FOUR DIMENSIONAL ULTRASOUND IN THE ASSESSMENT OF CENTRAL NERVOUS SYSTEM DEVELOPMENT AND FETAL BEHAVIORAL PATTERNS

Abstract

U posljednjim desetljećima morfološke su studije fetalnog mozga kao i ultrazvučno prikazivanje intrauterine fetalne aktivnosti u stvarnom vremenu donijele neprocjenjive informacije o najvažnijim događajima u razvoju ljudskog središnjeg živčanog sustava (CNS). Prikazano je da razvoj fetalnog mozga napreduje kroz slijed kompliciranih histogenetskih procesa, koji se odražavaju na fetalnim obrascima ponašanja. Veliki razvojni događaji, poput uspostavljanja ¬neuralnih veza u različitim područjima mozga, praćeni su pojavom novih obrazaca fetalne aktivnosti ili promjenom već postojećih obrazaca. Predloženo je da bi se ultrazvučno praćenje fetalnog ponašanja moglo upotrijebiti za procjenu ¬integriteta fetalnog CNS-a i, po mogućnosti, za detekciju funkcionalnih i strukturalnih poremećaja mozga. Nove, napredne tehnike prikazivanja, kao što je četverodimenzionalni ultrazvuk, otvaraju nove perspektive za proučavanje fetalnih obrazaca ponašanja i unaprijeđuju razvoj dijagnostičkih strategija za ranu detekciju ili moguću prevenciju disfunkcija mozga. Važnost ovih istraživanja je naglašena nedavnim otkrićima da mnogi okolišni čimbenici, uzrokujući fetalni stres, mogu ometati neurološki razvoj fetusa i ostaviti dugotrajne posljedice na moždanoj strukturi i funkciji. Značajni događaji u funkcionalnom razvoju fetalnog mozga, kao i utjecaj čimbenika okoliša na neurološki razvoj fetusa, obradit će se u ovom pregledu.During the past few decades, morphological studies of fetal brain as well as ultrasonic imaging of fetal intrauterine activities in realtime have provided invaluable information about the most important events in the development of human central nervous system. It has been shown that development of the fetal brain proceeds through a sequence of complicated histogenetic processes, which are reflected in the fetal behavioral patterns. Major developmental events, such as the establishment of neural connections in different regions of the brain, are accompanied by the occurrence of new patterns of fetal activities or by the transformation of existing patterns. It has been suggested that the ultrasound ¬assessment of fetal behavior could be used for the evaluation of the integrity of fetal CNS, and possibly for the detection of functional or structural brain disorders. The new advanced imaging techniques such as four-dimensional sonography, might open a new perspective for the studying of fetal behavioral patterns and facilitate the development of diagnostic strategies for early detection or possible prevention of brain dysfunctions. The importance of these investigations is ¬underlined by the recent findings that many environmental influences causing the fetal stress can interfere with the fetal neurodevelopment and leave the long term and profound consequences on brain structure and function. The major events in the functional development of fetal brain, as well as the influence of environmental factors on fetal neurodevelopment will be discussed in this review