daniela prayer · 2020. 2. 5. · corpus callosum agenesis . cca healthy fetuses whole brain...
TRANSCRIPT
![Page 1: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/1.jpg)
Medical University of Vienna, AUSTRIA
Division of Neuroradiology
And Musculoskeletal
Radiology
Fetal CNS MRI
Daniela Prayer
![Page 2: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/2.jpg)
Normal development
Malformations
Acquired pathology
Methods
![Page 3: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/3.jpg)
MR- methods for assessment of the fetal
CNS
2D morphology
3D morphology
Quantification of
brain tissue
Tractography
Functional MRI
Movement
Spectroscopy
![Page 4: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/4.jpg)
from smooth to structured
from thin
to thick
from layered
and disorganized to regionally
organized
and connected
In utero fetal brain development
![Page 5: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/5.jpg)
GW 22 GW 24 GW 18 GW 27
GW 29 GW 32 GW 34 GW 37
2D morphology surface axial images
![Page 6: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/6.jpg)
Malformations secondary to abnormal neuronal
and glial proliferation or apoptosis
Barkovich AJ et al Brain 2012: 135 1348-1369
GW 23+5
Insular indentation
![Page 7: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/7.jpg)
estimated gestational age (GA) – actual GA
developmental delay: 5.1 ± 4.0 GW
20 GW
20 GW
34 GW
34 GW
29 GW
29 GW
No signs of gyration in 11/19 cases at first MRI
examination
Fetal CNS pathology Early MR detection of lissencephaly
![Page 8: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/8.jpg)
23+5 29+3
Premature gyri
![Page 9: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/9.jpg)
GW 22+6
GW 29+0
GW 31+1
Cord
occlusion
because
of FFTS
2 weeks
Before
1st MRI
Aquired cortical pathology
![Page 10: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/10.jpg)
Results - Morphometry
23 GW
29 GW
n=16, 22-32 GW
25 GW
32 GW
L C
Kasprian G et al Cereb Cortex 2012
![Page 11: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/11.jpg)
Cerebral asymmetry pattern
in commissural agenesis
29 GW 25 GW 23 GW “classical“ “inverted“ “symmetric“
18-23/37; 55%
vs. 3.2% normal
1-8/37; 12.3%
vs. 2.6% normal 17-2/37; 32.7%
vs. 94.2% normal
High frequency of abnormal hemispheric asymmetry
patterns!
![Page 12: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/12.jpg)
CP
VZ
IZ
Ventricular Zone
+ Ganglionic Eminences
Periventricular Zone
Subventricular Zone
Intermediate Zone
Subplate
Cortical Plate
Marginal Zone
SZ
Histology
GW 20+4 T2 SP
GE
GE
Lamination of the fetal brain
![Page 13: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/13.jpg)
Fetus at 22 GW:
With abnormal lamination
17 GW, normal
22 GW, normal
22 GW
![Page 14: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/14.jpg)
Super-resolution
Rousseau F, Kim K, Studholme C, et al. Med Image Comput Comput Assist
Interv 2010;13:355-362
= 3D reconstruction technique from 2D data resulting
In images with higher resolution than the originally
acquired ones
![Page 15: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/15.jpg)
Super-resolution
(0.78-1.02mm isovoxel)
Neuroimage. 2015
![Page 16: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/16.jpg)
normal isolated CCA associated CCA
Disorders of axon guidance: effect on brain
volume
![Page 17: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/17.jpg)
Results group analysis – parenchymal thickness
normal isolated CCA vs.
![Page 18: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/18.jpg)
23 GW
Fetal brain parenchyma Connectivity at 23GW
![Page 19: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/19.jpg)
Low resolution tensor at 3T
GW 22
![Page 20: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/20.jpg)
frontal
parietal
GW 33
What tracts can we see?
CST/CPT
STR PTR ATR IFO
EC Corpus Callosum
GW 33
![Page 21: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/21.jpg)
GW 20
20GW
Postmortem/Histology Correlation
Probst bundles
Corpus callosum agenesis
![Page 22: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/22.jpg)
Dysgenetic corpus callosum? 28GW
Persisting
hippocampal
commissure
Tortori-Donati, Pediatric Radiology
Brain, Springer 2005
Functional
structure
Corpus callosum agenesis
![Page 23: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/23.jpg)
CCA
Healthy
Fetuses
Whole Brain
Connectome
Calcualted
From Diffusion
Tensor Data
![Page 24: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/24.jpg)
“ Node“ in a network:
Location from and to which
connections go:
Centrality – relative
importance within a graph –
influence of a node within a
network
Centrality of a node:
proportional to the
combined centralities of its
neighbors
FC Barcelona
![Page 25: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/25.jpg)
Tract count differences
(Re?)organization of connections in CCA
GW <25
More and shorter fibers in the temporal lobes!
![Page 26: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/26.jpg)
How do we know that what we see is true? Validation of in utero Diffusion Tensor Imaging
Structural tensor:
Image postprocessing
for directional analysis of
fibers on a microscopic
scale
Image grascale gradients
allow estimation of
Orientation of
underlying strcture
![Page 27: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/27.jpg)
How do we know that what we see is true? Validation of in utero Diffusion Tensor Imaging
![Page 28: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/28.jpg)
CCA, Heterotopia, Abnormal Gyration
25GW
Abnormal Connectivity
![Page 29: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/29.jpg)
Abnormal Connectivity
![Page 30: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/30.jpg)
Structure tensor analysis
![Page 31: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/31.jpg)
open
neural tube defects 1
closed
neural tube defects 1
Myelo-
meningocele Myelocele Meningocele Myelo-
cystocele
1: Tortori-Donati P, Rossi AMD, Biancheri R. Pediatric neuroradiology.
Berlin ; [Great Britain]: Springer 2005.
?
Classification “Spina bifida“
potentially treatable! surgery contraindicated!
![Page 32: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/32.jpg)
23GW
28GW
Chiari II Success of fetal surgery
before
after
![Page 33: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/33.jpg)
Neural tube defects functional assessment
hip flexion: L1/2
knee extension: L3 knee flexion: L4 foot dorsiflexion: L5
foot plantarflexion: sacral Lindseth RE. (1976) Treatment of the lower extremity in children
paralyzed by myelomeningocele (birth to 18 months).AAOSIC Lectures 25: 76–82.
Case 1, 22GW Case 2, 20GW Case 3
![Page 34: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/34.jpg)
functional assessment
L1
9/12 ratings correlated with ± 1 level of anatomical defect
No placode,
Closed NTD!
postnatal correlation?
Case 1, 22GW Case 2, 20GW Case 3
Neural tube defects
![Page 35: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/35.jpg)
29+4 31+5
Open vs. closed defect Vermian displacement
![Page 36: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/36.jpg)
22GW normal Chiari II
3D volumetric MRI Quantification
![Page 37: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/37.jpg)
CNTD Normal ONTD
(p<.001)**
Open vs. closed defect Clivus supraocciput angle
Ramona Woitek et al.
![Page 38: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/38.jpg)
GW 27+4
Spine ending with
sacrum tethered cord
No rectal
filling
Pathological meconium
signals
Skin defect
Cystic
lesion
Closed spinal defects- syndromes
Caudal regression syndrome Type II:
![Page 39: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/39.jpg)
GW 27+4 No peristalsis
Caudal regression syndrome Type II:
![Page 40: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/40.jpg)
GW 19+1
Curarino Triad:
Caudal regression syndrome
Presacral lesion
Megacolon spectrum
+/- anorectal abnorm
focal skin defect
kidney abnormalities
Eliás P, et al: Prenat Diagn. 2002 ,22(11):1005-10.
Caudal regression syndrome Type II:
![Page 41: Daniela Prayer · 2020. 2. 5. · Corpus callosum agenesis . CCA Healthy Fetuses Whole Brain Connectome Calcualted From Diffusion ... MRI of the fetal CNS comprises cerebral and spinal](https://reader033.vdocuments.us/reader033/viewer/2022061002/60b0a8a168e981000b46a554/html5/thumbnails/41.jpg)
Take home:
MRI of the fetal CNS comprises
cerebral and spinal assessment.
Detailed morphology is most
important, demonstration of
connectivity and movement
patterns may refine the prognostic
accuracy
GW13+5