Department of Maternal-Fetal Medicine, ICGON, Hospital Clinic, University of Barcelona; Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
Am J Obstet Gynecol. 2014 May;210(5):452.e1-8. doi: 10.1016/j.ajog.2013.12.008. Epub 2013 Dec 4.
We tested the hypothesis whether small-for-gestational-age (SGA) fetuses have different brain stem and cerebellar morphometry when compared with appropriate-for-gestational-age (AGA) fetuses and whether the differences in these structures were associated with their neonatal neurobehavior.
Magnetic resonance imaging was performed on 51 SGA fetuses and 47 AGA fetuses at 37 weeks' gestation. Pontine width, medullar width, vermian width and height, cerebellar primary fissure's depth, and cerebellar volume were measured and corrected by biparietal diameter and cerebellar volume by total intracranial volume. Ratios were compared between cases and control subjects. The association between morphometric differences and neurobehavioral outcome in SGAs was tested.
Brainstem and cerebellar ratios were significantly larger in SGA fetuses: pontine width, SGA 0.143 ± 0.01 vs AGA 0.135 ± 0.01 (P < .01); medullar width, SGA 0.088 ± 0.01 vs AGA 0.083 ± 0.01 (P = .03); vermian width, SGA 0.181 ± 0.03 vs AGA 0.162 ± 0.02 (P < .01); vermian height, SGA 0.235 ± 0.03 vs AGA 0.222 ± 0.01 (P < .01); cerebellar volume, SGA 0.042 ± 0.01 vs AGA 0.038 ± 0.00 (P = .04); with deeper cerebellar primary fissure in SGAs, SGA 0.041 ± 0.01 vs AGA 0.035 ± 0.01 (P = .01). Medullar, cerebellar biometries, and volumetry were significantly associated with different Neonatal Behavioral Assessment Scale cluster scores in SGA infants.
Brain stem and cerebellar morphometric measurements are significantly different in term SGA fetuses, which are associated significantly with their neurobehavioral outcome. This finding supports the existence of brain microstructural changes in SGA fetuses and lays the basis for potential image biomarkers to detect fetuses who are at risk.
我们检验了一个假说，即与适于胎龄（AGA）胎儿相比，小于胎龄（SGA）胎儿的脑干和小脑形态存在差异，以及这些结构的差异是否与其新生儿神经行为有关。
在 37 孕周时对 51 例 SGA 胎儿和 47 例 AGA 胎儿进行磁共振成像。测量并校正了脑桥宽度、延髓宽度、蚓部宽度和高度、小脑初级裂深度和小脑体积，并用双顶径和小脑体积校正了小脑体积。对病例组和对照组的比值进行了比较。测试了 SGA 中形态差异与神经行为结果之间的相关性。
SGA 胎儿的脑干和小脑比率显著较大：脑桥宽度，SGA 0.143 ± 0.01 比 AGA 0.135 ± 0.01（P <.01）；延髓宽度，SGA 0.088 ± 0.01 比 AGA 0.083 ± 0.01（P =.03）；蚓部宽度，SGA 0.181 ± 0.03 比 AGA 0.162 ± 0.02（P <.01）；蚓部高度，SGA 0.235 ± 0.03 比 AGA 0.222 ± 0.01（P <.01）；小脑体积，SGA 0.042 ± 0.01 比 AGA 0.038 ± 0.00（P =.04）；SGA 中小脑初级裂更深，SGA 0.041 ± 0.01 比 AGA 0.035 ± 0.01（P =.01）。SGA 婴儿的延髓、小脑生物测量和体积与新生儿行为评估量表不同聚类评分显著相关。
足月 SGA 胎儿的脑干和小脑形态学测量值存在显著差异，与神经行为结果显著相关。这一发现支持 SGA 胎儿存在脑微观结构变化的假设，并为检测有风险的胎儿提供了潜在的影像学生物标志物的基础。
