Fetal Brain Tumors, a Challenge in Prenatal Diagnosis, Counselling, and Therapy

Fetal brain tumors are a rare entity with an overall guarded prognosis. About 10% of congenital brain tumors are diagnosed during fetal life. They differ from the postnatally encountered pediatric brain tumors with respect to location and tumor type. Fetal brain tumors can be benign or malignant and infiltrate or displace adjacent brain structures. Due to their high mitotic rate, they can show rapid growth. Outcome depends on age of diagnosis, size, and histological tumor type. Findings like polyhydramnios and macrocephaly encountered on routine ultrasound are frequently associated. Detailed prenatal anomaly scan and subsequent fetal magnetic resonance imaging (MRI) may identify the brain tumor and its severity. Both maternal and fetal prognosis should be included in prenatal counselling and decision making

Automatic quantitative MRI texture analysis in small-for-gestational-age fetuses discriminates abnormal neonatal neurobehavior.

BackgroundWe tested the hypothesis whether texture analysis (TA) from MR images could identify patterns associated with an abnormal neurobehavior in small for gestational age (SGA) neonates.MethodsUltrasound and MRI were performed on 91 SGA fetuses at 37 weeks of GA. Frontal lobe, basal ganglia, mesencephalon and cerebellum were delineated from fetal MRIs. SGA neonates underwent NBAS test and were classified as abnormal if ≥ 1 area was 5(th) centile. Textural features associated with neurodevelopment were selected and machine learning was used to model a predictive algorithm.ResultsOf the 91 SGA neonates, 49 were classified as normal and 42 as abnormal. The accuracies to predict an abnormal neurobehavior based on TA were 95.12% for frontal lobe, 95.56% for basal ganglia, 93.18% for mesencephalon and 83.33% for cerebellum.ConclusionsFetal brain MRI textural patterns were associated with neonatal neurodevelopment. Brain MRI TA could be a useful tool to predict abnormal neurodevelopment in SGA

Prenatal assessment of congenital diaphragmatic hernia at north american fetal therapy network centers: A continued plea for standardization

IntroductionPrenatal work- up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work- up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between fetal centers.MethodsA survey regarding prenatal CDH work- up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36).ResultsAll responded. Sonographic measurement of lung- to- head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed- to- expected LHR. The method for measuring LHR varied: 58% (21/36) used a - trace- method, 25% (9/36) used - longest axis,- and 17% (6/36) used an - antero- posterior- method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in fetal lung volume measurement. Whereas all generated a total fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering fetal intervention.ConclusionPrenatal CDH work- up and management differs considerably among North American fetal diagnostic centers, highlighting a need for its standardization.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166359/1/pd5859_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166359/2/pd5859.pd

Clinical information and results regarding NBAS test.

<p>Results are expressed as mean ± and standard deviation. *MANCOVA statistical analysis was used to compare scores in cases vs controls from each area of the NBAS test adjusting for smoking status, gender, Apgar score below 7, gestational age at NBAS test and days of adaptation. GA: Gestational age. w =  weeks; d =  days.</p

Maternal characteristics of the population.

<p>Results are expressed as mean ± and standard deviation or percentage determined by Students t-test for independent samples, Pearson's <i>X</i>² or Fisher's exact test as appropriate. Y: years. BMI: Body mass index. GA: Gestational age.US: Ultrasound. MRI: Magnetic Resonance Imaging; w =  weeks. ^a Routine occupations, long-term unemployment, or never worked (United Kingdom National Statistics Socio-economic Classification).</p

Study areas obtained from delineated ROIs.

<p>Study areas obtained from delineated ROIs.</p