Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly

Abstract

Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10-15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta‐analysis

“…Sixteen studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] fetuses) in cases diagnosed on standard assessment of the fetal brain in the axial plane ( Figure 2). When stratifying the analysis according to the type of anomaly detected on MRI, the incidence of a callosal anomaly undetected on ultrasound was 0.7% (95% CI, 0.2-1.5%) in fetuses that underwent neurosonography and 2.9% (95% CI, 1.1-5.7%) in those that had standard assessment of the fetal brain, while the corresponding figures for a posterior fossa anomaly were 0.4% (95% CI, 0.1-1.1%) and 0.9% (95% CI, 0.2-2.1%) ( Table 3).…”

“…Six hundred and twenty articles were identified, of which 66 were assessed with respect to their eligibility for inclusion (Table S2) and 16 were included in the systematic review (Tables 1 and S3 and Figure 1) [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . These sixteen studies included 1159 fetuses diagnosed with isolated mild or moderate VM.…”

“…The main weaknesses of the studies were their retrospective design, small sample size, different gestational ages at examination and lack of stratification of the results according to laterality and degree of ventricular dilatation in most of the included studies. Furthermore, stratification of the analysis according to gestational age at MRI was possible only by adopting a single cut-off (of 24 weeks' gestation), and we could not perform 19 Lavongtheung (2018) 20 Mehlhorn (2017) 21 Gezer (2016) 22 Tonni (2016) 23 Baffero (2015) 24 Kandula (2015) 25 Paladini (2014) 26 Pasquini (2014) 27 Parazzini (2012) 28 Miguelote (2012) 29 Han Huang (2013) 30 Griffiths (2010) 31 Yin (2010) 32 Benacerraf (2007) 33 Morris (2007) 34 Only first author of each study is given. A study can be awarded a maximum of one star for each numbered item within the selection and outcome categories.…”

“…Furthermore, the risk of detecting associated anomalies is higher in fetuses with moderate, compared to those with mild, VM, while there was no difference between cases with unilateral, compared to those with bilateral, VM. Tonni (2016) 23 (a) Paladini (2014) 26 Baffero (2015) 24 Pasquini (2014) 27 Parazzini (2012) 28 Miguelote (2012) 29 Study Study Yin (2010) 32 Benacerraf (2007) 20 Mehlhorn (2017) 21 Gezer (2016) 22 Kandula (2015) 25 Han Huang (2013) 30 Griffiths (2010) 31 Morris (2007)…”

Indications for MRI in fetal isolated mild ventriculomegaly… ‘And then, there were none’

“…The rationale for this analysis was to investigate possible factors responsible for the striking discrepancy (0–100%, Table S1) in the reported usefulness of MRI in the assessment of IMV. Our analysis showed that having a radiologist/neuroradiologist rather than a fetal medicine specialist or obstetrician as first author, the atrial width being 12.1–15.0 mm rather than 10.0–12.0 mm and the ultrasound examination being by the transabdominal rather than the transvaginal route were all associated with a significant increase in the rate of CRIMR (Table ).…”