Meijerink Lotte, van Ooijen Inge, Terstappen Fieke, Alderliesten Thomas, Nievelstein Rutger A J, Lammertink Femke, Benders Manon, Bekker Mireille
Department of Obstetrics, Division Woman & Baby, University Medical Center Utrecht, Utrecht, Utrecht University, the Netherlands.
Department of Neonatology, Division Woman & Baby, University Medical Center Utrecht, Utrecht, Utrecht University, the Netherlands.
Eur J Obstet Gynecol Reprod Biol X. 2025 Jul 3;27:100417. doi: 10.1016/j.eurox.2025.100417. eCollection 2025 Sep.
To identify volumetric and diffusion-related brain differences expressed as apparent diffusion coefficient (ADC) values between early-onset brain-sparing fetal growth restriction (FGR) and healthy controls using magnetic resonance imaging (MRI) at 30 weeks of gestation.
This prospective, observational, monocenter cohort study included singleton pregnancies with early-onset brain-sparing FGR at the University Medical Center Utrecht. FGR fetuses were compared to healthy controls from the Utrecht YOUth Cohort. Fetal MRI of the brain was performed including T2-weighted and diffusion weighted imaging (DWI) sequences. We measured 2D biometrics, 3D volumetrics using BOUNTI, and ADC values in multiple brain and placental regions. Values were corrected to 30 weeks of gestation.
The study included 26 FGR fetuses at gestational age (GA) 26.3-32 weeks and 71 controls at GA 30.1-34 weeks. At 30 weeks, total brain volume (TBV) was significantly smaller in FGR (144.2 ± 11.5 vs 166.9 ± 17.5 milliliters, p < 0.001). After dividing all absolute volumes by TBV, only cerebellar volume remained significantly reduced (0.045 [0.00] vs 0.048 [0.01], p = 0.006). ADC values were lower in all brain regions except the cerebellum. Placental ADC values were also significantly lower in FGR.
Altered brain development in brain-sparing FGR is already present at 30 weeks of gestation. Lower brain volumes and ADC values may reflect the effects of altered perfusion, chronic hypoxia and microstructural changes in the brains of FGR fetuses. Future studies linking these MRI findings to long-term neurodevelopmental outcomes will aid in more personalized prognoses and might also inform the timing of delivery, ultimately enhancing clinical decision-making.
利用妊娠30周时的磁共振成像（MRI），确定早发型脑保护型胎儿生长受限（FGR）与健康对照之间以表观扩散系数（ADC）值表示的脑容量和扩散相关差异。
这项前瞻性、观察性、单中心队列研究纳入了乌得勒支大学医学中心的单胎妊娠早发型脑保护型FGR病例。将FGR胎儿与乌得勒支青年队列中的健康对照进行比较。对胎儿脑部进行MRI检查，包括T2加权和扩散加权成像（DWI）序列。我们测量了多个脑区和胎盘区域的二维生物特征、使用BOUNTI进行的三维容积测量以及ADC值。将这些值校正至妊娠30周。
该研究纳入了26例孕龄（GA）为26.3 - 32周的FGR胎儿和71例GA为30.1 - 34周的对照。在30周时，FGR胎儿的全脑体积（TBV）显著较小（144.2±11.5 vs 166.9±17.5毫升，p<0.001）。将所有绝对体积除以TBV后，只有小脑体积仍显著减小（0.045[0.00] vs 0.048[0.01]，p = 0.006）。除小脑外，所有脑区的ADC值均较低。FGR胎儿的胎盘ADC值也显著较低。
脑保护型FGR的脑发育改变在妊娠30周时就已存在。较低的脑容量和ADC值可能反映了FGR胎儿大脑灌注改变、慢性缺氧和微观结构变化的影响。未来将这些MRI结果与长期神经发育结局联系起来的研究，将有助于更个性化的预后评估，也可能为分娩时机提供参考，最终改善临床决策。
