Fetal MRI detects early alterations of brain development in Tetralogy of Fallot

Schellen, Christoph; Schwartz, Ernst; Gruber, G.M.; Mlczoch, Elisabeth; Weber, Michael; Brugger, Peter C.; Ulm, Barbara; Langs, Georg; Salzer‐Muhar, Ulrike; Prayer, Daniela; Kasprian, Gregor

doi:10.1016/j.ajog.2015.05.046

Cited by 68 publications

(78 citation statements)

References 45 publications

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“…This finding has also been reported in an MRI study in TOF fetuses [22]. The hypothesis that the specific type of heart defect, such as HLHS and TOF, might play an important role in fetal cerebral development has been suggested in an increasing number of studies [10, 13, 26, 28, 29].…”

Section: Discussionsupporting

confidence: 54%

“…Previous MRI studies on brain volume or brain weight only report on third-trimester measurements, which makes comparison with our results difficult [11, 18, 19, 22-26]. Smaller brain volumes are previously demonstrated in mixed CHD types in the third trimester, but these studies comprise small cohorts and most importantly, they report on selected (severe), nonconsecutive cases, and some even included chromosomal abnormalities [18, 19].…”

Section: Discussioncontrasting

confidence: 39%

“…Furthermore, in our experience, measuring the cerebral volume after GA 32 becomes less reliable with ultrasound because of extensive shadowing. The latter can also be regarded as a drawback of our study, but we deliberately chose to assess the second and early third trimester, even though previous research has focused on the third trimester, as studies have demonstrated that in certain types of CHD, the possible delay in head growth is already visible at midgestation [20-22]. …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies mainly focus on the third trimester, as this might be the period in which cortical folding and development accelerates. However, several studies show that at midgestation, fetal head circumference might already be delayed in certain CHD, possibly even predicting developmental delay [20-22]. …”

Section: Introductionmentioning

confidence: 99%

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Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

et al. 2019

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Objective: The aim of our study is to explore whether the cerebral growth is delayed in fetuses with congenital heart defects (CHD) in the second and early third trimester. Methods: A prospective cohort study was conducted in 77 CHD cases, with 75 healthy controls. 3D cerebral volume acquisition was performed sequentially. The volumes of the fetal hemicerebrum and extracerebral fluid were compared by linear regression analysis, and the Sylvian fissure was measured. Results: Between 19 and 32 weeks of gestation, 158 measurements in cases and 183 measurements in controls were performed (mean 2.2/subject). The volume growth of the hemicerebrum (R² = 0.95 vs. 0.95; p = 0.9) and the extracerebral fluid (R² = 0.84 vs. 0.82, p = 0.9) were similar. Fetuses with abnormal oxygen delivery to the brain have a slightly smaller brain at 20 weeks of gestation (p = 0.02), but this difference disappeared with advancing gestation. CHD cases demonstrated a slightly shallower Sylvian fissure (mean ratio 0.146 vs. 0.153; p = 0.004). Conclusions: Our study shows no differences in cerebral growth, studied in an unselected cohort, with successive cases of isolated CHD. Even in the severest CHD cases, cerebral size is similar in the early third trimester. The cause and meaning of a shallower Sylvian fissure is unclear; possibly, it is a marker for delayed cerebral maturation or it might be an expression of decreasing amount of extracerebral fluid.

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Section: Discussionsupporting

confidence: 54%

Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

et al. 2019

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“…The possibility of intrinsic brain defects in patients with CHD has been suggested recently by prenatal brain imaging studies showing brain abnormalities in subjects with CHD, even as fetuses. [35] [36] [37] Most of the structural imaging of neonates with CHD performed up to this point have focused more on volumetric alterations of relatively larger intracranial structures, instead of examining for more subtle dysplastic structures of relatively smaller structures including olfactory bulbs, hippocampus, and cerebellum. We note that some of the abnormalities that we detected in these structures appeared to represent a spectrum including small volumes (hypoplasia) vs alteration in shape or contours (dysplasia).…”

Section: Discussionmentioning

confidence: 99%

Brain Dysplasia Associated with Ciliary Dysfunction in Infants with Congenital Heart Disease

Panigrahy

Lee

Ceschin

et al. 2016

The Journal of Pediatrics

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Objective To test for associations between abnormal respiratory ciliary motion (CM) and brain abnormalities in infants with congenital heart disease (CHD) Study design We recruited 35 infants with CHD preoperatively and performed nasal tissue biopsy to assess respiratory CM by videomicroscopy. Cranial ultrasound and brain magnetic resonance imaging were obtained pre- and/or post-operatively and systematically reviewed for brain abnormalities. Segmentation was used to quantitate cerebrospinal fluid and regional brain volumes. Perinatal and perioperative clinical variables were collected. Results A total of 10 (28.5%) patients with CHD had abnormal CM. Abnormal CM was not associated with brain injury, but was correlated with increased extra-axial CSF volume (p<0.001), delayed brain maturation (p<0.05), and a spectrum of subtle dysplasia including the hippocampus (p<0.0078) and olfactory bulb (p<0.034). Abnormal CM was associated with higher composite dysplasia score (p<0.001) and both were correlated with elevated pre-operative serum lactate (p <0.001). Conclusion Abnormal respiratory CM in infants with CHD is associated with a spectrum of brain dysplasia. These findings suggest that ciliary defects may play a role in brain dysplasia in patients with CHD and have the potential to prognosticate neurodevelopmental risks.

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Advanced neuroimaging in the fetal brain: An update on technical advances and clinical findings

Ren

Dong

2023

iRADIOLOGY

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Magnetic resonance imaging (MRI) is widely used to provide detailed information regarding fetal brain development in utero. Conventional T1-and T2weighted sequences provide anatomical details of the normal brain and demonstrate brain lesions. In addition to providing highly detailed qualitative assessments of fetal brain development, advanced MRI methods such as threedimensional high-resolution MRI, diffusion MRI, magnetic resonance spectroscopy, and functional MRI can provide quantitative morphologic assessments of tissue microstructure and functional activity. This review aims to describe normal fetal brain development and highlight current state-of-the-art MRI sequences for fetal neuroimaging. We focus on current clinical applications which can provide a better understanding of in utero impairments in fetal brain development.

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Fetal MRI detects early alterations of brain development in Tetralogy of Fallot

Cited by 68 publications

References 45 publications

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

Brain Dysplasia Associated with Ciliary Dysfunction in Infants with Congenital Heart Disease

Advanced neuroimaging in the fetal brain: An update on technical advances and clinical findings

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