Abstract:
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Purpose: To evaluate the gyrus and sulcus formation (GSF), an indicator of brain maturation, in fetuses with intrauterine growth restriction (IUGR) using magnetic resonance (MR) imaging, and comparing it with appropriate growth for gestational age (AGA) fetuses.
Methods and Materials: The 175 infants were enrolled for the study and divided into three groups based on their body weight at delivery; small for gestational age (SGA) infants following a neurologically normal course (Group N, n = 37), SGA infants with an abnormal outcome (Group A, n = 15), and appropriate for gestational age infants (Group AGA, n=123). The study was being performed at our institution under the guidelines of the Medical Ethics Committee. In all cases, ultrasonography was performed within a few days before or after the MR images and compared with the normal fetal growth curve. IUGR fetuses were defined as estimated body weight less than 10th percentile on this growth curve. SGA infants were diagnosed when neonatal birth weight was below the 10th percentile and AGA infants were diagnosed when neonatal birth weight was between 10th and 90th percentile on the standard birth weight curve . Fetal MR images were obtained from 28 to 39 weeks of gestation in Groups N and A and during 18 to 39 weeks of gestation in Group AGA. Based on the 8-stages of development for GSF established by Abe et al., two perinatologists staged MR images among the three groups with no information concerning the fetuses and analyzed their neurological development in relation to gestational age.
Results: In all cases of Group AGA, fetal body weight was estimated by ultrasonography between the 10th and 90th percentile on the fetal growth curve. All cases of Groups N and A were below 10th percentile on the growth curve. In Group AGA, images were classified into stages 1 to 8 under this classification (P<.001). In Group N, images were classified into stages 3 to 8(P<.001). The gestational age of the cases determined for each stage did not differ significantly into stages 3 to 8, concerning the development of GSF between Groups N and AGA, despite differences in fetal estimated body weights. In Group A, 10 fetuses were unclassifiable because of brain malformations, and the remaining 5 showed delayed GSF when compared to those in Group AGA.
Conclusion: Evaluation of fetal GSF using MR images during the third trimester may be useful for predicting neurological outcome in IUGR fetuses.
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Abe MD, S,
Assessment of Cortical Gyrus and Sulcus Formation Using Magnetic Resonance Images in Fetuses with Intrauterine Growth Restriction. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3101407.html
