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MRI Studies of the Fetal Brain and Cranium
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology. (Neuroradiology)
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Ultrasound is the primary modality for fetal imaging, but Magnetic Resonance Imaging nowadays has a valuable complementary role as it often reveals findings that alter pregnancy management.

Knowledge on some clinically relevant areas of the normal fetal development is still lacking, and this was the aim of this project. We wanted 1) to obtain reference MRI data of normal brain measurements before 24 gestation weeks (GW), 2) to study the development of the hippocampus, 3) to study the development of the ear and 4) to test the ability of MRI for evaluating the lip and palate.

For this, we retrospectively analysed a database with 464 in vivo and 21 post mortem fetal MRI examinations.

Study I evaluated a series of 70 normal fetuses. A table of normal brain measurements from 17 to 23 GW was built, the first in the literature that includes ages below 20 GW.

Study II focused on the evolution of the hippocampus from 18 to 38 GW by evaluating 3 post mortem and 60 in vivo MRI examinations. Our results suggested this area to develop later and more asymmetrically than previously thought.

Study III analysed a series of 122 normal MRI in vivo and 16 MRI post mortem. We described the development of the fetal ear in vivo for the first time in the literature, realizing that the value of MRI is limited by the size of the structures evaluated.

In study IV, 60 brain-targeted MRI examinations of 55 normal fetuses and 5 fetuses with orofacial clefts were blindly reviewed by two readers, focusing on the lips and palates. Our results suggest a high accuracy of MRI in the evaluation of this area, regardless of fetal age or previous ultrasound findings.

This thesis brings new knowledge on the normal development of the fetal brain and cranium.

Place, publisher, year, edition, pages
Uppsala: Department of Radiology , 2012. , 53 p.
Keyword [en]
Fetal MRI, Brain, Cranium, Development, Normal, Ear, Lip, Palate, Biometry, Hippocampus, Measurements
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
URN: urn:nbn:se:uu:diva-164685ISBN: 978-91-506-2268-3 (print)OAI: oai:DiVA.org:uu-164685DiVA: diva2:469024
Public defence
2012-02-17, Grönwallsalen, Akademiska Sjukhuset, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2012-01-27 Created: 2011-12-22 Last updated: 2012-01-27Bibliographically approved
List of papers
1. The ear in fetal MRI: what can we really see?
Open this publication in new window or tab >>The ear in fetal MRI: what can we really see?
2011 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no 12, 1001-1008 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The aim of this study was to investigate the ability to depict the components of the ear on brain-oriented fetal MRI studies.

METHODS: Retrospective evaluation of the ear in MRI studies was performed post-mortem in 16 fetuses ranging from 15 to 22 gestation weeks (GW), and in 122 examinations in vivo of fetuses ranging from 20 to 38 GW. The cochlea, vestibular apparatus, middle ear, and external auditory canal were separately graded according to the components that were delineated.

RESULTS: The components of the inner and middle ear were fully delineated in 100% of the post-mortem examinations, but the external auditory canals were only seen in only 25%. In the in vivo group, the imaging detail was much lower. Cochlear turns could be identified in 75% of the fetuses, the vestibule and the lateral semicircular canals in 72% andossicles in 70%. Before 25 GW, the ability to identify these individual parts was 50%, 30%, and 33%, respectively, and above it was 89%, 93%, and 90% . In most cases, the external auditory canals could only be seen after 29 GW.

CONCLUSION: In fetal MRI studies in vivo, it is possible to depict the components of the ear in the majority of the fetuses, in such a manner as to exclude major malformations. However, MRI might not provide enough detail to rule out pathology of the ear before 25 GW, this being a critical age for pregnancy management in many countries.

Keyword
Fetal, MRI, Ear, Temporal bone, Development
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-157857 (URN)10.1007/s00234-011-0938-z (DOI)000297162600009 ()21850391 (PubMedID)
Available from: 2011-08-24 Created: 2011-08-24 Last updated: 2017-12-08Bibliographically approved
2. Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study
Open this publication in new window or tab >>Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study
Show others...
2011 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no 1, 43-48 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: To obtain measurements of the normal fetal brain before 24 weeks of gestation (GW), a deadline for medical decisions on fetal viability in a large number of countries. METHODS: We retrospectively reviewed 70 normal MR examinations of fetuses aged GW 17 to 23. The fronto-occipital diameter, the cerebral bi-parietal diameter, the transverse cerebellar diameter, the vermian height, and antero-posterior diameter were measured. RESULTS: The median, maximum, and minimum values for each parameter were displayed for each individual GW. CONCLUSION: The recorded data might contribute to a better assessment of fetal health by providing normal boundaries for the brain growth.

Keyword
Biometry, Brain, Fetal, MRI, Normal development
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-132616 (URN)10.1007/s00234-010-0772-8 (DOI)000285878200008 ()20878397 (PubMedID)
Available from: 2010-10-22 Created: 2010-10-22 Last updated: 2017-12-12Bibliographically approved
3.
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4. Visualisation of the fetal lip and palate: is brain-targeted MRI reliable?
Open this publication in new window or tab >>Visualisation of the fetal lip and palate: is brain-targeted MRI reliable?
Show others...
2011 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632XArticle in journal (Other academic) Submitted
Abstract [en]

Introduction: The purpose of the study was to evaluate the ability of brain-targeted MRI to assess the anatomy of the fetal upper lip and palate.

 

Methods: Two independent readers made a blind retrospective review of 60 MRI of fetuses of 20 to 38 gestational weeks (GW). Fifty-five fetuses had normal post-natal follow-up.  Five fetuses had oro-facial anomalies at post-natal follow-up, including five cleft lips (two bilateral, three unilateral), four cleft primary palates (two bilateral, two unilateral) and two cleft secondary palates.

The upper lip, primary palate, secondary palate and nasal septum were scored into four levels, from evidently normal to evidently abnormal. In case of a suspected pathology, the readers attempted a diagnosis.

 

Results: Interobserver agreement (weighted kappa) was 0.79 for the upper lip, 0.70 for the primary palate, 0.86 for the secondary palate, and 0.90 for the nasal septum. The scoring levels of the readers did not change significantly across gestational age.

The readers identified 100% of all pathological cases. The normality was correctly scored in 96-100% of the normal lips and primary palates and in 93-97% of the normal secondary palates depending on the reader. A deviated septum was only scored in two fetuses with unilateral cleft palates.

 

Conclusion:  MRI in experienced hands seems reliable for assessment of the fetal lip and palate, even in brain-targeted examinations. Attention should therefore be paid to the lip and palate in all fetal MRI examinations, since unsuspected clefts may be revealed.

 

 

Keyword
Fetal, MRI, Palate, Lip, Development
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
urn:nbn:se:uu:diva-164681 (URN)
Projects
MRI Studies of the Fetal Brain and Cranium
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2017-12-08Bibliographically approved

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