Are We Ready to investigate Cognitive Function of Fetal Brain? The Role of Advanced Four-dimensional Sonography

Abstract

Human brain is fascinating organ in so many ways. Some of its cognitive functions, such as ability to learn, memorize, think, percept different sensations, such as pain, to have emotion, process audiovisual inputs, and to coordinate reaction and movements have been subjects of studies for many years. Yet, till recently, we could only make assumptions about prenatal activities, interactions and its construction of complex structures in the time frame of antenatal life. With the prenatal assessment (sonoembryology, neurosonoembryology, KANET test, etc.) by latest advanced HDlive, Silhouette and Flow 3D/4D imaging there is possibility to follow in continuity normal structural and functional development from the early beginnings of "life" and on the other hand consider what might be different (not necessarily abnormal) and deviate from normal development and behavior. On this way, we are able to supplement knowledge of fundamental building blocks of development of fetal cognitive functions, to pay more attention and follow up fetuses at higher risk and finally find some of the possible origins of cognitive dysfunctions which may manifest in childhood or later in life. 82 With the introduction of different 3D/4D ultrasound modes we have ability to observe all of this in vivo while emerging, and make "time-lapse" of fetal neurodevelopment and behavior in correlation to its cognitive functional development.

Diagnosis of fetal syndromes by three- and four-dimensional ultrasound: is there any improvement?

“…In the prenatal assessment of pregnancies at risk, evaluation with 4D US and KANET could be included. Prenatal results can be compared with postnatal results of neonatal neurological evaluation in the follow-up period during the first 2-3 years of life [6][7][8].…”

“…[33]. Despite the fact that we are able to recognize some structural anomalies prenatally, the prediction of the exact extent of the damage and prognosis may still be a challenge [7,32].…”

“…Using four-dimensional (4D) technology, one can get an idea of the functionality of some organs and systems, for example, the brain or the eye, introducing new fields of fetal assessment like fetal neurology or fetal sono-ophthalmology [3]. Some new functional tests have even been introduced in everyday clinical practice, like the Kurjak antenatal neurodevelopmental test (KANET), to assess the function of the fetal brain [4][5][6][7], adding some additional valuable input into the diagnosis of fetal syndromes [8]. Many authors reported a shift of prenatal detection of fetal syndromes from the 2 nd to the 1 st trimester of pregnancy [3,8,[9][10][11][12][13].…”