Intracranial hemorrhage and additional anomalies detected on prenatal magnetic resonance imaging: A large, retrospective study in two tertiary medical institutions

Abstract

Objectives: To clarify the prenatal magnetic resonance (MR) imaging characteristics of fetal intracranial haemorrhages (ICHs) in a large cohort and correlate them with birth outcomes.

Methods: We retrospectively reviewed MR images of fetuses with ICH on screening ultrasound (US) on picture archiving communication system (PACS) servers within a nearly ten-year period from two medical tertiary centres. The indications, main abnormal findings and coexistent anomalies were recorded by two experienced radiologists with census readings.

Results: We recruited 126 cases (average gestational week, 28.0 ± 5.0 weeks) with prenatal MR imaging, including 116 singleton pregnancies and 10 monochromic twin pregnancies. Predominant coexistent anomalies were ventriculomegaly (35.7 %), holoprosencephaly or porencephaly (13.4 %) and enlarged posterior fossa/or posterior fossa cyst (8.7 %) in the lesion-based evaluation. The number of haemorrhagic lesions and the occurrence of the detected complications did not show a correlation with the size of the haematoma. The mass effect of ICH was more commonly observed in the fetus with large for gestational age (GA) than that with small for GA.

Conclusions: Prenatal MR imaging could better show ICH morphology and associated abnormal findings. As a complementary tool of US, MR imaging could help with prenatal counselling and treatment selection after birth.

Keywords: Fetal malformation; Fetus; Intracranial hemorrhages; Magnetic resonance imaging.

Fig. 1

The flowchart that illustrates the process of patient inclusion in the study.

Fig. 2

The frequency of fetal ICH and their average sizes across gestation in the present included samples.

Fig. 3

A 28-GW singleton pregnancy. The GM-IVH components (arrow) were detected on T1WI (A), T2WI (B) and DWI (C). On the upper plane, a patchy high signal (arrowhead) indicating early cerebral infarction in the frontal-parietal lobe was also displayed on DWI (D), which did not show any abnormal signal on the corresponding T2WI (E).

Fig. 4

A 25-GW singleton pregnancy. The GM-IVH mainly seen on one side of the lateral ventricle with both obvious enlargement of the ipsilateral posterior horn of the lateral ventricle and thinness of the adjacent grey matter in the occipital lobe on T1WI (A), T2WI (B) and DWI (C). The porencephaly was also seen in the occipital lobe (arrowhead). The TOP procedure was performed.

Fig. 5

A 22-GW singleton pregnancy. A diffuse iso-hyperintensity signal was seen in both cerebral hemispheres with diffuse loss of grey–white differentiation and effacement of the sulci on HASTE (A–B). The occipital lobe, thalamus and brainstem (arrowhead) mostly displayed isohypointensity signals on T2WI (B), slightly high signals on T1WI (C) and extremely restricted signals on DWI (D). All of these signs indicated postbleeding changes with diffuse cerebral oedema in the brain parenchyma. The TOP procedure was performed.

Fig. 6

A 37-GW singleton pregnancy. A giant GM-IVH haematoma had shifted the midline a little on T2WI (A) and T1WI (A). The volume of the involved cerebral parenchyma decreased more than on the normal side (arrowhead). This character can be seen more clearly on DWI images (C). This case also had TCS syndrome (not shown). After birth, a V-P shunting procedure at 2 months old was performed. The main symptoms included muscle weakness with normal defecation function.

Fig. 7

A 25-GW monochorionic twin pregnancy. One fetus had haemorrhagic components in the lateral ventricle on FIESTA images (A). GM-IVH displayed an extremely low signal on both T2WI (B) and DWI (C). Note that the ascites and hydrops fetalis are shown (arrow). On seven-week follow-up MR (D–F), this fetus grew as well as the normal fetus according to the estimated growth trend (D), and both the ascites and hemorrhage components largely resolved (E–F). The patient had a caesarean delivery at 35 GW (birth weight: 2220 g/1890 g, 1-min Apgar score: 9/9).

Fig. 8

A 25-GW TTTS stage 1 fetus in monochorionic twin pregnancy. One fetus had bleeding components (A) in the lateral ventricle on FIESTA images. Note that pleural effusion and ascites are shown (arrow). The band of the low signal in the adjacent parenchyma was also detected on the SS FSE image (B) and DWI (C). On three-week follow-up MR (D–F), both pleural effusion and ascites continued to grow (D). The hemorrhage components in the ventricle seemed to be resolved to some extent (E/F). However, subsequent US did not detect a fetal heartbeat and confirmed intrauterine fetal death. The other fetus (not shown) was delivered at 31 GW (birth weight: 1205 g, 1 min Apgar score: 9).