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Fetal MRI Round Table

Fetal MRI Round Table. Fetal brain injury Andrea Righini Radiology and Neuroradiology dept., Children’s Hospital V. Buzzi, Milan, Italy. NO fetal MRI NEEDED. T2 T1. clastic lesions. Brain clastic changes: peaks of excellence of fetal MRI. parenchymal water

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Fetal MRI Round Table

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  1. Fetal MRI Round Table Fetal brain injury Andrea Righini Radiology and Neuroradiology dept., Children’s Hospital V. Buzzi, Milan, Italy.

  2. NO fetal MRI NEEDED T2 T1 clastic lesions

  3. Brain clastic changes: peaks of excellence of fetal MRI parenchymal water increase (edema) smaller brainstem cerebellar clastic lesions clastic caused cortical malformations acute hypoxia-ischemia inflammation Fetal MRI Neuro-sonography

  4. Increased sensitivity acute ischemia Ann Neurol 2002. Baldoli C, Righini A, Parazzini C, Scotti G, Triulzi F. 32w female with vein of Galen malformation T2 DWI ADC

  5. Increased sensitivity acute ischemia monochorionic TWIN pregnancy condition 1 condition 2

  6. Increased sensitivity acute ischemia Righini A et al.. Ultrasound Obstet Gynecol. 2007 44 - 4 hours after co-twin death 14 days follow-up ADC = 0.40 T2w ss-FSE ADC T2w ss-FSE

  7. Increased sensitivity acute ischemia 24w twins TTTS, 7 dd laser coag. of plac. anastom, MCA veloc. increase, severe anemia donor donor recepient

  8. Increased sensitivity acute ischemia brain swelling donor ss-FSE T2 cytotoxic vs interstitial-vasogenic edema ADC = 0.48

  9. Acute ADC changes in dead twin brain: model of immature brain acute ischemia (1) 19w monochorionic-twins - TTTS - donor dead, recepient survivor (48 - 3 hours). survivor normal ADC survivor 1.80 dead DWI dead low ADC 0. 70 T2w ss-FSE ADC “research” lo lembo

  10. Acute ADC changes in dead twin brain: model of immature brain acute ischemia (2) mean normal ADC value > 80% ADC decrease ADC (mm2/msec) head compression and dehydration effect? time after death (hours)

  11. Increased sensitivity acute-subacute leukomalacya (1) 20w, bilateral 15 mm ventriculomegaly, mild macrocrania. acqueductal stenosis ? 15 mm ADC = 0.7

  12. acute-subacute leukomalacya (2) Signs of ependymal fragmentation and white matter lesion Muscle and GUT inflammatory infiltration signs

  13. Parenchymal edema detection and characterization

  14. BRAIN WATER INCREASE - GLOBAL 27 w, severe IUGR, anhydramnios, thorax hypoplasia, dead 2 days after MRI CSF spaces reduction gv sss ss-FSE-T2 ADC ADC increased = 2.3 mm2/msec FSE-T1 interstitial white matter edema, venous congestion?

  15. BRAIN WATER INCREASE - GLOBAL 31w fetus, heart failure, severe hydrops. interstitial white matter edema, venous congestion? deep medullay veins ss-FSE T2w Doneda C., Righini A et al.. AJNR in press

  16. BRAIN WATER INCREASE - FOCAL newborn II trim. CMV 20 SG 27 SG isolated WM edema and rarefaction Doneda C., Parazzini C. Righini A. et Al.. Radiology. 2010.

  17. Increased specificity in (clastic nature) ventriculomegaly cases possible prognosis and counselling implications

  18. increased specificity borderline ventriculomegaly: clastic aetiology? IVH-I and II 33w, unilateral ventriculomegaly 12 mm neonatal MRI “PROGNOSIS PROBABLY GOOD”

  19. increased specificity borderline ventriculomegaly: clastic aetiology? 33w, unilateral ventriculomegaly SPECTROSCOPY: creatine increase, sign of glyosis Girard N., et Al..Eur J Radiol. 2006 normal control creatine “PROGNOSIS PROBABLY NOT SO GOOD”

  20. Clastic caused cortical malformations (early detection)

  21. increased sensitivity and specificity Focal cortical rim anomalies: clastic aetiology? 23w, early gestation vaginal bleedings, borderline ventriculomegaly Pathology confirmed: CLASTIC AETIOLOGY “saw-tooth” necrosis large csf T2 pathology T1

  22. Smaller brainstem-cerebellar clastic lesions

  23. increased sensitivity brainstem clastic lesion 26w., bilateral ventriculomegaly, brain hyperecogeneity, absent limbs movements (intrauterine tetraplegia?). sinechiae nasim

  24. Unsolved issues • Statistics on MRI sensitivity and specificity are • substantially lacking. • - Prognosis of minor (isolated) findings: i.e. temporal lobe • T2-hyperintensity in CMV cases, small periventricular • hemorrhagic and necrotic lesions, …..etc. • Detection of lesions due to neurometabolicdiseases: • only very few single case reports.

  25. THANKS Cecilia Parazzini Chiara Doneda Filippo Arrigoni Andreana Ardemagni Mariangela Rustico Fabio Triulzi

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