Additional value of advanced neurosonography and magnetic resonance imaging in fetuses at risk for brain damage

Bloeme van der Knoop, Inge Zonnenberg, Jonathan Verbeke, Linda de Vries, Lou Pistorius, Mirjam M van Weissenbruch, R Jeroen Vermeulen, Johanna de Vries
Ultrasound in Obstetrics & Gynecology 2019 December 11

OBJECTIVES: To assess the additional value of fetal multiplanar (axial, coronal and sagittal) neurosonography and Magnetic Resonance Imaging (MRI) to axial ultrasound (US) planes to diagnose brain damage (visualized as periventricular echogenicity changes (PVE), intraventricular haemorrhage (IVH) and echogenicities in basal ganglia and/or thalami (BGTE)) and signal intensity changes in the equivalent brain areas on MRI in fetuses at high risk.

METHODS: A prospective, multicenter, observational study. Women eligible for participation were those where the fetus was at risk factor for acquired brain anomalies (congenital infection, fetal growth restriction, trauma during pregnancy, monochorionic twins). Examinations before birth were the following: axial US and advanced neurosonography biweekly; MRI of the brain once. After birth: brain US <24h and at term equivalent age. Brain MRI once at term equivalent age. An expert panel, blinded for medical history, evaluated the presence of PVE, PIVH and BGTE on US and (the equivalent) signal intensity changes on MRI. Scores were generated by consensus. The children were followed with examinations for psychomotor development at one year of age by means of Touwen examination and Alberta Infant Motor Scale and Bayley Scale of Infant Development-III, behavioural, sensory profile and linguistic questionnaires at two years of age; scores < -1 SD were considered suspect.

RESULTS: 56 fetuses were examined and in 39/56 fetuses all fetal imaging modalities were present. PVE was encountered in 6/39, 18/39 and 2/39 fetuses on axial US planes, neurosonography and MRI examinations, respectively. PIVH was found in 3/39; 10/39 and 1/39; and BGTE in none of 39; 6/39 and none of 39 examinations, respectively. Neurodevelopmental outcome was suspect in 8/50 infants at one year, and 41/41 children had scores > -1 SD on BSID-III, 20 children had scores <-1 SD on the behavioural (5/38), sensory profile (17/37) and/or linguistic (6/39) questionnaires at two years of age.

CONCLUSIONS: In this cohort of fetuses at risk for brain damage, the severity of acquired brain anomalies was limited. Nevertheless, neurosonography encountered more fetal PVE, PIVH and/or BGTE compared to axial planes and MRI. Fetal MRI did not demonstrate any anomalies that were not seen on neurosonography. Neurodevelopmental outcome at two years of age showed mainly no or mild impairments. This article is protected by copyright. All rights reserved.

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