Fetal Central Nervous System Anomalies Detected by Magnetic Resonance Imaging: A Two-Year Experience

Sepideh Sefidbakht, Sakineh Dehghani, Maryam Safari, Homeira Vafaei, Maryam Kasraeian, Sepideh Sefidbakht, Sakineh Dehghani, Maryam Safari, Homeira Vafaei, Maryam Kasraeian

Abstract

Background: Magnetic resonance imaging (MRI) is gradually becoming more common for thorough visualization of the fetus than ultrasound (US), especially for neurological anomalies, which are the most common indications for fetal MRI and are a matter of concern for both families and society.

Objectives: We investigated fetal MRIs carried out in our center for frequency of central nervous system anomalies. This is the first such report in southern Iran.

Materials and methods: One hundred and seven (107) pregnant women with suspicious fetal anomalies in prenatal ultrasound entered a cross-sectional retrospective study from 2011 to 2013. A 1.5 T Siemens Avanto scanner was employed for sequences, including T2 HASTE and Trufisp images in axial, coronal, and sagittal planes to mother's body, T2 HASTE and Trufisp relative to the specific fetal body part being evaluated, and T1 flash images in at least one plane based on clinical indication. We investigated any abnormality in the central nervous system and performed descriptive analysis to achieve index of frequency.

Results: Mean gestational age ± standard deviation (SD) for fetuses was 25.54 ± 5.22 weeks, and mean maternal age ± SD was 28.38 ± 5.80 years Eighty out of 107 (74.7%) patients who were referred with initial impression of borderline ventriculomegaly. A total of 18 out of 107 (16.82%) patients were found to have fetuses with CNS anomalies and the remainder were neurologically normal. Detected anomalies were as follow: 3 (16.6%) fetuses each had the Dandy-Walker variant and Arnold-Chiari II (with myelomeningocele). Complete agenesis of corpus callosum, partial agenesis of corpus callosum, and aqueductal stenosis were each seen in 2 (11.1%) fetuses. Arnold-Chiari II without myelomeningocele, anterior spina bifida associated with neurenteric cyst, arachnoid cyst, lissencephaly, and isolated enlarged cisterna magna each presented in one (5.5%) fetus. One fetus had concomitant schizencephaly and complete agenesis of the corpus callosum.

Conclusions: MRI is superior to ultrasound and physical exam of live births in detection of CNS anomalies. In this investigation within a single referral center in southern Iran, anomalies included Dandy-Walker variant and Arnold-Chiari II as the most common findings. Other findings with lower incidence were complete and partial agenesis of corpus callosum, aqueductal stenosis, anterior spina bifida, schizencephaly, arachnoid cyst, lissencephaly, and isolated enlarged cisterna magna.

Keywords: CNS Anomalies; Fetus; MRI.

Figures

Figure 1.. Aqueductal stenosis in a fetus…
Figure 1.. Aqueductal stenosis in a fetus with 28 weeks gestational age (wks GA). Axial(A), coronal(B) and sagittal(C) T2 HASTE image of fetal brain showing significant dilatation of lateral ventricle(arrow) and third ventricle(arrow head). Normal diameter of fourth ventricle (curved arrow) is the clue to diagnosis of aqueductal stenosis.
Figure 2.. Complete agenesis of corpus callosum…
Figure 2.. Complete agenesis of corpus callosum in a fetus with 35 wks GA. Coronal T2 HASTE image shows no fusion between two cerebral hemispheres and absence of corpus callosum(straight arrow) as direct signs and parallel alignment of lateral ventricles resembling “Tear Drop” (curved arrows)as an indirect sign of complete agenesis of corpus callosum.
Figure 3.. A and B, Schizencephaly in…
Figure 3.. A and B, Schizencephaly in a fetus with 34wks GA. Coronal T2 HASTE images show Cleavage in gray matter extending from ventricular margin to brain surface in two different sections (arrows). Both side of cleavage are covered by hypo-intense thin cortex. Abnormal fusion of midline structures and complete agenesis of corpus callosum is also present.
Figure 4.. Dandy-Walker variant in a fetus…
Figure 4.. Dandy-Walker variant in a fetus with 27wks GA. Axial(A and B) and sagittal(C and D) T2 HASTE images show hypoplastic lower vermis (arrows) and enlarged cisterna magna (curved arrows) and otherwise normal brain parenchyma.
Figure 5.. Arnold Chiari II in a…
Figure 5.. Arnold Chiari II in a fetus at 20wks GA; (A) Axial T2 HASTE image of fetal brain shows a “lemon Shape” skull(straight arrow) and dilatation of posterior horns of lateral ventricles (curved arrow). (B) axial T2 HASTE image of lumbar spine; open neural tube defect with associated myelomeningocele(straight arrow). (C) Sagittal T2 HASTE image of entire fetal body shows combination of findings; small crowded posterior fossa, herniation of inferior vermis and fourth ventricle(large arrow), dilatation of lateral ventricles(small arrow) and myelomeningocele in lumosacral spine(curved arrow).

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Source: PubMed

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