Fetal magnetic resonance imaging: supratentorial brain malformations
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FETAL IMAGING
Fetal magnetic resonance imaging: supratentorial brain malformations Jungwhan John Choi 1,2 & Edward Yang 1,2 & Janet S. Soul 2,3 & Camilo Jaimes 1,2,4 Received: 28 November 2019 / Revised: 16 March 2020 / Accepted: 23 April 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence of events that occurs during prenatal brain development; this includes familiarity with the processes of hemispheric cleavage, formation of interhemispheric commissures, neuro-glial proliferation and migration, and cortical folding. Disruption of these processes results in malformations observed on fetal MRI including holoprosencephaly, callosal agenesis, heterotopic gray matter, lissencephaly and other malformations of cortical development (focal cortical dysplasia, polymicrogyria). The radiologist should also be familiar with findings that have high association with specific conditions affecting the central nervous system or other organ systems. This review summarizes and illustrates common patterns of supratentorial brain malformations and emphasizes aspects that are important to patient care. Keywords Brain . Cerebrum . Congenital . Fetus . Magnetic resonance imaging . Malformation . Supratentorial
Introduction Congenital abnormalities occur in approximately 1.5–3% of pregnancies [1]. Many of these are detected on routine prenatal screening US and are subsequently characterized by a detailed sonographic examination or fetal MRI [2]. Structural abnormalities detected by fetal neuroimaging in the supratentorial brain have a broad differential diagnosis that includes dysgenesis of a single structure, complex (occasiona l l y s y n d r o m i c ) m al f o r m a ti o n s , a n d d e s t r u c t i v e (encephaloclastic) lesions. The high-soft tissue contrast of MRI and its multiplanar capabilities and advantageous safety profile make it the preferred imaging modality for evaluating the supratentorial brain in utero [3–6]. This is particularly true
* Camilo Jaimes [email protected] 1
Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA
2
Harvard Medical School, Boston, MA, USA
3
Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
4
Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA
when imaging is performed at 3 tesla (T), where the higher signal-to-noise ratio results in improved delineation of the small structures of the fetal brain and the layers of the telencephalic wall (cerebral hemispheres) [7]. Identifying and correctly classifying abnormalities are crucial to establishing the diagnosis and associated prognosis of the fetus, guiding prenatal counseling, and orienting appropriate medical workup or imaging follow-up. The first st
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