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Apparent diffusion coefficient measurements of the fetal brain during the third trimester of pregnancy: how reliable are they in clinical practice?
Author(s) -
Sartor Agnès,
Arthurs Owen,
Alberti Corinne,
Belarbi Nadia,
Tilea Bogdana,
Boizeau Priscilla,
Oury JeanFrancois,
ElmalehBerges Monique,
Gressens Pierre,
Sebag Guy,
Alison Marianne
Publication year - 2014
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4309
Subject(s) - effective diffusion coefficient , reproducibility , diffusion mri , white matter , pons , cerebellar hemisphere , cerebellum , nuclear medicine , medicine , gestational age , coefficient of variation , anatomy , pregnancy , magnetic resonance imaging , chemistry , radiology , biology , genetics , chromatography
Objective The objective of this study was to determine the reproducibility, the inter‐hemispheric difference and the reference apparent diffusion coefficient (ADC) values of the fetal brain according to gestational age. Method One hundred and one normal fetal brain (29.4–38.4 weeks) were analysed with diffusion‐weighted MR imaging. ADC was measured in frontal white matter (FWM), occipital white matter (OWM), centrum semi‐ovale (CSO), basal ganglia (BG), cerebellar hemisphere (CBM) and pons. ADC ratios (fronto‐occipital, fronto‐cerebellar and occipito‐cerebellar) were calculated. Inter‐observer reproducibility was assessed on 27 studies, using intra‐class correlation coefficient and Bland–Altman plot. Inter‐hemispheric difference was evaluated with Bland–Altman plot. Gestation‐specific reference intervals were estimated for each brain region. Results Inter‐observer bias was near zero. Limits of agreement (LOA) were clinically acceptable (−0.17; 0.20 to −0.38; 0.31 × 10 −3 mm 2 /s) for all brain regions except for CSO and pons. Inter‐hemispheric bias was near zero. Smallest LOA were for FWM (±0.09 mm 2 /s) and BG (±0.019 mm 2 /s). ADC values decreased, whereas ADC ratio increased with gestational age, reflecting normal maturation. Fronto‐occipital, fronto‐cerebellar and occipito‐cerebellar ratios were consistently above 0.8, 1 and 1, respectively. Conclusion The fetal brain regions with the highest reproducibility and smallest inter‐hemispheric differences are the frontal, occipital, cerebellar white matter and BG. ADC ratio could be useful to assess differential temporo‐spatial maturation. © 2013 John Wiley & Sons, Ltd.