The Normal and Pathological Fetal Brain: Ultrasonographic Features

316 Pages·2015·36.57 MB·English

by  Jean-Philippe Bault

The Normal
and Pathological
Fetal Brain
Ultrasonographic
Features
Jean-Philippe Bault
Laurence Loeuillet
123
The Normal and Pathological Fetal Brain

Jean-Philippe Bault (cid:129) Laurence Loeuillet
The Normal and
Pathological Fetal Brain
Ultrasonographic Features
Jean-Philippe Bault Laurence Loeuillet
Centre d'échographie Ambroise Paré Hôpital Cochin
Les Mureaux Paris
France France
ISBN 978-3-319-19970-2 ISBN 978-3-319-19971-9 (eBook)
DOI 10.1007/978-3-319-19971-9
Library of Congress Control Number: 2015947148
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
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Foreword
Nothing could interest me more than this new A tlas of normal and pathological
fetal brain ultrasound images prepared by Jean-Philippe Bault and Laurence
Loeuillet with assistance from Guillaume Benoist. Its high-resolution images pro-
vide not only a “map” of the developing brain but also close-ups of its various
“territories.”
In my younger days as a pediatrician and embryologist, focused on the problems
of developmental anomalies, the fetal brain was t erra incognita ! Prenatal brain
imaging was in its infancy, and neuropathological examinations were conducted
only rarely, for research purposes only.
With guidance from Claudie Larroche, who was educated in neuropathology at
Harvard, and inspired by her comprehensive knowledge of premature infants, we
endeavored to undertake a systematic analysis of the fetal brain. Thousands of
examinations later, we collated the results of this pioneering work on the dynamics
of brain development and the signifi cance of its malformations – including a special
focus on anatomical pathology-ultrasonic correlations – in what today have become
a number of classic books: T he Pathology of the Developing Human Nervous
System, S Duckett (ed) Lea & Febiger, 1994; Textbook of fetal and perinatal pathol-
ogy , Vol. 2, Wigglesworth JS and Singer DB (eds), Blackwell Scientifi c Publications,
Oxford 1995. Central Nervous System Malformations. Potter’s Pathology of the
Fetus and Infant , Vol 2, Gilbert-Barness E (ed), Mosby, St Louis 1997, 2009.
B ecause the fetal brain changes over time, its evaluation requires a comprehen-
sive knowledge of brain development, which begins in the middle of the 3rd week
of gestation and continues well after birth. The cerebral hemispheres and the cere-
bellum emerge very rapidly at the end of the 4th week, while their synaptic connec-
tions are slowly forged. The imaging of this origami-like art as practiced by nature
requires patience and pertinence, akin to the special qualities of the great photogra-
pher. The authors have met this challenge with talent! They have captured the
dynamics of brain development every 2 weeks from the 8th to the 34th week of
gestation. Each ultrasound image shown is accompanied by carefully selected
pathology specimens and histology preparations, and this superimposition provides
a clear picture of the architecture of the normal brain and of deformations in its
shape and structure. Generous practical advice is given on how to acquire high-
quality images and avoid pitfalls and, along with the precious guidelines provided,
make this atlas immensely useful for those interested in the developing brain,
v
vi Foreword
particularly trainee sonographers and those who already have some experience and
are seeking to perfect their technique.
In vivo observation of the fetal brain is an ancient dream that has come true! The
increasingly early acquisition of ever more high-resolution images has made ultra-
sonography the tool of choice for the diagnosis of brain anomalies.
After devoting the fi rst part of my life to a gross and microscopic analysis of the
developing brain, I should now switch to evaluating its image, which is far more
elegant.
Férechté Encha-Razavi, MD
President of the S ociété Française de Foetopathologie , 2005–2009
Unité de Génétique Embryo-Foetale, Necker-Enfants-Malades, Paris
Contents
Part I The Normal Brain
1 Brief Review of Embryology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Ultrasound Images of the Normal Brain . . . . . . . . . . . . . . . . . . . . . . . . 7
From 8 to 10 GW: Early Morphological Examination . . . . . . . . . . . . . . . . 7
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
From 11 to 13 GW: Early Morphological Examination . . . . . . . . . . . . . . . 9
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
From 14 to 16 GW: Morphological Examination . . . . . . . . . . . . . . . . . . . . 13
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
From 18 to 20 GW: Morphological Examination . . . . . . . . . . . . . . . . . . . . 19
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
From 21 to 23 GW: Morphological Examination . . . . . . . . . . . . . . . . . . . . 27
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Midline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
From 24 to 26 GW: Morphological Examination . . . . . . . . . . . . . . . . . . . . 41
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
From 28 to 30 GW: Morphological Examination . . . . . . . . . . . . . . . . . . . . 48
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
From 32 to 34 GW: Morphological Examination . . . . . . . . . . . . . . . . . . . . 57
Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
3 Detailled Study of Certain Brain Structures . . . . . . . . . . . . . . . . . . . . . 63
Corpus Callosum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Anatomy of the Corpus Callosum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Development of the Corpus Callosum . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Ultrasonographic Features of the Corpus Callosum . . . . . . . . . . . . . . . . 65
vii
viii Contents
Lateral Ventricles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Lateral Ventricles: Biometrics and Images . . . . . . . . . . . . . . . . . . . . . . . 73
Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Sylvian Fissure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Sylvian Fissure and Study of the Gyration . . . . . . . . . . . . . . . . . . . . . . . 78
Sylvian Fissure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Other Anatomical Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Changes in the Cerebellum Over Time . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Normal Ultrasound Images of the Posterior Fossa . . . . . . . . . . . . . . . . . 97
Cerebral Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Pericallosal Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Arteries of Central Gray Nuclei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Willis’ Circle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Venous Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Sutures and Fontanels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
4 Brain Biometrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Biparietal Diameter (BPD) and Head Circumference (HC) . . . . . . . . . . . . 123
Atrial Diameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Cisterna Magna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Corpus Callosum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Cerebellum and Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Transverse Diameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Cerebellar Vermis and Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Interorbital Distance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
5 Tips and Traps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Choosing the Right Route of Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Use of the Transvaginal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Moving the Fetus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Use of 3D Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Part II The Pathological Brain
6 First-Trimester Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Acrania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Holoprosencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Opacities in Skull Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Brain Anomalies Related to Neural Tube Closure Anomalies . . . . . . . . . . 148
Anomalies of the Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
7 Second- and Third-Trimester Pathologies . . . . . . . . . . . . . . . . . . . . . . . 153
Skull Contour Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Acrania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Opacities in Skull Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Other Examples of Skull Deformations Related to Craniosynostosis . . 161
Contents ix
Midline Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Holoprosencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Corpus Callosum Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Ventriculomegaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Defi nitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Etiologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Anomalies of the Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Anomalies of the Gyration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Ultrasound Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Intracranial Expansive Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Tuberous Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Corpus Callosum Lipomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Arachnoid Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Hematomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Cysts of the Germinal Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Hemimegalencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Infectious Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Cytomegalovirus (CMV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Toxoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Hemorrhagic and Ischemic Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Hemorrhagic Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Ischemic Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Vascular Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Vein of Galen Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Thrombosis of the Dural Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Other Vascular Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Biometric Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Microcephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Major Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Gyration Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Three Groups: Lissencephaly Type I (LIS I), II (LIS II),
and III (LIS III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Heterotopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Polymicrogyria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Part III Biometric Tables
8 Biometric Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Biparietal Diameter (Snidjers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311