Lateral Ventricular Width Research Articles

Pregnancy outcomes and genetic analysis for fetal ventriculomegaly.

Introduction: Fetal ventriculomegaly (VM) is associated with neurodevelopmental disorders, partly caused by genetic factor. Methods: To systematically investigate the genetic etiology of fetal VM and related pregnancy outcomes in different subgroups: IVM (isolated VM) and NIVM (non-isolated VM); unilateral and bilateral VM; mild, moderate, and severe VM, a retrospective study including 131 fetuses with VM was carried out from April 2017 to August 2022. Results: 82 cases underwent amniocentesis or cordocentesis, of whom 8 cases (9.8%) were found chromosomal abnormalities by karyotyping. Meanwhile, additional 8 cases (15.7%) with copy number variations (CNVs) were detected by copy number variation sequencing (CNV-seq). The detection rate (DR) of chromosomal abnormalities was higher in NIVM, bilateral VM and severe VM groups. And CNVs frequently occurred in NIVM, bilateral VM and moderate VM groups. In the NIVM group, the incidence of chromosomal aberrations and CNVs in multiple system anomalies (19.0%, 35.7%) was higher than that in single system anomalies (10.0%, 21.1%). After dynamic ultrasound follow-up, 124 cases were available in our cohort. 12 cases were further found other structural abnormalities, and lateral ventricular width was found increased in 8 cases and decreased in 15 cases. Meanwhile, 82 cases underwent fetal brain MRI, 10 cases of brain lesions and 11 cases of progression were additionally identified. With the involvement of a multidisciplinary team, 45 cases opted for termination of pregnancy (TOP) and 79 cases were delivered with live births. One infant death and one with developmental retardation were finally found during postnatal follow-ups. Discussion: CNV-seq combined with karyotyping could effectively improve the diagnostic rate in fetuses with VM. Meanwhile, dynamic ultrasound screening and multidisciplinary evaluation are also essential for assessing the possible outcomes of fetuses with VM.

A comparison of ventricular volume and linear indices in predicting shunt dependence in aneurysmal subarachnoid hemorrhage

BackgroundGuidelines for determining shunt dependence after aneurysmal subarachnoid hemorrhage (aSAH) remain unclear. We previously demonstrated change in ventricular volume (VV) between head CT scans taken pre- and post-EVD clamping was predictive of shunt dependence in aSAH. We sought to compare the predictive value of this measure to more commonly used linear indices. MethodsWe retrospectively analyzed images of 68 patients treated for aSAH who required EVD placement and underwent one EVD weaning trial, 34 of whom underwent shunt placement. We utilized an in-house MATLAB program to analyze VV and supratentorial VV (sVV) in head CT scans obtained before and after EVD clamping. Evans' index (EI), frontal and occipital horn ratio (FOHR), Huckman's measurement, minimum lateral ventricular width (LV-Min.), and lateral ventricle body span (LV-Body) were measured using digital calipers in PACS. Receiver operating curves (ROC) were generated. ResultsArea under the ROC curves (AUC) for the change in VV, sVV, EI, FOHR, Huckman's, LV-Min., and LV-Body with clamping were 0.84, 0.84, 0.65, 0.71.0.69, 0.67, and 0.66, respectively. AUC for post-clamp scan measurements were 0.75, 0.75, 0.74, 0.72, 0.72, 0.70, and 0.75, respectively. ConclusionVV change with EVD clamping was more predictive of shunt dependence in aSAH than change in linear measurements with clamping and all post-clamp measurements. Measurement of ventricular size on serial imaging with volumetrics or linear indices utilizing multidimensional data points may therefore be a more robust metric than unidimensional linear indices in predicting shunt dependence in this cohort. Prospective studies are needed for validation.

Linear structural features of Wilson’s disease and its correlation with neurological symptoms

To measure the linear structure of the brain in patients with Wilson's disease (WD) and analyze its correlation with neurological symptoms. A total of 174 patients diagnosed with WD were enrolled. According to the type of clinical presentation, the patients with WD were divided into two groups: neurological (NWD) and hepatic (HWD). Sixty healthy volunteers were assigned to a control group. All patients with WD and healthy controls underwent brain magnetic resonance imaging (MRI). The severity of the neurological symptoms was assessed using the Burke Fahn Marsden Movement subscale (BFM-M). Linear brain measurements were performed using T1-weighted MRI scans of all the patients, and the correlation between these linear indices and BFM-M score was investigated. The Huckman index, third ventricle width, and sulcus width of the NWD group were significantly higher than those of the HWD and control groups (P < .05). The frontal horn index, ventricular index, and lateral ventricular body width index of the NWD group were significantly lower than those of the HWD and control groups (P < .05). The Huckman index and third ventricle width of the HWD group were higher than those of the control group (P < .05), whereas the body width index of the lateral ventricle was lower than that of the control group (P < .05). The BFM-M score correlated with the Huckman index (r = 0.29, P < .05), third ventricle width (r = 0.426, P < .001), and lateral ventricular body width index (r = -0.19, P < .05). This study demonstrated significant changes in the linear structure of patients with WD. Linear brain measurement analysis could be used as a potential method to assess the severity of neurological symptoms in WD.

EP11.03: Structural and chromosomal abnormalities in fetuses with lateral ventricular atrium width between 9 and 10mm

EP11.03: Structural and chromosomal abnormalities in fetuses with lateral ventricular atrium width between 9 and 10mm

Prenatal work-up, associated anomalies and postnatal outcomes of foetuses with 9-9.9mm cerebral ventricular atria width.

To analyse prenatal work-up, associated anomalies and postnatal outcomes of foetuses with cerebral lateral ventricular width 9-9.9mm. This retrospective, observational, case-control study included 121 foetuses with initial presentation of isolated cerebral lateral ventricular width 9-9.9mm detected during routine ultrasound scans, 21-24weeks' gestation, in a tertiary referral centre, January 2001-December 2018. Controls included 123 foetuses with lateral ventricular width <9mm measured under the same parameters. Clinical characteristics, obstetrical history, ultrasound findings, prenatal work-up and pregnancy outcomes were collected from medical records. Information about postnatal functional and neurodevelopmental sequelae were obtained from telephone-based questionnaires. The study group had more males (82/116 (70.6%) versus 65/123 (52.8%), p=0.004), more prenatal testing, including brain magnetic resonance imaging (28/116 (24.1%) versus 0/123 (0%), p<0.001), echocardiography (46/116 (39.7%) versus 15/123 (12.2%), p<0.001) and targeted anomaly scans (102/116 (87.9%) versus 1/123 (0.008%), p<0.001). Long-term follow-up did not reveal more neurodevelopmental sequelae compared to controls. Gender-based analysis found more males with ventricular dilatation 9-9.9mm treated for developmental delay compared to females with similar findings (15/82 (18.2%) versus 1/34 (2.9%), p=0.010). Foetuses with 9-9.9mm cerebral lateral ventricular width versus <9mm underwent more prenatal testing but had similar rates of neurodevelopmental sequelae.

Chromosomal microarray analysis vs. karyotyping for fetal ventriculomegaly: a meta-analysis.

Background:Chromosomal abnormalities are important causes of ventriculomegaly (VM). In mild and isolated cases of fetal VM, obstetricians rarely give clear indications for pregnancy termination. We aimed to calculate the incidence of chromosomal abnormalities and incremental yield of chromosomal microarray analysis (CMA) in VM, providing more information on genetic counseling and prognostic evaluation for fetuses with VM.Methods:The Chinese language databases Wanfang Data, China National Knowledge Infrastructure, and China Biomedical Literature Database (from January 1, 1991 to April 29, 2020) and English language databases PubMed, Embase, and Cochrane Library (from January 1, 1945 to April 29, 2020) were systematically searched for articles on fetal VM. Diagnostic criteria were based on ultrasonographic or magnetic resonance imaging (MRI) assessment of lateral ventricular atrium width: ≥10 to <15 mm for mild VM, and ≥15 mm for severe VM. Isolated VM was defined by the absence of structural abnormalities other than VM detected by ultrasonography or MRI. R software was used for the meta-analysis to determine the incidence of chromosomal abnormalities and incremental yield of CMA in VM, and the combined rate and 95% confidence interval (CI) were calculated.Results:Twenty-three articles involving 1635 patients were included. The incidence of chromosomal abnormalities in VM was 9% (95% CI: 5%–12%) and incremental yield of CMA in VM was 11% (95% CI: 7%–16%). The incidences of chromosomal abnormalities in mild, severe, isolated, and non-isolated VM were 9% (95% CI: 4%–16%), 5% (95% CI: 1%–11%), 3% (95% CI: 1%–6%), and 13% (95% CI: 4%–25%), respectively.Conclusions:Applying CMA in VM improved the detection rate of abnormalities. When VM is confirmed by ultrasound or MRI, obstetricians should recommend fetal karyotype analysis to exclude chromosomal abnormalities. Moreover, CMA should be recommended preferentially in pregnant women with fetal VM who are undergoing invasive prenatal diagnosis. CMA cannot completely replace chromosome karyotype analysis.

Prognostic Analysis and Risk Factors Associated with Fetal Ventriculomegaly

Background: This study aimed to investigate the clinical outcome and related risk factors of fetal lateral ventriculomegaly (VM). Methods: A retrospective analysis was performed on 255 cases diagnosed as fetal VM. Prenatal imaging examination was carried out. The pregnancy outcomes were investigated through follow-up. According to the prognosis of children, they were divided into case group and control group. Multivariate logistic regression was used to analyze the factors influencing the prognosis of hydrocephalus. Results: After excluding the cases with either loss of follow-up or incomplete information, 102 cases were followed up. Twelve cases with poor prognosis were set as the case group. According to the maternal age, gestational age, gender of children, and follow-up time, 3 cases were selected from the other 90 cases for each child in the case group, respectively, and selected as the control group. Paired comparative analysis was performed on 48 cases. Using prognosis as a dependent variable, multivariate logistic regression analysis of the statistically significant factors indicated that the change speed of width ratio (CSWR) and maximum lateral ventricular width (MW) were associated with fetal prognosis. Conclusions: Our results suggested that CSWR and MW may have the value of predicting fetal prognosis.

Ultrasound evaluation of the relation between fetal lateral ventricle diameter and biometric parameters

Aim: The study was to assess the correlation between fetal lateral ventricular width and biometric measurements with ultrasound examination. Material and methods: A prospective case-control study on 178 fetuses as the control group with lateral ventricle diameter 4-7.9 mm and 80 fetuses as the case group with lateral ventricle diameter 8-12 mm. The study was done at Shariati hospital, from September 2015 to January 2019. All patients underwent a detailed ultrasound exam according to ISUOG guideline and biometric measurements, including head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, cerebellar diameter, cisterna magna width, average ultrasound gestational age, and estimated fetal weight were done. The atrium of lateral ventricles was measured. Singleton pregnancies without malformations were included. Fetuses with lateral ventricle width above 12 mm or with other cerebral anomalies were excluded. Those patients with lateral ventricle diameter 10-12mm underwent serologic evaluation for TORCH, karyotype study and a multiplanar brain ultrasound exam to asses other neurologic findings, and fetuses with normal karyotype and negative TORCH study were included. At least two follow-up ultrasound examinations at 26-28 weeks of gestational age and 32-34 weeks of gestational age were performed to evaluate ventricle size, and fetuses with lateral ventricle width above 12 mm were excluded. The two groups were matched according to gestational age and fetal gender. Then we compared fetal biometric measurements, mentioned above, in these groups. Results: The mean gestational age in the control group was 20.3 weeks, and in the case group was 20.5 weeks (P>0.05). The mean maternal age, maternal past medical history, obstetrical history, mode of conception, fetal presentation, and fetal gender did not differ between the groups. We compared 187 patients as the control group with 80 patients as the case group at the same gestational age and gender. The mean ventricular width in the case group was 8.6mm, and in the control group was 5.9mm. The study group had significantly larger head circumference (P=0.002), biparietal diameter (P<.001), femur length (P=0.005), and estimated fetal weight (P<.001) compared with the control group. Conclusion: The lateral ventricular width is dependent on other biometric parameters such as head circumference, biparietal diameter, and generally fetal size, and larger ventricle width is associated with larger parameters. This association may be the cause of some isolated mild ventriculomegaly, and isolated mild ventriculomegaly does not necessarily mean a pathological condition.

Meta analysis of fetal lateral ventriculomegaly and prognosis

Objective: To explore the neurological development of fetal with ventriculomegaly at 1 year after birth by systematically reviewing the domestic and international literature about prognosis of fetal ventriculomegaly. Methods: Wanfang database, CNKI, CBM, PubMed, EMBASE and the Cochrane Library were online searched to collect relevant literature published from January 1st, 1980 to November 22th, 2017. Literature were extracted based on the Newcastle-Ottawa Scale (NOS) , and analyzed by R software for meta-analysis. The corresponding model was selected according to the results of heterogeneity test to comprehensively analyze the prognosis of the fetus with ventriculomegaly. Results: Five studies were included in the meta analysis, all of them were of high quality (scores>5) . (1) The good prognosis rate of nervous system was 88% (95%CI:0.77-0.95) in fetus with mild ventriculomegaly, was 57% (95%CI:0.18-0.91) in those with moderate ventriculomegaly, and was 36% (95%CI:0.16-0.59) in those with severe ventriculomegaly. (2) The good prognosis rate of the nervous system was 86% (95%CI:0.75-0.94) in fetus with the isolated ventriculomegaly, while was 58% (95%CI:0.20-0.91) in those with non-isolated ventriculomegaly. The incidence of chromosomal abnormalities was 7% (95%CI:0.05-0.09) in ventriculomegaly. The improvement rate of lateral ventricle width in pregnancy was 41% (95%CI:0.27-0.57) . Conclusions: The prognosis of nervous system with mild ventriculomegaly is better than that of moderate and severe ventriculomegaly. The prognosis of nervous system with isolated ventriculomegaly is better than that of non-isolated ventriculomegaly. Fetal ventriculomegaly may be associated with fetal chromosomal abnormalities and intrauterine infection. The variation of fetal lateral ventricular width should be monitored regularly during pregnancy, the risk of poor prognosis should be informed, and pediatrician should be asked for evaluation.

Clinical significance and prognosis of asymmetric ventricles in fetuses

Objective To investigate the clinical significance and prognosis of ultrasound-identified asymmetric ventricles in fetuses, and to provide evidences for clinical consultation and management. Methods From January 2014 to May 2017, 142 singleton fetuses were enrolled who were diagnosed with asymmetric ventricles through prenatal ultrasound in Peking University First Hospital and successfully followed up after birth. Asymmetric ventricles included simple lateral ventricular asymmetry [lateral ventricular widths were normal (<10 mm) but with a difference of ≥2 mm between the two lateral ventricles and unilateral ventricular widening (only one lateral ventricle was ≥10 mm in width and the other was <10 mm). All 142 fetuses were divided into two groups according to whether they had other abnormalities (including abnormal ultrasound soft markers and structural abnormalities) or not. Clinical and imaging data of them were analyzed retrospectively. They were followed up for at least six months after birth. Neurological development regarding language, behavior and motor was evaluated using Denver Developmental Screening Test. Results There were 109 cases without other abnormalities and among them, 38 (35%) spontaneously recovered in utero, two (2%) became worse, and 69 (63%) remained unchanged. Thirty-one of the 109 cases received fetal cranial MRI and abnormal brain development was found in only one case. No abnormal findings were reported in karyotyping in 38 cases and viral detection in 31 cases. One hundred and five fetuses were successfully delivered and four were induced including two cases for wider in unilateral lateral ventricle, one of continued widening, and one with abnormal brain development suggested by fetal cranial MRI. Among the 33 cases with other abnormalities, two were spontaneously recovered in utero, one became worse , 15 unchanged and 15 were induced. Of the 20 cases underwent chromosomal examination, one unbalanced chromosome translocation was identified. Twelve fetuses underwent cranial MRI among which two were found abnormal (periventricular cyst and brain asymmetry). Sixteen cases were aborted including 15 with major abnormalities (major deformity or absence of extremities) and one with mild abnormality (abnormal ultrasound soft markers with progression in lateral ventricular width ≥15 mm in in-utero follow-up). Seventeen cases were born including 16 with mild abnormalities and one with severe abnormality (unilateral renal cystic disease without chromosome abnormality). No significant developmental abnormality in language, behavior and motor was reported during follow-up. Conclusions Asymmetric ventricles have no significant impact on fetal growth and postnatal development. The prognosis of asymmetric ventricles mainly depends on the width of lateral ventricles in utero and concomitant abnormalities. Therefore, close attention should be paid on monitoring and follow-up. Key words: Hydrocephalus; Lateral ventricles; Ultrasonography, prenatal; Prognosis

Practical one-dimensional measurements of age-related brain atrophy are validated by 3-dimensional values and clinical outcomes: a retrospective study.

BackgroundAge-related brain atrophy has been represented by simple 1-dimensional (1-D) measurements on computed tomography (CT) for several decades and, more recently, with 3-dimensional (3-D) analysis, using brain volume (BV) and cerebrospinal fluid volume (CSFV). We aimed to show that simple 1-D measurements would be associated with 3-D values of age-related atrophy and that they would be related to post-traumatic intracranial hemorrhage (ICH).MethodsPatients ≥60 years with head trauma were classified with central atrophy (lateral ventricular body width >30 mm) and/or cortical atrophy (sulcus width ≥2.5 mm). Composite atrophy was the presence of central or cortical atrophy. BV and CSFV were computed using a Siemens Syngo workstation (VE60A).ResultsOf 177 patients, traits were age 78.3 ± 10, ICH 32.2 %, central atrophy 39.5 %, cortical atrophy 31.1 %, composite atrophy 49.2 %, BV 1,156 ± 198 mL, and CSFV 102.5 ± 63 mL. CSFV was greater with central atrophy (134.4 mL), than without (81.7 mL, p < 0.001). BV was lower with cortical atrophy (1,034 mL), than without (1,211 mL; p < 0.001). BV was lower with composite atrophy (1,103 mL), than without (1,208 mL; p < 0.001). CSFV was greater with composite atrophy (129.1 mL), than without (76.8 mL, p < 0.001). CSFV÷BV was greater with composite atrophy (12.3 %), than without (6.7 %, p < 0.001). Age was greater with composite atrophy (80.4 years), than without (76.3, p = 0.006). Age had an inverse correlation with BV (p < 0.001) and a direct correlation with CSFV (p = 0.0002) and CSFV÷BV (p < 0.001). ICH was greater with composite atrophy (49.4 %), than without (15.6 %; p < 0.001; odds ratio = 5.3). BV was lower with ICH (1,089 mL), than without (1,188 mL; p = 0.002). CSFV÷BV was greater with ICH (11.1 %), than without (8.7 %, p = 0.02). ICH was independently associated with central atrophy (p = 0.001) and cortical atrophy (p = 0.003).ConclusionsSimple 1-D measurements of age-related brain atrophy are associated with 3-D values. Clinical validity of these methods is also supported by their association with post-injury ICH. Intracranial 3-D software is not available on many CT scanners and can be cumbersome, when available. Simple 1-D measurements, using the study methodology, are a practical method to objectify the presence of age-related brain atrophy.

Fetal ventriculomegaly: Pregnancy outcomes and follow-ups in ten years.

The aim of this study is to evaluate the pregnancy outcomes and prognoses for fetuses with ventriculomegaly. Two hundred and forty-one cases of fetuses with ventriculomegaly were included in this study. The subjects were divided into three groups according to their lateral ventricular width: "Mild Ventriculomegaly" (10 ‒ < 12 mm), "Moderate Ventriculomegaly" (12 ‒ < 15 mm) and "Severe Ventriculomegaly" (≥ 15 mm). Pediatric examination records and telephone interviews were conducted to track the outcomes of children until the age of 9 years. Eight-two cases were Isolated Ventriculomegaly (34.0%), while Non-Isolated Ventriculomegaly was found in 159 cases (66.0%). The pregnancy was terminated in 91 cases, and a higher abortion ratio was found in the NIVM (Non-Isolated Ventriculomegaly) group compared with the IVM (Isolated Ventriculomegaly) group. The fetuses were delivered in 150 cases, and four infants suffered deaths with NIVM. Of the surviving fetuses, 7 with IVM and 9 with NIVM showed significant abnormalities. The Mild and Moderate VM groups had more favorable prognoses compared with the Severe VM group. Regarding the outcomes and progression of lateral ventricular width, 1 out of 42 cases in the regressed group and 19 out of 108 cases in the stable group showed significant abnormalities. This study suggests that the degree and the progression of ventricular dilatation are main factors that affect pregnancy outcomes and prognoses.

Sonographic Evaluation of Normal Anatomy of Fetal Central Nervous System in Mid-Trimester

The central nervous system is a common site for congenital anomalies. Neural tube defects (NTDs) such as anencephaly, encephalocele and spina bifida are among the most common central nervous system congenital anomalies. They result from failure of closure of the neural tube during embryonic development. The neural tube formation starts during the fourth week (22 - 23 days) after fertilization and fuses approximately between the days 25th and 27th. Most of NTDs result from genetic factors and environmental factors which are poorly understood. Diagnostic sonography can show a detailed visualization of the fetal intracranial anatomy such as the cerebral hemispheres, midbrain, thalami, and lateral ventricles. They also can measure the ratio between lateral ventricular and cerebral hemispheric width. It might show as well, the ratio between gestation, the rapid growth of the cerebral hemispheres and the expansion of the cerebral ventricles. The ultrasound during pregnancy plays a prominent and influential role in the prenatal evaluation of the central nervous system. It gives an excellent window for viewing and evaluating the fetal central nervous system during the second trimester through the lateral ventricles and transthalamic view, thus effectively contributing in the diagnosis and treatment of its congenital anomalies.

The criterion value of fetal cerebral lateral ventricular atrium width for diagnosis of ventriculomegaly

Aim: To determine the distribution of cerebral lateral ventricular atrium width (LVAW) as established according to gestational weeks, and calculate the criterion value of LVAW that differentiates normal fetuses from abnormal fetuses. Materials and Methods: A total of 832 patients meeting the study's criteria were included in the control group. An additional 43 fetuses with LVAW > ten mm formed the case group. Results: The criterion value of LVAW was 9.7 mm. It did not change significantly throughout gestation. In the case group, 23 fetuses were terminated for fetal abnormalities, two fetuses died in utero, and 18 infants were born alive. Most of the abnormal development coincided with LVAW values greater than 12 mm. Conclusion: The authors suggest 9.7 mm as the criterion value, based on receiver operating characteristic (ROC) curve analysis. When the LVAW is between 9.8 and 12 mm without other fetal abnormalities, it may be regarded as a variation of the normal.

Age-related changes of lateral ventricular width and periventricular white matter in the human brain: a diffusion tensor imaging study.

Aging is the accumulation of multidimensional deterioration of processing of biological, psychological, and social changes with expansion over time (Bowen and Atwood, 2004; Grady, 2012). Aging-related changes are typically accompanied by decline in cognitive function, urinary control, sensory-motor function, and gait ability (Bradley et al., 1991; Bowen and Atwood, 2004; Hedden and Gabrieli, 2004; Grady, 2012; Moran et al., 2012). In addition, a number of studies have suggested changes in brain structure with normal aging, such as decrease in cortical thickness or increase in ventricular width (Blatter et al., 1995; Tang et al., 1997; Uylings and de Brabander, 2002; Preul et al., 2006; Apostolova et al., 2012). In particular, ventricular enlargement has been suggested as a structural biomarker for normal aging and progression of some illnesses, such as Alzheimer's disease (Blatter et al., 1995; Tang et al., 1997; Uylings and de Brabander, 2002; Preul et al., 2006; Apostolova et al., 2012). However, the question of how this structural change in the brain in normal elderly affects change of white matters remains a topic of interest and concern. Diffusion tensor imaging allows for evaluation of white matter due to its ability to capture and quantify water diffusion characteristics (Mori et al., 1999; Assaf and Pasternak, 2008; Neil, 2008). In normal white matter, water molecules move relatively freely in a direction parallel to nerve fiber tracts, however, their movements are restricted across tracts, which cause diffusion anisotropy in white matter. This selective restriction of water molecule movement allows for exploration of physical changes in white matter caused by normal aging using diffusion anisotropy. Some studies using DTI have reported on changes in periventricular white matter in patients with stroke or other brain injuries (Yeo et al., 2011; Hattori et al., 2012; Jang et al., 2013). In the current study, using DTI, we investigated ventricular enlargement with normal aging, and its effect on periventricular white matter.

Magnetic Resonance Volumetric Assessments of Brains in Fetuses With Ventriculomegaly Correlated to Outcomes

The purpose of this study was to correlate 2-dimensional magnetic resonance (MR) measurements of lateral ventricular width and 3-dimensional measurements of lateral ventricular and supratentorial parenchymal volumes to postnatal outcomes in fetuses with ventriculomegaly. A total of 307 fetuses (mean gestational age, 26.0 weeks; range, 15.7-39.4 weeks) had MR volumetry after referral for ventriculomegaly. Fetuses were grouped into those with (n = 114) and without (n = 193) other central nervous system (CNS) anomalies. Pregnancy and postnatal neurodevelopmental outcomes up to 3 years of age were obtained. A subgroup analysis was performed excluding fetuses with other CNS anomalies. Logistic regression analysis was performed to assess which measurement was most predictive of outcomes. There were 50 terminations, 2 stillbirths, and 255 live births. Seventy-five cases were lost to follow-up. Among 180 live-born neonates with follow-up, 140 had abnormal and 40 had normal outcomes. Atrial diameter (P < .0001), frontal horn diameter (P < .0001), and ventricular volume (P = .04) were predictive of live birth, with 92% specificity at 60% sensitivity. Among fetuses without other CNS anomalies, 180 of 193 pregnancies (93%) resulted in live deliveries, with atrial diameter (P < .0001), frontal horn diameter (P = .003), and ventricular volume (P = .008) associated with live birth and atrial diameter having the highest specificity (>99% at 60% sensitivity). Parenchymal volume was not associated with normal or abnormal outcomes (either live birth versus death or normal versus abnormal neurodevelopmental outcome). Among live-born neonates, no age-adjusted threshold for any of the measurements reliably distinguished between normal and abnormal neurodevelopmental outcomes. Ventricular volume and diameter, but not parenchymal volume, correlate with live birth in fetuses with ventriculomegaly. However, once live born, neither 2- nor 3-dimensional measurements can distinguish a fetus that will have a normal outcome.

Doppler-flow velocity indices in fetal middle cerebral artery in unilateral and bilateral mild ventriculomegaly

Objective. To study the association between fetal middle cerebral artery (MCA) Doppler-flow velocity waveforms and the lateral cerebral ventricular width in fetuses diagnosed with unilateral or bilateral ventriculomegaly.Methods. A prospective cohort evaluation of the association between Doppler-flow velocity indices of the MCA and ventricular width in singleton fetuses referred because of suspected ventriculomegaly between 20 and 40 weeks' gestation. Fetuses that were diagnosed as bilateral or unilateral ventriculomegaly were assigned to the study group and those with normal ventricular width served as controls.Results. Of the 53 women recruited to the study, in 30 (57%) fetuses (study group) at least one ventricle ≥10 mm was detected, of them 10 (33%) had bilateral ventriculomegaly and 20 (67%) had unilateral ventriculomegaly. Of the 30 fetuses 29 had mild ventriculomegaly. In 23 fetuses ventricular width was <10 mm (control group). Mean MCA pulsatility index (PI) and mean peak systolic velocity (PSV) were not different between the study group and the control group (p = 0.935 and p = 0.743, respectively). In a linear regression model, MCA-PSV was significantly correlated with gestational age, R2 = 0.309, p < 0.001.Discussion. Unilateral or bilateral mild ventriculomegaly is not associated with fetal MCA change in Doppler-flow velocity indices, suggesting different involvement of vascular component from severe ventriculomegaly.

Fetal lateral ventricular width: what should be its upper limit? A prospective cohort study and reanalysis of the current and previous data.

The upper limit of the fetal atrial width in normal fetuses is debated. This was a prospective cohort evaluation of the lateral ventricular width with special regard to the upper limit of its size. Measurements of fetal atrial ventricular size were obtained by abdominal ultrasonography in 427 male and female fetuses between 20 and 40 weeks' gestation of normal singleton pregnancies. In addition, reanalysis of previous data (8 studies) and the current data was performed to produce a pooled mean and SD. The mean ventricular width +/- SD was 6.2 +/- 1.2 mm. The ventricular width did not show significant modification throughout gestation. Reanalysis of the current and previous studies (8216 cases) yielded a pooled mean of 6.4 +/- 1.2. According to the current and previous studies, the upper cutoff of fetal ventricular atrium width should be 10 mm. This cutoff represents a range of approximately 3 SDs above the pooled mean, corresponding to a 99.74% confidence interval.

The Resistance Index in the Fetal Middle Cerebral Artery by Gestational Age and Ventricle Size in a Normal Population

In Brief OBJECTIVE To study the association between fetal middle cerebral artery flow and the lateral cerebral ventricular width throughout gestation. METHODS The study is a prospective cohort evaluation of 430 singleton male and female fetuses between 20 and 40 weeks' normal gestation. Abdominal ultrasonography and Doppler measurements were performed to measure the fetal atrial ventricular size and resistance index (RI) of the middle cerebral artery. RESULTS The mean (± standard deviation) ventricular width was 6.2 ± 1.2 mm. The modification in the RI of the middle cerebral artery throughout gestation showed a biphasic mode, increasing gradually to a peak at 30 weeks' gestation and decreasing progressively thereafter. No significant correlation was found between the middle cerebral artery flow and the lateral cerebral ventricular width (r = .11). In addition to the 430 cases studied, three cases of mild ventriculomegaly and three cases of hydrocephalus were evaluated. The RI of the middle cerebral artery was within the normal range in all six of these cases. CONCLUSION Fetal middle cerebral artery blood flow is not affected by the width of the lateral ventricles, even in enlarged ventricles. Prenatal ultrasonographic measurements of cerebral ventricular width and middle cerebral artery flow in 430 fetuses identified no significant association between middle cerebral artery flow and increased ventricular diameter.

The resistance index in the fetal middle cerebral artery by gestational age and ventricle size in a normal population

Objective To study the association between fetal middle cerebral artery flow and the lateral cerebral ventricular width throughout gestation. Methods The study is a prospective cohort evaluation of 430 singleton male and female fetuses between 20 and 40 weeks’ normal gestation. Abdominal ultrasonography and Doppler measurements were performed to measure the fetal atrial ventricular size and resistance index (RI) of the middle cerebral artery. Results The mean (± standard deviation) ventricular width was 6.2 ± 1.2 mm. The modification in the RI of the middle cerebral artery throughout gestation showed a biphasic mode, increasing gradually to a peak at 30 weeks’ gestation and decreasing progressively thereafter. No significant correlation was found between the middle cerebral artery flow and the lateral cerebral ventricular width ( r = .11). In addition to the 430 cases studied, three cases of mild ventriculomegaly and three cases of hydrocephalus were evaluated. The RI of the middle cerebral artery was within the normal range in all six of these cases. Conclusion Fetal middle cerebral artery blood flow is not affected by the width of the lateral ventricles, even in enlarged ventricles.