1. Fetal MRI Round Table Fetal brain injury Andrea Righini Radiology and Neuroradiology dept., Children’s Hospital V. Buzzi, Milan, Italy.

2. NO fetal MRI NEEDED clastic lesions T2 T1

3. Neuro-sonography Fetal MRI acute hypoxia-ischemia inflammation smaller brainstem cerebellar clastic lesions Brain clastic changes: peaks of excellence of fetal MRI parenchymal water increase (edema) clastic caused cortical malformations

4. Ann Neurol 2002. Baldoli C, Righini A, Parazzini C, Scotti G, Triulzi F. 32w female with vein of Galen malformation acute ischemia Increased sensitivity T2 DWI ADC

5. condition 1 condition 2 acute ischemia Increased sensitivity monochorionic TWIN pregnancy

6. T2w ss-FSE ADC T2w ss-FSE ADC = 0.40 44 - 4 hours after co-twin death acute ischemia Increased sensitivity Righini A et al.. Ultrasound Obstet Gynecol. 2007 14 days follow-up

7. 24w twins TTTS, 7 dd laser coag. of plac. anastom, MCA veloc. increase, severe anemia donor donor recepient acute ischemia Increased sensitivity

8. ss-FSE T2 donor ADC = 0.48 acute ischemia Increased sensitivity cytotoxic vs interstitial-vasogenic edema brain swelling

9. lo 0. 70 low ADC 19w monochorionic-twins - TTTS - donor dead, recepient survivor (48 - 3 hours). lembo normal ADC 1.80 T2w ss-FSE DWI ADC Acute ADC changes in dead twin brain: model of immature brain acute ischemia (1) surviv or dead “research”

10. time after death (hours) ADC  m 2 /msec) mean normal ADC value > 80% ADC decrease head compression and dehydration effect? Acute ADC changes in dead twin brain: model of immature brain acute ischemia (2)

11. ADC = 0.7 20w, bilateral 15 mm ventriculomegaly, mild macrocrania. 15 mm acute-subacute leukomalacya (1) Increased sensitivity acqueductal stenosis ?

12. Muscle and GUT inflammatory infiltration signs Signs of ependymal fragmentation and white matter lesion acute-subacute leukomalacya (2)

13. Parenchymal edema detection and characterization

14. 27 w, severe IUGR, anhydramnios, thorax hypoplasia, dead 2 days after MRI ADC increased = 2.3  m 2 /msec ss-FSE-T2 ADC FSE-T1 BRAIN WATER INCREASE - GLOBAL interstitial white matter edema, venous congestion? CSF spaces reduction sss gv

15. ss-FSE T2w 31w fetus, heart failure, severe hydrops. deep medullay veins BRAIN WATER INCREASE - GLOBAL interstitial white matter edema, venous congestion? Doneda C., Righini A et al.. AJNR in press

16. 20 SG 27 SG II trim. CMV newborn BRAIN WATER INCREASE - FOCAL Doneda C., Parazzini C. Righini A. et Al.. Radiology. 2010. WM edema and rarefaction isolated

17. Increased specificity in (clastic nature) ventriculomegaly cases possible prognosis and counselling implications

18. borderline ventriculomegaly: clastic aetiology? 12 mm 33w, unilateral ventriculomegaly increased specificity IVH-I and II “PROGNOSIS PROBABLY GOOD” neonatal MRI

19. borderline ventriculomegaly: clastic aetiology? increased specificity Girard N., et Al.. Eur J Radiol. 2006 normal control creatine SPECTROSCOPY: creatine increase, sign of glyosis 33w, unilateral ventriculomegaly “PROGNOSIS PROBABLY NOT SO GOOD”

20. Clastic caused cortical malformations (early detection)

21. T1 Pathology confirmed: CLASTIC AETIOLOGY 23w, early gestation vaginal bleedings, borderline ventriculomegaly “saw-tooth” pathologyT2 Focal cortical rim anomalies: clastic aetiology? increased sensitivity and specificity necrosis large csf

22. Smaller brainstem- cerebellar clastic lesions

23. 26w., bilateral ventriculomegaly, brain hyperecogeneity, absent limbs movements (intrauterine tetraplegia?). nasim brainstem clastic lesion increased sensitivity sinechiae

24. Unsolved issues - Statistics on MRI sensitivity and specificity are substantially lacking. - Prognosis of minor (isolated) findings: i.e. temporal lobe T2-hyperintensity in CMV cases, small periventricular hemorrhagic and necrotic lesions, …..etc. - Detection of lesions due to neurometabolic diseases: only very few single case reports.

25. THANKS Cecilia Parazzini Chiara Doneda Filippo Arrigoni Andreana Ardemagni Mariangela Rustico Fabio Triulzi