title: Pseudofeeders on fetal magnetic resonance imaging predict outcome in vein of Galen malformations.
abstract: OBJECTIVE
  Although vein of Galen aneurysmal malformations (VGAM) can be diagnosed in the fetus, the challenge is predicting the occurrence of its 2 major complications: cardiopulmonary failure and encephalomalacia. This study attempts to determine which fetal brain magnetic resonance imaging (MRI) features might be used to predict the development of these complications at birth.
  
  
  METHODS
  The cohort was extracted from a prospectively assembled database of VGAM cases managed at a single referral center from 2000 to 2014. Of 251 patients with VGAM, 83 cases were diagnosed prenatally. A total of 58 patient charts having at least 1 fetal MRI were reviewed. Patterns of brain parenchyma, hydrocephalus, and so-called middle cerebral artery (MCA) "pseudofeeders" were correlated with cardiac failure, pulmonary hypertension, and encephalomalacia at birth.
  
  
  RESULTS
  The median gestational age at fetal MRI was 32.3 weeks of pregnancy (±2.3). Nine fetuses (16%) had encephalomalacia. Thirty-one fetuses (53%) had MCA pseudofeeders. Twenty-six fetuses (45%) had prenatal hydrocephalus. Prenatal MCA pseudofeeders were a risk factor for encephalomalacia at birth (p = 0.001). MCA pseudofeeders and hydrocephalus were risk factors for both severe cardiac failure (p = 0.01 and p = 0.04, respectively) and severe pulmonary hypertension (p = 0.014 and p = 0.05, respectively) at birth.
  
  
  CONCLUSIONS
  MCA pseudofeeders are the result of impaired cerebral blood flow, and are thus a risk factor for further brain melting at birth. Their presence can be used for informing parents and as an aid in management decisions. Ann Neurol 2017;81:278-286.
authors.affiliation: Department of Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre.|Department of Neuroradiology, CHUV, Lausanne University Hospital, Lausanne.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Saliou
authors.affiliation: Department of Pediatric Radiology, Bicêtre Hospital, Le Kremlin-Bicêtre.
authors.forename: Irène
authors.initials: I
authors.lastname: Vraka
authors.affiliation: Center for Research in Epidemiology and Population Health, National Institute of Health and Medical Research, Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Teglas
authors.affiliation: Department of Obstetric Gynecology and Antenatal Diagnostics, Bicêtre Hospital, Le Kremlin-Bicêtre.
authors.forename: Marie-Victoire
authors.initials: MV
authors.lastname: Senat
authors.affiliation: Pediatric Resuscitation, Bicêtre Hospital, Le Kremlin-Bicêtre.
authors.forename: Philippe
authors.initials: P
authors.lastname: Durand
authors.affiliation: Department of Obstetric Gynecology and Antenatal Diagnostics, Bicêtre Hospital, Le Kremlin-Bicêtre.
authors.forename: Claire
authors.initials: C
authors.lastname: Colmant
authors.affiliation: Department of Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre.
authors.forename: Augustin
authors.initials: A
authors.lastname: Ozanne
authors.affiliation: Fetal Pathology Unit, Antoine Béclère Hospital, Clamart.
authors.forename: Jelena
authors.initials: J
authors.lastname: Martinovic
authors.affiliation: Pediatric Resuscitation, Bicêtre Hospital, Le Kremlin-Bicêtre.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tissiere
authors.affiliation: Department of Neuroradiology, CHUV, Lausanne University Hospital, Lausanne.|Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, Paris, France.|Laboratory of Information Processing and Communication, National Center for Scientific Research, Télécom ParisTech, University of Paris-Saclay, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Adamsbaum
mesh_terms: D000328:Adult; D004678:Encephalomalacia / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging*; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis; D012307:Risk Factors; D054080:Vein of Galen Malformations / Q000150:complications / Q000175:diagnosis*