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In utero DTI of fetal intracranial tumor

Case Study
Dr. Kasprian, Gregor, M.D. The Medical University of Vienna • Austria

Patient history

After sonographic suspicion of a large fetal intracranial hemorrhage, a fetal MR imaging examinations was planned at 27 gestational weeks (GW).

MR examination

The fetal MR examination was performed in supine position using a SENSE cardiac coil with 5 coil elements. After acquisition of a SSFP survey scan, a dedicated fetal neuroimaging examination was planned including multiplanar, orthogonal T2-weighted sequences. In addition an axial diffusion tensor sequence with 16 diffusion gradient encoding directions, b-values of 0s/mm² and 700s/mm² and a reconstructed voxel size of 0.94x0.94x3mm was acquired within 1 minute and 50 seconds. Using the Philips Intera 1.5T postprocessing workspace, the DTI sequence was geometrically coregistered with a T2-weighted sequence. After anatomical definition of multiple ROIs, deterministic tractography was performed using defined cutoff values (FA 0.15, maximum angle change 27°).

Images


The figures show the 3D tractography results with a coregistered T2-weighted sequence. The bilateral sensorimotor tracts (indicated in green) are severely displaced by the intracranial mass. The corpus callosum (blue) appears deformed, due to the extreme midline shift. The corticospinal pathways (green) are projected onto a 2D T2-weighted image at the level of the fetal brainstem.

Diagnosis

Fetal giant intracranial tumor.

Clinical impact of DTI

 

DTI and tractography depict the intact but displaced morphology of the fetal sensorimotor pathways. This case of a giant intracranial tumor illustrates the potential of these techniques to visualize the connectivity of the fetal brain and offer insights into brain structures, which cannot be obtained by conventional fetal MR sequences alone. Knowledge about the integrity of sensorimotor tracts may be of clinical value and may help to predict potential neurological sequelae of any prenatal CNS pathology.

Related reading



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Jan 25, 2012

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Case Study
Intera 1.5T
Body, Brain, DTI, Fetal, Neuro, Pregnant, Women's health
 

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