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Published on: January 7, 2019
Evaluation of Subependymal Gray Matter Heterotopias on Fetal MRI
U D Nagaraj1, J L Peiro2, K S Bierbrauer3
1From the Departments of Radiology and Medical Imaging (U.D.N., B.M.K.-F) University of Cincinnati College of Medicine (U.D.N., J.L.P., K.S.B., B.M.K.-F), Cincinnati, Ohio. usha.nagaraj@cchmc.org.
Background And Purpose:
Subependymal grey matter heterotopias are seen in a high proportion of children with Chiari II malformation and are potentially clinically relevant. However, despite its growing use, there is little in the literature describing its detection on fetal MRI. Our aim was to evaluate the accuracy in diagnosing subependymal gray matter heterotopias in fetuses with spinal dysraphism on fetal MR imaging.
Materials And Methods:
This study is a retrospective analysis of 203 fetal MRIs performed at a single institution for spinal dysraphism during a 10-year period. Corresponding obstetric sonography, postnatal imaging, and clinical/operative reports were reviewed.
Results:
Of the fetal MRIs reviewed, 95 fetuses were included in our analysis; 23.2% (22/95) were suspected of having subependymal gray matter heterotopias on fetal MR imaging prospectively. However, only 50% (11/22) of these cases were confirmed on postnatal brain MR imaging. On postnatal brain MR imaging, 28.4% (27/95) demonstrated imaging findings consistent with subependymal gray matter heterotopia. Only 40.7% (11/27) of these cases were prospectively diagnosed on fetal MR imaging.
Conclusions:
Fetal MR imaging is limited in its ability to identify subependymal gray matter heterotopias in fetuses with spinal dysraphism. It is believed that this limitation relates to a combination of factors, including artifacts from fetal motion, the very small size of fetal neuroanatomy, differences in imaging techniques, and, possibly, irregularity related to denudation of the ependyma/subependyma in the presence of spinal dysraphism and/or stretching of the germinal matrix in ventriculomegaly.
Insights
Fetal MRI has limited accuracy in detecting subependymal gray matter heterotopias in fetuses with spinal dysraphism. Postnatal imaging is crucial for confirming these potentially relevant findings.
Area of Science:
- Neuroimaging
- Fetal Medicine
- Pediatric Neurology
Background:
- Subependymal gray matter heterotopias are common in children with Chiari II malformation.
- These heterotopias may have clinical significance.
- Detection on fetal MRI is not well-described.
Purpose of the Study:
- To evaluate the accuracy of fetal MRI in diagnosing subependymal gray matter heterotopias.
- To assess detection rates in fetuses with spinal dysraphism.
Main Methods:
- Retrospective analysis of 203 fetal MRIs for spinal dysraphism over 10 years.
- Review of obstetric sonography, postnatal imaging, and clinical reports.
- Analysis of 95 included fetuses.
Main Results:
- 23.2% of fetal MRIs prospectively suspected heterotopias, but only 50% were confirmed postnatally.
- Postnatal MRI confirmed heterotopias in 28.4% of fetuses.
- Only 40.7% of confirmed cases were prospectively identified on fetal MRI.
Conclusions:
- Fetal MRI has limitations in identifying subependymal gray matter heterotopias in fetuses with spinal dysraphism.
- Factors contributing to limitations include fetal motion, small anatomy, imaging techniques, and spinal dysraphism-related changes.
- Postnatal imaging is essential for accurate diagnosis.
