Jaimes Camilo, Ferraciolli Suely Fazio, Orbach Darren B
From the Departments of Radiology (C.J., S.F.F.), Massachusetts General Hospital, Boston, Massachusetts.
Pediatric Imaging Research Center (C.J., S.F.F.), MA General Hospital, Boston, Massachusetts.
AJNR Am J Neuroradiol. 2025 Feb 3;46(2):231-239. doi: 10.3174/ajnr.A8377.
Four distinct vascular anomalies can be seen to affect the brain on fetal imaging: vein of Galen malformations, nongalenic arteriovenous pial fistulas, dural sinus malformations, and intracranial venous malformations. These congenital disorders affect the arteries and veins of the developing brain and are rarely seen beyond the neonatal stage. The 4 fetal cerebrovascular anomalies are associated with quite disparate natural histories and prognoses. MRI plays a pivotal role in the evaluation of fetuses with these conditions because of its ability to definitively establish the diagnosis, to detect subtle parenchymal injuries, to delineate the course of abnormal vessels in detail and to some extent the nature of vascular flow, and to identify ischemic, thrombotic, and hemorrhagic complications. Recently, an investigational transuterine embolization procedure targeted at treating fetuses with vein of Galen malformations who are at high risk for neonatal decompensation has emerged as a promising alternative to expectant management and postnatal embolization, with imaging being used to identify suitable patients for the intervention and in preprocedural planning. This manuscript reviews the essential imaging and clinical features of these 4 fetal neurovascular anomalies and underscores the practical aspects related to counseling, prognosis, and the multidisciplinary management of these entities.
大脑大静脉畸形、非大脑大静脉性软膜动静脉瘘、硬脑膜窦畸形和颅内静脉畸形。这些先天性疾病会影响发育中大脑的动脉和静脉，在新生儿期之后很少见。这四种胎儿脑血管异常具有截然不同的自然病程和预后。由于MRI能够明确诊断、检测细微的实质损伤、详细描绘异常血管的走行以及在一定程度上确定血流性质，并能识别缺血、血栓形成和出血性并发症，因此在评估患有这些疾病的胎儿时发挥着关键作用。最近，一种针对患有大脑大静脉畸形且有新生儿失代偿高风险胎儿的经子宫栓塞研究性手术，已成为一种有前景的替代方案，可替代期待治疗和出生后栓塞，影像学用于识别适合干预的患者并进行术前规划。本文综述了这四种胎儿神经血管异常的基本影像学和临床特征，并强调了与咨询、预后以及这些疾病的多学科管理相关的实际问题。
