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Region-specific changes in brain diffusivity in fetal isolated mild ventriculomegaly

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Abstract

Objectives

To evaluate the impact of symmetric and asymmetric isolated mild ventriculomegaly (IMVM, atrial width 10–15 mm) on apparent diffusion coefficient (ADC) values in fetal brain areas.

Methods

Sixty-seven sequential fetal head magnetic resonance imaging scans (feMRI) of VM cases performed between 2009 and 2014 were compared to 38 normal feMRI scans matched for gestational age (controls). Ultrasound- and MRI-proven IMVM cases were divided into asymmetrical (AVM, ≥2 mm difference in atrial width), symmetrical (SVM, <2 mm difference in atrial width), and asymmetrical IMVM with one normal-sized ventricle (AV1norm).

Results

ADC values were significantly elevated in the basal ganglia (BG) of the SVM and AV1norm groups compared to controls (p < 0.004 and p < 0.013, respectively). High diffusivity was constantly detected in the BG ipsilateral to the enlarged atria relative to the normal-sized atria in the AV1norm group (p < 0.03). Frontal lobe ADC values were significantly reduced in the AVM and SVM groups (p < 0.003 and p < 0.003 vs. controls). Temporal lobe ADC values were significantly reduced in the AVM group (p < 0.001 vs. controls).

Conclusion

Isolated mild ventriculomegaly is associated with distinct ADC value changes in different brain regions. This phenomenon could reflect the pathophysiology associated with different IMVM patterns.

Key Points

• Various ventriculomegaly patterns are associated with distinct diffusional changes

• Frontal and temporal lobe ADC values are altered bilaterally, even in asymmetric ventriculomegaly

• Basal ganglia ADC values are elevated ipsilateral to the enlarged ventricle

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Abbreviations

ADC:

Apparent diffusion coefficient

GA:

Gestational age

MRI:

Magnetic resonance imaging

feMRI:

fetal head MRI

BG:

Basal ganglia

DWI:

Diffusion weighted imaging

VM:

Ventriculomegaly

US:

Ultrasound

ROI:

Region of interest

References

  1. Sethna F, Tennant PW, Rankin J, Robson SC (2011) Prevalence, natural history, and clinical outcome of mild to moderate ventriculomegaly. Obstet Gynecol 117:867–876

    Article  PubMed  Google Scholar 

  2. McKechnie L, Vasudevan C, Levene M (2012) Neonatal outcome of congenital ventriculomegaly. Semin Fetal Neonatal Med 17:301–307

    Article  PubMed  Google Scholar 

  3. Hannon T, Tennant PW, Rankin J, Robson SC (2012) Epidemiology, natural history, progression, and postnatal outcome of severe fetal ventriculomegaly. Obstet Gynecol 120:1345–1353

    PubMed  Google Scholar 

  4. D'Addario V, Rossi AC (2012) Neuroimaging of ventriculomegaly in the fetal period. Semin Fetal Neonatal Med 17:310–318

    Article  PubMed  Google Scholar 

  5. Achiron R, Yagel S, Rotstein Z, Inbar O, Mashiach S, Lipitz S (1997) Cerebral lateral ventricular asymmetry: is this a normal ultrasonographic finding in the fetal brain? Obstet Gynecol 89:233–237

    Article  CAS  PubMed  Google Scholar 

  6. Lipitz S, Yagel S, Malinger G, Meizner I, Zalel Y, Achiron R (1998) Outcome of fetuses with isolated borderline unilateral ventriculomegaly diagnosed at mid-gestation. Ultrasound Obstet Gynecol 12:23–26

    Article  CAS  PubMed  Google Scholar 

  7. Kelly EN, Allen VM, Seaward G, Windrim R, Ryan G (2001) Mild ventriculomegaly in the fetus, natural history, associated findings and outcome of isolated mild ventriculomegaly: a literature review. Prenat Diagn 21:697–700

    Article  CAS  PubMed  Google Scholar 

  8. Palmen SJ, Hulshoff Pol HE, Kemner C et al (2005) Increased gray-matter volume in medication-naive high-functioning children with autism spectrum disorder. Psychol Med 35:561–570

    Article  PubMed  Google Scholar 

  9. Jackson DC, Irwin W, Dabbs K et al (2011) Ventricular enlargement in new-onset pediatric epilepsies. Epilepsia 52:2225–2232

    Article  PubMed Central  PubMed  Google Scholar 

  10. Wright IC, Sham P, Murray RM, Weinberger DR, Bullmore ET (2002) Genetic contributions to regional variability in human brain structure: methods and preliminary results. NeuroImage 17:256–271

    Article  CAS  PubMed  Google Scholar 

  11. Sadan S, Malinger G, Schweiger A, Lev D, Lerman-Sagie T (2007) Neuropsychological outcome of children with asymmetric ventricles or unilateral mild ventriculomegaly identified in utero. BJOG 114:596–602

    Article  CAS  PubMed  Google Scholar 

  12. Falip C, Blanc N, Maes E et al (2007) Postnatal clinical and imaging follow-up of infants with prenatal isolated mild ventriculomegaly: a series of 101 cases. Pediatr Radiol 37:981–989

    Article  PubMed  Google Scholar 

  13. Garel C, Luton D, Oury JF, Gressens P (2003) Ventricular dilatations. Childs Nerv Syst 19:517–523

    Article  PubMed  Google Scholar 

  14. Salomon LJ, Ouahba J, Delezoide AL et al (2006) Third-trimester fetal MRI in isolated 10- to 12-mm ventriculomegaly: is it worth it? BJOG 113:942–947

    Article  CAS  PubMed  Google Scholar 

  15. Pier DB, Levine D, Kataoka ML et al (2011) Magnetic resonance volumetric assessments of brains in fetuses with ventriculomegaly correlated to outcomes. J Ultrasound Med 30:595–603

    PubMed Central  PubMed  Google Scholar 

  16. Kyriakopoulou V, Vatansever D, Elkommos S et al (2013) Cortical overgrowth in fetuses with isolated ventriculomegaly. Cereb Cortex 24:2141–2150

    Article  PubMed  Google Scholar 

  17. Tatli B, Ozer I, Ekici B et al (2012) Neurodevelopmental outcome of 31 patients with borderline fetal ventriculomegaly. Clin Neurol Neurosurg 114:969–971

    Article  PubMed  Google Scholar 

  18. Kutuk MS, Ozgun MT, Uludag S, Dolanbay M, Poyrazoglu HG, Tas M (2013) Postnatal outcome of isolated, nonprogressive, mild borderline fetal ventriculomegaly. Childs Nerv Syst 29:803–808

    Article  PubMed  Google Scholar 

  19. Garcia-Flores J, Recio M, Uriel M et al (2013) Fetal magnetic resonance imaging and neurosonography in congenital neurological anomalies: supplementary diagnostic and postnatal prognostic value. J Matern Fetal Neonatal Med 26:1517–1523

    Article  PubMed  Google Scholar 

  20. Gholipour A, Akhondi-Asl A, Estroff JA, Warfield SK (2012) Multi-atlas multi-shape segmentation of fetal brain MRI for volumetric and morphometric analysis of ventriculomegaly. NeuroImage 60:1819–1831

    Article  PubMed Central  PubMed  Google Scholar 

  21. Boyer AC, Goncalves LF, Lee W et al (2013) Magnetic resonance diffusion-weighted imaging: reproducibility of regional apparent diffusion coefficients for the normal fetal brain. Ultrasound Obstet Gynecol 41:190–197

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Schneider MM, Berman JI, Baumer FM et al (2009) Normative apparent diffusion coefficient values in the developing fetal brain. AJNR Am J Neuroradiol 30:1799–1803

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Hoffmann C, Weisz B, Lipitz S et al (2014) Regional apparent diffusion coefficient values in 3rd trimester fetal brain. Neuroradiology 56:561–570

    Article  PubMed  Google Scholar 

  24. Aslan M, Dogan M, Celik O et al (2012) Comparison of brain apparent diffusion coefficient value in naturally and assisted conceived newborns. J Matern Fetal Neonatal Med 25:2762–2765

    Article  PubMed  Google Scholar 

  25. Erdem G, Celik O, Hascalik S, Karakas HM, Alkan A, Firat AK (2007) Diffusion-weighted imaging evaluation of subtle cerebral microstructural changes in intrauterine fetal hydrocephalus. Magn Reson Imaging 25:1417–1422

    Article  PubMed  Google Scholar 

  26. International Society of Ultrasound in O, Gynecology Education C (2007) Sonographic examination of the fetal central nervous system: guidelines for performing the 'basic examination' and the 'fetal neurosonogram'. Ultrasound Obstet Gynecol 29:109–116

    Article  Google Scholar 

  27. Aukland SM, Odberg MD, Gunny R, Chong WK, Eide GE, Rosendahl K (2008) Assessing ventricular size: is subjective evaluation accurate enough? New MRI-based normative standards for 19-year-olds. Neuroradiology 50:1005–1011

    Article  PubMed  Google Scholar 

  28. Chen CP, Lin SP, Chang TY et al (2002) Perinatal imaging findings of inherited Sotos syndrome. Prenat Diagn 22:887–892

    Article  PubMed  Google Scholar 

  29. Huisman TA (2011) Fetal magnetic resonance imaging of the brain: is ventriculomegaly the tip of the syndromal iceberg? Semin Ultrasound CT MR 32:491–509

    Article  PubMed  Google Scholar 

  30. Yamasaki M, Nonaka M, Bamba Y, Teramoto C, Ban C, Pooh RK (2012) Diagnosis, treatment, and long-term outcomes of fetal hydrocephalus. J Matern Fetal Neonatal Med 17:330–335

    Article  Google Scholar 

  31. Robson S, McCormack K, Rankin J (1998) Prenatally detected mild/moderate cerebral ventriculomegaly: associated anomalies and outcome. Northern Congenital Abnormality Survey Steering Group. Eur J Pediatr Surg 8:70–71

    PubMed  Google Scholar 

  32. Vergani P, Locatelli A, Strobelt N et al (1998) Clinical outcome of mild fetal ventriculomegaly. Am J Obstet Gynecol 178:218–222

    Article  CAS  PubMed  Google Scholar 

  33. Bloom SL, Bloom DD, DellaNebbia C, Martin LB, Lucas MJ, Twickler DM (1997) The developmental outcome of children with antenatal mild isolated ventriculomegaly. Obstet Gynecol 90:93–97

    Article  CAS  PubMed  Google Scholar 

  34. Arora A, Bannister CM, Russell S, Rimmer S (1998) Outcome and clinical course of prenatally diagnosed cerebral ventriculomegaly. Eur J Pediatr Surg 8:63–64

    PubMed  Google Scholar 

  35. Mercier A, Eurin D, Mercier PY, Verspyck E, Marpeau L, Marret S (2001) Isolated mild fetal cerebral ventriculomegaly: a retrospective analysis of 26 cases. Prenat Diagn 21:589–595

    Article  CAS  PubMed  Google Scholar 

  36. Malinger G, Svirsky R, Ben-Haroush A, Golan A, Bar J (2011) Doppler-flow velocity indices in fetal middle cerebral artery in unilateral and bilateral mild ventriculomegaly. J Matern Fetal Neonatal Med 24:506–510

    Article  PubMed  Google Scholar 

  37. Thickman D, Mintz M, Mennuti M, Kressel HY (1984) MR imaging of cerebral abnormalities in utero. J Comput Assist Tomogr 8:1058–1061

    Article  CAS  PubMed  Google Scholar 

  38. Lyall AE, Woolson S, Wolfe HM et al (2012) Prenatal isolated mild ventriculomegaly is associated with persistent ventricle enlargement at ages 1 and 2. Early Hum Dev 88:691–698

    Article  PubMed Central  PubMed  Google Scholar 

  39. Righini A, Bianchini E, Parazzini C et al (2003) Apparent diffusion coefficient determination in normal fetal brain: a prenatal MR imaging study. AJNR Am J Neuroradiol 24:799–804

    PubMed  Google Scholar 

  40. Manganaro L, Perrone A, Savelli S et al (2007) Evaluation of normal brain development by prenatal MR imaging. Radiol Med 112:444–455

    Article  CAS  PubMed  Google Scholar 

  41. Tanner SF, Ramenghi LA, Ridgway JP et al (2000) Quantitative comparison of intrabrain diffusion in adults and preterm and term neonates and infants. AJR Am J Roentgenol 174:1643–1649

    Article  CAS  PubMed  Google Scholar 

  42. Marks MP, de Crespigny A, Lentz D, Enzmann DR, Albers GW, Moseley ME (1996) Acute and chronic stroke: navigated spin-echo diffusion-weighted MR imaging. Radiology 199:403–408

    Article  CAS  PubMed  Google Scholar 

  43. Barajas RF Jr, Rubenstein JL, Chang JS, Hwang J, Cha S (2010) Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma. AJNR Am J Neuroradiol 31:60–66

    Article  PubMed Central  PubMed  Google Scholar 

  44. Sotak CH (2004) Nuclear magnetic resonance (NMR) measurement of the apparent diffusion coefficient (ADC) of tissue water and its relationship to cell volume changes in pathological states. Neurochem Int 45:569–582

    Article  CAS  PubMed  Google Scholar 

  45. Rumboldt Z, Camacho DL, Lake D, Welsh CT, Castillo M (2006) Apparent diffusion coefficients for differentiation of cerebellar tumors in children. AJNR Am J Neuroradiol 27:1362–1369

    CAS  PubMed  Google Scholar 

  46. Miller SP, McQuillen PS, Hamrick S et al (2007) Abnormal brain development in newborns with congenital heart disease. N Engl J Med 357:1928–1938

    Article  CAS  PubMed  Google Scholar 

  47. Hagen T, Ahlhelm F, Reiche W (2007) Apparent diffusion coefficient in vasogenic edema and reactive astrogliosis. Neuroradiology 49:921–926

    Article  PubMed  Google Scholar 

  48. Senat MV, Bernard JP, Schwarzler P, Britten J, Ville Y (1999) Prenatal diagnosis and follow-up of 14 cases of unilateral ventriculomegaly. Ultrasound Obstet Gynecol 14:327–332

    Article  CAS  PubMed  Google Scholar 

  49. Kinzler WL, Smulian JC, McLean DA, Guzman ER, Vintzileos AM (2001) Outcome of prenatally diagnosed mild unilateral cerebral ventriculomegaly. J Ultrasound Med 20:257–262

    CAS  PubMed  Google Scholar 

  50. Gilmore JH, van Tol JJ, Lewis Streicher H et al (2001) Outcome in children with fetal mild ventriculomegaly: a case series. Schizophr Res 48:219–226

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is Chen Hoffmann MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Tali Bdolach, Ph.D kindly provided statistical advice for this manuscript. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in .Yaniv G, Hoffmann C, Weisz B, et al. (2014) Region selective reductions in brain apparent diffusion coefficient in CMV-infected fetuses. Ultrasound Obstet Gynecol. DOI 10.1002/uog.14737. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv, Israel

    Gal Yaniv, Ronen Bercovitz, Dafi Bergman, Gahl Greenberg & Chen Hoffmann

  2. The Institute for Research in Military Medicine, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

    Gal Yaniv

  3. The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Aviv, Israel

    Gal Yaniv

  4. Obstetrics and Gynecology Department, Sheba Medical Center, Tel Aviv, Israel

    Eldad Katorza

  5. Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA

    Anat Biegon

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  1. Gal Yaniv
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Correspondence to Gal Yaniv.

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Yaniv, G., Katorza, E., Bercovitz, R. et al. Region-specific changes in brain diffusivity in fetal isolated mild ventriculomegaly. Eur Radiol 26, 840–848 (2016). https://doi.org/10.1007/s00330-015-3893-y

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  • DOI: https://doi.org/10.1007/s00330-015-3893-y

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