Rupa Radhakrishnan1, Stephanie L Merhar2, Patricia Burns3, Bin Zhang4, Foong-Yen Lim3, Beth M Kline-Fath5. 1. Department of Radiology, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA. rupa.rad@gmail.com. 2. Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 3. Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 4. Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 5. Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Abstract
BACKGROUND: Many infants with congenital diaphragmatic hernia (CDH) show brain abnormality on postnatal brain MRI related to severity of CDH, degree of lung hypoplasia, intrathoracic liver, right diaphragmatic hernia and large diaphragmatic defect. It is not known whether these factors affect brain growth in utero in CDH. OBJECTIVE: To assess prenatal brain morphometry and abnormalities on fetal MR in congenital diaphragmatic hernia. MATERIALS AND METHODS: We retrospectively reviewed 109 fetal MRIs in 63 fetuses with CDH from 2009 to 2014 (27 died before discharge, 36 survived to discharge). We compared brain injury and gestational-age-corrected z-scores of brain measurements between survivors and non-survivors. We assessed correlations between brain abnormalities and CDH severity. RESULTS: Enlarged extraaxial space was the most common abnormality, frequently seen on fetal MRI at >28 weeks of gestation, similar in survivors versus non-survivors. Anteroposterior cerebellar vermis dimension at >28 weeks of gestation was smaller in non-survivors compared to survivors (P=.02) and positively correlated with observed/expected total fetal lung volume (P=.01). Transverse cerebellar diameter at >28 weeks of gestation was also positively correlated with observed/expected total fetal lung volume (P=.04). We did not identify maturational delay, abnormal parenchymal signal or intracranial hemorrhage on fetal MRI. CONCLUSION: Enlarged extraaxial spaces in the third trimester was the most common abnormality on fetal MRI in congenital diaphragmatic hernia. Cerebellar dimensions on fetal MRI are associated with CDH severity. There was no major brain parenchymal injury on fetal MRI, even in the third trimester, in CDH survivors and non-survivors.
BACKGROUND: Many infants with congenital diaphragmatic hernia (CDH) show brain abnormality on postnatal brain MRI related to severity of CDH, degree of lung hypoplasia, intrathoracic liver, right diaphragmatic hernia and large diaphragmatic defect. It is not known whether these factors affect brain growth in utero in CDH. OBJECTIVE: To assess prenatal brain morphometry and abnormalities on fetal MR in congenital diaphragmatic hernia. MATERIALS AND METHODS: We retrospectively reviewed 109 fetal MRIs in 63 fetuses with CDH from 2009 to 2014 (27 died before discharge, 36 survived to discharge). We compared brain injury and gestational-age-corrected z-scores of brain measurements between survivors and non-survivors. We assessed correlations between brain abnormalities and CDH severity. RESULTS: Enlarged extraaxial space was the most common abnormality, frequently seen on fetal MRI at >28 weeks of gestation, similar in survivors versus non-survivors. Anteroposterior cerebellar vermis dimension at >28 weeks of gestation was smaller in non-survivors compared to survivors (P=.02) and positively correlated with observed/expected total fetal lung volume (P=.01). Transverse cerebellar diameter at >28 weeks of gestation was also positively correlated with observed/expected total fetal lung volume (P=.04). We did not identify maturational delay, abnormal parenchymal signal or intracranial hemorrhage on fetal MRI. CONCLUSION: Enlarged extraaxial spaces in the third trimester was the most common abnormality on fetal MRI in congenital diaphragmatic hernia. Cerebellar dimensions on fetal MRI are associated with CDH severity. There was no major brain parenchymal injury on fetal MRI, even in the third trimester, in CDH survivors and non-survivors.
Authors: T Van Mieghem; I Sandaite; K Michielsen; L Gucciardo; E Done; P Dekoninck; F Claus; J Deprest Journal: Ultrasound Obstet Gynecol Date: 2010-10 Impact factor: 7.299
Authors: Carol E Barnewolt; Shaun M Kunisaki; Dario O Fauza; Luanne P Nemes; Judy A Estroff; Russell W Jennings Journal: J Pediatr Surg Date: 2007-01 Impact factor: 2.545
Authors: Enrico Danzer; Deborah Zarnow; Marsha Gerdes; Jo Ann D'Agostino; Jennifer Siegle; Michael W Bebbington; Alan W Flake; N Scott Adzick; Holly L Hedrick Journal: J Pediatr Surg Date: 2012-03 Impact factor: 2.545
Authors: R Radhakrishnan; S Merhar; J Meinzen-Derr; B Haberman; F Y Lim; P Burns; E Zorn; B Kline-Fath Journal: AJNR Am J Neuroradiol Date: 2016-05-05 Impact factor: 3.825
Authors: R Radhakrishnan; S L Merhar; W Su; B Zhang; P Burns; F Y Lim; B M Kline-Fath Journal: AJNR Am J Neuroradiol Date: 2017-12-21 Impact factor: 3.825
Authors: E Danzer; M Gerdes; J A D'Agostino; C Hoffman; J Bernbaum; M W Bebbington; J Siegle; J Sulkowski; N E Rintoul; A W Flake; N Scott Adzick; H L Hedrick Journal: J Perinatol Date: 2013-05-09 Impact factor: 2.521
Authors: Rupa Radhakrishnan; Brandon P Brown; David M Haas; Yong Zang; Christina Sparks; Senthilkumar Sadhasivam Journal: J Neuroradiol Date: 2021-01-05 Impact factor: 3.447