Fetal Intraventricular Hemorrhage in Open Neural Tube Defects: Prenatal Imaging Evaluation and Perinatal Outcomes
| Autor: | Lori J. Howell, Juan Sebastian Martin-Saavedra, Beverly G. Coleman, Julie S. Moldenhauer, Gregory G. Heuer, Larissa T. Bilaniuk, Ryne A. Didier, Suzanne E. DeBari, Edward R. Oliver, N.S. Adzick |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Gray matter heterotopia medicine.medical_specialty Hindbrain Pediatrics Ultrasonography Prenatal 030218 nuclear medicine & medical imaging 03 medical and health sciences Fetus 0302 clinical medicine Pregnancy Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Neural Tube Defects cardiovascular diseases Cerebral Hemorrhage Third Ventricle Ventricular size Neural tube defect business.industry Neural tube Prenatal imaging medicine.disease Magnetic Resonance Imaging Rhombencephalon Fetal Diseases medicine.anatomical_structure Intraventricular hemorrhage Cardiology Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | AJNR Am J Neuroradiol |
| ISSN: | 1936-959X 0195-6108 |
| Popis: | BACKGROUND AND PURPOSE: Fetal imaging is crucial in the evaluation of open neural tube defects. The identification of intraventricular hemorrhage prenatally has unclear clinical implications. We aimed to explore fetal imaging findings in open neural tube defects and evaluate associations between intraventricular hemorrhage with prenatal and postnatal hindbrain herniation, postnatal intraventricular hemorrhage, and ventricular shunt placement. MATERIALS AND METHODS: After institutional review board approval, open neural tube defect cases evaluated by prenatal sonography between January 1, 2013 and April 24, 2018 were enrolled (n = 504). The presence of intraventricular hemorrhage and gray matter heterotopia by both prenatal sonography and MR imaging studies was used for classification. Cases of intraventricular hemorrhage had intraventricular hemorrhage without gray matter heterotopia (n = 33) and controls had neither intraventricular hemorrhage nor gray matter heterotopia (n = 229). A total of 135 subjects with findings of gray matter heterotopia were excluded. Outcomes were compared with regression analyses. RESULTS: Prenatal and postnatal hindbrain herniation and postnatal intraventricular hemorrhage were more frequent in cases of prenatal intraventricular hemorrhage compared with controls (97% versus 79%, 50% versus 25%, and 63% versus 12%, respectively). Increased third ventricular diameter, specifically >1 mm, predicted hindbrain herniation (OR = 3.7 [95% CI, 1.5–11]) independent of lateral ventricular size and prenatal intraventricular hemorrhage. Fetal closure (n = 86) was independently protective against postnatal hindbrain herniation (OR = 0.04 [95% CI, 0.01–0.15]) and postnatal intraventricular hemorrhage (OR = 0.2 [95% CI, 0.02–0.98]). Prenatal intraventricular hemorrhage was not associated with ventricular shunt placement. CONCLUSIONS: Intraventricular hemorrhage is relatively common in the prenatal evaluation of open neural tube defects. Hindbrain herniation is more common in cases of intraventricular hemorrhage, but in association with increased third ventricular size. Fetal closure reverses hindbrain herniation and decreases the rate of intraventricular hemorrhage postnatally, regardless of the presence of prenatal intraventricular hemorrhage. |
| Databáze: | OpenAIRE |
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