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Published on: January 7, 2021
Three-Dimensional Volumetric Magnetic Resonance Imaging Detects Early Alterations of the Brain Growth in Fetuses With
Jing-Ya Ren1, Ming Zhu1, Su-Zhen Dong1
1Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Congenital heart disease (CHD) in fetuses is linked to altered brain development, detectable by 3D MRI early in pregnancy. Key brain structures show reduced volumes, while fluid spaces increase, indicating developmental deviations.
Area of Science:
- Neuroimaging
- Fetal Development
- Cardiology
Background:
- Published studies indicate brain development alterations in third-trimester fetuses with congenital heart disease (CHD).
- However, the precise timing and pattern of these brain development changes in fetuses with CHD remain largely unknown.
Purpose of the Study:
- To investigate alterations in intracranial structure volumes in fetuses with CHD during early pregnancy.
- Utilizing three-dimensional (3D) volumetric magnetic resonance imaging (MRI) at a median gestational age (GA) of 26 weeks.
Main Methods:
- Retrospective analysis of 40 fetuses with CHD and 120 healthy fetuses using 1.5-T MRI.
- Manual segmentation quantified volumes of cortical gray matter (GMV), subcortical brain (SBV), intracranial cavity (ICV), lateral ventricles (VV), cerebellum, brainstem, and extra-cerebrospinal fluid (e-CSF).
- Statistical comparison using Z scores and t-tests for fetuses with GA < 26 weeks.
Main Results:
- Fetuses with CHD exhibited significantly reduced GMV, SBV, cerebellum, and brainstem volumes (P < 0.05) in early pregnancy (GA < 26 weeks), with increasing divergence as GA advanced.
- Elevated e-CSF, e-CSF to ICV ratio, and VV were observed in CHD fetuses compared to controls (P < 0.05).
- No significant reduction in ICV volume or GMV to SBV ratio was found in the CHD group during mid-gestation (GA < 26 weeks).
Conclusions:
- Three-dimensional volumetric MRI can detect altered brain development trajectories in fetuses with CHD early in pregnancy.
- These findings highlight early neurodevelopmental deviations associated with fetal CHD.
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.
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