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Virtual angiography of the fetal brain using postmortem MRI
Author(s) -
Katorza E.,
Salem Y.,
Shashar D.,
Gilboa Y.,
Achiron R.,
Hoffmann C.
Publication year - 2014
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.12483
Subject(s) - medicine , autopsy , pregnancy , gestation , neurological examination , ventriculomegaly , fetus , radiology , encephalopathy , obstetrics , pediatrics , surgery , pathology , genetics , biology
Postmortem fetal information can help the parents to grieve, while any finding can be used to evaluate if there is increased risk in future pregnancies1. This information is obtained mainly from autopsy, which requires goodquality specimens, short length of time between death and the procedure, and well-educated and experienced neuropathologists with the necessary unique equipment2. Recently, postmortem magnetic resonance imaging (MRI)/computed tomography has been used to replace traditional invasive autopsy examination. This may be an alternative in the 40% of cases which cannot be autopsied because of parental refusal in order to protect the integrity of their fetus, or when standard autopsy is not available3. Malformations of the central nervous system (CNS) are a major cause of developmental delay and neurological deficits4. Cerebral sinovenous thrombosis (CSVT) is a rare condition in fetuses and is mostly diagnosed late during the second or third trimester. The clinical manifestations of CSVT are non-specific, may be subtle and may include seizures, altered levels of consciousness and encephalopathy, focal neurological deficits (cranial nerve palsies, hemiparesis, hemisensory loss) and diffuse neurological symptoms5. A 31-year-old primigravida was referred to our department at 33 weeks’ gestation for ultrasound evaluation due to bilateral ventriculomegaly which was identified on routine ultrasound examination 1 day before admission. Her medical history was unremarkable with no family history of genetic or congenital disease. The pregnancy was conceived spontaneously. The nuchal translucency thickness at 12 weeks’ gestation was 1.1 mm. An early anatomy scan at 15 weeks’ gestation, followed by a second-trimester fetal anatomy survey at 22 weeks’ gestation, were considered normal. Serological tests for syphilis, toxoplasma, rubella, cytomegalovirus and herpes were negative. Targeted sonographic examination of the fetal CNS (‘fetal neurosonogram’), conducted at our institution at 32.5 weeks’ gestation revealed bilateral ventriculomegaly (15 mm), with suspected hemorrhage involving the brain