Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI

Nagaraj, Usha D.; Bierbrauer, Karin; Zhang, B.; Peiró, José L.; Kline‐Fath, Beth M.

doi:10.3174/ajnr.a5116

Cited by 45 publications

(36 citation statements)

References 23 publications

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“…Presence or absence of bowel dilation was also recorded, defined as small bowel diameter of >3 mm or large bowel diameter > 8 mm . The degree of hindbrain herniation (Chiari II malformation), upper level of the spinal dysraphic defect, and presence of equinovarus foot deformity (unilateral or bilateral) were also recorded …”

Section: Methodsmentioning

confidence: 99%

“…6 The degree of hindbrain herniation (Chiari II malformation), upper level of the spinal dysraphic defect, and presence of equinovarus foot deformity (unilateral or bilateral) were also recorded. 3 What's already known about this topic?…”

Section: Mr Scanning Parametersmentioning

confidence: 99%

“…Since the results of the randomized trial of prenatal versus postnatal repair of myelomeningocele (aka MOMS trial) were published in 2011, fetal MRI has become an essential tool in the prenatal evaluation of fetuses with open spinal dysraphism for prenatal counseling and determining eligibility for fetal surgery. [1][2][3] The MOMS trial has established guidelines in selecting appropriate candidates for fetal surgery. One of the key exclusion criteria is prenatal identification of fetal anomalies unrelated to the known open spinal dysraphism.…”

Section: Introductionmentioning

confidence: 99%

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Decreased rectal meconium signal on MRI in fetuses with open spinal dysraphism

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Section: Methodsmentioning

confidence: 99%

Section: Mr Scanning Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decreased rectal meconium signal on MRI in fetuses with open spinal dysraphism

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“…Beghly et al showed that the low antero posterior diameter of the PF associated with hydrocephalus is one of the characteristic MRI images of Chiari II malformation [53]. The confirmation of cerebellum herniation, which can only be performed by fetal MRI, is one of the main criteria for in utero surgery of myeolomeningocele [54].…”

Section: Us Vs Mri In Spina Bifidamentioning

confidence: 99%

Ultrasound and magnetic resonance imaging in the prenatal diagnosis of open spina bifida

et al. 2018

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Open spina bifida, also known as spina bifida aperta is a neural tube defect involving the lack of closure of vertebral arches and associated meninges and/or spinal cord abnormalities.Ultrasound examination is the gold standard for the diagnosis of spina bifida aperta. It represents the main imaging tool used to ascertain this diagnosis early in gestation. Three-dimensional ultrasound is necessary to detect the level and the size of the defect. Magnetic resonance imaging (MRI) represents a more sensitive tool, giving specific information of the defect and associated anomalies, playing an important role in ruling out differential diagnosis. Due to the advent of MRI use, it is possible today to achieve in utero treatment of fetuses with this pathology. The aim of the current review is to provide an update of literature regarding the role of ultrasound and MRI in the prenatal diagnosis of spina bifida aperta.

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“…Consequently, the rhombencephalic vesicle including the developing fourth ventricle fails to expand and a small posterior fossa evolves. Indeed, intrauterine repair of the open spinal dysraphism has been shown to result in the improvement of the posterior fossa deformity [2,3]. Although the hallmark of Chiari II malformation is a small posterior fossa, supratentorial abnormalities, such as periventricular nodular heterotopia and callosal dysgenesis, are not uncommon [4], possibly related to the impairment of neuronal migration and axonal guidance by altered CSF hydrodynamics [5].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Diffusivity Changes in Fetuses with Chiari II Malformation

2018

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Objectives: Chiari II malformation is a congenital abnormality characterized by a small posterior fossa with downward displacement of the hindbrain into the foramen magnum. Diffusion-weighted imaging (DWI) can be used to quantitatively characterize brain injury and physiological maturation. We aim to evaluate DWI parameters of the infra- and supratentorial brain in fetuses with Chiari II malformation. Methods: MRI and US studies of 26 fetuses with Chiari II malformation and 15 controls were evaluated for the presence/severity of hydrocephalus, myelomeningocele level, and brain apparent diffusion coefficient (ADC) values. Cerebral flow impedance parameters (resistance and pulsatile indexes, resistance index [RI], and pulsatility index [PI] respectively) from concurrently preformed fetal US were also evaluated. Results: Of the Chiari II group, 16 fetuses had hydrocephalus. There was increasing severity of lateral ventriculomegaly in the high compared to low spinal dysraphism subgroups. There were significant lower ADC values in the frontal (p = 0.01) and temporal lobes (p = 0.05) in Chiari II group compared with normal, regardless of the presence or severity of hydrocephalus. Fetuses with Chiari II showed significantly lower RI and PI values. Conclusions: Abnormal ADC values indicate supratentorial microstructural changes in fetuses with Chiari II malformation. Further investigation of the role of diffusion imaging metrics in evaluating abnormal brain development, parenchymal damage and efficacy of fetal surgery is needed.

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Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI

Abstract: In fetuses with open spinal dysraphism and severe Chiari II malformation that do not undergo prenatal repair, most have no change in the severity of cerebellar ectopia/Chiari grade. However, in fetuses that undergo in utero repair, most have resolved cerebellar ectopia postnatally.

Cited by 45 publications

References 23 publications

Decreased rectal meconium signal on MRI in fetuses with open spinal dysraphism

Decreased rectal meconium signal on MRI in fetuses with open spinal dysraphism

Ultrasound and magnetic resonance imaging in the prenatal diagnosis of open spina bifida

Cerebral Diffusivity Changes in Fetuses with Chiari II Malformation

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