Fetal Magnetic Resonance Imaging Research Articles

Perinatal outcome of fetal pulmonary pathology in relation to pulmonary volume measured with nuclear magnetic resonance

Introduction: The prognosis in fetal lung disease is related to the size of the pulmonary malformation and secondary pulmonary hypoplasia. The mass effect on the underlying fetal lung results in a decrease in fetal lung volume and an increased likelihood of developing respiratory distress during the neonatal period. Objectives: Estimate the lung volume cut-off points related to neonatal morbidity and mortality in fetuses with congenital pulmonary malformation measured through magnetic resonance imaging. Methodology: Analytical retrospective cohort study from July 1, 2013, to June 30, 2017. Lung volumes were measured by magnetic resonance imaging in fetuses with congenital pulmonary malformation. The different measures are described and the association of lung volume with neonatal mortality is evaluated. Results: We analyzed 26 fetuses with congenital pulmonary malformation. The mortality described was 46.1% (12/26). The mean lung volume in the group with mortality was 19.7cm3 (95% CI 12.1-27.3), vs 58.6cm3 in the group without mortality (95% CI 39.0-78.1) (p=0.0010). Average lung volumes less than 34.9 cm3 were associated with higher mortality. Conclusion: The perinatal result of fetal lung disease is related to lung volume measured with Fetal Magnetic Resonance Imaging, finding that lung volumes less than 34.9cm3 were associated with higher mortality.

Through-Plane Super-Resolution With Autoencoders in Diffusion Magnetic Resonance Imaging of the Developing Human Brain.

Fetal brain diffusion magnetic resonance images (MRI) are often acquired with a lower through-plane than in-plane resolution. This anisotropy is often overcome by classical upsampling methods such as linear or cubic interpolation. In this work, we employ an unsupervised learning algorithm using an autoencoder neural network for single-image through-plane super-resolution by leveraging a large amount of data. Our framework, which can also be used for slice outliers replacement, overperformed conventional interpolations quantitatively and qualitatively on pre-term newborns of the developing Human Connectome Project. The evaluation was performed on both the original diffusion-weighted signal and the estimated diffusion tensor maps. A byproduct of our autoencoder was its ability to act as a denoiser. The network was able to generalize fetal data with different levels of motions and we qualitatively showed its consistency, hence supporting the relevance of pre-term datasets to improve the processing of fetal brain images.

Association of Elevated Maternal Psychological Distress, Altered Fetal Brain, and Offspring Cognitive and Social-Emotional Outcomes at 18 Months

Prenatal maternal psychological distress is associated with disturbances in fetal brain development. However, the association between altered fetal brain development, prenatal maternal psychological distress, and long-term neurodevelopmental outcomes is unknown. To determine the association of fetal brain development using 3-dimensional magnetic resonance imaging (MRI) volumes, cortical folding, and metabolites in the setting of maternal psychological distress with infant 18-month neurodevelopment. Healthy mother-infant dyads were prospectively recruited into a longitudinal observational cohort study from January 2016 to October 2020 at Children's National Hospital in Washington, DC. Data analysis was performed from January 2016 to July 2021. Prenatal maternal stress, anxiety, and depression. Prenatal maternal stress, anxiety, and depression were measured using validated self-report questionnaires. Fetal brain volumes and cortical folding were measured from 3-dimensional, reconstructed T2-weighted MRI scans. Fetal brain creatine and choline were quantified using proton magnetic resonance spectroscopy. Infant neurodevelopment at 18 months was measured using Bayley Scales of Infant and Toddler Development III and Infant-Toddler Social and Emotional Assessment. The parenting stress in the parent-child dyad was measured using the Parenting Stress Index-Short Form at 18-month testing. The cohort consisted of 97 mother-infant dyads (mean [SD] maternal age, 34.79 [5.64] years) who underwent 184 fetal MRI visits (87 participants with 2 fetal studies each) with maternal psychological distress measures between 24 and 40 gestational weeks and completed follow-up infant neurodevelopmental testing. Prenatal maternal stress was negatively associated with infant cognitive performance (β = -0.51; 95% CI, -0.92 to -0.09; P = .01), and this association was mediated by fetal left hippocampal volume. In addition, prenatal maternal anxiety, stress, and depression were positively associated with all parenting stress measures at 18-month testing. Finally, fetal cortical local gyrification index and sulcal depth were negatively associated with infant social-emotional performance (local gyrification index: β = -54.62; 95% CI, -85.05 to -24.19; P < .001; sulcal depth: β = -14.22; 95% CI, -23.59 to -4.85; P = .002) and competence scores (local gyrification index: β = -24.01; 95% CI, -40.34 to -7.69; P = .003; sulcal depth: β = -7.53; 95% CI, -11.73 to -3.32; P < .001). In this cohort study of 97 mother-infant dyads, fetal cortical local gyrification index and sulcal depth were associated with infant 18-month social-emotional and competence outcomes, and fetal left hippocampal volume mediated the association between prenatal maternal stress and infant cognitive outcome. These findings suggest that altered prenatal brain development in the setting of elevated maternal distress has adverse infant sociocognitive outcomes, and identifying early biomarkers associated with long-term neurodevelopment may assist in early targeted interventions.

Fetal thoracic teratomas: mediastinal or pericardial?

Mediastinal and pericardial teratomas have overlapping imaging features that may make accurate prenatal diagnosis challenging. To identify prenatal imaging features that may aid in distinguishing between mediastinal and pericardial teratomas. Prenatally diagnosed pericardial and mediastinal teratomas evaluated at our fetal center from 1995 to 2020 were included in this Institutional Review Board-approved study. Lesion volume was calculated using prospectively reported ultrasound (US) measurements and the formula of a prolate ellipsoid, which was then normalized to head circumference. Prenatal US and magnetic resonance imaging (MRI) studies were anonymized with two fetal imagers reviewing the US studies and two different fetal imagers reviewing the MRI studies. These experienced reviewers scored location of the mass in the craniocaudal axis and in the transverse axis. MRI reviewers also scored the presence of inferior cardiaccompression by the lesion and whether there was identifiable thymic tissue. Reviewer disagreements were resolved by consensus review. Eleven pericardial teratomas and 10 mediastinal teratomas were identified. All cases underwent detailed fetal anatomic US and fetal echocardiogram and 10/11 (91%) pericardial teratomas and 8/10 (80%) mediastinal teratomas underwent fetal MRI. Median volume was higher for mediastinal teratomas compared to pericardial teratomas (42.5mL [interquartile range (IQR) 15.9 - 67.2mL] vs. 8.1mL [IQR 7.7 - 27.7mL], P=0.01) and median volume/head circumference was also statistically higher in mediastinal teratomas (1.33 [IQR 0.78 - 2.61] vs. 0.43 [IQR 0.38 - 1.10], P=0.01). Logistic regression analysis demonstrated a statistical difference between teratoma types with respect to location in the craniocaudal axis by both modalities with mediastinal teratomas more commonly located in the upper and upper-middle thorax compared to pericardial teratomas, which were more commonly found in the middle thorax (US, P=0.03; MRI, P=0.04). Logistic regression analysis also demonstrated a statistical difference between teratoma types with respect to position along the transverse axis by both modalities with mediastinal teratomas more commonly located midline or left paramedian and pericardial teratomas more often right paramedian in location (US, P&lt;0.01; MRI, P=0.02). Inferior cardiac compression observed by MRI was associated more commonly with mediastinal teratomas compared to pericardial teratomas (87.5% [7/8] vs. 10% [1/10], P&lt;0.01). Identifiable thymus by MRI was more commonly observed in cases of pericardial teratomas, however, this difference was not statistically significant (P=0.32). Mediastinal teratomas are associated with larger lesion size and inferior cardiac compression when compared to pericardial teratomas. These features combined with lesion location in the craniocaudal and transverse axes may allow for more accurate prenatal diagnosis and optimal perinatal and surgical management.

Motion correction and volumetric reconstruction for fetal functional magnetic resonance imaging data

Motion correction is an essential preprocessing step in functional Magnetic Resonance Imaging (fMRI) of the fetal brain with the aim to remove artifacts caused by fetal movement and maternal breathing and consequently to suppress erroneous signal correlations. Current motion correction approaches for fetal fMRI choose a single 3D volume from a specific acquisition timepoint with least motion artefacts as reference volume, and perform interpolation for the reconstruction of the motion corrected time series. The results can suffer, if no low-motion frame is available, and if reconstruction does not exploit any assumptions about the continuity of the fMRI signal. Here, we propose a novel framework, which estimates a high-resolution reference volume by using outlier-robust motion correction, and by utilizing Huber L2 regularization for intra-stack volumetric reconstruction of the motion-corrected fetal brain fMRI. We performed an extensive parameter study to investigate the effectiveness of motion estimation and present in this work benchmark metrics to quantify the effect of motion correction and regularised volumetric reconstruction approaches on functional connectivity computations. We demonstrate the proposed framework’s ability to improve functional connectivity estimates, reproducibility and signal interpretability, which is clinically highly desirable for the establishment of prognostic noninvasive imaging biomarkers. The motion correction and volumetric reconstruction framework is made available as an open-source package of NiftyMIC.

Early imaging predictors of fetal cerebral ischemic injury in monochorionic twin pregnancy complicated by spontaneous single intrauterine death.

Monochorionic twin pregnancies are at increased risk of single intrauterine death (sIUD) and subsequent brain injury in the surviving twin owing to shared placentation. We assessed the association between middle cerebral artery peak systolic velocity (MCA-PSV) and cerebral injury on magnetic resonance imaging (MRI) and examined the association between cerebral findings on diffusion-weighted imaging (DWI) and those on T2-weighted imaging following spontaneous sIUD. This was a retrospective cohort study of monochorionic pregnancies complicated by spontaneous sIUD followed at a tertiary center between January 2008 and January 2020. Pregnancies with sIUD following laser treatment, those with selective feticide, double IUD occurring on the same day or sIUD before 14 weeks' gestation were excluded, as were cases in which MCA-PSV was not measured or DWI-MRI was not performed. The ability of MCA-PSV Doppler to predict subsequent cerebral injury on MRI was assessed, and DWI findings were analyzed and compared with those on susceptibility-weighted imaging (SWI) and T2-weighted MRI to determine its diagnostic accuracy. We assessed 64 monochorionic pregnancies complicated by spontaneous sIUD. Of these, 47 (73.4%) pregnancies underwent fetal brain MRI and met the inclusion criteria. Sixteen (34.0%) of these fetuses demonstrated cerebral injury on MRI. The median interval between the diagnosis of sIUD and MRI examination was 5 days. Fetuses with increased MCA-PSV > 1.5 multiples of the median (MoM) following sIUD were significantly more likely to demonstrate cerebral injury on MRI than were those with normal MCA-PSV (68.8% vs 38.7%; P = 0.05). The sensitivity and specificity of MCA-PSV > 1.5 MoM for predicting cerebral injury on MRI were 68.8% (95% CI, 41.3-88.9%) and 61.3% (95% CI, 42.2-78.2%), respectively. Patterns of early cerebral injury on T2-weighted and SWI-MRI included acute or subacute tissue swelling (n = 6), parenchymal atrophy (n = 7), loss of cortical ribbon (n = 1) and hemorrhage (n = 8). Early MRI within approximately 2 weeks after the diagnosis of sIUD demonstrated abnormal DWI along with coexisting SWI and T2-weighted sequelae in 56.3% (9/16) of cases. When DWI was normal and a second MRI examination was performed later (n = 7), there were no ischemic changes evident on T2-weighted imaging. Increased MCA-PSV is associated with, but predicts poorly, cerebral injury after sIUD. Early MRI with DWI within approximately 2 weeks after the diagnosis of sIUD is valuable in identifying any cerebral injury. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal intrakraniyal kanama: prenatal görüntüleme bulguları ve postnatal klinik sonuçlar

Aim: To investigate imaging findings and postnatal clinical features of fetal intracranial hemorrhage.&#x0D; Materials and Method: Fetal intracranial hemorrhage cases detected in our institution between 2018 and 2020 by ultrasonography and magnetic resonance imaging were included. Maternal characteristics, ultrasonography and magnetic resonance imaging findings, and postnatal outcomes were noted.&#x0D; Results: A total of 10 cases with a gestational age of 21-35 weeks at the time of diagnosis were detected. Eight cases had an intraventricular hemorrhage, one case had a cerebellar hemorrhage, and one case had both intraventricular and subdural hemorrhage. An identifiable risk factor was detected in 60% of the cases. While intracranial hemorrhage was diagnosed by ultrasonography in seven cases, in 3 cases it was detected by magnetic resonance imaging that was performed for indications other than intracranial hemorrhage. In two cases pregnancy was terminated, one intrauterine fetal death occurred and seven cases born alive were followed up for at least six months in the postnatal period. Among these, the neurological disorder was observed in 66.6%.&#x0D; Conclusion: Fetal magnetic resonance imaging plays an important role in the diagnosis and characterization of intracranial hemorrhage and is complementary to ultrasonography. Hence we recommend using ultrasonography and magnetic resonance imaging together in its diagnosis.

Clinical Applications of Fetal MRI in the Brain.

Fetal magnetic resonance imaging (MRI) has become a widely used tool in clinical practice, providing increased accuracy in prenatal diagnoses of congenital abnormalities of the brain, allowing for more accurate prenatal counseling, optimization of perinatal management, and in some cases fetal intervention. In this article, a brief description of how fetal ultrasound (US) and fetal MRI are used in clinical practice will be followed by an overview of the most common reasons for referral for fetal MRI of the brain, including ventriculomegaly, absence of the cavum septi pellucidi (CSP) and posterior fossa anomalies.

Fetal Organ Anomaly Classification Network for Identifying Organ Anomalies in Fetal MRI.

Rapid development in Magnetic Resonance Imaging (MRI) has played a key role in prenatal diagnosis over the last few years. Deep learning (DL) architectures can facilitate the process of anomaly detection and affected-organ classification, making diagnosis more accurate and observer-independent. We propose a novel DL image classification architecture, Fetal Organ Anomaly Classification Network (FOAC-Net), which uses squeeze-and-excitation (SE) and naïve inception (NI) modules to automatically identify anomalies in fetal organs. This architecture can identify normal fetal anatomy, as well as detect anomalies present in the (1) brain, (2) spinal cord, and (3) heart. In this retrospective study, we included fetal 3-dimensional (3D) SSFP sequences of 36 participants. We classified the images on a slice-by-slice basis. FOAC-Net achieved a classification accuracy of 85.06, 85.27, 89.29, and 82.20% when predicting brain anomalies, no anomalies (normal), spinal cord anomalies, and heart anomalies, respectively. In a comparison study, FOAC-Net outperformed other state-of-the-art classification architectures in terms of class-average F1 and accuracy. This work aims to develop a novel classification architecture identifying the affected organs in fetal MRI.

Artificial intelligence applied to fetal MRI: A scoping review of current research.

Artificial intelligence (AI) is defined as the development of computer systems to perform tasks normally requiring human intelligence. A subset of AI, known as machine learning (ML), takes this further by drawing inferences from patterns in data to 'learn' and 'adapt' without explicit instructions meaning that computer systems can 'evolve' and hopefully improve without necessarily requiring external human influences. The potential for this novel technology has resulted in great interest from the medical community regarding how it can be applied in healthcare. Within radiology, the focus has mostly been for applications in oncological imaging, although new roles in other subspecialty fields are slowly emerging.In this scoping review, we performed a literature search of the current state-of-the-art and emerging trends for the use of artificial intelligence as applied to fetal magnetic resonance imaging (MRI). Our search yielded several publications covering AI tools for anatomical organ segmentation, improved imaging sequences and aiding in diagnostic applications such as automated biometric fetal measurements and the detection of congenital and acquired abnormalities. We highlight our own perceived gaps in this literature and suggest future avenues for further research. It is our hope that the information presented highlights the varied ways and potential that novel digital technology could make an impact to future clinical practice with regards to fetal MRI.

Motion corrected fetal body magnetic resonance imaging provides reliable 3D lung volumes in normal and abnormal fetuses.

ObjectivesTo calculate 3D‐segmented total lung volume (TLV) in fetuses with thoracic anomalies using deformable slice‐to‐volume registration (DSVR) with comparison to 2D‐manual segmentation. To establish a normogram of TLV calculated by DSVR in healthy control fetuses.MethodsA pilot study at a single regional fetal medicine referral centre included 16 magnetic resonance imaging (MRI) datasets of fetuses (22–32 weeks gestational age). Diagnosis was CDH (n = 6), CPAM (n = 2), and healthy controls (n = 8). Deformable slice‐to‐volume registration was used for reconstruction of 3D isotropic (0.85 mm) volumes of the fetal body followed by semi‐automated lung segmentation. 3D TLV were compared to traditional 2D‐based volumetry. Abnormal cases referenced to a normogram produced from 100 normal fetuses whose TLV was calculated by DSVR only.ResultsDeformable slice‐to‐volume registration‐derived TLV values have high correlation with the 2D‐based measurements but with a consistently lower volume; bias −1.44 cm3 [95% limits: −2.6 to −0.3] with improved resolution to exclude hilar structures even in cases of motion corruption or very low lung volumes.ConclusionsDeformable slice‐to‐volume registration for fetal lung MRI aids analysis of motion corrupted scans and does not suffer from the interpolation error inherent to 2D‐segmentation. It increases information content of acquired data in terms of visualising organs in 3D space and quantification of volumes, which may improve counselling and surgical planning.

Can fetal magnetic resonance imaging aid prognosis in gastroschisis: A multicenter study.

To assess the contribution and impact of fetal magnetic resonance imaging (MRI) in managing fetal gastroschisis. We conducted an observational retrospective study of gastroschisis patients at three fetal medicine centers from 2008 to 2019. The primary endpoint was the number of cases in which the MRI provided relevant information related to gastroschisis. A total of 189 patients were included, and our study group included 38 patients who underwent MRI. For the eight patients with suspected gastroschisis, MRI confirmed the diagnosis. In six cases, it provided additional relevant information (spiral turn, intestine ischemia, and bowel size discrepancy). For the 17 patients with ultrasound signs of additional gastrointestinal anomalies, MRI detected one case of unidentified complex gastroschisis on sonography. For the 13 patients undergoing routine MRI, no significant information was obtained. One termination of pregnancy and one fetoscopy were performed a few days after the MRI results. There was no subsequent follow-up or additional bowel complications to support management. Although MRI did not change the management of pregnancies complicated by fetal gastroschisis, patients presenting with fetal gastroschisis with intraabdominal bowel dilatation could benefit from MRI to allow for more precise prenatal counseling to predict postnatal intestinal complications before birth.

Year-end academic review of 2021: Advances in the field of birth defect prevention and control in China as of 2021

Year-end academic review of 2021: Advances in the field of birth defect prevention and control in China as of 2021

Regional brain development in fetuses with Dandy-Walker malformation: A volumetric fetal brain magnetic resonance imaging study.

Dandy-Walker malformation (DWM) is a common prenatally diagnosed cerebellar malformation, characterized by cystic dilatation of the fourth ventricle, upward rotation of the hypoplastic vermis, and posterior fossa enlargement with torcular elevation. DWM is associated with a broad spectrum of neurodevelopmental abnormalities such as cognitive, motor, and behavioral impairments, which cannot be explained solely by cerebellar malformations. Notably, the pathogenesis of these symptoms remains poorly understood. This study investigated whether fetal structural developmental abnormalities in DWM extended beyond the posterior fossa to the cerebrum even in fetuses without apparent cerebral anomalies. Post-acquisition volumetric fetal magnetic resonance imaging (MRI) analysis was performed in 12 fetuses with DWM and 14 control fetuses. Growth trajectories of the volumes of the cortical plate, subcortical parenchyma, cerebellar hemispheres, and vermis between 18 and 33 weeks of gestation were compared. The median (interquartile range) gestational ages at the time of MRI were 22.4 (19.4–24.0) and 23.9 (20.6–29.2) weeks in the DWM and control groups, respectively (p = 0.269). Eight of the 12 fetuses with DWM presented with associated cerebral anomalies, including hydrocephalus (n = 3), cerebral ventriculomegaly (n = 3), and complete (n = 2) and partial (n = 2) agenesis of the corpus callosum (ACC); 7 presented with extracerebral abnormalities. Chromosomal abnormalities were detected by microarray analysis in 4 of 11 fetuses with DWM, using amniocentesis. Volumetric analysis revealed that the cortical plate was significantly larger in fetuses with DWM than in controls (p = 0.040). Even without ACC, the subcortical parenchyma, whole cerebrum, cerebellar hemispheres, and whole brain were significantly larger in fetuses with DWM (n = 8) than in controls (p = 0.004, 0.025, 0.033, and 0.026, respectively). In conclusion, volumetric fetal MRI analysis demonstrated that the development of DWM extends throughout the brain during the fetal period, even without apparent cerebral anomalies.

Correlation between fetal heart rate evolution patterns and magnetic resonance imaging findings in severe cerebral palsy: Alongitudinal study.

ObjectiveTo investigate the association between hypoxic‐ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).DesignLongitudinal study.SettingDatabase of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.SampleInfants with severe CP born at ≥34 weeks of gestation.MethodsThe intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non‐reassuring (NR‐NR); reassuring‐prolonged deceleration (R‐PD); Hon's pattern (R‐Hon); persistently reassuring (R‐R); and unclassified. The brain magnetic resonance imaging (MRI) scans were categorised based on the predominant site involved: basal ganglia‐thalamus (BGT); white matter (WM); watershed (WS); stroke; normal; and unclassified.Main outcome measuresManifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed.ResultsAmong 672 eligible infants, 76% had BGT‐dominant injury, 5.4% WM, 1.2% WS, 1.6% stroke, 1.9% normal, and 14% unclassified. Placental abruption and small‐for‐gestational age were associated with an increased (adjusted odds ratio [aOR] 8.02) and decreased (aOR 0.38) risk of BGT injury, respectively. The majority of infants had BGT injury in most FHR groups (bradycardia, 97%; NR‐NR, 75%; R‐PD, 90%; R‐Hon, 76%; and R‐R, 45%). The risk profiles in case of BGT in the NR‐NR group were similar to those in the R‐PD and R‐Hon groups.ConclusionBGT‐dominant brain damage accounted for three‐fourths of the cases of CP in term or near‐term infants, even in prenatal onset cases. Hypoxic‐ischaemic insult has a major impact on CP development during the antenatal period.Tweetable abstractBasal ganglia‐thalamus injury constitutes 76% of severe cerebral palsy cases, predominant even in antenatal‐onset cases.

Fetal magnetic resonance imaging at 3Tesla - the European experience.

The Fetal Imaging Taskforce was established in 2018 by the European Society of Paediatric Radiology. The first survey on European practice of fetal imaging published in2020 revealed that 30% of fetal magnetic resonance imaging (MRI) is performed at 3 tesla (T). The purpose of this second survey was to identify the impact of 3-T fetal MRI with an emphasis on image quality, diagnostic yield, and technical challenges and artifacts at higher field strengths. To describe the prenatal imaging practice at 3-T MRI units in various centres in Europe and to prepare recommendations on behalf of the Fetal Imaging Taskforce. A survey was sent to all members performing 3-T fetal MRI. Questions included practitioner experience, magnet brand, protocols, counselling, artifacts and benefits of imaging at higher field strengths. Twenty-seven centres replied and reported improved spatial resolution and improved signal-to-noise ratio when performing fetal MRI at 3T. Shading and banding artifacts and susceptibility to motion artifacts were common problems identified by practitioners at the higher field strength. For all neurological indications, practitioners reported a benefit of imaging at 3T, most marked for posterior fossa evaluation and parenchymal lesions. The use of 3-T magnets in fetal MRI has improved the availability and quality of advanced imaging sequences and allowed for better anatomical evaluation. There remain significant challenges to minimize the impact of artifacts on image quality. This paper includes guidelines for clinical practice and imaging at 3T.

Fetal Brain Volume Predicts Neurodevelopment in Congenital Heart Disease.

Neurodevelopmental impairment is common in children with congenital heart disease (CHD), but postnatal variables explain only 30% of the variance in outcomes. To explore whether the antecedents for neurodevelopmental disabilities might begin in utero, we analyzed whether fetal brain volume predicted subsequent neurodevelopmental outcome in children with CHD. Fetuses with isolated CHD and sociodemographically comparable healthy control fetuses underwent fetal brain magnetic resonance imaging and 2-year neurodevelopmental evaluation with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and the Adaptive Behavior Assessment System, Third Edition (ABAS-3). Hierarchical regression evaluated potential predictors of Bayley-III and ABAS-3 outcomes in the CHD group, including fetal total brain volume adjusted for gestational age and sex, sociodemographic characteristics, birth measures, and medical history. The CHD group (n=52) had lower Bayley-III cognitive, language, and motor scores than the control group (n=26), but fetal brain volumes were similar. Within the CHD group, larger fetal total brain volume correlated with higher Bayley-III cognitive, language, and motor scores and ABAS-3 adaptive functioning scores (r=0.32-0.47; all P<0.05), but this was not noted in the control group. Fetal brain volume predicted 10% to 21% of the variance in neurodevelopmental outcome measures in univariate analyses. Multivariable models that also included social class and postnatal factors explained 18% to 45% of the variance in outcome, depending on developmental domain. Moreover, in final multivariable models, fetal brain volume was the most consistent predictor of neurodevelopmental outcome across domains. Small fetal brain volume is a strong independent predictor of 2-year neurodevelopmental outcomes and may be an important imaging biomarker of future neurodevelopmental risk in CHD. Future studies are needed to support this hypothesis. Our findings support inclusion of fetal brain volume in risk stratification models and as a possible outcome in fetal neuroprotective intervention studies.

Newborn with a Large Intracranial Mass.

Newborn with a Large Intracranial Mass.

Optimization of the image contrast for the developing fetal brain using 3D radial VIBE sequence in 3\xa0T magnetic resonance imaging

BackgroundFaster and motion robust magnetic resonance imaging (MRI) sequences are desirable in fetal brain MRI. T1-weighted images are essential for evaluating fetal brain development. We optimized the radial volumetric interpolated breath-hold examination (VIBE) sequence for qualitative T1-weighted images of the fetal brain with improved image contrast and reduced motion sensitivity.Materials and methodsThis was an institutional review board-approved prospective study. Thirty-five pregnant subjects underwent fetal brain scan at 3 Tesla MRI. T1-weighted images were acquired using a 3D radial VIBE sequence with flip angles of 6º, 9º, 12º, and 15º. T1-weighted images of Cartesian VIBE sequence were acquired in three of the subjects. Qualitative assessments including image quality and motion artifact severity were evaluated. The image contrast ratio between gray and white matter were measured. Interobserver reliability and intraobserver repeatability were assessed using intraclass correlation coefficient (ICC).ResultsInterobserver reliability and intraobserver repeatability universally revealed almost perfect agreement (ICC > 0.800). Significant differences in image quality were detected in basal ganglia (P = 0.023), central sulcus (P = 0.028), myelination (P = 0.007) and gray matter (P = 0.023) among radial VIBE with flip angles 6º, 9º, 12º, 15º. Image quality at the 9º flip angle in radial VIBE was generally better than flip angle of 15º. Radial VIBE sequence with 9º flip angle of gray matter was significantly different by gestational age (GA) before and after 28 weeks (P = 0.036). Quantified image contrast was significantly different among different flip angles, consistent with qualitative analysis of image quality.ConclusionsThree-dimensional radial VIBE with 9º flip angle provides optimal, stable T1-weighted images of the fetal brain. Fetal brain structure and development can be evaluated using high-quality images obtained using this angle. However, different scanners will achieve different TRs and so the FA should be re-optimized each time a new protocol is employed.

Characterization of Lesions in the Central Nervous System Based on Neurosonography and Magnetic Resonance in Fetus with Isolated Congenital Heart Defects. A Systematic Review

Introduction: Congenitalheartdefectsrepresentoneofthemainmalformationsdiagnosed prenatally. These are a major cause of neuro developmental disorders and it has even been proposed that structural brain alteration is found from early stages of fetal development. Objective: The objective of this study was to review the existing evidence of prenatal diagnosis of structural braina lterations found in fetal brain magnetic resonance imaging and neurosonography in fetus with isolated congenital heart defect. Materials and Methods: A search of Pubmed, Science Direct, Clinical Key and EBSCO databases was conducted in order to review study cases of fetuses with congenital heart defect between 18 and 37 week with Doppler ultrasonography, neurosonography and /or fetal brain magnetic resonance imaging. Results: A total of 16 articles were selected and it was found that the fetuses with congenital heart defect present structural neurological alterations from intrauterine life showed by neurosonography and fetal brain magnetic resonance imaging. Conclusion: The evidence emphasizes on the importance of studying in detail the central nervous system of fetuses with congenital heart defect and the relationship between structural brain alterations and neurodevelopmental disorders impairment since prenatal stages.