Apparent Diffusion Coefficient Assessment of Brain Development in Normal Fetuses and Ventriculomegaly

Abstract

Diffusion neuro-MRI has benefited significantly from sophisticated pre-processing procedures aimed at improving image quality and diagnostic. In this work, diffusion-weighted imaging (DWI) was used with artifact correction and the apparent diffusion coefficient (ADC) was quantified to investigate fetal brain development. The DWI protocol was designed in order to limit the acquisition time and to estimate ADC without perfusion bias. The ADC in normal fetal brains was compared to cases with isolated ventriculomegaly (VM), a common fetal disease whose DWI studies are still scarce. DWI was performed in 58 singleton fetuses (Gestational age (GA) range: 19-38w) at 1.5T. In 31 cases, VM was diagnosed on ultrasound. DW-Spin Echo EPI with b-values = 50, 200, 700 s/mm 2 along three orthogonal axes was used. All images were corrected for noise, Gibbs-ringing, and motion artifacts. The signal-to-noise ratio (SNR) was calculated and the ADC was measured with a linear least-squared algorithm. A multi-way ANOVA was used to evaluate differences in ADC between normal and VM cases and between second and third trimester in different brain regions. Correlation between ADC and GA was assessed with linear and quadratic regression analysis. Noise and artifact correction considerably increased SNR and the goodness-of-fit. ADC measurements were significantly different between second and third trimester in centrum semiovale, frontal white matter, thalamus, cerebellum and pons of both normal and VM brains (p ≤ 0.03). ADC values were significantly different between normal and VM in centrum semiovale and frontal white matter (p ≤ 0.02). ADC values in centrum semiovale, thalamus, cerebellum and pons linearly decreased with GA both in normal and VM brains, while a quadratic relation with GA was found in basal ganglia and occipital white matter of normal brains and in frontal white matter of VM (p ≤ 0.02). ADC values in all fetal brain regions were lower than those reported in literature where DWI with b = 0 was performed. Conversely, they were in agreement with the results of other authors who measured perfusion and diffusion contributions separately. By optimizing our DWI protocol we achieved an unbiased quantification of brain ADC in reasonable scan time. Our findings suggested that ADC can be a useful biomarker of brain abnormalities associated with VM.

Establishing and Comparing the Normal apparent Diffusion Coefficient Values of Fetal Organs and Placenta Using 1.5 Tesla and 3.0 T MRI at Various Gestational Age

“…The measurements of the normal apparent diffusion coefficient (ADC) at 1.5T and 3T MRI in different fetal brain regions and organs can help to better understand the aetiology and evolution of certain pathologies like demyelination, cerebral infection, metabolic disorders, lung and renal maturities, placental insufficiency, and FGR (fetal growth retardation) ( 20 - 22 ).…”

Two‐Compartment Perfusion MR IVIM Model to Investigate Normal and Pathological Placental Tissue

“…5c the cerebral ventricles membranes clearly have higher f 2 values, whereas they are not visible in the conventional f IVIM map. 25 Moreover, D * 2 (Fig. 5g) has a homogeneous value inside the ventricles.…”

Fetal MRI: what’s new? A short review

“…To overcome this drawback, but renouncing the perfusion estimate, fetal brains can be investigated by quantifying ADC. By normalizing DWI at different b -values data with the DWI at a b -value of 50 s/mm 2 , the perfusion bias in estimating the ADC value is strongly reduced, as shown in a recent paper [ 21 ]: ADC in centrum semiovale and frontal white matter significantly discriminated between normal fetal brain and ventriculomegaly.…”