Imaging of fetal ventriculomegaly
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FETAL IMAGING
Imaging of fetal ventriculomegaly David M. Mirsky 1 & Nicholas V. Stence 1 & Andria M. Powers 1 & Andra L. Dingman 2 & Ilana Neuberger 1 Received: 20 March 2020 / Revised: 18 August 2020 / Accepted: 8 October 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Fetal ventriculomegaly is the most common central nervous system abnormality detected by prenatal imaging. It has a high association with other anomalies. Etiologies and prognoses for fetal ventriculomegaly range from normal outcomes to significant neurodevelopmental sequelae. In this paper, we review the development, terminology, pathogenesis, imaging and prognosis of fetal ventriculomegaly. Keywords Brain . Central nervous system . Fetus . Magnetic resonance imaging . Ventricles . Ventriculomegaly
Introduction Fetal ventriculomegaly is defined as in utero enlargement of the lateral ventricles. It is the most common central nervous system (CNS) abnormality detected by prenatal US, with an incidence of approximately 1% [1, 2]. Considered a “tip of the iceberg” finding, fetal ventriculomegaly has a high association with other CNS and non-CNS anomalies and should prompt a thorough investigation of the entire brain and body [2–5]. Etiologies and prognoses for fetal ventriculomegaly range from normal outcomes to significant neurodevelopmental sequelae. In this article, we review the development, terminology, pathogenesis, imaging and prognosis of fetal ventriculomegaly.
Ventricular development The lateral ventricles undergo a dramatic transformation throughout gestational life. These changes are largely related to the development of the surrounding structures. The inward folding and maturation of the cerebral surfaces result in a decrease in the volume of the lateral ventricles. Early on * David M. Mirsky [email protected] 1
2
Department of Radiology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO 80045, USA Division of Child Neurology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
during the vesicular period, at 10–13 weeks of gestation, the lateral ventricles occupy much of the fetal brain. At that time, the frontal horns, body and atrium are rudimentary in appearance. As the brain develops, the ventricles take shape with the appearance of four distinct horns. This morphology becomes recognizable on imaging at approximately 16 weeks [6–10]. With time, the lateral ventricles narrow and appear less prominent. By term, they appear small with respect to the developed brain. Despite the apparent evolution, the atrial diameter remains fairly constant (Fig. 1).
Terminology Ventriculomegaly is the preferred terminology for enlarged ventricles identified in utero. The term hydrocephalus describes a subset of ventriculomegaly patients that also have increased cerebrospinal fluid (CSF) pressure within the ventricular system, obstruction being a com
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