OP04.11: MR diagnosis of ischemia/infarct in the fetal brain; spectrum of appearance and significance of findings

Abstract

Objectives: Fetal stroke is defined as fetal intracranial hemorrhage that occurs between 14 weeks of gestation and the onset of labor. It has been associated with postnatal epilepsy, mental retardation, and cerebral palsy and may be caused by antenatal ischemic, thrombotic, or hemorrhagic injury. Maternal alloimmune thrombocytopenia and trauma are common predisposing conditions, but there are many unknown risk factors. MRI can depict intracranial hemorrhage, infarct, porencephaly, cystic encephalomalacia, and ischemia. Methods: This was a retrospective, chart review of cases performed between January 1, 2000 through February 2008. A comparison of CNS findings on prenatal ultrasound and fetal MRI was performed to assess potential differences in the two imaging modalities Results: Review of fetal MRI’s revealed 23 cases of diagnosed CNS hemorrhage, ischemia, and infarcts. MRI can delineate the features and extent of the cerebral injury and can define acute and chronic ischemic changes. This is extremely important for predicting prognosis and decision making. Prior studies have shown that major destructive lesions, diffuse excessive high signal intensity within the white matter, cerebellar hemorrhage, and ventricular dilatation after intraventricular hemorrhage are associated with adverse outcomes, but punctate white matter lesions, hemorrhage, or ventricular dilatation without intraventricular hemorrhage are not necessarily correlated with unfavorable results. Conclusions: We present the spectrum of CNS injury diagnosed at our institution. Accurate diagnosis of CNS injury was valuable in prenatal counseling and decision making. It is hoped that additional studies will be performed with long term outcomes assessment to assist in prognostication of fetuses diagnosed with CNS ischemia/infarct.