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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Structural intracranial abnormalities and brain volumes in foetuses with congenital heart disease
P D Griffiths1, T Everett2, M J Campbell3
1Department of Academic Radiology, University of Sheffield, UK.
Insights
In utero MRI detects intracranial abnormalities in fetuses with congenital heart disease (CHD), but rarely impacts clinical management. Fetuses with CHD show smaller brain volumes compared to normal fetuses.
Area of Science:
- Prenatal imaging
- Fetal medicine
- Pediatric cardiology
Background:
- Congenital heart disease (CHD) is associated with an increased risk of intracranial abnormalities.
- Fetal brain development may be impacted by CHD.
Purpose of the Study:
- To determine the prevalence of intracranial abnormalities in fetuses with CHD using in utero magnetic resonance imaging (iuMRI).
- To assess the impact of these abnormalities on prognostication.
- To measure fetal brain volumes in cases of CHD.
Main Methods:
- Ninety-four pregnant women with fetuses diagnosed with CHD (normal ultrasonography) underwent routine iuMRI and 3D-volume imaging.
- Expert review assessed the clinical management implications of any detected intracranial abnormalities.
Main Results:
- Intracranial abnormalities were identified in 11.7% of fetuses with CHD.
- However, only 1 case showed potential impact on clinical management.
- Fetuses with CHD exhibited significantly smaller brain volumes compared to controls.
Conclusions:
- While iuMRI can detect intracranial abnormalities in fetuses with CHD, its routine use is not supported due to limited impact on clinical management.
- Fetuses with CHD consistently demonstrate reduced brain volumes, supporting further research into neurodevelopmental outcomes.
Aim:
Emerging data suggest an increased risk of intracranial abnormalities in foetuses with congenital heart disease (CHD). The aim of this study is to assess the prevalence of intracranial abnormalities recognised on in utero magnetic resonance imaging (iuMRI) in foetuses with CHD. We will also assess the potential effect on prognostication and measure the brain volumes.
Materials And Methods:
Ninety-four pregnant women carrying foetuses with a CHD were studied. All of the foetuses had no evidence of a structural intracranial abnormality on ultrasonography. The women had routine iuMRI and 3D-volume imaging of the foetal brain. The effect on prognostication of any intracranial abnormality shown on iuMRI was judged by experienced foetal medicine and paediatric cardiology experts.
Results:
Intracranial abnormalities were present in 11/94 foetuses (11.7%, 95% CI: 6.7%-19.8%) but it was judged that the results would have had an effect on clinical management in only 1/11 foetuses. Brain volumes of foetuses with CHD were statistically significantly smaller compared with normal foetuses (mean z-score in foetuses with CHD and no intracranial abnormality: -1.07 ± 1.25, P < .001).
Conclusion:
There is a relatively high rate of intracranial abnormalities detectable on iuMRI in foetuses with CHD but only a small effect on prognostication from detecting the abnormalities. We believe that our work does not support routine iuMRI of the brain in foetuses with CHD. There is, however, strong support for the thesis that foetuses with CHD have smaller brain volume when compared with normal foetuses.
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