title: Fetal MRI detects early alterations of brain development in Tetralogy of Fallot.
abstract: OBJECTIVE
  Prenatal imaging has identified alterations of brain growth in fetuses with congenital heart disease. However, little is known about the timing of altered brain development and its occurrence in specific congenital heart disease subgroups. This magnetic resonance imaging study aimed to identify early (median, 25 gestational weeks [GW]) changes in fetal total brain (TBV), gray matter (GMV), and subcortical brain (SBV) volumes in Tetralogy of Fallot (TOF) cases in utero.
  
  
  METHODS
  Fetal magnetic resonance imaging (1.5 Tesla) was performed in 24 fetuses who were diagnosed with TOF and 24 normal age-matched control fetuses (20-34 GW). TBV, GMV, SBV, intracranial cavity, cerebellar, ventricular, and external cerebrospinal fluid volumes were quantified by manual segmentation based on coronal T2-weighted sequences. Mixed model analyses of variance and t-tests were conducted to compare cases and control fetuses.
  
  
  RESULTS
  TBV was significantly lower (P < .001) in early (<25 GW) and late TOF cases. Both GMV (P = .003) and SBV (P = .001) were affected. The GMV-to-SBV ratio declined in fetuses with TOF (P = .026). Compared with normal fetuses, ventricular volume was increased (P = .0048). External cerebrospinal fluid was enlarged in relation to head size (P < .001). Intracranial cavity volume (P = .314) and cerebellar volume (P = .074) were not significantly reduced in fetuses with TOF.
  
  
  CONCLUSIONS
  TOF is associated with smaller volumes of gray and white matter and enlarged cerebrospinal fluid spaces. These changes are present at ≤25 GW and indicate altered fetal brain growth in this pathophysiologic entity during early stages of human brain development.
authors.affiliation: Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schellen
authors.affiliation: Computational Image Analysis and Radiology Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Schwartz
authors.initials: S
authors.lastname: Ernst
authors.affiliation: Center for Anatomy and Cell Biology, Department of Systematic Anatomy, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerlinde M
authors.initials: GM
authors.lastname: Gruber
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mlczoch
authors.affiliation: Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: Center for Anatomy and Cell Biology, Department of Systematic Anatomy, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Brugger
authors.affiliation: Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ulm
authors.affiliation: Computational Image Analysis and Radiology Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Langs
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Salzer-Muhar
authors.affiliation: Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Prayer
authors.affiliation: Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. Electronic address: gregor.kasprian@meduniwien.ac.at.
authors.forename: Gregor
authors.initials: G
authors.lastname: Kasprian
mesh_terms: D001921:Brain / Q000196:embryology* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015233:Models, Statistical; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000196:embryology* / Q000473:pathology
keywords: Tetralogy of Fallot; brain; development; fetal; imaging; magnetic resonance imaging