From the Departments of Radiology (C.J., A.G., J.E., S.K.W., E.Y.), Cardiology (V.R., C.S., K.G.F., W.T., J.W.N., D.W.), Neurology (C.K.R.), Fetal-Neonatal Neuroimaging and Developmental Science Center (C.J.), Boston Children's Hospital, Boston, Massachusetts.
Radiology (C.J., A.G., J.E., S.K.W., E.Y.), Pediatrics (K.G.F., W.T., J.W.N., D.W.), Neurology (C.K.R.), Harvard Medical School, Boston, Massachusetts.
AJNR Am J Neuroradiol. 2020 Aug;41(8):1525-1531. doi: 10.3174/ajnr.A6635. Epub 2020 Jul 9.
Brain MRI of newborns with congenital heart disease show signs of immaturity relative to healthy controls. Our aim was to determine whether the semiquantitative fetal total maturation score can detect abnormalities in brain maturation in fetuses with congenital heart disease in the second and third trimesters.
We analyzed data from a prospective study of fetuses with and without congenital heart disease who underwent fetal MR imaging at 25-35 weeks' gestation. Two independent neuroradiologists blinded to the clinical data reviewed and scored all images using the fetal total maturation score. Interrater reliability was evaluated by the intraclass correlation coefficient using the individual reader scores, which were also used to calculate an average score for each subject. Comparisons of the average and individual reader scores between affected and control fetuses and relationships with clinical variables were evaluated using multivariable linear regression.
Data from 69 subjects (48 cardiac, 21 controls) were included. High concordance was observed between readers with an intraclass correlation coefficient of 0.98 (95% CI, 0.97-0.99). The affected group had significantly lower fetal total maturation scores than the control group (-estimate, -0.9 [95% CI, -1.5 to -0.4], = .002), adjusting for gestational age and sex. Averaged fetal total maturation, germinal matrix, myelination, and superior temporal sulcus scores were significantly delayed in fetuses with congenital heart disease versus controls ( < .05 for each). The fetal total maturation score was not significantly associated with any cardiac, anatomic, or physiologic variables.
The fetal total maturation score is sensitive to differences in brain maturation between fetuses with isolated congenital heart disease and healthy controls.
患有先天性心脏病的新生儿的脑部 MRI 显示相对于健康对照存在不成熟迹象。我们的目的是确定在第二和第三个三个月，半定量胎儿总成熟评分是否可以检测出先天性心脏病胎儿脑成熟度的异常。
我们分析了一项前瞻性研究的数据，该研究纳入了在 25-35 周胎龄接受胎儿磁共振成像检查的伴有或不伴有先天性心脏病的胎儿。两位独立的神经放射科医生在不了解临床数据的情况下对所有图像进行了回顾和评分，并使用胎儿总成熟评分进行评分。使用个体读者评分评估组内相关系数的观察者间可靠性，还使用每个受试者的平均评分来计算评分。使用多元线性回归评估受影响和对照组胎儿的平均和个体读者评分之间的差异以及与临床变量的关系。
纳入 69 名受试者（48 名心脏，21 名对照组）的数据。读者之间具有高度一致性，组内相关系数为 0.98（95%CI，0.97-0.99）。与对照组相比，受影响组的胎儿总成熟评分明显降低（估计值为-0.9[95%CI，-1.5 至-0.4]， =.002），调整了胎龄和性别。与对照组相比，先天性心脏病胎儿的总成熟、神经生发基质、髓鞘形成和颞上沟评分明显延迟（每项 均<.05）。胎儿总成熟评分与任何心脏、解剖或生理变量均无显著相关性。
胎儿总成熟评分对孤立性先天性心脏病胎儿与健康对照组之间的脑成熟差异敏感。
