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Research ArticlePediatric Neuroimaging
Open Access

Longitudinal MRI Evaluation of Brain Development in Fetuses with Congenital Diaphragmatic Hernia around the Time of Fetal Endotracheal Occlusion

D. Emam, M. Aertsen, L. Van der Veeken, L. Fidon, P. Patkee, V. Kyriakopoulou, L. De Catte, F. Russo, P. Demaerel, T. Vercauteren, M. Rutherford and J. Deprest
American Journal of Neuroradiology February 2023, 44 (2) 205-211; DOI: https://doi.org/10.3174/ajnr.A7760
D. Emam
aFrom the Department of Development and Regeneration (D.E., L.V.d.V., L.D.C., F.R., J.D.), Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
bDepartment Obstetrics and Gynaecology (D.E., L.F.), Faculty of Medicine, Tanta University, Tanta, Egypt
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M. Aertsen
cDepartment of Imaging and Pathology (M.A., P.D.), Clinical Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium
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L. Van der Veeken
aFrom the Department of Development and Regeneration (D.E., L.V.d.V., L.D.C., F.R., J.D.), Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
dClinical Department Obstetrics and Gynaecology (L.V.d.V., L.D.C., F.R., J.D.), University Hospitals Leuven, Leuven, Belgium
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L. Fidon
bDepartment Obstetrics and Gynaecology (D.E., L.F.), Faculty of Medicine, Tanta University, Tanta, Egypt
fDivision of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health and School of Biomedical Engineering and Imaging Sciences (L.F., T.V., J.D.), King’s College London, King’s Health Partners, St. Thomas’ Hospital, London, UK
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P. Patkee
eCentre for the Developing Brain (P.P., V.K., M.R., J.D.)
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V. Kyriakopoulou
eCentre for the Developing Brain (P.P., V.K., M.R., J.D.)
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  • ORCID record for V. Kyriakopoulou
L. De Catte
aFrom the Department of Development and Regeneration (D.E., L.V.d.V., L.D.C., F.R., J.D.), Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
dClinical Department Obstetrics and Gynaecology (L.V.d.V., L.D.C., F.R., J.D.), University Hospitals Leuven, Leuven, Belgium
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F. Russo
aFrom the Department of Development and Regeneration (D.E., L.V.d.V., L.D.C., F.R., J.D.), Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
dClinical Department Obstetrics and Gynaecology (L.V.d.V., L.D.C., F.R., J.D.), University Hospitals Leuven, Leuven, Belgium
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P. Demaerel
cDepartment of Imaging and Pathology (M.A., P.D.), Clinical Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium
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T. Vercauteren
fDivision of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health and School of Biomedical Engineering and Imaging Sciences (L.F., T.V., J.D.), King’s College London, King’s Health Partners, St. Thomas’ Hospital, London, UK
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M. Rutherford
eCentre for the Developing Brain (P.P., V.K., M.R., J.D.)
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J. Deprest
aFrom the Department of Development and Regeneration (D.E., L.V.d.V., L.D.C., F.R., J.D.), Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
dClinical Department Obstetrics and Gynaecology (L.V.d.V., L.D.C., F.R., J.D.), University Hospitals Leuven, Leuven, Belgium
eCentre for the Developing Brain (P.P., V.K., M.R., J.D.)
fDivision of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health and School of Biomedical Engineering and Imaging Sciences (L.F., T.V., J.D.), King’s College London, King’s Health Partners, St. Thomas’ Hospital, London, UK
gInstitute for Women’s Health (J.D.), University College London, London, UK
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    FIG 1.

    T2-weighted images in the axial (A), coronal (B), and sagittal (C) planes illustrating automated segmentations of the extra-axial space (yellow), white matter (red), ventricular system (green), and cerebellum (blue).

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    FIG 2.

    Graphs demonstrating the paired observations of the total skull volume, total brain grading, extra-axial space volume, cerebellar volume, atrial width, and ventricular volume. The provided P value is the significance level of the Wilcoxon-Mann-Whitney test comparing the observations at the second time point in fetuses with congenital diaphragmatic hernia with that in healthy controls. The mean values of the control populations (full red line) with the 95% confidence intervals (dashed red line) are also shown.

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    FIG 3.

    Three orthogonal T2-weighted spin-echo images in a healthy fetus (A–C) and a fetus with a left-sided diaphragmatic hernia (D–F), both at a GA of 30 weeks 4 days. In the axial plane (A and D), the enlarged pericerebral space is evident (arrowheads). The difference in gyrification is most evident in the parietal area and best seen in the coronal plane (circle in B and E) and to a lesser extent in the sagittal plane (arrows in C and F). The enlarged pericerebral space in the coronal and sagittal planes is marked with arrowheads.

Tables

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  • General characteristics of the congenital diaphragmatic hernia group

    General Characteristics
    Left/right/bilateral28 (66.7%)/12 (28.6%)/2 (4.8%)
    o/e TFLV at first MR imaging
     <15%6 (14.2%)
     16%–25%13 (31%)
     26%–45%22 (52.4%)
     >45%1 (2.4%)
    Liver herniation40 (95.2%)
    Liver/thorax ratio30.13 (9.67)
    Fetal position at MR imaging 1 (cephalic/breech/transverse)28 (67%)/13 (31%)/1 (2%)
    Fetal position at MR imaging 2 (cephalic/breech/transverse)37 (88%)/5 (12%) / 0
    GA at MR imaging 1 (mean)28.0 (SD, 2.1)
    GA at MR imaging 2 (mean)33.2 (SD, 1.3)
    Individual interval4.83 (1.85)
    Fetal endoluminal tracheal occlusion40 (95%)
    • Note:—o/e indicates observed over expected ratio.

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American Journal of Neuroradiology: 44 (2)
American Journal of Neuroradiology
Vol. 44, Issue 2
1 Feb 2023
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Cite this article
D. Emam, M. Aertsen, L. Van der Veeken, L. Fidon, P. Patkee, V. Kyriakopoulou, L. De Catte, F. Russo, P. Demaerel, T. Vercauteren, M. Rutherford, J. Deprest
Longitudinal MRI Evaluation of Brain Development in Fetuses with Congenital Diaphragmatic Hernia around the Time of Fetal Endotracheal Occlusion
American Journal of Neuroradiology Feb 2023, 44 (2) 205-211; DOI: 10.3174/ajnr.A7760

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Brain in Fetuses with Diaphragmatic Hernia
D. Emam, M. Aertsen, L. Van der Veeken, L. Fidon, P. Patkee, V. Kyriakopoulou, L. De Catte, F. Russo, P. Demaerel, T. Vercauteren, M. Rutherford, J. Deprest
American Journal of Neuroradiology Feb 2023, 44 (2) 205-211; DOI: 10.3174/ajnr.A7760
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