Fetal Intraparenchymal Hemorrhage Imaging Patterns, Etiology, and Outcomes: A Single Center Cohort Study

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-08-31 DOI:10.1002/ana.27072

Rachel Vassar MD, Elizabeth George MBBS, Andrew Mogga BS, Yi Li MD, Mary E. Norton MD, Orit Glenn MD, Dawn Gano MD, MAS

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Abstract

Objective

This study examines associations among fetal brain magnetic resonance imaging (MRI) injury patterns, etiologies, and outcomes in fetal intraparenchymal hemorrhage (IPH).

Methods

This is a retrospective, single-center cohort study of IPH diagnosed on fetal MRI (1996–2022). IPH and associated abnormalities were categorized by 2 pediatric neuroradiologists; electronic medical records were reviewed by 2 pediatric neurologists to classify etiology and outcomes including cerebral palsy, epilepsy, developmental delay, and death.

Results

Forty-four fetuses with IPH were identified (34 singleton and 10 twin gestations) with MRI at median 24 weeks gestation (interquartile range [IQR] = 22–28 weeks). IPH was commonly supratentorial (84%) and focal (50%) or focal with diffuse injury (43%) and was often associated with germinal matrix hemorrhage (GMH; 75%) and/or intraventricular hemorrhage (IVH; 52%). An etiology was identified in 75%, including twin-twin transfusion syndrome (TTTS, n = 10), COL4A1/2 variants (n = 8), or other fetal/maternal conditions (n = 15). COL4A1/2 variants were associated with focal IPH and the presence of hemorrhagic porencephaly, and intrauterine transfusion was associated with infratentorial hemorrhage. Twenty-two fetuses were liveborn, and 18 pregnancies were terminated. Among those with follow-up ≥ 12 months (median = 7 years), 12 of 13 had cerebral palsy, 6 of 13 had developmental delay, and 5 of 13 had epilepsy.

Interpretation

An etiology for fetal IPH with or without GMH-IVH is identified in most cases in our cohort and is commonly TTTS, COL4A1/2 variants, or other maternal/fetal comorbidities. Pattern of fetal IPH on MRI is associated with etiology. Cerebral palsy and neurodevelopmental impairment were common in liveborn infants. Genetic studies should be considered in cases of fetal IPH without an otherwise apparent cause. ANN NEUROL 2024;96:1137–1147

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胎儿脑实质内出血成像模式、病因和结果：单中心队列研究

目的：本研究探讨胎儿脑磁共振成像（MRI）损伤模式、病因和胎儿脑实质内出血（IPH）预后之间的关联：本研究探讨了胎儿脑实质内出血（IPH）的胎儿脑磁共振成像（MRI）损伤模式、病因和结局之间的关联：这是一项回顾性单中心队列研究，研究对象为经胎儿磁共振成像诊断的 IPH（1996-2022 年）。两名儿科神经放射科医生对IPH及相关异常进行了分类；两名儿科神经科医生对电子病历进行了审查，以对病因和结果（包括脑瘫、癫痫、发育迟缓和死亡）进行分类：44名患有IPH的胎儿（34名单胎，10名双胎）在妊娠中位24周（四分位间距[IQR] = 22-28周）时接受磁共振成像检查。IPH常见于脑室上（84%）、局灶性（50%）或局灶性伴弥漫性损伤（43%），通常伴有胚芽基质出血（GMH；75%）和/或脑室内出血（IVH；52%）。75%的病例找到了病因，包括双胎输血综合征（TTTS，n = 10）、COL4A1/2变异（n = 8）或其他胎儿/母体疾病（n = 15）。COL4A1/2变异与局灶性IPH和出血性脑室畸形有关，宫内输血与脑室下出血有关。22名胎儿为活产，18名胎儿终止妊娠。在随访时间≥12个月（中位数=7年）的胎儿中，13个中有12个患有脑瘫，13个中有6个发育迟缓，13个中有5个患有癫痫：在我们的队列中，大多数病例的胎儿IPH伴有或不伴有GMH-IVH，其病因通常是TTTS、COL4A1/2变异或其他母体/胎儿合并症。核磁共振成像上胎儿 IPH 的形态与病因有关。活产婴儿中常见脑瘫和神经发育障碍。对于无明显病因的胎儿 IPH 病例，应考虑进行遗传学研究。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.