Three‐Dimensional Volumetric Magnetic Resonance Imaging Detects Early Alterations of the Brain Growth in Fetuses With Congenital Heart Disease

Abstract

Background: Several published studies have shown alterations of brain development in third-trimester fetuses with congenital heart disease (CHD). However, little is known about the timing and pattern of altered brain development in fetuses with CHD. Purpose: To investigate the changes in the volume of intracranial structures in fetuses with CHD by three-dimensional (3D) volumetric magnetic resonance imaging (MRI) in the earlier stages of pregnancy (median gestational age [GA], 26 weeks). Study Type: Retrospective. Population: Forty women carrying a fetus with CHD (including 20 fetuses with GA <26 weeks) and 120 pregnant women carrying a healthy fetus (including 50 fetuses with GA <26 weeks). Field Strength/Sequence: Two-dimensional single-shot turbo spin echo sequence at 1.5 -T. Assessment: Three-dimensional volumetric parameters from slice-to-volume registered images, including cortical gray matter volume (GMV), subcortical brain tissue volume (SBV), intracranial cavity volume (ICV), lateral ventricles volume (VV), cerebellum, brainstem, and extra-cerebrospinal fluid (e-CSF) were quantified by manual segmentation from one primary and two secondary observers. Statistical Tests: Volumes were presented graphically with quadratic curve fitting. Scatterplots were produced mapping volumes against GA in normal and CHD fetuses. For GA <26 weeks, Z scores were calculated and Student's t-tests were conducted to compare volumes between the normal and CHD fetuses. Results: In fetuses with CHD GMV, SBV, cerebellum, and brainstem were significantly reduced (all P < 0.05) in early stages of pregnancy (GA <26 weeks), with differences becoming progressively greater with increasing GA. Compared with normal fetuses, e-CSF, e-CSF to ICV ratio, and VV were higher in fetuses with CHD (all P < 0.05). However, ICV volume and the GMV to SBV ratio were not significantly reduced in the CHD group (P = 0.94 and P = 0.13, respectively) during the middle gestation (GA <26 weeks). Data Conclusion: There appear to be alterations of brain development trajectory in CHD fetuses that can be detected by 3D volumetric MRI in the earlier stages of pregnancy. Level of Evidence: 4 Technical Efficacy: Stage 3

Brainstem and cerebellar volumes at magnetic resonance imaging are smaller in fetuses with congenital heart disease

“…7 Cerebellar volumes in cases of fetal CHD were reported to be smaller 8 or unchanged, 9 and few studies assessed brainstem development in these fetuses. 5,8,10 Moreover, most previous studies focused on third-trimester fetuses with hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), or tetralogy of Fallot (TOF), 5 whereas others grouped mixed types of CHD according to hemodynamics or uni-vs biventricular physiology. 11 Infratentorial structures are crucial in brain function and neurodevelopment, 12,13 which may be altered in children with CHD.…”

Magnetic Resonance Imaging Segmentation via Weighted Level Set Model Based on Local Kernel Metric and Spatial Constraint

“…Magnetic resonance imaging (MRI) is a part and parcel of medical imaging for its virtues such as rapid acquirement, non-intrusive and painless [ 1 ]. MRI images have been widely used in treatment evaluation, brain development monitoring, diagnosis, and so on [ 2 , 3 , 4 , 5 ]. However, the quality of MRI images is often influenced by various reasons such as low-contrast, noise and intensity inhomogeneity (IIH) during the imaging process, so it is not convenient to accurately segment and extract brain tissues.…”

Reference biometry of foetal brain by prenatal MRI and the distribution of measurements in foetuses with ventricular septal defect

“…Previous studies have compared the measurements of the brain between normal foetuses and foetuses with congenital heart diseases, but the results conflicted with each other. Some studies indicated that delayed development could be observed in foetuses with congenital heart disease [ 4 , 5 ], while no significant difference was found in some other studies [ 6 , 7 ]. The prevalence of delayed brain development may vary by the types of congenital heart diseases.…”