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Longitudinal evaluation of brain development in fetuses with congenital diaphragmatic hernia on MRI: an original research study
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  • Doaa Emam,
  • Michael Aertsen,
  • Lennart Van der Veeken,
  • Lucas Fidon,
  • Prachi Patkee,
  • Vanessa Kyriakopoulou,
  • Luc De Catte,
  • Francesca Russo,
  • Philippe Demaerel,
  • Tom Vercauteren,
  • Mary Rutherford,
  • Jan Deprest
Doaa Emam
Tanta University Faculty of Medicine

Corresponding Author:doaaemam188@gmail.com

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Michael Aertsen
Universitaire Ziekenhuizen Leuven
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Lennart Van der Veeken
KU Leuven
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Lucas Fidon
King's College London
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Prachi Patkee
King's College London
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Vanessa Kyriakopoulou
King's College London
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Luc De Catte
KU Leuven Biomedical Sciences Group
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Francesca Russo
KU Leuven University Hospitals Leuven
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Philippe Demaerel
KU Leuven University Hospitals Leuven
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Tom Vercauteren
King's College London
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Mary Rutherford
King's College London
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Jan Deprest
Center for Surgical Technologies
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Abstract

Objective To document longitudinal changes in brain development in fetuses with congenital diaphragmatic hernia (CDH). Design Retrospective cohort study Setting Single tertiary fetal surgery center Population Fetuses with isolated CDH and at least two MRI-examinations (n=42 fetuses). Fifty-six fetuses who underwent MRI for a condition not interfering with fetal brain development or fetuses from healthy volunteers served as controls. Methods Biometry included biparietal and fronto-occipital diameter, ventricular atrial width, transcerebellar diameter, head circumference and width of the extra-axial space. Cortical maturation was assessed using a qualitative and quantitative grading system. 3D volumes were segmented for white matter, intra-axial and extra-axial cerebrospinal fluid and cerebellum. Main outcome measures Brain development on MRI with subjective and objective assessment. Results The mean GA at first MRI was 28.0 ± 2.1 wks and at the second 33.2 ± 1.3 wks. The mean GA in controls was 30.7 ± 4.2 wks. At 28 weeks CDH fetuses displayed abnormal maturation grading (p<0.003) and fissure depth (p<0.05). By 33 wks, the brain grading indices were still abnormal (p<0.01), but fissure depth measurements were in the normal range (p>0.05). Also, the extra-axial fluid and the ventricular volume were increased (resp. p 0.0054 and p 0.0243). There was no difference in white matter or cerebellum volume (p>0.05). Conclusions Brain development in CDH fetuses around 28 weeks appears to be delayed. This is less prominent at 33 weeks. In addition, there was an increase in ventricular and extra-axial space volume in the third trimester.