Abstract
BackgroundReported date of last menstrual period and ultrasonography measurements are the most commonly used methods for determining gestational age in antenatal life. However, the mother cannot always determine the last menstrual period with certainty, and ultrasonography measurements are accurate only in the first trimester. We aimed to assess the ability of various biometric measurements on magnetic resonance imaging (MRI) in determining the accurate gestational age of an individual fetus in the second half of gestation.MethodsWe used MRI to scan a total of 637 fetuses ranging in age from 22 to 40 gestational weeks. We evaluated 9 standard fetal 2D biometric parameters, and regression models were fitted to assess normal fetal brain development. A stepwise linear regression model was constructed to predict gestational age, and measurement accuracy was determined in a held-out, unseen test sample (n = 49).ResultsA second-order polynomial regression model was found to be the best descriptor of biometric measures including brain bi-parietal diameter, head circumference, and fronto-occipital diameter in relation to normal fetal growth. Normal fetuses showed divergent growth patterns for the cerebrum and cerebellum, where the cerebrum undergoes rapid growth in the second trimester, while the cerebellum undergoes rapid growth in the third trimester. Moreover, a linear model based on biometrics of brain bi-parietal diameter, length of the corpus callosum, vermis area, transverse cerebellar diameter, and cerebellar area accurately predicted gestational age in the second and third trimesters (cross-validation R2 = 0.822, p < 0.001).ConclusionsThese results support the use of MRI biometry charts to improve MRI evaluation of fetal growth and suggest that MRI biometry measurements offer a potential estimation model of fetal gestational age in the second half of gestation, which is vital to any assessment of pregnancy, fetal development, and neonatal care.
Highlights
Reported date of last menstrual period and ultrasonography measurements are the most commonly used methods for determining gestational age in antenatal life
These results support the use of magnetic resonance imaging (MRI) biometry charts to improve MRI evaluation of fetal growth and suggest that MRI biometry measurements offer a potential estimation model of fetal gestational age in the second half of gestation, which is vital to any assessment of pregnancy, fetal development, and neonatal care
Methods for estimating gestational age based on the measurement of crown‐rump length (CRL) in the first trimester, and fetal biometric measurements such as the brain bi-parietal diameter, head circumference, femur length, and abdominal circumference in the last two trimesters [1, 5], were reported decades ago and are still used today [6]
Summary
Reported date of last menstrual period and ultrasonography measurements are the most commonly used methods for determining gestational age in antenatal life. Methods for estimating gestational age based on the measurement of crown‐rump length (CRL) in the first trimester, and fetal biometric measurements such as the brain bi-parietal diameter, head circumference, femur length, and abdominal circumference in the last two trimesters [1, 5], were reported decades ago and are still used today [6]. Sonographic assessment within the first trimester is recognized as the most accurate estimate of gestational age, it shows large variation in the second and third trimesters due to variability in organ size [1, 4]. The inaccuracy of sonographic assessment has propelled the need to find different approaches that can be used to accurately determine gestational age
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