title: Fetal MRI insular cortical morphometry and its association with neurobehavior in late-onset small-for-gestational-age fetuses.
abstract: OBJECTIVE
  To evaluate insular cortical morphometry assessed by magnetic resonance imaging (MRI) in late-onset small-for-gestational-age (SGA) fetuses compared with controls, and its association with neurobehavioral outcomes.
  
  
  METHODS
  MRI was performed in 65 late-onset SGA and 59 normally-grown fetuses at 37 weeks' gestation. T2-weighted half Fourier acquisition single-shot turbo spin echo (HASTE) anatomical and diffusion-weighted images were acquired. Insular cortical thickness, volume and fractional anisotropy values were assessed, and asymmetry indices were constructed. At 42 weeks of age, a Neonatal Behavioral Assessment Scale (NBAS) test was performed on the SGA neonates.
  
  
  RESULTS
  Late-onset SGA fetuses had significantly thinner insular cortical thickness and smaller insular cortical volume than did controls. SGA fetuses also presented a more pronounced left asymmetry in the posterior cortex and significantly lower fractional anisotropy values in the left insula. Insular measurements in the SGA group were significantly correlated with neurobehavior as assessed by NBAS scores.
  
  
  CONCLUSIONS
  Insular cortical morphometry was significantly different in late-onset SGA fetuses and correlated with poorer neurobehavioral performance. These data support the impact of growth restriction on brain development and the potential value of cortical assessment as a biomarker of neurodevelopment in at-risk fetuses.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), and University of Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Egaña-Ugrinovic
authors.forename: M
authors.initials: M
authors.lastname: Sanz-Cortes
authors.forename: F
authors.initials: F
authors.lastname: Figueras
authors.forename: C
authors.initials: C
authors.lastname: Couve-Perez
authors.forename: E
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000196:embryology / Q000473:pathology*; D002560:Cerebrovascular Circulation; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000473:pathology / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011247:Pregnancy; D011446:Prospective Studies; D011597:Psychomotor Performance
keywords: IUGR; SGA; fetal brain imaging; insula; insular cortex; neurobehavior