Association of gestational age with MRI-based biometrics of brain development in fetuses

Abstract

Background: Reported date of last menstrual period and ultrasonography measurements are the most commonly used methods for determining gestational age in antenatal life. However, the mother cannot always determine the last menstrual period with certainty, and ultrasonography measurements are accurate only in the first trimester. We aimed to assess the ability of various biometric measurements on magnetic resonance imaging (MRI) in determining the accurate gestational age of an individual fetus in the second half of gestation.

Methods: We used MRI to scan a total of 637 fetuses ranging in age from 22 to 40 gestational weeks. We evaluated 9 standard fetal 2D biometric parameters, and regression models were fitted to assess normal fetal brain development. A stepwise linear regression model was constructed to predict gestational age, and measurement accuracy was determined in a held-out, unseen test sample (n = 49).

Results: A second-order polynomial regression model was found to be the best descriptor of biometric measures including brain bi-parietal diameter, head circumference, and fronto-occipital diameter in relation to normal fetal growth. Normal fetuses showed divergent growth patterns for the cerebrum and cerebellum, where the cerebrum undergoes rapid growth in the second trimester, while the cerebellum undergoes rapid growth in the third trimester. Moreover, a linear model based on biometrics of brain bi-parietal diameter, length of the corpus callosum, vermis area, transverse cerebellar diameter, and cerebellar area accurately predicted gestational age in the second and third trimesters (cross-validation R² = 0.822, p < 0.001).

Conclusions: These results support the use of MRI biometry charts to improve MRI evaluation of fetal growth and suggest that MRI biometry measurements offer a potential estimation model of fetal gestational age in the second half of gestation, which is vital to any assessment of pregnancy, fetal development, and neonatal care.

Keywords: Fetal brain maturity; Gestational age; Magnetic resonance imaging.

Fig. 1

Illustration of magnetic resonance imaging slice showing measurements of: a brain biparietal diameter; b head circumference; c transverse cerebellar diameter; d cerebellar area; e fronto-occipital diameter; f length of the corpus callosum; g corpus callosum area; h vermis height; i vermis area

Fig. 2

Best fit models for the relationship between the 9 chosen biometric measurements and gestational age in the discovery dataset. a BPD, the brain biparietal diameter; b HC, head circumference; c TCD, transverse cerebellar diameter; d CA, cerebellar area; e FOD, fronto-occipital length; f LCC, length of the corpus callosum; g CCA, corpus callosum area; h VH, vermis height; i VA, vermis area

Fig. 3

Predicted GA was significantly correlated with measured GA in the held-out validation dataset using the built model based on biometric measurements, including brain biparietal diameter, length of the corpus callosum, vermis area, cerebellar area, and transverse cerebellar diameter. GA gestational age