Delayed rotation of the cerebellar vermis: a pitfall in early second-trimester fetal magnetic resonance imaging

Pinto, Joana; Paladini, D.; Severino, Mariasavina; Morana, Giovanni; Pais, Rui; Martinetti, Carola; Rossi, Andrea

doi:10.1002/uog.15782

Cited by 24 publications

(26 citation statements)

References 11 publications

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“…This contrasts with the study by Paladini et al [ 15 ], who described a diagnostic accuracy of fetal MRI lower than that of fetal ultrasound when the former was carried out before week 24 of gestation (90.4% vs 93.1% for fetal MRI and fetal ultrasound, respectively). Nevertheless, caution should be exercised when interpreting fetal MRI performed before week 24-25 of gestation (10), as several CNS pathologies cannot be accurately diagnosed until the gestational age is greater than 24 weeks, such as the delay in the rotation of the vermis [ 17 ], or in the resolution of Blake's pouch cyst [ 18 ], which may be mistaken for vermian hypoplasia. When performed before week 24, MRI also has a low sensitivity in the diagnosis of heterotopias [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Diagnostic Accuracy of MRI in Prenatal Diagnosis

Rodríguez

Andreu‐Vázquez

Thuissard-Vasallo

et al. 2020

Radiology Research and Practice

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There is some controversy about the value of fetal MRI in prenatal diagnosis, and most of the studies examine its accuracy in central nervous system (CNS) pathology. The objective of this retrospective study was to assess the diagnostic accuracy and usefulness of fetal MRI in the prenatal diagnosis of central nervous system (CNS) pathology and non-CNS pathology. Patients referred to the Radiology Department between 2007 and 2018 for a fetal MRI after detection of an anomaly in the fetal ultrasound, a high-risk pregnancy, or an inconclusive fetal ultrasound (n = 623) were included in the study. Postnatal diagnosis was used to assess the diagnostic accuracy of MRI. Fetal MRI was considered to provide additional information over fetal ultrasound when findings of the fetal MRI were not detected in the fetal ultrasound or when established a pathological condition that was not detected in the fetal ultrasound. Fetal MRI provided useful information for the perinatal management and prognosis over fetal ultrasound when findings of the fetal MRI changed the postnatal prognosis, leaded to the decision to legally terminate the pregnancy, changed prenatal or postnatal follow-up, or helped in the planning of prenatal or postnatal treatment. Fetal MRI offered an accurate diagnosis in 97% of cases (compared to 90.4% of fetal ultrasound; p < 0.001 ). Concordance between fetal ultrasound and fetal MRI was 92.1%. Fetal MRI provided additional information over fetal ultrasound in 23.1% of cases. In 11.6% of cases, the information was useful for the perinatal management and prognosis. In 45 cases (7.2%), fetal MRI was the only accurate diagnosis. In conclusion, fetal MRI has a superior diagnostic accuracy, especially in CNS pathology, and provides additional useful information in CNS, thoracic, and abdominal pathology.

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Section: Discussionmentioning

confidence: 99%

Real-Life Diagnostic Accuracy of MRI in Prenatal Diagnosis

Rodríguez

Andreu‐Vázquez

Thuissard-Vasallo

et al. 2020

Radiology Research and Practice

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“…The following parameters were assessed quantitatively using the open-source software application ITK-SNAP (www .itksnap.org), version 3.6 17 (Figure 1): number of differentiable vermian lobules, BV angle, midsagittal vermian area, area of brainstem structures (mesencephalon, pons and medulla oblongata), presence of vermian tail sign, presence of external mechanical pressure on the vermis, differentiability of the declive, folium and tuber (DFT) and differentiability of the uvula from the nodulus. The vermian tail sign 18 was described initially in DWM and could further help in distinguishing it from other cPFM that show gross anatomic similarities (for example, if the vermis is uprotated by Blake's pouch, it can be confused with DWM 19 ).…”

Section: Image Evaluationmentioning

confidence: 99%

Quantitative fetal magnetic resonance imaging assessment of cystic posterior fossa malformations

Dovjak

Diogo

Brugger

et al. 2020

Ultrasound in Obstet & Gyne

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Objective Normal cognitive development usually requires a structurally intact and complete cerebellar vermis. The aim of this study was to evaluate whether quantification by fetal magnetic resonance imaging (MRI) of vermis‐ and brainstem‐specific imaging markers improves the definition of cystic posterior fossa malformations (cPFM). Methods Fetuses diagnosed with cPFM that had an available midsagittal plane on T2‐weighted MRI were identified retrospectively and compared with gestational‐age (GA) matched brain‐normal controls. Fetuses with cPFM were assigned to three groups, according to standard criteria (vermian size and brainstem–vermis (BV) angle): normal vermian area and BV angle < 25° (Group 1); reduced vermian area and/or BV angle of 25–45° (Group 2); and reduced vermian area and BV angle > 45° (Group 3; Dandy–Walker malformation (DWM) group). The number of differentiable vermian lobules and the areas of the vermis, mesencephalon, pons and medulla oblongata were quantified, correlated with and controlled for GA, and compared between the study groups. Results In total, 142 cases of cPFM were included, with a mean GA of 25.20 ± 5.11 weeks. Cases comprised Blake's pouch cyst (n = 46), arachnoid cyst (n = 12), inferior vermian hypoplasia (n = 5), megacisterna magna (n = 35) and classic DWM (n = 44). In the control group, 148 fetuses were included, with a mean GA of 25.26 ± 4.12 weeks. All quantified areas and the number of differentiable vermian lobules had a significant positive correlation with GA. The number of vermian lobules and the areas of all quantified regions, except for that of the medulla oblongata, differed significantly between the study groups (P ≤ 0.015 for all). The control group had the highest number of differentiable vermian lobules and the DWM group had the lowest (P < 0.01). Conclusions Prenatal MRI assessment of vermian lobules is a useful addition to standard neuroradiological and neurosonographic techniques. The quantification of vermian lobules using fetal MRI allows further differentiation of cPFM into subgroups and thereby improves the classification of hindbrain malformations. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

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“…As fetal MRI technology emerged during the late 1990s and early 2000s, there was hope that it could replace early postnatal MRI for diagnosing fetal anomalies . However, given inherent limitations in imaging very small structures, some posterior fossa anomalies, such as inferior vermian hypoplasia, can be misdiagnosed in the fetal period . Furthermore, long‐term neurodevelopmental outcomes for small or isolated posterior fossa lesions have not been rigorously studied, and are therefore less clearly characterized .…”

Section: Introductionmentioning

confidence: 99%

3D Super‐Resolution Motion‐Corrected MRI: Validation of Fetal Posterior Fossa Measurements

Pier

Gholipour

Afacan

et al. 2016

Journal of Neuroimaging

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Background and Purpose Current diagnosis of fetal posterior fossa anomalies by sonography and conventional MRI is limited by fetal position, motion, and by 2D, rather than 3D, representation. In this study, we aimed to validate the use of a novel MRI technique, 3D Super-Resolution Motion-Corrected MRI, to image the fetal posterior fossa. Methods From a database of pregnant women who received fetal MRIs at our institution, images of 49 normal fetal brains were reconstructed. Six measurements of the cerebellum, vermis, and pons were obtained for all cases on 2D conventional and 3D reconstructed MRI, and the agreement between the two methods was determined using concordance correlation coefficients. Concordance of axial and coronal measurements of the transcerebellar diameter was also assessed within each method. Results Between the two methods, the concordance of measurements was high for all six structures, (p<0.001), and was highest for larger structures such as the transcerebellar diameter. Within each method, agreement of axial and coronal measurements of the transcerebellar diameter was superior in 3D reconstructed MRI compared to 2D conventional MRI (p<0.001). Conclusions This comparison study validates the use of 3D Super-Resolution Motion-Corrected MRI for imaging the fetal posterior fossa, as this technique results in linear measurements that have high concordance with 2D conventional MRI measurements. Lengths of the transcerebellar diameter measured within a 3D reconstruction are more concordant between imaging planes, as they correct for fetal motion and orthogonal slice acquisition. This technique will facilitate further study of fetal abnormalities of the posterior fossa.

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Delayed rotation of the cerebellar vermis: a pitfall in early second-trimester fetal magnetic resonance imaging

Cited by 24 publications

References 11 publications

Real-Life Diagnostic Accuracy of MRI in Prenatal Diagnosis

Real-Life Diagnostic Accuracy of MRI in Prenatal Diagnosis

Quantitative fetal magnetic resonance imaging assessment of cystic posterior fossa malformations

3D Super‐Resolution Motion‐Corrected MRI: Validation of Fetal Posterior Fossa Measurements

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