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Ann Neurol. 2017 Feb;81(2):278-286. doi: 10.1002/ana.24873.

Pseudofeeders on fetal magnetic resonance imaging predict outcome in vein of Galen malformations.

Author information

1
Department of Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre.
2
Department of Neuroradiology, CHUV, Lausanne University Hospital, Lausanne.
3
Department of Pediatric Radiology, Bicêtre Hospital, Le Kremlin-Bicêtre.
4
Center for Research in Epidemiology and Population Health, National Institute of Health and Medical Research, Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre.
5
Department of Obstetric Gynecology and Antenatal Diagnostics, Bicêtre Hospital, Le Kremlin-Bicêtre.
6
Pediatric Resuscitation, Bicêtre Hospital, Le Kremlin-Bicêtre.
7
Fetal Pathology Unit, Antoine Béclère Hospital, Clamart.
8
Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, Paris, France.
9
Laboratory of Information Processing and Communication, National Center for Scientific Research, Télécom ParisTech, University of Paris-Saclay, Paris, France.

Erratum in

Abstract

OBJECTIVE:

Although vein of Galen aneurysmal malformations (VGAM) can be diagnosed in the fetus, the challenge is predicting the occurrence of its 2 major complications: cardiopulmonary failure and encephalomalacia. This study attempts to determine which fetal brain magnetic resonance imaging (MRI) features might be used to predict the development of these complications at birth.

METHODS:

The cohort was extracted from a prospectively assembled database of VGAM cases managed at a single referral center from 2000 to 2014. Of 251 patients with VGAM, 83 cases were diagnosed prenatally. A total of 58 patient charts having at least 1 fetal MRI were reviewed. Patterns of brain parenchyma, hydrocephalus, and so-called middle cerebral artery (MCA) "pseudofeeders" were correlated with cardiac failure, pulmonary hypertension, and encephalomalacia at birth.

RESULTS:

The median gestational age at fetal MRI was 32.3 weeks of pregnancy (±2.3). Nine fetuses (16%) had encephalomalacia. Thirty-one fetuses (53%) had MCA pseudofeeders. Twenty-six fetuses (45%) had prenatal hydrocephalus. Prenatal MCA pseudofeeders were a risk factor for encephalomalacia at birth (p = 0.001). MCA pseudofeeders and hydrocephalus were risk factors for both severe cardiac failure (p = 0.01 and p = 0.04, respectively) and severe pulmonary hypertension (p = 0.014 and p = 0.05, respectively) at birth.

INTERPRETATION:

MCA pseudofeeders are the result of impaired cerebral blood flow, and are thus a risk factor for further brain melting at birth. Their presence can be used for informing parents and as an aid in management decisions. Ann Neurol 2017;81:278-286.

PMID:
28076893
DOI:
10.1002/ana.24873
[Indexed for MEDLINE]

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