Total and Regional Brain Volumes in Fetuses With Congenital Heart Disease

Daniel Cromb; Alena Uus; Milou P M Van Poppel; Johannes K Steinweg; Alexandra F Bonthrone; Alessandra Maggioni; Paul Cawley; Alexia Egloff; Vanessa Kyriakopolous; Jacqueline Matthew; Anthony Price; Kuberan Pushparajah; John Simpson; Reza Razavi; Maria DePrez; David Edwards; Jo Hajnal; Mary Rutherford; David F A Lloyd; Serena J Counsell

doi:10.1002/jmri.29078

Total and Regional Brain Volumes in Fetuses With Congenital Heart Disease

J Magn Reson Imaging. 2023 Oct 17. doi: 10.1002/jmri.29078. Online ahead of print.

Authors

Daniel Cromb¹, Alena Uus^{1

2}, Milou P M Van Poppel^{2

3

4}, Johannes K Steinweg^{2

3

4}, Alexandra F Bonthrone¹, Alessandra Maggioni¹, Paul Cawley^{1

5}, Alexia Egloff¹, Vanessa Kyriakopolous¹, Jacqueline Matthew^{1

2}, Anthony Price^{1

2}, Kuberan Pushparajah^{2

3

4}, John Simpson^{2

3

4}, Reza Razavi², Maria DePrez^{1

2}, David Edwards¹, Jo Hajnal^{1

2}, Mary Rutherford^{1

5}, David F A Lloyd^{1

2

3

4}, Serena J Counsell¹

Affiliations

¹ Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
² Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
³ Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Science, King's College London, London, UK.
⁴ Paediatric and Fetal Cardiology Department, Evelina London Children's Hospital, London, UK.
⁵ MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.

PMID: 37846811
DOI: 10.1002/jmri.29078

Abstract

Background: Congenital heart disease (CHD) is common and is associated with impaired early brain development and neurodevelopmental outcomes, yet the exact mechanisms underlying these associations are unclear.

Purpose: To utilize MRI data from a cohort of fetuses with CHD as well as typically developing fetuses to test the hypothesis that expected cerebral substrate delivery is associated with total and regional fetal brain volumes.

Study type: Retrospective case-control study.

Population: Three hundred eighty fetuses (188 male), comprising 45 healthy controls and 335 with isolated CHD, scanned between 29 and 37 weeks gestation. Fetuses with CHD were assigned into one of four groups based on expected cerebral substrate delivery.

Field strength/sequence: T2-weighted single-shot fast-spin-echo sequences and a balanced steady-state free precession gradient echo sequence were obtained on a 1.5 T scanner.

Assessment: Images were motion-corrected and reconstructed using an automated slice-to-volume registration reconstruction technique, before undergoing segmentation using an automated pipeline and convolutional neural network that had undergone semi-supervised training. Differences in total, regional brain (cortical gray matter, white matter, deep gray matter, cerebellum, and brainstem) and brain:body volumes were compared between groups.

Statistical tests: ANOVA was used to test for differences in brain volumes between groups, after accounting for sex and gestational age at scan. P_FDR -values <0.05 were considered statistically significant.

Results: Total and regional brain volumes were smaller in fetuses where cerebral substrate delivery is reduced. No significant differences were observed in total or regional brain volumes between control fetuses and fetuses with CHD but normal cerebral substrate delivery (all P_FDR > 0.12). Severely reduced cerebral substrate delivery is associated with lower brain:body volume ratios.

Data conclusion: Total and regional brain volumes are smaller in fetuses with CHD where there is a reduction in cerebral substrate delivery, but not in those where cerebral substrate delivery is expected to be normal.

Evidence level: 3 TECHNICAL EFFICACY: Stage 3.

Keywords: MRI; congenital heart disease; fetal brain development.

Abstract

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