Fetal MRI pp 309-327 | Cite as

Acquired Brain Pathology

  • Daniela Prayer
  • Ulrika Asenbaum
  • Peter C. Brugger
  • Gregor Kasprian
Part of the Medical Radiology book series (MEDRAD)


Acute brain injury is rarely seen, but salient features include acute hemorrhage, thrombosis, and localized or general edema. Findings are rarely specific with regard to etiology. In addition to maternal disease, risk factors for acquired brain lesions include disorders of the placenta and/or umbilical cord, exposure to toxic agents, metabolic disease, iatrogenic hazards, fetal cardiovascular disease, and space-occupying lesions. Most often, defective stages are found, characterized by local or diffuse tissue loss, and/or hemorrhagic residuals, and/or calcification. In order to describe an acquired lesion most accurately, in addition to T2-weighted sequences, T1-weighted, diffusion-weighted, and echoplanar (or T2*) information is necessary. In case of suspected infection, the whole fetus and the extrafetal structures must be screened for pathological changes.


Periventricular Leukomalacia Ganglionic Eminence Posthemorrhagic Hydrocephalus Pyruvate Dehydrogenase Deficiency Subependymal Cyst 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abboud P, Mansour G, Lebrun JM, Zejli A, Bock S, Lepori M, Morville P (2001) Acute carbon monoxide poisoning during pregnancy: 2 cases with different neonatal outcome. J Gynecol Obstet Biol Reprod (Paris) 30:708–711Google Scholar
  2. Abdel-Salam GM, Zaki MS, Saleem SN, Gaber KR (2008) Microcephaly, malformation of brain development and intracranial calcification in sibs: pseudo-TORCH or a new syndrome. Am J Med Genet A 146A:2929–2936PubMedCrossRefGoogle Scholar
  3. Al-Khan A, Caligiuri A, Apuzzio J (2003) Parvovirus B-19 infection during pregnancy. Infect Dis Obstet Gynecol 11:175–179PubMedCrossRefGoogle Scholar
  4. Asenbaum U, Brugger PC, Kasprian G, Ulm B, Messerschmidt A, Prayer D (2009) MRI of fetal intracerebral hemorrhage. Neuroradiology 51:51Google Scholar
  5. Auriti C, Piersigilli F, De Gasperis MR, Seganti G (2009) Congenital varicella syndrome: still a problem? Fetal Diagn Ther 25:224–229PubMedCrossRefGoogle Scholar
  6. Baldoli C, Righini A, Parazzini C, Scotti G, Triulzi F (2002) Demonstration of acute ischemic lesions in the fetal brain by diffusion magnetic resonance imaging. Ann Neurol 52:243–246PubMedCrossRefGoogle Scholar
  7. Barbu D, Mert I, Kruger M, Bahado-Singh RO (2009) Evidence of fetal central nervous system injury in isolated congenital heart defects: microcephaly at birth. Am J Obstet Gynecol 201(43):e41–47Google Scholar
  8. Barkovich AJ (2005) Pediatric neuroimaging. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  9. Barkovich AJ, Girard N (2003) Fetal brain infections. Childs Nerv Syst 19:501–507PubMedCrossRefGoogle Scholar
  10. Bauder F, Beinder E, Arlettaz R, Albisetti M, Boltshauser E, Gessler P (2009) Intrauterine subdural hemorrhage in a preterm neonate possibly associated with maternal low-molecular weight heparin treatment. J Perinatol 29:521–523PubMedCrossRefGoogle Scholar
  11. Beltinger C, Saule H (1988) Sonography of subependymal cysts in congenital rubella syndrome. Eur J Pediatr 148:206–207PubMedCrossRefGoogle Scholar
  12. Brugger PC, Stuhr F, Lindner C, Prayer D (2006) Methods of fetal MR: beyond T2-weighted imaging. Eur J Radiol 57:172–181PubMedCrossRefGoogle Scholar
  13. Carletti A, Colleoni GG, Perolo A, Simonazzi G, Ghi T, Rizzo N, Pilu G (2009) Prenatal diagnosis of cerebral lesions acquired in utero and with a late appearance. Prenat Diagn 29:389–395PubMedCrossRefGoogle Scholar
  14. Chang CL, Chiu NC, Ho CS, Li ST (2006) Frontal horn cysts in normal neonates. Brain Dev 28:426–430PubMedCrossRefGoogle Scholar
  15. de Vries LS, Gunardi H, Barth PG, Bok LA, Verboon-Maciolek MA, Groenendaal F (2004) The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection. Neuropediatrics 35:113–119PubMedCrossRefGoogle Scholar
  16. Degani S (2006) Sonographic findings in fetal viral infections: a systematic review. Obstet Gynecol Surv 61:329–336PubMedCrossRefGoogle Scholar
  17. Derauf C, Kekatpure M, Neyzi N, Lester B, Kosofsky B (2009) Neuroimaging of children following prenatal drug exposure. Semin Cell Dev Biol 20:441–454PubMedCrossRefGoogle Scholar
  18. Doneda C, Parazzini C, Righini A, Rustico M, Tassis B, Fabbri E, Arrigoni F, Consonni D, Triulzi F (2010) Early cerebral lesions in cytomegalovirus infection: prenatal MR imaging. Radiology 255:613–621PubMedCrossRefGoogle Scholar
  19. Downer EJ, Campbell VA (2010) Phytocannabinoids, CNS cells and development: a dead issue? Drug Alcohol Rev 29:91–98PubMedCrossRefGoogle Scholar
  20. Duin LK, Willekes C, Baldewijns MM, Robben SG, Offermans J, Vles J (2007) Major brain lesions by intrauterine herpes simplex virus infection: MRI contribution. Prenat Diagn 27:81–84PubMedCrossRefGoogle Scholar
  21. Enders M, Weidner A, Zoellner I, Searle K, Enders G (2004) Fetal morbidity and mortality after acute human parvovirus B19 infection in pregnancy: prospective evaluation of 1018 cases. Prenat Diagn 24:513–518PubMedCrossRefGoogle Scholar
  22. Engman ML, Lewensohn-Fuchs I, Mosskin M, Malm G (2010) Congenital cytomegalovirus infection: the impact of cerebral cortical malformations. Acta Paediatr 99(9):1344–1349PubMedCrossRefGoogle Scholar
  23. Fichera A, Zambolo C, Accorsi P, Martelli P, Ambrosi C, Frusca T (2009) Perinatal outcome and neurological follow up of the cotwins in twin pregnancies complicated by single intrauterine death. Eur J Obstet Gynecol Reprod Biol 147:37–40PubMedCrossRefGoogle Scholar
  24. Fryer SL, Schweinsburg BC, Bjorkquist OA, Frank LR, Mattson SN, Spadoni AD, Riley EP (2009) Characterization of white matter microstructure in fetal alcohol spectrum disorders. Alcohol Clin Exp Res 33:514–521PubMedCrossRefGoogle Scholar
  25. Gaffney G, Squier MV, Johnson A, Flavell V, Sellers S (1994) Clinical associations of prenatal ischaemic white matter injury. Arch Dis Child Fetal Neonatal Ed 70:F101–106PubMedCrossRefGoogle Scholar
  26. Garel C, Delezoide AL, Elmaleh-Berges M, Menez F, Fallet-Bianco C, Vuillard E, Luton D, Oury JF, Sebag G (2004) Contribution of fetal MR imaging in the evaluation of cerebral ischemic lesions. Am J Neuroradiol 25:1563–1568PubMedGoogle Scholar
  27. Girard N, Gire C, Sigaudy S, Porcu G, d’Ercole C, Figarella-Branger D, Raybaud C, Confort-Gouny S (2003) MR imaging of acquired fetal brain disorders. Childs Nerv Syst 19:490–500PubMedCrossRefGoogle Scholar
  28. Glenn OA, Bianco K, Barkovich AJ, Callen PW, Parer JT (2007) Fetal cerebellar hemorrhage in parvovirus-associated non-immune hydrops fetalis. J Matern Fetal Neonatal Med 20:769–772PubMedCrossRefGoogle Scholar
  29. Gotsch F, Romero R, Kusanovic JP, Mazaki-Tovi S, Pineles BL, Erez O, Espinoza J, Hassan SS (2007) The fetal inflammatory response syndrome. Clin Obstet Gynecol 50:652–683PubMedCrossRefGoogle Scholar
  30. Govaert P (2009) Prenatal stroke. Semin Fetal Neonatal Med 14:250–266PubMedCrossRefGoogle Scholar
  31. Guibaud L, Attia-Sobol J, Buenerd A, Foray P, Jacquet C, Champion F, Arnould P, Pracros JP, Golfier F (2004) Focal sonographic periventricular pattern associated with mild ventriculomegaly in foetal cytomegalic infection revealing cytomegalic encephalitis in the third trimester of pregnancy. Prenat Diagn 24:727–732PubMedCrossRefGoogle Scholar
  32. Guimiot F, Garel C, Fallet-Bianco C, Menez F, Khung-Savatovsky S, Oury JF, Sebag G, Delezoide AL (2008) Contribution of diffusion-weighted imaging in the evaluation of diffuse white matter ischemic lesions in fetuses: correlations with fetopathologic findings. Am J Neuroradiol 29:110–115PubMedCrossRefGoogle Scholar
  33. Isaacs H (2009) Fetal brain tumors: a review of 154 cases. Am J Perinatol 26:453–466PubMedCrossRefGoogle Scholar
  34. Johansson PA, Dziegielewska KM, Liddelow SA, Saunders NR (2008) The blood-CSF barrier explained: when development is not immaturity. Bioessays 30:237–248PubMedCrossRefGoogle Scholar
  35. Kang BK, Na DG, Ryoo JW, Byun HS, Roh HG, Pyeun YS (2001) Diffusion-weighted MR imaging of intracerebral hemorrhage. Korean J Radiol 2:183–191PubMedCrossRefGoogle Scholar
  36. Kasprian G, Brugger PC, Weber M, Krssak M, Krampl E, Herold C, Prayer D (2008) In utero tractography of fetal white matter development. Neuroimage 43:213–224PubMedCrossRefGoogle Scholar
  37. Laure-Kamionowska M, Dambska M (1992) Damage of maturing brain in the course of toxoplasmic encephalitis. Neuropatol Pol 30:307–314PubMedGoogle Scholar
  38. Laurichesse Delmas H, Winer N, Gallot D, Lopes K, Perrotin F, Fluncker S, Geissler F, Beaufrere AM, Vendittelli F, Couture C, Lemery D (2008) Prenatal diagnosis of thrombosis of the dural sinuses: report of six cases, review of the literature and suggested management. Ultrasound Obstet Gynecol 32:188–198PubMedCrossRefGoogle Scholar
  39. Leventer RJ, Jansen A, Pilz DT, Stoodley N, Marini C, Dubeau F, Malone J, Mitchell LA, Mandelstam S, Scheffer IE, Berkovic SF, Andermann F, Andermann E, Guerrini R, Dobyns WB (2010) Clinical and imaging heterogeneity of polymicrogyria: a study of 328 patients. Brain 133:1415–1427PubMedCrossRefGoogle Scholar
  40. Levitsky DB, Mack LA, Nyberg DA, Shurtleff DB, Shields LA, Nghiem HV, Cyr DR (1995) Fetal aqueductal stenosis diagnosed sonographically: how grave is the prognosis? Am J Roentgenol 164:725–730CrossRefGoogle Scholar
  41. Limperopoulos C (2009) Disorders of the fetal circulation and the fetal brain. Clin Perinatol 36:561–577PubMedCrossRefGoogle Scholar
  42. Limperopoulos C, Tworetzky W, McElhinney DB, Newburger JW, Brown DW, Robertson RL Jr, Guizard N, McGrath E, Geva J, Annese D, Dunbar-Masterson C, Trainor B, Laussen PC, du Plessis AJ (2010) Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation 121:26–33PubMedCrossRefGoogle Scholar
  43. Makhoul IR, Zmora O, Tamir A, Shahar E, Sujov P (2001) Congenital subependymal pseudocysts: own data and meta-analysis of the literature. Isr Med Assoc J 3:178–183PubMedGoogle Scholar
  44. Malinger G, Lev D, Ben Sira L, Kidron D, Tamarkin M, Lerman-Sagie T (2002) Congenital periventricular pseudocysts: prenatal sonographic appearance and clinical implications. Ultrasound Obstet Gynecol 20:447–451PubMedCrossRefGoogle Scholar
  45. McQuillen PS, Miller SP (2010) Congenital heart disease and brain development. Ann NY Acad Sci 1184:68–86PubMedCrossRefGoogle Scholar
  46. Messerschmidt A, Brugger PC, Boltshauser E, Zoder G, Sterniste W, Birnbacher R, Prayer D (2005) Disruption of cerebellar development: potential complication of extreme prematurity. Am J Neuroradiol 26:1659–1667PubMedGoogle Scholar
  47. Mets MB, Chhabra MS (2008) Eye manifestations of intrauterine infections and their impact on childhood blindness. Surv Ophthalmol 53:95–111PubMedCrossRefGoogle Scholar
  48. Mlczoch E, Brugger PC, Hanslik A, Ulm B, Salzer-Muhar U, Pollak A, Prayer D (2010) Prenatal brain pathology in congenital heart disease - does oxygen saturation of cerebral blood influence its occurrence? Ultrasound Obstet Gynecol 35:627–635CrossRefGoogle Scholar
  49. Mochel F, Grebille AG, Benachi A, Martinovic J, Razavi F, Rabier D, Simon I, Boddaert N, Brunelle F, Sonigo P (2006) Contribution of fetal MR imaging in the prenatal diagnosis of Zellweger syndrome. Am J Neuroradiol 27:333–336PubMedGoogle Scholar
  50. Nelson KB (2008) Causative factors in cerebral palsy. Clin Obstet Gynecol 51:749–762PubMedCrossRefGoogle Scholar
  51. Nissenkorn A, Michelson M, Ben-Zeev B, Lerman-Sagie T (2001) Inborn errors of metabolism: a cause of abnormal brain development. Neurology 56:1265–1272PubMedCrossRefGoogle Scholar
  52. Nomura ML, Barini R, De Andrade KC, Milanez H, Simoni RZ, Peralta CF, Machado IN, Zambelli H, Maio KT (2009) Congenital hydrocephalus: gestational and neonatal outcomes. Arch Gynecol Obstet 282:607–611Google Scholar
  53. Oboh AE, Orsi NM, Campbell J (2006) Amniotic fluid cytokine profile in association with fetal hyperechogenic bowel. Eur J Obstet Gynecol Reprod Biol 128:86–90PubMedCrossRefGoogle Scholar
  54. Oi S (2003) Diagnosis, outcome, and management of fetal abnormalities: fetal hydrocephalus. Childs Nerv Syst 19:508–516PubMedCrossRefGoogle Scholar
  55. Ozanne A, Alvarez H, Krings T, Lasjaunias P (2007) Pediatric neurovascular malformations: vein of Galen arteriovenous malformations (VGAM), pial arteriovenous malformations (pial AVM), dural sinus malformations (DSM). J Neuroradiol 34:145–166PubMedCrossRefGoogle Scholar
  56. Pati S, Helmbrecht GD (1994) Congenital schizencephaly associated with in utero warfarin exposure. Reprod Toxicol 8:115–120PubMedCrossRefGoogle Scholar
  57. Pătraşcu A, Berceanu S, Popescu CF, Gheorman V, Berceanu C (2009) Clinical and histopathological correlations of the modifications of fetal membranes in amniochorial infection. Rom J Morphol Embryol 50:67–72PubMedGoogle Scholar
  58. Pharoah PO, Dundar Y (2009) Monozygotic twinning, cerebral palsy and congenital anomalies. Hum Reprod Update 15:639–648PubMedCrossRefGoogle Scholar
  59. Piastra M, Pietrini D, Massimi L, Caldarelli M, De Luca D, Del Lungo LM, De Carolis MP, Di Rocco C, Conti G, Zecca E (2009) Severe subdural hemorrhage due to minimal prenatal trauma. J Neurosurg Pediatr 4:543–546PubMedCrossRefGoogle Scholar
  60. Pistorius LR, Smal J, de Haan TR, Page-Christiaens GC, Verboon-Maciolek M, Oepkes D, de Vries LS (2008) Disturbance of cerebral neuronal migration following congenital parvovirus B19 infection. Fetal Diagn Ther 24:491–494PubMedCrossRefGoogle Scholar
  61. Prasad AN, Bunzeluk K, Prasad C, Chodirker BN, Magnus KG, Greenberg CR (2007) Agenesis of the corpus callosum and cerebral anomalies in inborn errors of metabolism. Congenit Anom (Kyoto) 47:125–135CrossRefGoogle Scholar
  62. Prasad AN, Malinger G, Lerman-Sagie T (2009) Primary disorders of metabolism and disturbed fetal brain development. Clin Perinatol 36:621–638PubMedCrossRefGoogle Scholar
  63. Prayer D, Kuhle S, Prokesch R et al (1999) In vitro MR imaging of blood containing fetal hemoglobin (abstr). Radiology 213:144Google Scholar
  64. Prayer D, Brugger PC, Kasprian G, Witzani L, Helmer H, Dietrich W, Eppel W, Langer M (2006a) MRI of fetal acquired brain lesions. Eur J Radiol 57:233–249PubMedCrossRefGoogle Scholar
  65. Prayer D, Kasprian G, Krampl E, Ulm B, Witzani L, Prayer L, Brugger PC (2006b) MRI of normal fetal brain development. Eur J Radiol 57:199–216PubMedCrossRefGoogle Scholar
  66. Reardon W, Donnai D (2007) Dysmorphology demystified. Arch Dis Child Fetal Neonatal Ed 92:F225–229PubMedCrossRefGoogle Scholar
  67. Redline RW, O’Riordan MA (2000) Placental lesions associated with cerebral palsy and neurologic impairment following term birth. Arch Pathol Lab Med 124:1785–1791PubMedGoogle Scholar
  68. Reinhardt K, Mohr A, Gartner J, Spohr HL, Brockmann K (2010) Polymicrogyria in fetal alcohol syndrome. Birth Defects Res A Clin Mol Teratol 88:128–131PubMedGoogle Scholar
  69. Righini A, Salmona S, Bianchini E, Zirpoli S, Moschetta M, Kustermann A, Nicolini U, Triulzi F (2004) Prenatal magnetic resonance imaging evaluation of ischemic brain lesions in the survivors of monochorionic twin pregnancies: report of 3 cases. J Comput Assist Tomogr 28:87–92PubMedCrossRefGoogle Scholar
  70. Righini A, Kustermann A, Parazzini C, Fogliani R, Ceriani F, Triulzi F (2007) Diffusion-weighted magnetic resonance imaging of acute hypoxic-ischemic cerebral lesions in the survivor of a monochorionic twin pregnancy: case report. Ultrasound Obstet Gynecol 29:453–456PubMedCrossRefGoogle Scholar
  71. Righini A, Fiori L, Parazzini C, Doneda C, Arrigoni F, Riva E, Triulzi F (2010) Early prenatal magnetic resonance imaging of glutaric aciduria type 1: case report. J Comput Assist Tomogr 34:446–448PubMedCrossRefGoogle Scholar
  72. Robinson JN, Norwitz ER, Mulkern R, Brown SA, Rybicki F, Tempany CM (2001) Prenatal diagnosis of pyruvate dehydrogenase deficiency using magnetic resonance imaging. Prenat Diagn 21:1053–1056PubMedCrossRefGoogle Scholar
  73. Roza SJ, Steegers EA, Verburg BO, Jaddoe VW, Moll HA, Hofman A, Verhulst FC, Tiemeier H (2008) What is spared by fetal brain-sparing? Fetal circulatory redistribution and behavioral problems in the general population. Am J Epidemiol 168:1145–1152PubMedCrossRefGoogle Scholar
  74. Simonazzi G, Segata M, Ghi T, Sandri F, Ancora G, Bernardi B, Tani G, Rizzo N, Santini D, Bonasoni P, Pilu G (2006) Accurate neurosonographic prediction of brain injury in the surviving fetus after the death of a monochorionic cotwin. Ultrasound Obstet Gynecol 27:517–521PubMedCrossRefGoogle Scholar
  75. Tang PH, Bartha AI, Norton ME, Barkovich AJ, Sherr EH, Glenn OA (2009) Agenesis of the corpus callosum: an MR imaging analysis of associated abnormalities in the fetus. Am J Neuroradiol 30:257–263PubMedCrossRefGoogle Scholar
  76. Taweevisit M, Thorner PS (2010) Massive fetal thrombotic vasculopathy associated with excessively long umbilical cord and fetal demise: case report and literature review. Pediatr Dev Pathol 13:112–115PubMedCrossRefGoogle Scholar
  77. Unger S, Salem S, Wylie L, Shah V (2010) Newborn frontal horn cysts: cause for concern? J Perinatol 8 July doi:10.1038/jp.2010.79Google Scholar
  78. van Baalen A, Versmold H (2007) Non-haemorrhagic subependymal pseudocysts: ultrasonographic, histological and pathogenetic variability. Ultraschall Med 28:296–300PubMedCrossRefGoogle Scholar
  79. van Gelder-Hasker MR, van Wezel-Meijler G, de Groot L, van Geijn HP, de Vries JI (2003) Peri- and intraventricular cerebral sonography in second- and third-trimester high-risk fetuses: a comparison with neonatal ultrasound and relation to neurological development. Ultrasound Obstet Gynecol 22:110–120PubMedCrossRefGoogle Scholar
  80. Vazquez E, Castellote A, Mayolas N, Carreras E, Peiro JL, Enriquez G (2009) Congenital tumours involving the head, neck and central nervous system. Pediatr Radiol 39:1158–1172PubMedCrossRefGoogle Scholar
  81. Verbrugge J, Choudhary AK, Ladda R (2009) Tethered cord, corpus callosum abnormalities, and periventricular cysts in Wolf-Hirschhorn syndrome. Report of two cases and review of the literature. Am J Med Genet A 149A:2280–2284PubMedCrossRefGoogle Scholar
  82. Ville Y, Jenkins E, Shearer MJ, Hemley H, Vasey DP, Layton M, Nicolaides KH (1993) Fetal intraventricular haemorrhage and maternal warfarin. Lancet 341:1211PubMedCrossRefGoogle Scholar
  83. Volpe JJ (2001) Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res 50:553–562PubMedCrossRefGoogle Scholar
  84. Zuerrer M, Martin E, Boltshauser E (1991) MR imaging of intracranial hemorrhage in neonates and infants at 2.35 Tesla. Neuroradiology 33:223–229PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Daniela Prayer
    • 1
  • Ulrika Asenbaum
    • 1
  • Peter C. Brugger
    • 2
  • Gregor Kasprian
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity Hospital ViennaViennaAustria
  2. 2.Center of Anatomy and Cell BiologyMedical University ViennaViennaAustria

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