Analysis of MRI brain biometrics in fetuses monitored for intra uterine growth restriction and their prognostic value: Results of a prospective multicenter study

Eric Xu; Jean-Marie Jouannic; Marianne Alison; Pierre-Yves Ancel; Stéphanie Friszer; Jessica Rousseau; Lucie Guilbaud; Catherine Adamsbaum; François Goffinet; Eléonore Blondiaux

doi:10.1016/j.ejogrb.2024.04.043

Analysis of MRI brain biometrics in fetuses monitored for intra uterine growth restriction and their prognostic value: Results of a prospective multicenter study

Eur J Obstet Gynecol Reprod Biol. 2024 Apr 30:298:91-97. doi: 10.1016/j.ejogrb.2024.04.043. Online ahead of print.

Affiliations

¹ Service de Radiologie Pédiatrique, Hôpital Armand Trousseau, GRC IMAGES, Médecine Sorbonne Université, APHP, Paris, France.
² Service de Médecine Fœtale, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.
³ Service de Radiologie Pédiatrique, Hôpital Robert Debré, APHP, Université Paris Diderot, Paris France.
⁴ Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France; Unité de recherche clinique, CIC-Mère enfant, AP-HP, FHU PREMA, Hôpital Cochin, F-75014 Paris, France.
⁵ Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France.
⁶ Service de Radiopédiatrie, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France.
⁷ Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France; Maternité Port Royal, Hôpital Cochin, APHP, DHU Risques et Grossesse, Université Paris Descartes, Paris, France.
⁸ Service de Radiologie Pédiatrique, Hôpital Armand Trousseau, GRC IMAGES, Médecine Sorbonne Université, APHP, Paris, France. Electronic address: eleonore.blondiaux@aphp.fr.

PMID: 38735121
DOI: 10.1016/j.ejogrb.2024.04.043

Abstract

Objective: Show a prognostic value of brain changes in fetuses with intra uterine growth restriction (IUGR) on early neonatal outcome.

Study design: We prospectively recruited pregnant women whose fetuses presented fetal weight < 5th centile. A brain MRI was performed between 28 and 32 weeks of gestation (WG). Several brain biometrics were measured (as fronto-occipital diameter (FOD) and transverse cerebellar diameter (TCD)). Neonatal prognosis was evaluated according to a composite criterion.

Results: Of the 78 patients included, 62 had a fetal brain MRI. The mean centile value of FOD was lower in the unfavorable outcome group (n = 9) compared to the favorable outcome group (n = 53) (24.5 ± 16.8 vs. 8.6 ± 13.2, p = 0.004). The ROC curve for predicting risk of unfavorable neonatal outcome based on FOD presented an area under the curve of 0.81 (95 % CI, [0.63---0.99]) and a threshold determined at the 3rd centile was associated with sensitivity of 0.78 and a specificity of 0.89. In multivariate analysis, a FOD less than the 3rd centile was significantly associated with an unfavorable neonatal risk. There also was a reduction in TCD (25.5 ± 21.5 vs. 10.4 ± 10.4, p = 0.03) in the unfavorable neonatal outcome group.

Conclusion: We found an association between a reduction in FOD and TCD in fetal MRIs conducted between 28 and 32 WG in fetuses monitored for IUGR with an unfavorable neonatal outcome. Our results suggest that these biometric changes could constitute markers of poor neonatal prognosis.

Keywords: Fetal growth restriction; Fronto-occipital diameter; MRI; Neonatal prognosis; Transverse cerebellar diameter.