurements of the brain stem and the posterior fossa and the ventricular width in all populations for their reliability and differences between the groups. RESULTS The transverse cerebellar diameter, cerebellar herniation level, clivus-supraocciput angle, transverse diameter of the posterior fossa, posterior fossa area, and ventricular width showed an acceptable intra- and interobserver reliability (intraclass correlation coefficient > 0.5). In fetuses with open spinal dysraphism, these measurements were significantly different from those of healthy fetuses (all with P < .0001). Furthermore, they also changed significantly (P value range = .01 to < .0001) within 1 week after the fetal operation with an evolution toward normal, most evident for the clivus-supraocciput angle (65.9 ± 12.5°; 76.6 ± 10.9; P < .0001) and cerebellar herniation level (-9.9 ± 4.2 mm; -0.7 ± 5.2; P < .0001). CONCLUSIONS In fetuses with open spinal dysraphism, brain stem measurements varied substantially between observers. However, measurements characterizing the posterior fossa could be reliably assessed and were significantly different from normal. Following a fetal operation, these deviations from normal values changed significantly within 1 week.
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Affiliation(s)
- M Aertsen
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Verduyckt
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - F De Keyzer
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - T Vercauteren
- School of Biomedical Engineering and Imaging Sciences (T.V.), King's College, London
| | - F Van Calenbergh
- Department of Neurosurgery (F.V.C.), University Hospitals Leuven, Leuven, Belgium
| | - L De Catte
- Academic Department of Development and Regeneration, Cluster Woman and Child (L.D.C., J.D.), Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - S Dymarkowski
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - P Demaerel
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Academic Department of Development and Regeneration, Cluster Woman and Child (L.D.C., J.D.), Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, (J.D.), London, UK
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16
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Rethmann C, Scheer I, Meuli M, Mazzone L, Moehrlen U, Kellenberger CJ. Evolution of posterior fossa and brain morphology after in utero repair of open neural tube defects assessed by MRI. Eur Radiol 2017; 27:4571-4580. [DOI: 10.1007/s00330-017-4807-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
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