Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p &lt; 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p &lt; 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p &lt; 0.0001) or FOHR and 3D VS (r = 0.842, p &lt; 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p &lt; 0.0001) than with FOHR (r = 0.674, p &lt; 0.0001; p &lt; 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r &gt; 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.</jats:p></jats:sec>

Volume growth trend and correlation of atrial diameter with lateral ventricular volume in normal fetus and fetus with ventriculomegaly

“…Our findings in terms of the relationship between AD and volume in VM group are consistent with those of a previous study. [27] The equations acquired in the present study suggest that the lateral ventricular volume could be estimated using AD. To the best of our knowledge, this is the first study to evaluate the association between linear measurement and volume of the normal LV.…”

Acquired hydrocephalus is associated with neuroinflammation, progenitor loss, and cellular changes in the subventricular zone and periventricular white matter

“…The expansion of the ventricles was especially pronunced in the body of the lateral ventricles. Other studies in posthemorrhagic hydrocephalus and fetal ventriculomegaly have reported that the body dilates to a greater extent than other ventricle regions, such as the frontal horn [ 65 , 66 ].…”

Use of Fetal Magnetic Resonance Image Analysis and Machine Learning to Predict the Need for Postnatal Cerebrospinal Fluid Diversion in Fetal Ventriculomegaly

“…13 Commonly used linear measures were obtained using measurement tools in EasyViz software (Medical Insight). Atrial diameter was measured in the axial plane on a single section at the level of the atria of the lateral ventricles and the glomus of the choroid plexus 14 ( Figure 1A). The fronto-occipital horn ratio (FOHR) was calculated using the same axial section used to measure atrial diameter; it is the mean of the maximum frontal and occipital horn diameters divided by the biparietal diameter [(a + c)/2b] ( Figure 1A).…”