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MR-based morphometry of the posterior fossa in fetuses with neural tube defects of the spine.

Woitek R, Dvorak A, Weber M, Seidl R, Bettelheim D, Schöpf V, Amann G, Brugger PC, Furtner J, Asenbaum U, Prayer D, Kasprian G - PLoS ONE (2014)

Bottom Line: Normal fetuses showed a significant increase in the TDPF (r = .956; p<.001) and CSA (r = .714; p<.001) with gestational age.In both ONTDs and in CNTDs the TDPF was significantly different from controls (p<.001).The skull base morphology in fetuses with ONTDs differs significantly from cases with CNTDs and normal controls.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

ABSTRACT

Objectives: In cases of "spina bifida," a detailed prenatal imaging assessment of the exact morphology of neural tube defects (NTD) is often limited. Due to the diverse clinical prognosis and prenatal treatment options, imaging parameters that support the prenatal differentiation between open and closed neural tube defects (ONTDs and CNTDs) are required. This fetal MR study aims to evaluate the clivus-supraocciput angle (CSA) and the maximum transverse diameter of the posterior fossa (TDPF) as morphometric parameters to aid in the reliable diagnosis of either ONTDs or CNTDs.

Methods: The TDPF and the CSA of 238 fetuses (20-37 GW, mean: 28.36 GW) with a normal central nervous system, 44 with ONTDS, and 13 with CNTDs (18-37 GW, mean: 24.3 GW) were retrospectively measured using T2-weighted 1.5 Tesla MR -sequences.

Results: Normal fetuses showed a significant increase in the TDPF (r = .956; p<.001) and CSA (r = .714; p<.001) with gestational age. In ONTDs the CSA was significantly smaller (p<.001) than in normal controls and CNTDs, whereas in CNTDs the CSA was not significantly smaller than in controls (p = .160). In both ONTDs and in CNTDs the TDPF was significantly different from controls (p<.001).

Conclusions: The skull base morphology in fetuses with ONTDs differs significantly from cases with CNTDs and normal controls. This is the first study to show that the CSA changes during gestation and that it is a reliable imaging biomarker to distinguish between ONTDs and CNTDs, independent of the morphology of the spinal defect.

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Correlations of the TDPF and CSA with gestational age.a) Correlation between the TDPF and gestational age in 238 fetuses with normal CNS development. Squares show TDPF values. The regression line is continuous (r = .956; p<.001). Dashed lines show calculated 10th and 90th percentiles. b) Correlation between the CSA and gestational age. Circles show CSA values of 238 fetuses with normal CNS development. The regression line is continuous (r = .714; p<.001). Dashed lines show 10th and 90th percentiles.
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pone-0112585-g005: Correlations of the TDPF and CSA with gestational age.a) Correlation between the TDPF and gestational age in 238 fetuses with normal CNS development. Squares show TDPF values. The regression line is continuous (r = .956; p<.001). Dashed lines show calculated 10th and 90th percentiles. b) Correlation between the CSA and gestational age. Circles show CSA values of 238 fetuses with normal CNS development. The regression line is continuous (r = .714; p<.001). Dashed lines show 10th and 90th percentiles.

Mentions: When we began evaluating fetuses with NTDs (17–37 GW, mean: 24.3 GW), we observed a significant correlation between gestational age and the TDPF (r = .943, p<.000) (Figure 4a), and a lower and insignificant correlation between the CSA and gestational age (r = .103, p = .452) (Figure 4b). As the finding concerning the CSA was in contrast to previously published results [10], we subsequently evaluated 238 fetuses with normal CNS development to obtain their CSA and TDPF (20–37 GW, mean: 28.36 GW) to confirm whether there was an increase in the CSA during gestation. These 238 fetuses were homogeneously distributed with regard to their gestational age, with 13–15 fetuses in each gestational week except for the 21st and 37th gestational weeks, in which there were only 10 and nine fetuses, respectively. Mean values, standard deviations, 10th and 90th percentiles for each gestational week between the 21st and 37th gestational week, and mean and standard deviations for all fetuses with a normal CNS development are shown in Table 3. In this cohort of fetuses, we found a significant and very high correlation between gestational age and the TDPF (r = .956; p<.001) (Figure 5a), and a significant correlation between gestational age and the CSA (r = .714; p<.001) (Figure 5b).


MR-based morphometry of the posterior fossa in fetuses with neural tube defects of the spine.

Woitek R, Dvorak A, Weber M, Seidl R, Bettelheim D, Schöpf V, Amann G, Brugger PC, Furtner J, Asenbaum U, Prayer D, Kasprian G - PLoS ONE (2014)

Correlations of the TDPF and CSA with gestational age.a) Correlation between the TDPF and gestational age in 238 fetuses with normal CNS development. Squares show TDPF values. The regression line is continuous (r = .956; p<.001). Dashed lines show calculated 10th and 90th percentiles. b) Correlation between the CSA and gestational age. Circles show CSA values of 238 fetuses with normal CNS development. The regression line is continuous (r = .714; p<.001). Dashed lines show 10th and 90th percentiles.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231033&req=5

pone-0112585-g005: Correlations of the TDPF and CSA with gestational age.a) Correlation between the TDPF and gestational age in 238 fetuses with normal CNS development. Squares show TDPF values. The regression line is continuous (r = .956; p<.001). Dashed lines show calculated 10th and 90th percentiles. b) Correlation between the CSA and gestational age. Circles show CSA values of 238 fetuses with normal CNS development. The regression line is continuous (r = .714; p<.001). Dashed lines show 10th and 90th percentiles.
Mentions: When we began evaluating fetuses with NTDs (17–37 GW, mean: 24.3 GW), we observed a significant correlation between gestational age and the TDPF (r = .943, p<.000) (Figure 4a), and a lower and insignificant correlation between the CSA and gestational age (r = .103, p = .452) (Figure 4b). As the finding concerning the CSA was in contrast to previously published results [10], we subsequently evaluated 238 fetuses with normal CNS development to obtain their CSA and TDPF (20–37 GW, mean: 28.36 GW) to confirm whether there was an increase in the CSA during gestation. These 238 fetuses were homogeneously distributed with regard to their gestational age, with 13–15 fetuses in each gestational week except for the 21st and 37th gestational weeks, in which there were only 10 and nine fetuses, respectively. Mean values, standard deviations, 10th and 90th percentiles for each gestational week between the 21st and 37th gestational week, and mean and standard deviations for all fetuses with a normal CNS development are shown in Table 3. In this cohort of fetuses, we found a significant and very high correlation between gestational age and the TDPF (r = .956; p<.001) (Figure 5a), and a significant correlation between gestational age and the CSA (r = .714; p<.001) (Figure 5b).

Bottom Line: Normal fetuses showed a significant increase in the TDPF (r = .956; p<.001) and CSA (r = .714; p<.001) with gestational age.In both ONTDs and in CNTDs the TDPF was significantly different from controls (p<.001).The skull base morphology in fetuses with ONTDs differs significantly from cases with CNTDs and normal controls.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

ABSTRACT

Objectives: In cases of "spina bifida," a detailed prenatal imaging assessment of the exact morphology of neural tube defects (NTD) is often limited. Due to the diverse clinical prognosis and prenatal treatment options, imaging parameters that support the prenatal differentiation between open and closed neural tube defects (ONTDs and CNTDs) are required. This fetal MR study aims to evaluate the clivus-supraocciput angle (CSA) and the maximum transverse diameter of the posterior fossa (TDPF) as morphometric parameters to aid in the reliable diagnosis of either ONTDs or CNTDs.

Methods: The TDPF and the CSA of 238 fetuses (20-37 GW, mean: 28.36 GW) with a normal central nervous system, 44 with ONTDS, and 13 with CNTDs (18-37 GW, mean: 24.3 GW) were retrospectively measured using T2-weighted 1.5 Tesla MR -sequences.

Results: Normal fetuses showed a significant increase in the TDPF (r = .956; p<.001) and CSA (r = .714; p<.001) with gestational age. In ONTDs the CSA was significantly smaller (p<.001) than in normal controls and CNTDs, whereas in CNTDs the CSA was not significantly smaller than in controls (p = .160). In both ONTDs and in CNTDs the TDPF was significantly different from controls (p<.001).

Conclusions: The skull base morphology in fetuses with ONTDs differs significantly from cases with CNTDs and normal controls. This is the first study to show that the CSA changes during gestation and that it is a reliable imaging biomarker to distinguish between ONTDs and CNTDs, independent of the morphology of the spinal defect.

Show MeSH
Related in: MedlinePlus