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Updated: Sep 15, 2025
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Foetal disruptive brain injuries: Diagnosing the underlying pathogenetic mechanisms with cranial ultrasonography
Ana Alarcón1,2,3,4, Nuria Carreras1,3,4, Tobias Muehlbacher5
1Department of Neonatology, Hospital Sant Joan de Déu, BCNatal (Barcelona Centre for Maternal, Fetal and Neonatal Medicine), Barcelona, Spain.
Insights
Antenatal destructive events can cause fetal brain lesions, impacting neurodevelopment. Imaging like cranial ultrasonography and MRI aids in diagnosing and managing these conditions, guiding individualized patient care.
Area of Science:
- Neuroscience
- Pediatric Radiology
- Developmental Biology
Background:
- Antenatal destructive events affecting the fetal central nervous system result in disruptive brain lesions.
- These lesions are frequently linked to impaired neurodevelopment in newborns.
- Causes include vascular events, teratogen exposure, infections, genetic, and metabolic disorders.
Purpose of the Study:
- To provide a pictorial differential diagnosis of fetal disruptive brain lesions.
- To outline common findings associated with antenatal brain damage.
- To illustrate how imaging patterns, combined with clinical data, can identify underlying causes and support patient management.
Main Methods:
- Utilizing a pictorial approach for differential diagnosis.
- Employing cranial ultrasonography as the first-line imaging modality.
- Complementing ultrasonography with brain magnetic resonance imaging to detect neuronal dysmigration and dysplasia.
Main Results:
- Common findings include antenatal hemorrhagic and ischemic brain injuries, porencephaly, schizencephaly, multicystic encephalomalacia, hydranencephaly, germinolytic cysts, and lenticulostriate vasculopathy.
- Specific conditions like genetic cerebral vascular diseases, monochorionic twin pregnancies, congenital heart disease, maternal drug use, congenital infections, and inborn errors of metabolism show distinct imaging patterns.
- These imaging patterns aid in identifying underlying mechanisms and causes of fetal brain disruption.
Conclusions:
- A systematic approach using imaging and clinical correlation is crucial for diagnosing fetal brain lesions.
- Identifying the underlying cause of antenatal brain damage is essential for effective, individualized patient management.
- Advanced imaging techniques aid in characterizing the extent and nature of fetal brain lesions, informing prognosis and care.
Abstract:
Antenatal destructive events affecting the central nervous system of the foetus lead to disruptive brain lesions that are often associated with impaired neurodevelopment. The pathogenesis of these lesions encompasses a range of causes, including haemorrhagic, embolic, or other vascular events; exposure to teratogens, such as drugs or substance abuse; congenital brain infections; genetic conditions; and metabolic disorders. Cranial ultrasonography is the first-line imaging modality to diagnose these antepartum brain lesions in the newborn infant; it is often complemented by brain magnetic resonance imaging to detect associated neuronal dysmigration and dysplasia. Using a pictorial approach, a differential diagnosis of foetal disruptive brain lesions and common findings related to antenatal brain damage can be made, including antenatal haemorrhagic and ischaemic brain injuries, porencephaly, schizencephaly, multicystic encephalomalacia, and hydranencephaly, as well as germinolytic cysts and lenticulostriate vasculopathy. The main conditions associated with foetal brain disruption, such as genetic cerebral vascular diseases, monochorionic twin pregnancies, congenital heart disease, maternal drug use, congenital infections, and inborn errors of metabolism can be used to illustrate typical imaging patterns that, when combined with clinical presentation, can assist in identifying the underlying mechanisms and causes, thus supporting individualized patient management.
