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Sonographic assessment of normal and abnormal patterns of fetal cerebral lamination.
MedLine Citation:
PMID:  22610990     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Prenatal development of the brain is characterized by gestational age-specific changes in laminar structure of the brain parenchyma before 30 gestational weeks. Cerebral lamination patterns of normal fetal brain development have been described histologically, by postmortem in-vitro MRI, and in-vivo fetal MRI. The purpose of this study is to evaluate normal transient sonographic appearances of laminar organization of the cerebral wall, and to evaluate the sonographic appearance of cerebral lamination in abnormal brain development. Methods: We studied 92 normal fetuses between 17 and 38 weeks' gestation retrospectively for visibility of the subplate zone relative to the intermediate zone. Characteristic sonographic findings of cerebral lamination were correlated with gestational age in order to evaluate transient structures. In addition, we retrospectively reviewed the fetal ultrasound findings of 68 fetuses with abnormal cerebral laminations pattern for gestational age. Results: The subplate-intermediate zone interface was identified as early as 17 weeks, and in all fetuses between 18 and 28 weeks (N = 57). The subplate appeared anechoic, and the intermediate zone homogeneously more echogenic than the subplate in all fetuses before 28 weeks. The intermediate zone-subplate zone interface was not identified in any fetus after 34 weeks (N = 13). The abnormal cohort included fetuses with a prenatal diagnosis of CMV infection (N = 6), lissencephaly (N = 6), fetal stroke (N = 4), intracranial hemorrhage (N = 12), ischemia (N = 11), thanatophoric dysplasia (N = 6), teratogen exposure (N = 4), severe ventriculomegaly (N = 15), microcephaly (N = 2), and 1 case each of lumbosacral meningomyelocele and encephalocele. There were 3 patterns of abnormal cerebral lamination: (1) no normal laminar pattern before 28 weeks, detected in 23 fetuses in association with severe ventriculomegaly, diffuse ischemia, and microcephaly; (2) focal disruption of lamination, detected in 26, associated with hemorrhage, porencephaly, migrational abnormalities, thanatophoric dysplasia, meningomyelocele, and encephalocele; (3) increased prominence and echogenicity of the intermediate zone and persistence of a laminar pattern beyond 33 weeks (detected in 12 fetuses), associated with Type 1 lissencephaly in 6 fetuses, and CMV infection in 6. In CMV infection, the earliest indication of the infection was focal inhomogeneity and increased echogenicity of the intermediate zone, which predates the development of microcephaly, ventriculomegaly, and intracranial calcification. Conclusions: The fetal subplate and intermediate zones can be reliably demonstrated on routine sonography before 28 weeks, and disappear after 34 weeks. These findings represent normal gestational age-dependent transient laminar patterns of cerebral development and are consistent with histological studies. Changes in the sonographic visualization of lamination are related to composition of the subplate zone due to development of fibre systems and axon strata in the developing white matter. Sonography is therefore able to identify evidence of cortical lamination in the normal fetal brain, and assess timing of maturation changes. Abnormal fetal cerebral lamination patterns for gestational age are also visible on sonography, and may indicate abnormal brain development. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Denise Pugash; Glenda Hendson; Christopher P Dunham; Kathryn Dewar; Deborah M Money; Daniela Prayer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-18
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
University of British Columbia - Radiology, Vancouver, Canada. dpugash@cw.bc.ca.
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