Fetal MRI Round Table
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Transcript of Fetal MRI Round Table
Fetal MRI Round Table
Fetal brain injury
Andrea Righini Radiology and Neuroradiology dept., Children’s Hospital V. Buzzi, Milan, Italy.
NO fetal MRI NEEDED
clastic lesionsT2 T1
Neuro-sonography
Fetal MRI
acutehypoxia-ischemiainflammation
smallerbrainstemcerebellarclasticlesions
Brain clastic changes:peaks of excellence of fetal MRI
parenchymal water increase (edema)
clastic causedcorticalmalformations
Ann Neurol 2002. Baldoli C, Righini A, Parazzini C, Scotti G, Triulzi F.
32w female with vein of Galen malformation
acute ischemiaIncreased sensitivity
T2 DWI ADC
DEADSURVIVOR
PLACENTA ANASTOMOSES
RECEPIENTDONOR
PLACENTA ANASTOMOSES
condition 1 condition 2
acute ischemia
Increased sensitivity
monochorionic TWIN pregnancy
T2w ss-FSE ADC T2w ss-FSE
ADC = 0.40
44 - 4 hours after co-twin death
acute ischemiaIncreased sensitivity
Righini A et al.. Ultrasound Obstet Gynecol. 2007
DEADSURVIVOR
PLAC ENT A ANA STO MOSES
Righini A et al.. Com pu t Assist Tom ogr. 2004 Jan-Feb;28(1):8 7-92.
morte del gemellomonocoriale
14 days follow-up
24w twins TTTS, 7 dd laser coag. of plac. anastom, MCA veloc. increase, severe anemia donor
donor
recepient
RECEPIENTDONOR
PLAC ENT A ANA STO MOSES
trasfusione feto-fetale
acute ischemiaIncreased sensitivity
ss-FSE T2
donor
ADC = 0.48
RECEPIENTDONOR
PLAC ENT A ANA STO MOSES
trasfusione feto-fetale
acute ischemiaIncreased sensitivity
cytotoxic vs interstitial-vasogenic edema
brain swelling
lo
0. 70
low ADC
19w monochorionic-twins - TTTS - donor dead, recepient survivor (48 - 3 hours).
lembo
normal ADC
1.80
T2w ss-FSE
DWI
ADC
Acute ADC changes in dead twin brain: model of immature brain acute ischemia (1)
survivor
survivor
deaddead
“research”
,2
,4
,6
,8
1
1,2
1,4
1,6
1,8
2
0 50 100 150 200 250 300 350 400 450 500 550 600time after death (hours)
A
DC
m
2 /mse
c)
mean normal ADC value
> 80% ADC decrease
head compression and dehydration effect?
Acute ADC changes in dead twin brain: model of immature brain acute ischemia (2)
ADC = 0.7
20w, bilateral 15 mm ventriculomegaly, mild macrocrania.
15 mm
acute-subacute leukomalacya (1)Increased sensitivity
acqueductalstenosis ?
Muscle and GUT inflammatory infiltration signs
Signs of ependymal fragmentation and white matter lesion
acute-subacute leukomalacya (2)
Parenchymal edema detectionand characterization
27 w, severe IUGR, anhydramnios, thorax hypoplasia, dead 2 days after MRI
ADC increased = 2.3 m2/msec
ss-FSE-T2 ADC
FSE-T1
BRAIN WATER INCREASE - GLOBAL
interstitial white matter edema, venous congestion?
CSF spaces reduction
sss
gv
ss-FSE T2w
31w fetus, heart failure, severe hydrops.
deepmedullayveins
BRAIN WATER INCREASE - GLOBAL
interstitial white matter edema, venous congestion?
Doneda C., Righini A et al.. AJNR in press
20 SG
27 SG
II trim. CMV newborn
BRAIN WATER INCREASE - FOCAL
Doneda C., Parazzini C. Righini A. et Al.. Radiology. 2010.WM edema and rarefaction
isolated
Increased specificityin (clastic nature)ventriculomegaly cases
possible prognosis and counsellingimplications
borderline ventriculomegaly: clastic aetiology?
12 mm
33w, unilateral ventriculomegaly
increased specificity
IVH-I and II
“PROGNOSIS PROBABLY GOOD”neonatal MRI
borderline ventriculomegaly: clastic aetiology?increased specificity
Girard N., et Al.. Eur J Radiol. 2006
normal controlcreatine
SPECTROSCOPY:creatine increase,sign of glyosis
33w, unilateral ventriculomegaly
“PROGNOSIS PROBABLY NOT SO GOOD”
Clastic caused cortical malformations (early detection)
T1
Pathology confirmed:CLASTIC AETIOLOGY
23w, early gestation vaginal bleedings, borderline ventriculomegaly
“saw-tooth”
pathologyT2
Focal cortical rim anomalies: clastic aetiology?increased sensitivity and specificity
necrosislarge csf
Smaller brainstem-cerebellar clastic lesions
26w., bilateral ventriculomegaly, brain hyperecogeneity, absent limbs movements (intrauterine tetraplegia?).
nasim
brainstem clastic lesionincreased sensitivity
sinechiae
Unsolved issues - Statistics on MRI sensitivity and specificity are substantially lacking.
- Prognosis of minor (isolated) findings: i.e. temporal lobe T2-hyperintensity in CMV cases, small periventricular hemorrhagic and necrotic lesions, …..etc.
- Detection of lesions due to neurometabolic diseases: only very few single case reports.
THANKSCecilia ParazziniChiara DonedaFilippo ArrigoniAndreana ArdemagniMariangela RusticoFabio Triulzi