Revue
Fetal brain injuryLésions acquises du cerveau fœtal

https://doi.org/10.1016/S0150-9861(04)96979-9Get rights and content

Summary

Improvements in MRI techniques widen the indications for fetal brain imaging and fetal brain injury represents the third indication of fetal brain magnetic resonance imaging (MRI) after the evaluation of suspected central nervous system (CNS) malformations and ventricular dilatation. Optimal MR imaging technique is necessary in order to collect as much data as possible about the fetal brain. Diffusion images can be used routinely in addition to the standard protocol of fetal brain MRI that consists of T1 and T2 weighted images of the fetal brain. Monovoxel proton magnetic resonance spectroscopy can also be performed in utero, but this technique is still more part of research protocol than of routine clinical protocol. Fetal brain injury includes hypoxia-ischemia, congenital infections (especially toxoplasmosis and cytomegalovirus infections), brain damage due to malformation such as vascular brain malformation and heart malformation, pregnancies at risk of fetal brain damage, and even inherited metabolic diseases, especially mitochondrial diseases. MRI findings in fetal brain injury consist of acute or chronic lesions that can be seen alone or in combination. Acute response of the fetal brain is less commonly seen than the chronic response compared to the brain response encountered in the postnatal period.

Résumé

Grâce aux améliorations récentes des techniques d’IRM, les indications d’IRM cérébrale foetale sont aujourd’hui de plus en plus fréquentes. L’exploration des lésions acquises du cerveau foetal représente la troisième indication d’IRM cérébrale foetale, après l’évaluation morphologique des malformations cérébrales et des dilatations ventriculaires. Une technique optimale d’imagerie est nécessaire afin de permettre une analyse très précise du cerveau foetal. Le protocole standard comprend des séquences pondérées T1 et des séquences pondérées T2. L’ IRM en pondération de diffusion peut également être proposée en routine clinique. La spectroscopie monovoxel du proton peut être réalisée, mais n’est pas de pratique courante clinique. Les lésions cérébrales foetales acquises incluent l’hypoxo-ischémie, les infections congénitales (notamment la toxoplasmose et le cytomégalovirus), les lésions cérébrales consécutives à différentesmalformations (malformations vasculaires cérébrales, malformations cardiaques par exemple), les grossesses à risque pour le cerveau foetal et les maladies métaboliques innées comme les maladies mitochondriales. La séméiologie IRM des lésions cérébrales foetales acquises comprend des lésions aiguës et des lésions chroniques, soit isolées, soit combinées. Les lésions aiguës du cerveau foetal sont moins fréquentes que les lésions chroniques, à l’inverse de ce que l’on constate dans la période post-natale.

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