title: Brain Injury in Neonates with Complex Congenital Heart Disease: What Is the Predictive Value of MRI in the Fetal Period?
abstract: 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.
authors.affiliation: From the Advanced Pediatric Brain Imaging Research Laboratory (M.B.-R., C.L.) Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., C.L.) Fetal and Transitional Medicine (M.B.-R., A.d.P., C.L.).
authors.forename: M
authors.identifier: 0000-0003-0641-0054
authors.initials: M
authors.lastname: Brossard-Racine
authors.affiliation: Fetal and Transitional Medicine (M.B.-R., A.d.P., C.L.).
authors.forename: A
authors.identifier: 0000-0003-3144-8791
authors.initials: A
authors.lastname: du Plessis
authors.affiliation: Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., C.L.).
authors.forename: G
authors.identifier: 0000-0002-1999-336X
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Divisions of Radiology (R.R.).
authors.forename: R
authors.identifier: 0000-0001-5741-3867
authors.initials: R
authors.lastname: Robertson
authors.affiliation: Division of Cardiology (M.D.), Children's National Health System, Washington DC.
authors.forename: M
authors.identifier: 0000-0002-0942-5481
authors.initials: M
authors.lastname: Donofrio
authors.affiliation: Cardiology (W.T.), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.
authors.forename: W
authors.identifier: 0000-0002-8422-2158
authors.initials: W
authors.lastname: Tworetzky
authors.affiliation: From the Advanced Pediatric Brain Imaging Research Laboratory (M.B.-R., C.L.) Division of Diagnostic Imaging and Radiology (M.B.-R., G.V., C.L.) Fetal and Transitional Medicine (M.B.-R., A.d.P., C.L.) climpero@childrensnational.org.
authors.forename: C
authors.identifier: 0000-0003-1735-0069
authors.initials: C
authors.lastname: Limperopoulos
mesh_terms: D001921:Brain / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D005333:Fetus; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012680:Sensitivity and Specificity