Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly

Abstract

Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns.

Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age.

Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10–15 mm that was further divided as mild (10.1–12.0 mm) and moderate (12.1–15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period.

Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases.

Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Resumo

Introdução Ventriculomegalia (VM) é uma das anomalias mais frequente no ultrassom pre-natal. Ressonâncias magnéticas (RM) melhoram a precisão do diagnóstico e previsão do desenvolvimento em recém-nascidos.

Objetivo A proposta deste estudo foi avaliar a correlação entre ultrassom e RM em fetos com leve e moderada VM isolada. O objetivo secundário foi reportar o resultado neurológico na idade de 4 anos.

Métodos Fetos com diagnóstico pré-natal pelo ultrassom de VM foram identificados na idade de 4 anos. Ventriculomegalia foi definida como medida do átrio do ventrículo lateral entre 10–15 mm, a qual foi subdividida em leve (10,1–12,0 mm) e moderada (12,1–15,0 mm). Fetos com VM foram seguidos nos períodos pré-natal e pós-natal por ultrassom e RM. O resultado neurológico foi realizado usando a escala de desenvolvimento mental de Griffiths, quando indicada, até a idade de 4 anos.

Resultados Sessenta e dois fetos foram identificados. Ventriculomegalia bilateral ocorreu sem 58% dos casos. Uma dilatação estável foi observada em 45%, progressiva em 13% e regressiva em 4,5% dos casos, respectivamente. Ressonância magnética fetal foi realizada em 54 fetos, e foi concordante com os achados do ultrassom em 85% dos casos. Desenvolvimento neurológico anormal foi observado em 9,6% dos casos.

Conclusão Fetos nos quais ocorreu progressão da VM são de alto risco para desenvolvimento neurológico anormal. Apesar do ultrassom e da RM mostrarem substancial concordância na definição do grau de dilatação ventricular, uma baixa correlação foi vista na avaliação da VM associada ou não com anomalias do sistema nervoso central.

Keywords

fetus - ventriculomegaly - ultrasound - magnetic resonance imaging - neurodevelopmental outcome

Palavras-chave

feto - ventriculomegalia - ultrassom - ressonância magnética - desenvolvimento neurológico

Note

Study performed in the Prenatal Diagnostic Unit, Department of Obstetrics & Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Italy.

• References

• 1 Parazzini C, Righini A, Doneda C , et al. Is fetal magnetic resonance imaging indicated when ultrasound isolated mild ventriculomegaly is present in pregnancies with no risk factors?. Prenat Diagn 2012; 32 (8) 752-757
• 2 Pilu G, Hobbins JC. Sonography of fetal cerebrospinal anomalies. Prenat Diagn 2002; 22 (4) 321-330
• 3 Vergani P, Locatelli A, Strobelt N , et al. Clinical outcome of mild fetal ventriculomegaly. Am J Obstet Gynecol 1998; 178 (2) 218-222
• 4 Ouahba J, Luton D, Vuillard E , et al. Prenatal isolated mild ventriculomegaly: outcome in 167 cases. BJOG 2006; 113 (9) 1072-1079
• 5 Levene MI, Chervenak FA, Whittle M. Fetal and neonatal neurology and neurosurgery. 3rd ed. London: Churchill Livingstone; 2001
• 6 Signorelli M, Tiberti A, Valseriati D , et al. Width of the fetal lateral ventricular atrium between 10 and 12 mm: a simple variation of the norm?. Ultrasound Obstet Gynecol 2004; 23 (1) 14-18
• 7 Cardoza JD, Goldstein RB, Filly RA. Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium. Radiology 1988; 169 (3) 711-714
• 8 Kinzler WL, Smulian JC, McLean DA, Guzman ER, Vintzileos AM. Outcome of prenatally diagnosed mild unilateral cerebral ventriculomegaly. J Ultrasound Med 2001; 20 (3) 257-262
• 9 Nejat F, Kazmi SS, Ardakani SB. Congenital brain tumors in a series of seven patients. Pediatr Neurosurg 2008; 44 (1) 1-8
• 10 D'Addario V, Pinto V, Di Cagno L, Pintucci A. Sonographic diagnosis of fetal cerebral ventriculomegaly: an update. J Matern Fetal Neonatal Med 2007; 20 (1) 7-14
• 11 Whitelaw A. Neonatal hydrocephalus - clinical assessment and non surgical treatment. In: Levene MI, Chervenak FA, Whittle M, editors. Fetal and neonatal neurology and surgery. 3rd ed. London: Churchill Livingstone; 2001. . p. 739–61.
• 12 Sherer DM, Onyeije CI. Prenatal ultrasonographic diagnosis of fetal intracranial tumors: a review. Am J Perinatol 1998; 15 (5) 319-328
• 13 Fong KW, Ghai S, Toi A, Blaser S, Winsor EJ, Chitayat D. Prenatal ultrasound findings of lissencephaly associated with Miller-Dieker syndrome and comparison with pre- and postnatal magnetic resonance imaging. Ultrasound Obstet Gynecol 2004; 24 (7) 716-723
• 14 Malinger G, Kidron D, Schreiber L , et al. Prenatal diagnosis of malformations of cortical development by dedicated neurosonography. Ultrasound Obstet Gynecol 2007; 29 (2) 178-191
• 15 Pilu G, Falco P, Gabrielli S, Perolo A, Sandri F, Bovicelli L. The clinical significance of fetal isolated cerebral borderline ventriculomegaly: report of 31 cases and review of the literature. Ultrasound Obstet Gynecol 1999; 14 (5) 320-326
• 16 Gaglioti P, Danelon D, Bontempo S, Mombrò M, Cardaropoli S, Todros T. Fetal cerebral ventriculomegaly: outcome in 176 cases. Ultrasound Obstet Gynecol 2005; 25 (4) 372-377
• 17 Graham E, Duhl A, Ural S, Allen M, Blakemore K, Witter F. The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity. J Matern Fetal Med 2001; 10 (4) 258-263
• 18 Pastorino D, Prefumo F, Rossi A , et al. Apparently isolated borderline ventriculomegaly and lissencephaly. Prenat Diagn 2007; 27 (5) 483-484
• 19 Nicolaides KH, Berry S, Snijders RJ, Thorpe-Beeston JG, Gosden C. Fetal lateral cerebral ventriculomegaly: associated malformations and chromosomal defects. Fetal Diagn Ther 1990; 5 (1) 5-14
• 20 Mercier A, Eurin D, Mercier PY, Verspyck E, Marpeau L, Marret S. Isolated mild fetal cerebral ventriculomegaly: a retrospective analysis of 26 cases. Prenat Diagn 2001; 21 (7) 589-595
• 21 Morris JE, Rickard S, Paley MN, Griffiths PD, Rigby A, Whitby EH. The value of in-utero magnetic resonance imaging in ultrasound diagnosed foetal isolated cerebral ventriculomegaly. Clin Radiol 2007; 62 (2) 140-144
• 22 Breeze AC, Alexander PM, Murdoch EM, Missfelder-Lobos HH, Hackett GA, Lees CC. Obstetric and neonatal outcomes in severe fetal ventriculomegaly. Prenat Diagn 2007; 27 (2) 124-129
• 23 Lam SJ, Kumar S. Evolution of fetal ventricular dilatation in relation to severity at first presentation. J Clin Ultrasound 2014; 42 (4) 193-198
• 24 Gaglioti P, Oberto M, Todros T. The significance of fetal ventriculomegaly: etiology, short- and long-term outcomes. Prenat Diagn 2009; 29 (4) 381-388
• 25 Valsky DV, Ben-Sira L, Porat S , et al. The role of magnetic resonance imaging in the evaluation of isolated mild ventriculomegaly. J Ultrasound Med 2004; 23 (4) 519-523 , quiz 525–526
• 26 Benacerraf BR, Shipp TD, Bromley B, Levine D. What does magnetic resonance imaging add to the prenatal sonographic diagnosis of ventriculomegaly?. J Ultrasound Med 2007; 26 (11) 1513-1522
• 27 Levine D, Barnes PD, Robertson RR, Wong G, Mehta TS. Fast MR imaging of fetal central nervous system abnormalities. Radiology 2003; 229 (1) 51-61
• 28 Salomon LJ, Ouahba J, Delezoide AL , et al. Third-trimester fetal MRI in isolated 10- to 12-mm ventriculomegaly: is it worth it?. BJOG 2006; 113 (8) 942-947
• 29 Manganaro L, Savelli S, Francioso A , et al. Role of fetal MRI in the diagnosis of cerebral ventriculomegaly assessed by ultrasonography. Radiol Med (Torino) 2009; 114 (7) 1013-1023
• 30 Parazzini C, Righini A, Doneda C, Rustico M, Lanna M, Triulzi F. Response to “Is fetal magnetic resonance imaging indicated when ultrasound isolated mild ventriculomegaly is present in pregnancies with no risk factors?”. Prenat Diagn 2014; 34 (9) 919
• 31 Garel C, Alberti C. Coronal measurement of the fetal lateral ventricles: comparison between ultrasonography and magnetic resonance imaging. Ultrasound Obstet Gynecol 2006; 27 (1) 23-27
• 32 Melchiorre K, Bhide A, Gika AD, Pilu G, Papageorghiou AT. Counseling in isolated mild fetal ventriculomegaly. Ultrasound Obstet Gynecol 2009; 34 (2) 212-224
• 33 Baffero GM, Crovetto F, Fabietti I , et al. Prenatal ultrasound predictors of postnatal major cerebral abnormalities in fetuses with apparently isolated mild ventriculomegaly. Prenat Diagn 2015; 35 (8) 783-788
• 34 Griffiths PD, Reeves MJ, Morris JE , et al. A prospective study of fetuses with isolated ventriculomegaly investigated by antenatal sonography and in utero MR imaging. AJNR Am J Neuroradiol 2010; 31 (1) 106-111
• 35 Cardoen L, De Catte L, Demaerel P , et al. The role of magnetic resonance imaging in the diagnostic work-up of fetal ventriculomegaly. Facts Views Vis Obgyn 2011; 3 (3) 159-163