An Automated Localization, Segmentation and Reconstruction Framework for Fetal Brain MRI
Michael EbnerGuotai WangWenqi LiMichaël AertsenPremal A. PatelRosalind AughwaneAndrew MelbourneTom DoelAnna L. DavidJan DeprestSébastien OurselinTom Vercauteren
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Ventriculomegaly
We report on identical premature twins (monochorionic diamniotic). As fetuses, they both demonstrated sonographic and MRI evidence of cerebral bilateral ventriculomegaly. Neonatal brain US showed bilateral ventriculomegaly, similar in both twins. During follow-up, these physical and imaging similarities persisted. To the best of our knowledge, this is the first report on similar bilateral ventriculomegaly in Identical Twins (IT). A genetic origin of this finding in our IT is suggested. Should more cases of ventriculomegaly be reported in the future in several sets of IT, cerebral ventriculomegaly can then be added to the list of similar CNS features observed in identical twins.
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Ventriculomegaly
Obstructive hydrocephalus
Cerebral ventricle
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Ventriculomegaly is defined as dilatation ≥10 mm of the fetal cerebral lateral ventricles on ultrasound at 20 weeks gestation1 2.
Aim
To assess the aetiology and neurological outcomes of ventriculomegaly at a University hospital from 2009–2012.Methods
35 women with ventriculomegaly were identified on anomaly/fetal medicine scans between 20 to 30 weeks of gestation. They were investigated for aneuploidy, infections and further abnormalities. Long term neurological outcomes including the differences between mild (10–12 mm), moderate (13–15 mm) and severe(≥16 mm) ventriculomegaly in unilateral/bilateral and stable/progressive cases were examined.Results
Ultrasound scanning data: 26 women were offered invasive testing for aneuploidy, it was contraindicated or not appropriate in 9 patients. 5 women accepted invasive testing, 12 declined and 9 are still considering. Karyotyping was normal in all 5 women. 31 women had a negative TORCH screen. 13 women had a fetal MRI scan. Apgar scores were normal in all babies. 7 out of 18 babies with stable or progressive ventriculomegaly had abnormal cranial USS or MRI postnatally. All babies with mild ventriculomegaly at diagnosis have no developmental abnormalities currently. 2/7 babies with moderate ventriculomegaly and 1/2 babies with severe ventriculomegaly have delayed development.Conclusion
Ventriculomegaly of >13 mm can indicate a change of prognostic outcome.References
Melchiorre. K, Bhide. A, Gika. A.D, Pilu. G & Papageorghiou A.T. Counselling in isolated mild fetal ventriculomegaly. Ultrasound Obstet Gynaecol 2009;34:212–224. Sethna. F, Tennant. P.W.G, Rankin. J & Robson. S.C. Prevalence, Natural History and Clinical Outcome of Mild to Moderate Ventriculomegaly. Obstetrics & Gynaecology 2011;117:867–876.Ventriculomegaly
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To evaluate perinatal and up to 24 months outcomes in the fetuses with isolated ventriculomegaly. A retrospective study of pregnancy outcomes and postnatal development of infants up to 24 months was performed in 40 cases with prenatally diagnosed isolated ventriculomegaly. They were divided into three groups according to the width of the lateral ventricles: borderline ventriculomegaly (10.0-11.9 mm) – 30 cases, moderate ventriculomegaly (12.0-14.9 mm) – 6 cases and severe ventriculomegaly (more than 15.0 mm) – 4 cases. Neurological disorders diagnosed immediately after birth were in two infants with borderline ventriculomegaly, but they did not require further treatment or neurological follow up at the age of 12 months. Intrauterine pneumonia was in one case. Neonates with moderate ventriculomegaly showed neurological disorders in two cases: an infant had not required any treatment by the age of 12 months, and another one had speech delay at 18 months. A newborn was postnatally revealed asymptomatic cerebral hernia in the parietal area with a favourable postoperative prognosis by MRI. Down's syndrome was diagnosed postnatally in an infant with apparently isolated moderate ventriculomegaly (parents refused prenatal invasive diagnosis). Four infants with apparently isolated severe ventriculomegaly were prenatally suspected aqueduct stenosis which was confirmed after birth. The neonates had severe neurological signs. Thus, we found no one case of truly isolated ventriculomegaly with a favourable outcome in fetuses with the width of the lateral ventricles more than 15 mm. The incidence of unfavourable perinatal outcomes in fetuses with isolated borderline ventriculomegaly was 10.0% and it was 6 times higher in moderate ventriculomegaly (66.6%). Borderline ventriculomegaly had favourable outcomes compared with moderate one which demonstrated unfavourable outcomes in every third case. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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Ventriculomegaly
Etiology
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A 39-year-old woman presented with long-standing overt ventriculomegaly in adults (LOVA) manifesting as gradually worsening headache. Past history included treatment for myeloschisis at birth. Intelligence quotient (IQ) was 115 and preoperative psychological assessment using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) showed normal scores in all domains. However, scores for constructional ability were slightly low. Computed tomography revealed severe ventriculomegaly involving the lateral and third ventricles, and magnetic resonance imaging showed aqueductal stenosis. Endoscopic third ventriculostomy was performed under a diagnosis of LOVA. Postoperatively, the headache resolved and the RBANS showed improvements in memory and constructional ability. Detailed evaluation of cognitive function provides a good indicator in the treatment of hydrocephalus with normal IQ.
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Aqueductal stenosis
Endoscopic third ventriculostomy
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Fetal ventriculomegaly (VM) is a dilation of the lateral ventricle. Different patients have different etiologies for fetal ventriculomegaly, which can be idiopathic, structural, or chromosomal. A measurement of 10–15 mm is commonly referred to as mild ventriculomegaly, while measurements of 15–20 and >20 mm and above are defined as moderate and severe ventriculomegaly. Objective: To find the frequency of spinal defects (SD) in fetuses with ventriculomegaly (VM). Methods: It was a cross-sectional analytical study which included 103 pregnant ladies who had evidence of ventriculomegaly visited multiple centers during research period. Convenient sampling method was used. The presence of ventriculomegaly was confirmed using transabdominal probe with frequency 3-5 MHz. Frequency was calculated and crosstabs were made using SPSS version 21.0. Results: Among 103 pregnant patients, frequency of fetal spinal defects was 25.2%. Frequency of ventriculomegaly was as follow: mild ventriculomegaly 43.7%, moderate ventriculomegaly 31.2%, and severe ventriculomegaly 25.2%. Among 103 patients, 25.2% patients had AFI greater than 21. Frequency of mother's H/O any fetal spinal defects in their previous pregnancies was 15.5%. Conclusions: The study concluded that frequency of spinal defects in fetuses with ventriculomegaly was 25.2% and spinal defects occur in those patients who had severe ventriculomegaly (>20mm) and had AFI greater than 25
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Objective: To evaluate the prenatal and postnatal follow up, treatment and the outcome of the patients with ventriculomegaly. Methods: Patients with lateral cerebral ventricle size 10mm and higher were included. 69 patients were considered but 8 patients refused to join our study. The patients were divided into two groups as they had additional anomalies (combined ventriculomegaly) or not (isolated ventriculomegaly). Each group was divided into three subgroups according to their lateral cerebral ventricle size as mild (10-12 mm), moderate (12.1-4.9 mm), severe (15 mm and more) ventriculomegaly. Results: 10 fetuses with isolated ventriculomegaly and combined ventriculomegaly died after birth. Neurosurgical operations were performed for ten patients. We performed chromosomal analysis for 16.7% of our patients. Caesarian delivery was higher (91.7%) in combined ventriculomegaly groups and all newborns went to NNICU. In isolated ventriculomegaly group 18 patients showed normal neurological development at sixth month. None of the patients with combined ventriculomegaly group showed normal neurological development at sixth month. In severe ventriculomegaly group termination ratio was higher (64.7%) than isolated ventriculomegaly group (11%). The survival rate was 90% in mild ventriculomegaly group and 42.9% in severe ventriculomegaly group. Conclusion: Termination is more often in isolated severe ventriculomegaly than mild and moderate ventriculomegaly group because the prognosis is worse. Because the prognosis of the patients with mild ventriculomegaly is good decision for termination will be well evaluated with the family.
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