title: Prevalence and spectrum of in utero structural brain abnormalities in fetuses with complex congenital heart disease.
abstract: OBJECTIVE
  Brain injury is a major complication in neonates with complex congenital heart disease. Preliminary evidence suggests that fetuses with congenital heart disease are at greater risk for brain abnormalities. However, the nature and frequency of these brain abnormalities detected by conventional fetal MR imaging has not been examined prospectively. Our primary objective was to determine the prevalence and spectrum of brain abnormalities detected on conventional clinical MR imaging in fetuses with complex congenital heart disease and, second, to compare the congenital heart disease cohort with a control group of fetuses from healthy pregnancies.
  
  
  METHODS
  We prospectively recruited pregnant women with a confirmed fetal congenital heart disease diagnosis and healthy volunteers with normal fetal echocardiogram findings who underwent a fetal MR imaging between 18 and 39 weeks gestational age.
  
  
  RESULTS
  A total of 338 fetuses (194 controls; 144 with congenital heart disease) were studied at a mean gestational age of 30.61 ± 4.67 weeks. Brain abnormalities were present in 23% of the congenital heart disease group compared with 1.5% in the control group (P < .001). The most common abnormalities in the congenital heart disease group were mild unilateral ventriculomegaly in 12/33 (36.4%) and increased extra-axial spaces in 10/33 (30.3%). Subgroup analyses comparing the type and frequency of brain abnormalities based on cardiac physiology did not reveal significant associations, suggesting that the brain abnormalities were not limited to those with the most severe congenital heart disease.
  
  
  CONCLUSIONS
  This is the first large prospective study reporting conventional MR imaging findings in fetuses with congenital heart disease. Our results suggest that brain abnormalities are prevalent but relatively mild antenatally in fetuses with congenital heart disease. The long-term predictive value of these findings awaits further study.
authors.affiliation: From the Advanced Pediatric Brain Imaging Research Laboratory (M.B.-R., I.E.E., D.F., C.L.)Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., D.B., I.E.E., D.F., C.L.)Fetal and Transitional Medicine (M.B.-R., A.d.P., M.D., C.L.).
authors.forename: M
authors.initials: M
authors.lastname: Brossard-Racine
authors.affiliation: Fetal and Transitional Medicine (M.B.-R., A.d.P., M.D., C.L.).
authors.forename: A J
authors.initials: AJ
authors.lastname: du Plessis
authors.affiliation: Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., D.B., I.E.E., D.F., C.L.).
authors.forename: G
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Department of Radiology (R.R.), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.
authors.forename: R
authors.initials: R
authors.lastname: Robertson
authors.affiliation: Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., D.B., I.E.E., D.F., C.L.).
authors.forename: D
authors.initials: D
authors.lastname: Bulas
authors.affiliation: From the Advanced Pediatric Brain Imaging Research Laboratory (M.B.-R., I.E.E., D.F., C.L.)Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., D.B., I.E.E., D.F., C.L.).
authors.forename: I E
authors.initials: IE
authors.lastname: Evangelou
authors.affiliation: Fetal and Transitional Medicine (M.B.-R., A.d.P., M.D., C.L.)Division of Cardiology (M.D.), Children's National Medical Center, Washington DC.
authors.forename: M
authors.initials: M
authors.lastname: Donofrio
authors.affiliation: From the Advanced Pediatric Brain Imaging Research Laboratory (M.B.-R., I.E.E., D.F., C.L.)Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., D.B., I.E.E., D.F., C.L.).
authors.forename: D
authors.initials: D
authors.lastname: Freeman
authors.affiliation: From the Advanced Pediatric Brain Imaging Research Laboratory (M.B.-R., I.E.E., D.F., C.L.)Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., D.B., I.E.E., D.F., C.L.)Fetal and Transitional Medicine (M.B.-R., A.d.P., M.D., C.L.) climpero@childrensnational.org.
authors.forename: C
authors.initials: C
authors.lastname: Limperopoulos
mesh_terms: D000328:Adult; D001921:Brain / Q000002:abnormalities*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000473:pathology*; D005333:Fetus; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies