From the Fetal i+D Fetal Medicine Research Center (N.H., M.P.-C., E.G., E.E.), BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
BCN MedTech (O.M.B., G.P., G.S., M.A.G.B.), Universitat Pompeu Fabra, Barcelona, Spain.
AJNR Am J Neuroradiol. 2019 Sep;40(9):1567-1574. doi: 10.3174/ajnr.A6165.
Fetuses with isolated nonsevere ventriculomegaly (INSVM) are at risk of presenting neurodevelopmental delay. However, the currently used clinical parameters are insufficient to select cases with high risk and determine whether subtle changes in brain development are present and might be a risk factor. The aim of this study was to perform a comprehensive evaluation of cortical development in INSVM by magnetic resonance (MR) imaging and assess its association with neonatal neurobehavior.
Thirty-two INSVM fetuses and 29 healthy controls between 26-28 weeks of gestation were evaluated using MR imaging. We compared sulci and fissure depth, cortical maturation grading of specific areas and sulci and volumes of different brain regions obtained from 3D brain reconstruction of cases and controls. Neonatal outcome was assessed by using the Neonatal Behavioral Assessment Scale at a mean of 4 ± 2 weeks after birth.
Fetuses with INSVM showed less profound and underdeveloped sulcation, including the Sylvian fissure (mean depth: controls 16.8 ± 1.9 mm, versus INSVM 16.0 ± 1.6 mm; = .01), and reduced global cortical grading (mean score: controls 42.9 ± 10.2 mm, versus INSVM: 37.8 ± 9.9 mm; = .01). Fetuses with isolated nonsevere ventriculomegaly showed a mean global increase of gray matter volume (controls, 276.8 ± 46.0 ×10 mm, versus INSVM 277.5 ± 49.3 ×10 mm, = .01), but decreased mean cortical volume in the frontal lobe (left: controls, 53.2 ± 8.8 ×10 mm, versus INSVM 52.4 ± 5.4 ×10 mm; = < .01). Sulcal depth and brain volumes were significantly associated with the Neonatal Behavioral Assessment Scale severity ( = .005, Nagelkerke R = 0.732).
INSVM fetuses showed differences in cortical development, including regions far from the lateral ventricles, that are associated with neonatal neurobehavior. These results suggest the possible use of these parameters to identify cases at higher risk of altered neurodevelopment.
孤立性非重度脑室扩张（INSVM）的胎儿存在神经发育迟缓的风险。然而，目前使用的临床参数不足以选择高风险病例，并确定是否存在细微的脑发育变化，以及这些变化是否可能成为一个危险因素。本研究旨在通过磁共振成像（MR）对 INSVM 胎儿进行全面的皮质发育评估，并评估其与新生儿神经行为的相关性。
对 26-28 孕周的 32 例 INSVM 胎儿和 29 例健康对照组进行 MR 成像评估。我们比较了病例组和对照组的脑沟和脑裂深度、特定区域皮质成熟分级以及不同脑区的体积。新生儿结局采用新生儿行为评估量表在出生后 4±2 周进行评估。
INSVM 胎儿的脑沟裂较浅且发育不全，包括大脑外侧裂（平均深度：对照组 16.8±1.9mm，INSVM 组 16.0±1.6mm；P=.01），皮质整体成熟评分降低（平均评分：对照组 42.9±10.2mm，INSVM 组 37.8±9.9mm；P=.01）。孤立性非重度脑室扩张的胎儿全脑灰质体积平均增加（对照组 276.8±46.0×10mm，INSVM 组 277.5±49.3×10mm；P=.01），但额叶皮质体积减少（左侧：对照组 53.2±8.8×10mm，INSVM 组 52.4±5.4×10mm；P<.01）。脑沟裂深度和脑容量与新生儿行为评估量表的严重程度显著相关（P=.005，Nagelkerke R=0.732）。
INSVM 胎儿的皮质发育存在差异，包括远离侧脑室的区域，这些差异与新生儿神经行为相关。这些结果表明，这些参数可能可用于识别神经发育改变风险较高的病例。
