Prenatal MR imaging detection of deep medullary vein involvement in fetal brain damage

Abstract

Looking for anomalies distributed in DMV territory, we reviewed 78 fetal MR imaging examinations performed at our institution reporting unequivocal cerebral clastic lesions. We selected 3 cases, all of which had severe cardiocirculatory failure and parenchymal frontoparietal WM hemorrhagic lesions with characteristic fan-shaped distribution. Brain edema and other signs of venous hypertension were also evident. Our data suggest that in utero transient venous hypertension may be responsible for the onset of atypical frontal-located PVL.

Fig 1.

Patient 1. A−C, Axial, coronal, and sagittal single-shot fast spin-echo T2-weighted images show diffuse brain swelling, with size reduction of cortical and ventricular spaces and slight diffuse hyperintensity of the WM. Small linear fan-shaped hypointense lesions are also detected in the frontal WM (black arrows). Subcutaneous edema is also seen (asterisks). D, Sagittal single-shot fast spin-echo T2-weighted image confirms soft-tissue thickening (asterisk) and shows vein of Galen and straight sinus enlargement (black arrow). E, Frontal periventricular lesions (white arrows) are hypointense on a T2* b = 0 image, suggesting the presence of microhemorrhage. F, ADC map at the level of the centrum semiovale with regions of interest positioned in the perilesional WM.

Fig 2.

Patient 2. A, Coronal single-shot fast spin-echo T2-weighted image demonstrates a wedge-shaped pattern of periventricular lesions (arrows); head subcutaneous tissue thickening is also evident (asterisk). B, Coronal T1-weighted image shows hyperintensity of periventricular lesions (arrows). C, Sagittal single-shot fast spin-echo T2-weighted image confirms subcutaneous edema (asterisk) and better demonstrates the anterior distribution of the lesions (arrows). D, ADC map with regions of interest positioned in the subcortical WM.

Fig 3.

Patient 3. A, Axial single-shot fast spin-echo T2-weighted image at the level of the basal ganglia shows hypointense wedge-shaped lesions anterior to the left frontal horn and small linear lesions converging on the ventricle angle bilaterally (arrows), in addition to diffuse brain swelling with size reduction of cortical spaces. B, Axial single-shot fast spin-echo T2-weighted image at the level of centrum semiovale shows diffuse brain edema and periventricular frontoparietal hypointense radial-oriented lesions (arrows). C, Median sagittal single-shot fast spin-echo T2-weighted image shows slight hyperintensity and swelling of the corpus callosum and cerebellar vermis (black arrows). D, ADC map at the level of the centrum semiovale with regions of interest positioned in the perilesional WM.