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Obstetrics and Gynegology2024№4
The role of magnetic resonance...

The role of magnetic resonance imaging and ultrasound diagnosis of fetal growth restriction in combination with pathological changes in fetal brain

DOI
https://dx.doi.org/10.18565/aig.2023.55

Kulabukhova P.V., Bychenko V.G., Shmakov R.G.

1) Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky, Moscow, Russia

Background: Fetal growth restriction (FGR) is a common complication of pregnancy and, in severe cases, leads to increased perinatal mortality, neonatal morbidity, and poor prognosis for life expectancy in patients with congenital malformations of the central nervous system and hypoxic-ischemic changes in the brain. Early detection of brain injury in IUGR enables to predict short-term and long-term outcomes for the development of the central nervous system, that currently remains a serious issue.
Objective: The aim of the study was to assess the role of ultrasound and MRI in diagnosis of FGR in combination with pathological changes in fetal brain.
Materials and methods: The retrospective study included 24 patients with suspected FGR. The mean age of patients (Me; Q1–Q3) was 33 (25–41) years, the average pregnancy length was 27.5 (20–35) weeks. The patients underwent simultaneous diagnostic US and MRI of the fetuses in the second and third trimester of pregnancy to assess fetal head circumference using percentile values of nomograms, and identify comorbidity, including the changes in fetal brain.
Results: No false positive results were found. MRI data and US imaging data were absolutely similar in nomograms for measurement of fetal brain volume using percentile method in 24 fetuses (100%) with FGR. Among them, FGR in combination with congenital diaphragmatic hernia was diagnosed in 3 fetuses (12.5%), and spina bifida in 1 fetus (4.2%). Comparison of two imaging techniques showed that false-negative results of ultrasound detection of malformation of the cortical plate and assessment of sulcation of the fetal brain were found in 3 fetuses (12.5%) versus 7 fetuses (29.2%) using MRI. Also, ultrasound imaging in diagnosing isolated unilateral cerebellar hypoplasia, showed false negative results in 2 fetuses (8.3%) versus false negative MRIs in 5 fetuses (20.9%).
Conclusion: The study showed that diagnostic ultrasound and MRI are comparable techniques in assessing biometry of the fetal brain using centile nomograms. However, MRI helps to perform more careful assessment of the concomitant pathology of the fetal brain. 

Authors' contriburions: Kulabukhova P.V. – the concept and design of the study, material collection and processing, analysis of the obtained data, writing the text of the article; Bychenko V.G. – the concept and design of the article, editing the text of the article; approval of the final variant of manuscript; Shmakov R.G. – the concept and design of the article, editing the text of the article, approval of the final variant of manuscript.  All authors have read and approved the final version of the article before publication and agreed to be responsible for all aspects of the study and ensure that they have considered and solved all issues related to the accuracy and academic integrity of all parts of the study.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted within the support of the State Assignment of the Ministry of Health of the Russian Federation [State Registration number 121040600408-4].
Ethical Approval: The study was approved by the local Ethics Committee of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data and associated images.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Kulabukhova P.V., Bychenko V.G., Shmakov R.G. The role of magnetic resonance imaging and 
ultrasound diagnosis of fetal growth restriction in combination with pathological changes in fetal brain
Akusherstvo i Gynecologia/Obstetrics and Gynecology. 2024; (4): 51-58 (in Russian)
https://dx.doi.org/10.18565/aig.2023.55

Keywords

fetal growth restriction (FGR)
the central nervous system (CNS)
brain malformations
hypoxic-ischemic brain injury
centile nomograms
Full text (in Russian)

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Received 20.12.2023

Accepted 04.04.2024

About the Authors

Polina V. Kulabukhova, Radiologist, Radiology Department, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, +7(916)618-88-97, kulpola@mail.ru, https://orcid.org/0000-0002-0363-3669
Vladimir G. Bychenko, PhD, Radiologist, Head of the Department of Radiation Diagnostics, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Oparina str., 4, v_bychenko@oparina4.ru, https://orcid.org/0000-0002-1459-4124
Roman G. Shmakov, Dr. Med. Sci., Professor of the RAS, Non-staff Chief Specialist in Obstetrics at Ministry of Health of Russia; Director of GBUZ MO MONIIAG, 101000, Russia, Moscow, Pokrovka str., 22А, https://orcid.org/0000-0002-2206-1002
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