Mufti, N;
Chappell, J;
Aertsen, M;
Ebner, M;
Fidon, L;
Deprest, J;
David, AL;
... GIFT-Surg Imaging Working Group, .; + view all
(2023)
Assessment of longitudinal brain development using super-resolution magnetic resonance imaging following fetal surgery for open spina bifida.
Ultrasound in Obstetrics & Gynecology
, 62
pp. 707-720.
10.1002/uog.26244.
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Mufti_Ultrasound in Obstet Gyne - 2023 - Mufti - Assessment of longitudinal brain development using super‐resolution magnetic.pdf Download (2MB) | Preview |
Abstract
OBJECTIVES: Fetal surgery is offered in selected fetuses with open spina bifida (OSB) to improve long-term outcome. Using advanced Magnetic Resonance Imaging (MRI) quantification of volume, surface area, shape of cerebral structures, and surface curvature analysis using parameters that correspond to gyrification, we studied the effect of fetal surgery on brain development. METHODS: We compared MRI images of 29 OSB fetuses before fetal surgery (<24 weeks), one- and six-weeks post-surgery, to 36 age-matched normal controls (21+2-36+2 weeks). Automated super-resolution reconstruction provided 3D isotropic volumetric brain images. Unmyelinated white matter, cerebellum and ventricles were automatically segmented and manually refined; cerebral volume, surface area, and shape parameter (volume/surface area) were quantified. Mathematical markers (shape index (SI) and curvedness) were used to measure gyrification. Parameters were assessed according to lesion type (e.g., myeloschisis (MS)), persistent postoperative hindbrain herniation (HH), and presence of supratentorial anomalies namely partial agenesis of the corpus callosum (pACC), and heterotopia (HT). RESULTS: OSB ventricular volume growth (mm3 /week) and shape parameter (mm/week) were higher six weeks post-surgery compared to controls; (2500.94, IQR: 1665.51-3604.1 mm3 /week vs 708.21, IQR: 435.06-965.77 mm3 /week, p<0.001), and (0.075, IQR: 0.047-0.112 mm/week vs 0.022, IQR: 0.009-0.042 mm/week, p=0.046). Ventricular volume growth increased six weeks post-surgery in cases with pACC (p<0.001) and persistent HH (p=0.002). During that time period, OSB unmyelinated white matter shape parameter change (mm/week) decreased compared to controls (0.056, IQR: 0.044-0.092 mm/week vs 0.159, IQR: 0.1-0.247 mm/week, p=0.002) particularly in cases of persistent HH (p=0.011), MS (p=0.015), HT (p=0.022), HT with CC anomalies (p=0.017), and persistent HH with CC anomalies (p=0.007). Six weeks postoperatively despite a remarkable reduction in curvedness/week (mm-1 ) (0.061, IQR: 0.040-0.093 mm-1 /week vs 0.094, IQR: 0.072-0.145 mm-1 /week, p<0.001) compared to the initial increase one week after (0.144, IQR: 0.101-0.233 mm-1 /week vs 0.072, IQR: 0.059-0.08 mm-1 /week, p<0.001), gyrification using SI appeared increased overall compared to controls. This observation was more prominent in fetuses with pACC, and severe ventriculomegaly (p-value range=0.006 to<0.001). CONCLUSIONS: Following fetal OSB repair, volume, shape and curvedness in ventricles and unmyelinated white matter were significantly different from normal fetuses. Morphological brain changes after fetal surgery were not limited to effects on CSF circulation. These observations may have neurocognitive implications for postnatal outcomes. This article is protected by copyright. All rights reserved.
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