Brain Injury in Neonates with Complex Congenital Heart Disease: What Is the Predictive Value of MRI in the Fetal Period?
Brain Injury in Neonates with Complex Congenital Heart Disease: What Is the Predictive Value of MRI in the Fetal Period?
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DOI：
10.3174/ajnr.a4716
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发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Limperopoulos C
中科院分区：
文献类型：
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作者：
Brossard-Racine M;du Plessis A;Vezina G;Robertson R;Donofrio M;Tworetzky W;Limperopoulos C
先天性心脏病新生儿脑损伤是不良神经发育结局的重要预测因素。先天性心脏病的脑发育受损可能有产前起源，但胎儿脑MR成像预测新生儿脑病变的敏感性和特异性目前尚不清楚。本研究旨在探讨常规胎儿磁共振成像对预测复杂先天性心脏病新生儿术前磁共振成像异常的价值。对103例确诊为先天性心脏病的胎儿（平均胎龄31.57 ± 3.86周）进行了MR成像检查，并在出生后心脏手术前重复检查（平均胎龄6.8 ± 12.2天）。每项MR成像研究均由儿科神经放射科医生阅读。17/103例（16%）胎儿的胎儿MR成像和33/103例（32%）新生儿的新生儿MR成像检测到脑异常。只有9/33的研究异常的新生儿的结果之前，胎儿磁共振成像的异常结果。常规胎脑MR成像预测新生儿脑部异常的敏感性和特异性分别为27%和89%。先天性心脏病胎儿宫内磁共振成像检测到的脑异常与出生后术前脑损伤的高风险相关。然而，出生后MR成像中的大部分异常在胎儿MR成像中不存在;这一结果可能是由于常规胎儿MR成像的局限性和胎儿研究后出现的新病变。出生后的大脑磁共振成像研究，需要确认存在的损伤前心内直视手术。
Brain injury in neonates with congenital heart disease is an important predictor of adverse neurodevelopmental outcome. Impaired brain development in congenital heart disease may have a prenatal origin, but the sensitivity and specificity of fetal brain MR imaging for predicting neonatal brain lesions are currently unknown. We sought to determine the value of conventional fetal MR imaging for predicting abnormal findings on neonatal preoperative MR imaging in neonates with complex congenital heart disease. MR imaging studies were performed in 103 fetuses with confirmed congenital heart disease (mean gestational age, 31.57 ± 3.86 weeks) and were repeated postnatally before cardiac surgery (mean age, 6.8 ± 12.2 days). Each MR imaging study was read by a pediatric neuroradiologist. Brain abnormalities were detected in 17/103 (16%) fetuses by fetal MR imaging and in 33/103 (32%) neonates by neonatal MR imaging. Only 9/33 studies with abnormal neonatal findings were preceded by abnormal findings on fetal MR imaging. The sensitivity and specificity of conventional fetal brain MR imaging for predicting neonatal brain abnormalities were 27% and 89%, respectively. Brain abnormalities detected by in utero MR imaging in fetuses with congenital heart disease are associated with higher risk of postnatal preoperative brain injury. However, a substantial proportion of anomalies on postnatal MR imaging were not present on fetal MR imaging; this result is likely due to the limitations of conventional fetal MR imaging and the emergence of new lesions that occurred after the fetal studies. Postnatal brain MR imaging studies are needed to confirm the presence of injury before open heart surgery.