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