title: Evaluation of Subependymal Gray Matter Heterotopias on Fetal MRI.
abstract: OBJECTIVE
  Subependymal grey matter heterotopias are seen in a high proportion of children with Chiari II malformation and are potentially clinically relevant. However, despite its growing use, there is little in the literature describing its detection on fetal MRI. Our aim was to evaluate the accuracy in diagnosing subependymal gray matter heterotopias in fetuses with spinal dysraphism on fetal MR imaging.
  
  
  METHODS
  This study is a retrospective analysis of 203 fetal MRIs performed at a single institution for spinal dysraphism during a 10-year period. Corresponding obstetric sonography, postnatal imaging, and clinical/operative reports were reviewed.
  
  
  RESULTS
  Of the fetal MRIs reviewed, 95 fetuses were included in our analysis; 23.2% (22/95) were suspected of having subependymal gray matter heterotopias on fetal MR imaging prospectively. However, only 50% (11/22) of these cases were confirmed on postnatal brain MR imaging. On postnatal brain MR imaging, 28.4% (27/95) demonstrated imaging findings consistent with subependymal gray matter heterotopia. Only 40.7% (11/27) of these cases were prospectively diagnosed on fetal MR imaging.
  
  
  CONCLUSIONS
  Fetal MR imaging is limited in its ability to identify subependymal gray matter heterotopias in fetuses with spinal dysraphism. It is believed that this limitation relates to a combination of factors, including artifacts from fetal motion, the very small size of fetal neuroanatomy, differences in imaging techniques, and, possibly, irregularity related to denudation of the ependyma/subependyma in the presence of spinal dysraphism and/or stretching of the germinal matrix in ventriculomegaly.
authors.affiliation: From the Departments of Radiology and Medical Imaging (U.D.N., B.M.K.-F) University of Cincinnati College of Medicine (U.D.N., J.L.P., K.S.B., B.M.K.-F), Cincinnati, Ohio. usha.nagaraj@cchmc.org.
authors.forename: U D
authors.identifier: http://orcid.org/0000-0001-8251-7481
authors.initials: UD
authors.lastname: Nagaraj
authors.affiliation: Pediatric Surgery (J.L.P.) University of Cincinnati College of Medicine (U.D.N., J.L.P., K.S.B., B.M.K.-F), Cincinnati, Ohio.
authors.forename: J L
authors.identifier: http://orcid.org/0000-0002-2272-1381
authors.initials: JL
authors.lastname: Peiro
authors.affiliation: Pediatric Neurosurgery (K.S.B.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio University of Cincinnati College of Medicine (U.D.N., J.L.P., K.S.B., B.M.K.-F), Cincinnati, Ohio.
authors.forename: K S
authors.identifier: http://orcid.org/0000-0002-3806-9930
authors.initials: KS
authors.lastname: Bierbrauer
authors.affiliation: From the Departments of Radiology and Medical Imaging (U.D.N., B.M.K.-F) University of Cincinnati College of Medicine (U.D.N., J.L.P., K.S.B., B.M.K.-F), Cincinnati, Ohio.
authors.forename: B M
authors.identifier: http://orcid.org/0000-0003-3872-9027
authors.initials: BM
authors.lastname: Kline-Fath
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging / Q000473:pathology; D016477:Artifacts; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D004805:Ependyma / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005333:Fetus / Q000000981:diagnostic imaging / Q000473:pathology*; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000000981:diagnostic imaging / Q000473:pathology*; D016216:Ultrasonography, Prenatal