TY - JOUR
T1 - Cortical spectral matching and shape and volume analysis of the fetal brain pre- and post-fetal surgery for spina bifida
T2 - a retrospective study
AU - Mufti, Nada
AU - Aertsen, Michael
AU - Ebner, Michael
AU - Fidon, Lucas
AU - Patel, Premal
AU - Rahman, Muhamad Bin Abdul
AU - Brackenier, Yannick
AU - Ekart, Gregor
AU - Fernandez, Virginia
AU - Vercauteren, Tom
AU - Ourselin, Sebastien
AU - Thomson, Dominic
AU - De Catte, Luc
AU - Demaerel, Philippe
AU - Deprest, Jan
AU - David, Anna L.
AU - Melbourne, Andrew
N1 - Funding Information:
This work was supported by the Guided Instrumentation of Fetal Therapy and Surgery (GIFT-Surg) project, funded by the Wellcome Trust [203148/Z/16/Z; 203145Z/16/Z; WT101957] and Engineering and Physical Sciences Research Council (EPSRC) [NS/A000049/1; NS/A000050/1; NS/A000027/1; EP/L016478/1]. SO is the principal investigator on this grant, and ALD, JD, TV and AM are co-investigators. YB, GE and VF are funded by the Engineering and Physical Sciences Research Council (EPSRC) Centre for Doctoral Training (CDT) in Medical Imaging, King’s College London. LF is funded by the European Union’s Horizon 2020 research and innovation programme under the Marie-Sklodowska-Curie grant agreement TRABIT No 765148. NM is funded with the support of the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) (203145Z/16/Z). ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. JD is supported by the Great Ormond Street Hospital Children’s Charity.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Purpose: A retrospective study was performed to study the effect of fetal surgery on brain development measured by MRI in fetuses with myelomeningocele (MMC). Methods: MRI scans of 12 MMC fetuses before and after surgery were compared to 24 age-matched controls without central nervous system abnormalities. An automated super-resolution reconstruction technique generated isotropic brain volumes to mitigate 2D MRI fetal motion artefact. Unmyelinated white matter, cerebellum and ventricles were automatically segmented, and cerebral volume, shape and cortical folding were thereafter quantified. Biometric measures were calculated for cerebellar herniation level (CHL), clivus-supraocciput angle (CSO), transverse cerebellar diameter (TCD) and ventricular width (VW). Shape index (SI), a mathematical marker of gyrification, was derived. We compared cerebral volume, surface area and SI before and after MMC fetal surgery versus controls. We additionally identified any relationship between these outcomes and biometric measurements. Results: MMC ventricular volume/week (mm3/week) increased after fetal surgery (median: 3699, interquartile range (IQR): 1651–5395) compared to controls (median: 648, IQR: 371–896); P = 0.015. The MMC SI is higher pre-operatively in all cerebral lobes in comparison to that in controls. Change in SI/week in MMC fetuses was higher in the left temporal lobe (median: 0.039, IQR: 0.021–0.054), left parietal lobe (median: 0.032, IQR: 0.023–0.039) and right occipital lobe (median: 0.027, IQR: 0.019–0.040) versus controls (P = 0.002 to 0.005). Ventricular volume (mm3) and VW (mm) (r = 0.64), cerebellar volume and TCD (r = 0.56) were moderately correlated. Conclusions: Following fetal myelomeningocele repair, brain volume, shape and SI were significantly different from normal in most cerebral layers. Morphological brain changes after fetal surgery are not limited to hindbrain herniation reversal. These findings may have neurocognitive outcome implications and require further evaluation.
AB - Purpose: A retrospective study was performed to study the effect of fetal surgery on brain development measured by MRI in fetuses with myelomeningocele (MMC). Methods: MRI scans of 12 MMC fetuses before and after surgery were compared to 24 age-matched controls without central nervous system abnormalities. An automated super-resolution reconstruction technique generated isotropic brain volumes to mitigate 2D MRI fetal motion artefact. Unmyelinated white matter, cerebellum and ventricles were automatically segmented, and cerebral volume, shape and cortical folding were thereafter quantified. Biometric measures were calculated for cerebellar herniation level (CHL), clivus-supraocciput angle (CSO), transverse cerebellar diameter (TCD) and ventricular width (VW). Shape index (SI), a mathematical marker of gyrification, was derived. We compared cerebral volume, surface area and SI before and after MMC fetal surgery versus controls. We additionally identified any relationship between these outcomes and biometric measurements. Results: MMC ventricular volume/week (mm3/week) increased after fetal surgery (median: 3699, interquartile range (IQR): 1651–5395) compared to controls (median: 648, IQR: 371–896); P = 0.015. The MMC SI is higher pre-operatively in all cerebral lobes in comparison to that in controls. Change in SI/week in MMC fetuses was higher in the left temporal lobe (median: 0.039, IQR: 0.021–0.054), left parietal lobe (median: 0.032, IQR: 0.023–0.039) and right occipital lobe (median: 0.027, IQR: 0.019–0.040) versus controls (P = 0.002 to 0.005). Ventricular volume (mm3) and VW (mm) (r = 0.64), cerebellar volume and TCD (r = 0.56) were moderately correlated. Conclusions: Following fetal myelomeningocele repair, brain volume, shape and SI were significantly different from normal in most cerebral layers. Morphological brain changes after fetal surgery are not limited to hindbrain herniation reversal. These findings may have neurocognitive outcome implications and require further evaluation.
KW - Cortical spectral matching
KW - Fetal surgery
KW - MRI
KW - Myelomeningocele
KW - Shape
KW - Volume
UR - http://www.scopus.com/inward/record.url?scp=85105406649&partnerID=8YFLogxK
U2 - 10.1007/s00234-021-02725-8
DO - 10.1007/s00234-021-02725-8
M3 - Article
C2 - 33934181
AN - SCOPUS:85105406649
SN - 0028-3940
VL - 63
SP - 1721
EP - 1734
JO - Neuroradiology
JF - Neuroradiology
IS - 10
ER -