| PART I MRI evaluation for temporal lobe morphological changes in fetuses with isolated left lateral ventriculomegaly and its language function prognosis analysisBackgroundThe development of sulcus and gyrus in fetuses with ventriculomegaly has been proved to be abnormal,which is mainly presented delayed development of sulcus near the lateral ventricle,such as parieto occipital sulcu and calcarine sulcu.However,it is unclear whether the in the temporal lobe sulcus present abnormal,as well as the language prognosis of VM fetuses.Anatomical and functional abnormalities of the temporal lobe can lead to language disorders,hearing disorders,epilepsy,autism,and other neuropsychiatric disorders.And VM is often found in imaging examinations of patients with these diseases.Postnatal follow-up studies have shown that VM fetuses may have adverse outcomes such as language disorders and autism.In conclusion,VM,language disorder,temporal lobe development are closely related.Based on this,a scientific hypothesis is proposed: temporal lobe development of VM fetuses is abnormal,prenatal MRI indicators are related to their language prognosis.There are structural and functional asymmetries in the temporal lobe of normal fetuses.In order to avoid confusion caused by laterality,this study only included fetuses with isolated left ventriculomegaly(ILVM).Based on prenatal imaging markers,this study explored the impact of ventriculomegaly on their language prognosis,providing scientific basis for clinical prenatal consultation,intrauterine management,and early differential prognosis.MethodsPatients with ILVM diagnosed by fetal brain MRI were prospectively enrolled.According to the gestational age,the matched cases without abnormal fetal brain MRI scan were selected as the control group(1:1).The sulcus of bilateral temporal lobes were measured on the coronal view of Half-fourier acquisition single-shot turbo spinecho(HASTE)sequence.They include Heschl’s sulcus(HS),Superior temporal sulcus(STS),Inferior temporal sulcus(ITS),Occipitotemporal sulcus(OTS),Collateral sulcus,(CS).Coronal and axial images of HASTE sequence were used to observe the morphology of the hippocampus in the two groups,and the proportion of hippocampal malrotation was compared between the two groups.Both groups were followed up for neurodevelopment using the Gessel scale after birth to obtain the prognosis of language function,and a score less than 85 was defined as poor language prognosis.SPSS software was used for statistical analysis.The measurement data conforming to normal distribution were expressed as mean ± standard deviation,and the measurement data not conforming to normal distribution were expressed as median(interquartile range).Independent sample t test or Mann-Whitney U test was used to compare the measurement data between the two groups,chi-square test was used to compare the classification data between the two groups,Pearson or Spearman correlation analysis was used to analyze the correlation between variables,and p < 0.05 was statistically significant.ResultsThere were 27 cases in the ILVM group and the control group,respectively.The average gestational age was 30.78 ±2.17 week.There was no significant difference in the width of right lateral ventricle,maternal age and birth sex between the two groups.The left accessory sulcus in the ILVM group was larger than the control group(103.28 °±29.25 °vs82.31 °±34.63 °,p=0.02).There was no significant difference in the angle of the right accessory sulcus and bilateral superior temporal sulcus,inferior temporal sulcus,occipital temporal sulcus and transverse temporal gyrus sulcus.The proportion of left hippocampal malrotation in the ILVM group was significantly higher than the control group(77.8% vs 3.7%,p < 0.001).There were significant differences in overall prognosis,language,social behavior and fine motor prognosis between the two groups(p <0.001,p<0.001,p=0.035,p=0.039,p=0.024).The development of ILVM group was lower than that of control group(p <0.001).Shallow CS and rotation of the hippocampus in ILVM fetus were not significantly related to its language prognosis(r = 0.019,r = 0.113).ConclusionsThe morphological development of temporal lobe in ILVM fetuses is abnormal,mainly manifested as the shallower Angle of the left CS and the increased proportion of left hippocampal malrotation.Compared with the control group,the overall prognosis is poor,and the risk of poor prognosis of language function and social behavior function is increased.In fetuses with ILVM,the Angle of the left CS and the malrotation of the hippocampus are not related to the language prognosis.PART II MRI evaluation for temporal lobe white matter volume changes in fetuses with isolated left lateral ventriculomegaly and its language function prognosis analysisBackgroundFetal VM has been shown to have abnormal brain volume,including the total supratentorial brain volume and the gray and white matter volumes of the occipital lobe,frontal lobe and cingulate gyrus.However,it is still unclear whether there are abnormal volumes of the temporal lobe and each temporal gyrus.White matter volume is the main component of gyrus.Studies have found that the changes of temporal white matter volume and fiber tracts in fetus and infancy are related to language function.Based on the first part of the study on temporal lobe morphological abnormalities,a scientific hypothesis was proposed that the white matter volume of each temporal gyrus in ILVM fetuses was abnormal,which was related to the language prognosis.MethodsThe data with good image quality in the first part of the study were selected as the case group,and no motion artifacts were required,which could meet the requirement of layer-by-layer manual segmentation of temporal white matter.With gestational age as the matching condition,the cases without abnormal fetal head MRI were matched 1:1 as the control group.The ITK-SNAP software was used to manually delineate and segment the white matter of each gyrus in the left temporal lobe of the two groups,and the absolute volume of white matter in each gyrus was calculated.The relative volume of white matter in each gyrus was obtained by dividing the white matter volume of each gyrus by the white matter volume of each gyrus.The prognostic evaluation criteria and statistical analysis methods were the same as those in Part I.ResultsThis part of the study included 15 cases in the ILVM group and 15 cases in the control group,a mean gestational age of 30 weeks.The absolute and relative volumes of the left parahippocampal gyrus in the ILVM group were significantly smaller than those in the control group(p=0.020,p=0.012),and the volumes of the left transverse temporal gyrus and white matter of the temporal pole were larger than the control group(p=0.030,p=0.005,p=0.045,p=0.040).There were no statistical differences in the absolute and relative volumes of the left superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus and sinohypothalamic gyrus,and the total white matter volume of each temporal lobe gyrus between the two groups.There were significant differences in overall prognosis,language prognosis,and gross motor prognosis between the two groups,with an increased risk of poor prognosis in the ILVM group(p=0.005,p=0.035,p=0.021).absolute and relative volumes of the left parahippocampal gyrus in the ILVM group were moderately negatively correlated with their language prognosis(r=-0.557,p=0.031,r=-0.542,p=0.037)ConclusionsThe volume of temporal lobe white matter is abnormal in ILVM fetuses,mainly manifested as decreased absolute and relative volumes of left PHG and temporal pole white matter,and increased absolute and relative volumes of left HG white matter.Compared with the control group,the overall prognosis is poor,and the risk of poor language function prognosis is increased.The absolute and relative volumes of white matter in the left PHG are moderately negatively correlated with the language outcome in fetuses with ILVM. |
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