4 years ago

Prenatal assessment of cerebellar vermian lobulation: fetal MRI with 3 Tesla post-mortem correlation

Michael Weber, Gregor O. Dovjak, Dieter Bettelheim, Gerlinde M. Gruber, Peter C. Brugger, Georg Langs, Jae W. Song, Gregor Kasprian, Daniela Prayer
Objectives To optimize the imaging assessment of fetal hindbrain malformations, this observational MRI study aimed to provide quantitative biometric data in normal vermian development in human fetal brains in vivo. Methods In this retrospective, review board approved study, 78 fetuses (18–32 gestational weeks (GW)) scanned prenatally at 1.5T, and seven fetuses (16-30GW), scanned within 24 hours post-mortem at 3T,were included. All fetal brains were segmented on a T2-weighted midline sagittal slice. The mean relative area contribution (MRAC, proportion of the lobule relative to total vermian area) of all discernable vermian lobules was determined. Inter- and intrarater variability of a representative selection (22 cases) was determined with the Intraclass correlation coefficient based on voxel based differences. Furthermore, a linear regression model was used to assess the correlation between vermian lobules and gestational age. Results After 22GW 7 of 9 vermian lobules could be reliably discriminated. MRAC showed a mean difference of 2.89 ± 3.01% between in vivo and post-mortem measurements. The intraclass correlation coefficient (ICC) of voxel based interrater differences was 0.91 ± 0.05 and intrarater ICC was 0.95 ± 0.03. Growth of cerebellar lobules was non-uniform - the MRAC of Culmen and DFT (Declive + Folium + Tuber) increased with gestational age, whereas Lingula, Centralis, Pyramis and Nodulus decreased. Conclusions Vermian lobulation can be accurately and reliably assessed prenatally, on exact midsagittal T2-weighted sequences after 22GW. Fetal vermian lobules show non-uniform growth, with an expansion of DFT and Culmen at the expense of spinocerebellar structures. An evaluation of vermian lobulation could supply a better characterization of fetuses with hindbrain malformations.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18826

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