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In utero DTI of lobar holoprosencephaly

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

Patient history

After sonographic suspicion of a major fetal brain malformation, a young pregnant women was referred to fetal MR imaging at 33 gestational weeks.

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 different commissural and projection pathways in a case of holoprosencephaly at 33 gestational weeks. The tractography results are projected onto a coregistered axial T2 TSE sequence. Please note the prominent anterior commissure (pink), the partially developed hippocampal commissure (blue), the corticospinal tracts (green) and frontopontine trajectories (yellow).

Diagnosis

Lobar holoprosencephaly.

Clinical impact of DTI

DTI and tractography offered new insights into the connectivity of the malformed fetal brain in utero and in vivo, which will further help to characterize these pathologies in a more specific way.

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Jan 25, 2012

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

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