A Magnetic Resonance Template for Normal Cerebellar Development in the Human Fetus

Chong, Brian W.; Babcook, Catherine J.; Pang, Dachling; Ellis, William G.

doi:10.1097/00006123-199710000-00029

Cited by 48 publications

(27 citation statements)

References 10 publications

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“…One major limitation is our incomplete understanding of the normal temporal and structural range of fetal brain development, which may compromise reliable interpretation of the more subtle posterior fossa anomalies. Concerns regarding the limited resolution of fetal MRI in the posterior fossa have been raised by others, showing a delay of up to 5 weeks between known anatomic stages of development [26] and those detected by fetal MRI [27]. In our study, early gestational age at the time of fetal MRI was a significant predictor of discrepancy between the fetal and postnatal MRI posterior fossa findings.…”

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confidence: 45%

How Accurately Does Current Fetal Imaging Identify Posterior Fossa Anomalies?

Limperopoulos

Robertson

Khwaja

et al. 2008

American Journal of Roentgenology

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OBJECTIVE-The first objective of our study was to describe the prevalence and spectrum of posterior fossa anomalies over 5 years in a major fetal care center where the referral diagnosis (by fetal sonography) was investigated by fetal MRI and, if confirmed, by postnatal MRI if possible. The second objective was to assess the accuracy with which fetal MRI predicts postnatal MRI findings in this population. MATERIALS AND METHODS-We retrospectively identified all cases of suspected fetal posterior fossa anomalies referred to our center from 2002 through 2006. We reviewed maternal, fetal, neonatal, and follow-up records of all cases and fetal and early postnatal imaging studies.RESUlTS-Of the 90 cases of suspected fetal posterior fossa anomalies (by fetal sonography) referred over the study period, 60 (67%) were confirmed by fetal MRI. Of 42 live-born infants, 39 (93%) underwent postnatal MRI. There was complete agreement in fetal and postnatal MRI diagnoses in 23 infants (59%). In 16 cases (41%), fetal and postnatal MRI diagnoses disagreed; postnatal MRI excluded fetal MRI diagnoses in six cases (15%) and revealed additional anomalies in 10 cases (26%).CONClUSION-Although a valuable adjunct to fetal sonography in cases of suspected posterior fossa anomaly, current fetal MRI, particularly in early gestation, has limitations in accurately predicting postnatal MRI abnormalities. Advancing the accuracy of MRI for the diagnosis of posterior fossa anomalies will require greater understanding of normal brain development and improved tissue resolution of fetal MRI. During the interim, our findings strongly support the need for postnatal MRI follow-up in cases with suspected posterior fossa anomalies by fetal MRI. Posterior fossa malformations are among the most common brain anomalies identified by current fetal imaging techniques. Advances in MRI during fetal and early postnatal life continue to provide important insights into normal and abnormal development of the cerebellum and brainstem [1][2][3][4][5][6]. Despite the rapid progress in fetal imaging, the prenatal diagnosis of posterior fossa dysgenesis remains challenging due to both false-positive and false-negative diagnoses [7][8][9][10][11][12][13]. As a result, a variety of classification schemes have been proposed for posterior fossa anomalies 14-17] without any scheme receiving widespread acceptance to date. KeywordsAbnormalities of posterior fossa development can, in general, be divided into those in a small posterior fossa with "crowding" of its contents (e.g., Chiari's malformations) versus those occurring in a normal or enlarged posterior fossa. The latter category, which is the focus of this study, may be further subcategorized into anomalies in a posterior fossa with normal fluid spaces versus those associated with enlarged (relatively or absolutely) posterior fossa fluid spaces.The primary reason for performing fetal imaging is to gather accurate information about fetal structure on which to base reliable counseling. This counseling to parents is i...

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mentioning

confidence: 45%

How Accurately Does Current Fetal Imaging Identify Posterior Fossa Anomalies?

Limperopoulos

Robertson

Khwaja

et al. 2008

American Journal of Roentgenology

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“…These myelination processes have been demonstrated in pathological specimens derived from human fetuses (Chong et al, 1997; Triulzi et al, 2005, 2006). They have also been shown using conventional MRI techniques (Barkovich et al, 1988; Van der Knaap and Valk, 1990; for review Paus et al, 2001).…”

Section: Introductionmentioning

confidence: 84%

Development of cerebellar connectivity in human fetal brains revealed by high angular resolution diffusion tractography

et al. 2014

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High angular resolution diffusion imaging (HARDI) tractography has provided insight into major white matter pathways and cortical development in the human fetal cerebrum. Our objective in this study was to further apply HARDI tracography to the developing human cerebellum ranging in fetal and adult stages, to outline in broad strokes the 3-dimensional development of white matter and local gray matter organization in the cerebellum. We imaged intact fixed fetal cerebellum specimens at 17 gestational weeks (W), 21W, 31W, 36W, and 38W along with an adult cerebellum for comparison. At the studied earliest gestational age (17W), coherent pathways that formed the superior, middle, inferior cerebellar peduncles were already detected, but pathways between deep cerebellar nuclei and the cortex were not observed until after 38W. At 36–38W, we identified emerging regional specification of the middle cerebellar peduncle. In the cerebellar cortex, we observed disappearance of radial organization in the sagittal orientation during the studied developmental stages similar to our previous observations in developing cerebral cortex. In contrast, in the axial orientation, cerebellar cortical pathways emerged first sparsely (31W) and then with increased prominence at 36–38W with pathways detected both in the radial and tangential directions to the cortical surface. The cerebellar vermis first contained only tangential pathways to the long axes of folia (17–21W), but pathways parallel to the long axes of folia emerged between 21–31W. Our results show the potential for tractography to image developing cerebellar connectivity using HARDI tractography.

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“…Qualitative study of the cerebellar morphology by in vivo [11] and ex vivo [42] MRI describes the increase in foliation, deepening of primary and emergence of secondary fissures in the second and third trimesters. Visual inspection of the cerebellum on MRI and segmentation-derived surface renderings (Fig.…”

Section: Discussionmentioning

confidence: 99%

3D Morphometric Analysis of Human Fetal Cerebellar Development

et al. 2011

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To date, growth of the human fetal cerebellum has been estimated primarily from linear measurements from ultrasound and 2D magnetic resonance imaging (MRI). In this study, we use 3D analytical methods to develop normative growth trajectories for the cerebellum in utero. We measured cerebellar volume, linear dimensions, and local surface curvature from 3D reconstructed MRI of the human fetal brain (N = 46). We found that cerebellar volume increased approximately 7-fold from 20 to 31 gestational weeks. The better fit of the exponential curve (R2 = 0.96) compared to the linear curve (R2 = 0.92) indicated acceleration in growth. Within-subject cerebellar and cerebral volumes were highly correlated (R2 = 0.94), though the cerebellar percentage of total brain volume increased from approximately 2.4% to 3.7% (R2 = 0.63). Right and left hemispheric volumes did not significantly differ. Transcerebellar diameter, vermal height, and vermal anterior to posterior diameter increased significantly at constant rates. From the local curvature analysis, we found that expansion along the inferior and superior aspects of the hemispheres resulted in decreased convexity, which is likely due to the physical constraints of the dura surrounding the cerebellum and the adjacent brainstem. The paired decrease in convexity along the inferior vermis and increased convexity of the medial hemisphere represents development of the paravermian fissure, which becomes more visible during this period. In this 3D morphometric analysis of the human fetal cerebellum, we have shown that cerebellar growth is accelerating at a greater pace than the cerebrum and described how cerebellar growth impacts the shape of the structure.

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A Magnetic Resonance Template for Normal Cerebellar Development in the Human Fetus

Cited by 48 publications

References 10 publications

How Accurately Does Current Fetal Imaging Identify Posterior Fossa Anomalies?

How Accurately Does Current Fetal Imaging Identify Posterior Fossa Anomalies?

Development of cerebellar connectivity in human fetal brains revealed by high angular resolution diffusion tractography

3D Morphometric Analysis of Human Fetal Cerebellar Development

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