From the Department of Development and Regeneration (D.E., L.V.d.V., L.D.C., F.R., J.D.), Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.
Department Obstetrics and Gynaecology (D.E., L.F.), Faculty of Medicine, Tanta University, Tanta, Egypt.
AJNR Am J Neuroradiol. 2023 Feb;44(2):205-211. doi: 10.3174/ajnr.A7760. Epub 2023 Jan 19.
Congenital diaphragmatic hernia is associated with high mortality and morbidity, including evidence suggesting neurodevelopmental comorbidities after birth. The aim of this study was to document longitudinal changes in brain biometry and the cortical folding pattern in fetuses with congenital diaphragmatic hernia compared with healthy fetuses.
This is a retrospective cohort study including fetuses with isolated congenital diaphragmatic hernia between January 2007 and May 2019, with at least 2 MR imaging examinations. For controls, we used images from fetuses who underwent MR imaging for an unrelated condition that did not compromise fetal brain development and fetuses from healthy pregnant women. Biometric measurements and 3D segmentations of brain structures were used as well as qualitative and quantitative grading of the supratentorial brain. Brain development was correlated with disease-severity markers.
Forty-two fetuses were included, with a mean gestational age at first MR imaging of 28.0 (SD, 2.1) weeks and 33.2 (SD, 1.3) weeks at the second imaging. The mean gestational age in controls was 30.7 (SD, 4.2) weeks. At 28 weeks, fetuses with congenital diaphragmatic hernia had abnormal qualitative and quantitative maturation, more extra-axial fluid, and larger total skull volume. By 33 weeks, qualitative grading scores were still abnormal, but quantitative scoring was in the normal range. In contrast, the extra-axial fluid volume remained abnormal with increased ventricular volume. Normal brain parenchymal volumes were found.
Brain development in fetuses with congenital diaphragmatic hernia around 28 weeks appears to be delayed. This feature is less prominent at 33 weeks. At this stage, there was also an increase in ventricular and extra-axial space volume.
先天性膈疝与高死亡率和发病率相关，包括出生后存在神经发育合并症的证据。本研究旨在记录与健康胎儿相比，先天性膈疝胎儿的脑生物测量和皮质折叠模式的纵向变化。
这是一项回顾性队列研究，纳入了 2007 年 1 月至 2019 年 5 月期间患有单纯性先天性膈疝的胎儿，这些胎儿至少进行了 2 次磁共振成像（MR）检查。对照组则使用因与胎儿脑发育无关的疾病而接受 MR 检查但未影响胎儿脑发育的胎儿以及健康孕妇的胎儿的图像。我们使用了脑结构的生物测量和 3D 分割以及大脑幕上结构的定性和定量分级来评估脑发育。脑发育与疾病严重程度标志物相关。
共纳入 42 例胎儿，首次 MR 成像的平均胎龄为 28.0（标准差，2.1）周，第二次成像的平均胎龄为 33.2（标准差，1.3）周。对照组的平均胎龄为 30.7（标准差，4.2）周。在 28 周时，先天性膈疝胎儿的定性和定量成熟均异常，有更多的脑外间隙液，总颅骨体积更大。到 33 周时，定性分级评分仍异常，但定量评分在正常范围内。相反，脑外间隙液体积仍异常，伴脑室体积增加。发现正常的脑实质体积。
先天性膈疝胎儿约 28 周时的脑发育似乎延迟。在 33 周时，这种特征不太明显。在这个阶段，脑室和脑外间隙的体积也增加了。
