Objective: We tested the hypothesis that chronic fetal hypoxia, at a severity present in many types of congenital heart disease, would lead to abnormal neurodevelopment. Methods: Eight mid-gestation fetal sheep were cannulated onto a pumpless extracorporeal oxygenator via the umbilical vessels and supported in a fluid-filled environment for 22 ± 2 days under normoxic or hypoxic conditions. Total parenteral nutrition was provided. Control fetuses (n = 7) were harvested at gestational age 133 ± 4 days. At necropsy, brains were fixed for histopathology. Neurons were quantified in white matter tracts, and the thickness of the external granular layer of the cerebellum was measured to assess neuronal migration. Capillary density and myelination were quantified in white matter. Data were analyzed with unpaired Student t tests or 1-way analysis of variance, as appropriate. Results: Oxygen delivery was reduced in hypoxic fetuses (15.6 ± 1.8 mL/kg/min vs 24.3 ± 2.3 mL/kg/min, P <.01), but umbilical blood flow and caloric delivery were not different between the 2 groups. Compared with normoxic and control animals, hypoxic fetuses had reduced neuronal density and increased external granular layer thickness. Compared with normoxic and control animals, hypoxic fetuses had increased capillary density in white matter. Cortical myelin integrity score was lower in the hypoxic group compared with normoxic and control animals. There was a significant negative correlation between myelin integrity and capillary density. Conclusions: Chronic fetal hypoxia leads to white matter hyper-vascularity, decreased neuronal density, and impaired myelination, similar to the neuropathologic findings observed in children with congenital heart disease. These findings support the hypothesis that fetal hypoxia, even in the setting of normal caloric delivery, impairs neurodevelopment.

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The accuracy of MRI after long-course chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC) has been questioned. We have evaluated our experience of sequential MRI to assess pre-operative downstaging with histopathology correlation. 17 patients with LARC had three MRI scans: MRI 1, before treatment; MRI 2, 6 weeks post-CRT; and MRI 3, pre-operatively. MRI T and N staging were reported, with T3 subdivided into T3a (<5 mm through wall), T3b (1-5 mm), T3c (5-15 mm) and T3d (>15 mm). The maximal wall measurements and a prediction of vascular involvement were also correlated with histopathology. Histopathological agreement with MRI 3 was high: T 82%; N 88% and vascular 73%. Statistically significant (p<0.01) T downstaging was shown in MRI 2 and MRI 3 groups. In the 6 weeks post-CRT scan, T downstaging occurred in 6% of patients, with a further 29.4% showing T3c to T3b downsizing. 41% showed N stage improvement. In the third MRI group pre-surgery, 41.2% showed an MRI T stage improvement, with a further T3 downsizing in 17.6% of patients. 50% of these responders had shown no T stage improvement on their second scan. The sequential scans also showed significant reduction in wall thickness (p<0.01). In conclusion, the pre-operative MRI showed ongoing response to CRT up to 12 weeks post-CRT, which has important clinical implications regarding the most appropriate time to operate. Improved agreement between MRI 3 and histopathology compared with previous studies including only one post-treatment MRI was also demonstrated.