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Fetal diffusion tensor quantification of brainstem pathology in Chiari II malformation

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Abstract

Objectives

This prenatal MRI study evaluated the potential of diffusion tensor imaging (DTI) metrics to identify changes in the midbrain of fetuses with Chiari II malformations compared to fetuses with mild ventriculomegaly, hydrocephalus and normal CNS development.

Methods

Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated from a region of interest (ROI) in the midbrain of 46 fetuses with normal CNS, 15 with Chiari II malformations, eight with hydrocephalus and 12 with mild ventriculomegaly. Fetuses with different diagnoses were compared group-wise after age-matching. Axial T2W-FSE sequences and single-shot echo planar DTI sequences (16 non-collinear diffusion gradient-encoding directions, b-values of 0 and 700 s/mm2, 1.5 Tesla) were evaluated retrospectively.

Results

In Chiari II malformations, FA was significantly higher than in age-matched fetuses with a normal CNS (p = .003), while ADC was not significantly different. No differences in DTI metrics between normal controls and fetuses with hydrocephalus or vetriculomegaly were detected.

Conclusions

DTI can detect and quantify parenchymal alterations of the fetal midbrain in Chiari II malformations. Therefore, in cases of enlarged fetal ventricles, FA of the fetal midbrain may contribute to the differentiation between Chiari II malformation and other entities.

Key Points

• FA in the fetal midbrain is elevated in Chiari II malformations.

• FA is not elevated in hydrocephalus and mild ventriculomegaly without Chiari II.

• Measuring FA may help distinguish different causes for enlarged ventricles prenatally.

• Elevated FA may aid in the diagnosis of open neural tube defects.

• Elevated FA might contribute to stratification for prenatal surgery in Chiari II.

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Abbreviations

ADC:

Apparent diffusion coefficient

CNS:

Central nervous system

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

GW:

Gestational weeks/ weeks of gestation

ROI(s):

Region(s) of interest

SSFSE:

Single-shot fast spin-echo

TE:

Echo time

TR:

Repetition time

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Acknowledgments

The scientific guarantor of this publication is Gregor Kasprian, MD (Senior Author). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

Michael Weber (Co-Author) kindly provided statistical advice for this manuscript and has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in Woitek R, Dvorak A, Weber M, et al (2014) MR-based morphometry of the posterior fossa in fetuses with neural tube defects of the spine. PLoS One 9:e112585

Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria

    Ramona Woitek, Daniela Prayer, Michael Weber, Veronika Schöpf, Julia Furtner, Ulrika Asenbaum & Gregor Kasprian

  2. Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria

    Gabriele Amann

  3. Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria

    Rainer Seidl

  4. Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

    Dieter Bettelheim

  5. Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria

    Peter C Brugger

Authors
  1. Ramona Woitek
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  2. Daniela Prayer
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  3. Michael Weber
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Correspondence to Ramona Woitek.

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Woitek, R., Prayer, D., Weber, M. et al. Fetal diffusion tensor quantification of brainstem pathology in Chiari II malformation. Eur Radiol 26, 1274–1283 (2016). https://doi.org/10.1007/s00330-015-3939-1

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  • DOI: https://doi.org/10.1007/s00330-015-3939-1

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