MRI of the fetal posterior fossa View Full Text


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Article Info

DATE

2004-11-23

AUTHORS

Catherine Adamsbaum, Marie Laure Moutard, Christine André, Valérie Merzoug, Solène Ferey, Marie Pierre Quéré, Fanny Lewin, Catherine Fallet-Bianco

ABSTRACT

MRI is a useful tool to complement US for imaging of the fetal posterior fossa (PF). In France, the discovery of a PF malformation in the fetus frequently leads to termination of pregnancy (80% in a personal series). However, despite improved accuracy in the diagnosis of PF abnormalities, prognosis remains uncertain. The first objective of this review is to document the normal MRI landmarks of the developing fetal PF. Because of their thinness, the visibility of the cerebellar fissures is dramatically delayed on MRI compared to macroscopic data. An important landmark is identification of the primary fissure of the vermis, normally seen at around 25–26 weeks’ gestation (WG) on the sagittal slice, separating the larger posterior lobe from the anterior lobe (volume ratio around 2:1). The prepyramidal and secondary fissures are usually only identifiable after 32 WG and the hemispheric fissures are difficult to see until the end of pregnancy. Considering the signal changes, high signal on T2-weighted (T2-W) sequences is seen from 25 WG in the posterior part of the brain stem (tegmentum and ascending sensory tracts) related to myelination. The low signal intensities seen within the cerebellum on T2-W images correspond to high cellularity of grey matter (deep nuclei), as there is no myelination within the white matter before 38 WG. The second objective is to highlight the signs highly predictive of a poor neurological prognosis. Lack of pontine curvature or vermian agenesis without a PF cyst (small volume of PF) is greatly associated with poor neurological status. The third objective is to propose a diagnostic strategy in difficult cases where prognosis is important, e.g. the Dandy Walker continuum. Analysis of the cerebellum is often impossible if a PF cyst is present (whatever its nature) as the mass effect usually blurs the foliation and even impairs evaluation of the normal ratio between the posterior and anterior lobes of the vermis. Isolated cerebellar hypoplasias raise the question of prognosis and genetic counselling. Such uncertainties require an amniocentesis and a careful search for other anomalies (cerebral and extracerebral). Unilateral abnormalities of a cerebellar hemisphere can be associated with good neurological status if they are isolated. The final objective is to discuss other rare PF fetal abnormalities, such as vascular malformations and tumours. More... »

PAGES

124-140

References to SciGraph publications

  • 2001-02. Disorganised unilateral cerebellar folia: a mild form of cerebellar cortical dysplasia? in NEURORADIOLOGY
  • 2001-09. Pontoneocerebellar hypoplasia: definition of MR features in PEDIATRIC RADIOLOGY
  • 2003-09. Development and developmental disorders of the human cerebellum in JOURNAL OF NEUROLOGY
  • 1999-02. Cerebellar atrophy: an important feature of carbohydrate deficient glycoprotein syndrome type 1 in PEDIATRIC RADIOLOGY
  • 2003-07-16. Dandy-Walker malformation: prenatal diagnosis and prognosis in CHILD'S NERVOUS SYSTEM
  • 1996-10. Congenital pontocerebellar atrophy in three patients: clinical, radiologic and etiologic considerations in NEURORADIOLOGY
  • 2003-06-21. MR imaging of acquired fetal brain disorders in CHILD'S NERVOUS SYSTEM
  • 1994-02. MRI in cerebellar hypoplasia in NEURORADIOLOGY
  • 2003-07-17. MR imaging of fetal brain malformations in CHILD'S NERVOUS SYSTEM
  • 1994-12. Vermian agenesis without posterior fossa cyst in PEDIATRIC RADIOLOGY
  • 1997. Vascular Diseases in Neonates, Infants and Children, Interventional Neuroradiology Management in NONE
  • 2004. Abnormalities of the Posterior Cerebral Fossa in MRI OF THE FETAL BRAIN
  • 2000-06. Presumed capillary telangiectasia of the pons: MRI and follow-up in EUROPEAN RADIOLOGY
  • 2000-04. Blake's pouch cyst: an entity within the Dandy-Walker continuum in NEURORADIOLOGY
  • 1996-06. Cystic malformations of the posterior cranial fossa originating from a defect of the posterior membranous area in CHILD'S NERVOUS SYSTEM
  • 2001-07. Genetic regulation of cerebellar development in NATURE REVIEWS NEUROSCIENCE
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00247-004-1316-3

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    PUBMED

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    30 schema:description MRI is a useful tool to complement US for imaging of the fetal posterior fossa (PF). In France, the discovery of a PF malformation in the fetus frequently leads to termination of pregnancy (80% in a personal series). However, despite improved accuracy in the diagnosis of PF abnormalities, prognosis remains uncertain. The first objective of this review is to document the normal MRI landmarks of the developing fetal PF. Because of their thinness, the visibility of the cerebellar fissures is dramatically delayed on MRI compared to macroscopic data. An important landmark is identification of the primary fissure of the vermis, normally seen at around 25–26 weeks’ gestation (WG) on the sagittal slice, separating the larger posterior lobe from the anterior lobe (volume ratio around 2:1). The prepyramidal and secondary fissures are usually only identifiable after 32 WG and the hemispheric fissures are difficult to see until the end of pregnancy. Considering the signal changes, high signal on T2-weighted (T2-W) sequences is seen from 25 WG in the posterior part of the brain stem (tegmentum and ascending sensory tracts) related to myelination. The low signal intensities seen within the cerebellum on T2-W images correspond to high cellularity of grey matter (deep nuclei), as there is no myelination within the white matter before 38 WG. The second objective is to highlight the signs highly predictive of a poor neurological prognosis. Lack of pontine curvature or vermian agenesis without a PF cyst (small volume of PF) is greatly associated with poor neurological status. The third objective is to propose a diagnostic strategy in difficult cases where prognosis is important, e.g. the Dandy Walker continuum. Analysis of the cerebellum is often impossible if a PF cyst is present (whatever its nature) as the mass effect usually blurs the foliation and even impairs evaluation of the normal ratio between the posterior and anterior lobes of the vermis. Isolated cerebellar hypoplasias raise the question of prognosis and genetic counselling. Such uncertainties require an amniocentesis and a careful search for other anomalies (cerebral and extracerebral). Unilateral abnormalities of a cerebellar hemisphere can be associated with good neurological status if they are isolated. The final objective is to discuss other rare PF fetal abnormalities, such as vascular malformations and tumours.
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    39 MRI
    40 PF abnormality
    41 T2
    42 T2-weighted sequences
    43 WG
    44 abnormalities
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    46 agenesis
    47 amniocentesis
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    70 end
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    75 fetuses
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    84 gray matter
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    105 normal ratio
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    108 poor neurological prognosis
    109 poor neurological status
    110 posterior fossa
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    113 pregnancy
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