Radhakrishnan Rupa, Merhar Stephanie L, Burns Patricia, Zhang Bin, Lim Foong-Yen, Kline-Fath Beth M
Department of Radiology, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Radiol. 2019 Feb;49(2):217-223. doi: 10.1007/s00247-018-4272-z. Epub 2018 Oct 6.
Many infants with congenital diaphragmatic hernia (CDH) show brain abnormality on postnatal brain MRI related to severity of CDH, degree of lung hypoplasia, intrathoracic liver, right diaphragmatic hernia and large diaphragmatic defect. It is not known whether these factors affect brain growth in utero in CDH.
To assess prenatal brain morphometry and abnormalities on fetal MR in congenital diaphragmatic hernia.
We retrospectively reviewed 109 fetal MRIs in 63 fetuses with CDH from 2009 to 2014 (27 died before discharge, 36 survived to discharge). We compared brain injury and gestational-age-corrected z-scores of brain measurements between survivors and non-survivors. We assessed correlations between brain abnormalities and CDH severity.
Enlarged extraaxial space was the most common abnormality, frequently seen on fetal MRI at >28 weeks of gestation, similar in survivors versus non-survivors. Anteroposterior cerebellar vermis dimension at >28 weeks of gestation was smaller in non-survivors compared to survivors (P=.02) and positively correlated with observed/expected total fetal lung volume (P=.01). Transverse cerebellar diameter at >28 weeks of gestation was also positively correlated with observed/expected total fetal lung volume (P=.04). We did not identify maturational delay, abnormal parenchymal signal or intracranial hemorrhage on fetal MRI.
Enlarged extraaxial spaces in the third trimester was the most common abnormality on fetal MRI in congenital diaphragmatic hernia. Cerebellar dimensions on fetal MRI are associated with CDH severity. There was no major brain parenchymal injury on fetal MRI, even in the third trimester, in CDH survivors and non-survivors.
许多先天性膈疝（CDH）婴儿出生后的脑部磁共振成像（MRI）显示存在脑异常，这与CDH的严重程度、肺发育不全程度、胸腔内肝脏、右侧膈疝及大的膈肌缺损有关。目前尚不清楚这些因素是否会影响CDH胎儿的脑宫内生长。
评估先天性膈疝胎儿磁共振成像（MR）上的产前脑形态学及异常情况。
我们回顾性分析了2009年至2014年间63例患有CDH胎儿的109份胎儿MRI（27例在出院前死亡，36例存活至出院）。我们比较了存活者与非存活者之间的脑损伤情况以及脑测量值的孕周校正z评分。我们评估了脑异常与CDH严重程度之间的相关性。
轴外间隙增宽是最常见的异常，在孕周>28周的胎儿MRI上经常可见，存活者与非存活者相似。孕周>28周时，非存活者的小脑蚓部前后径较存活者小（P = 0.02），且与观察到的/预期的胎儿肺总体积呈正相关（P = 0.01）。孕周>28周时，小脑横径也与观察到的/预期的胎儿肺总体积呈正相关（P = 0.04）。我们在胎儿MRI上未发现成熟延迟、实质信号异常或颅内出血。
孕晚期轴外间隙增宽是先天性膈疝胎儿MRI上最常见的异常。胎儿MRI上的小脑尺寸与CDH严重程度相关。无论是CDH存活者还是非存活者，即使在孕晚期，胎儿MRI上也未发现主要的脑实质损伤。
