Three-dimensional Sonographic Calculation Of The Volume Of The Intracranial Structures In Fetuses With Congenital Heart Disease And Normal Fetuses

Background:Neurological and developmental dysfunction are among the most common extracardiac complications in children with congenital heart disease (CHD). Increasing evidence indicates that adverse neurodevelopmental outcomes in CHD children are due not only to perioperative insult but to inborn factors as well. Thus, it is important to evaluate neurodevelopmental status of fetuses with CHD.Objectives:To assess the normal fetal frontal lobe and thalamic volume and to evaluate the differences of volume between normal fetuses and CHD fetuses. Likewise, to examine the association between the changes in volume and cerebral blood flow.Methods:Volume of frontal lobe and thalamus were measured using3D ultrasound imaging and Virtual Organ Computer-aided Analysis (VOCAL) in74fetuses with CHD and172normal fetuses, and blood flow in middle cerebral artery (MCA) and umbilical artery (UA), PI and CPR, were obtained. Examine the association between the volume of the intracranial structures and GA, BPD and HC. T-tests were used to evaluate the difference of volume and cerebral blood flow between normal fetuses and CHD fetuses. Examine the association between the changes of volume and cerebral blood flow.Results:Volumes were satisfactorily obtained in241fetus,168(168/172) normal fetus (28.20±4.44week) and73(73/74) fetus with CHD (28.15±4.04week).1. The normal fetal volume of frontal lobe and thalamus were highly correlated with GA, BPD and HC (P<0.001). The best-fit regression equation of volume and GA were:frontal volume=e c7.393-100.037*GA)(R2=0.965, P<0.0001), thalamic volume=e (4.823-111.718*GA)(R2=0.983, p<0.0001).2. During the third trimester (≥30week), frontal and thalamic volume were significantly smaller in CHD fetuses (P<0.001, P<0.05). After adjusting volumes for HC the frontal volume was still significantly smaller in CHD fetus than in normal fetuses (P<0.001).3. MCA-PI and CPR were found to be significantly lower in the CHD group compared with controls (P<0.05, P<0.001). Furthermore, low CPR was significantly associated with decreased frontal lobe and thalamic volume (R=0.618,0.634, P<0.001).Conclusions:The fetal intracranial structures volume measurements using3D-ultrasound had an excellent reliability. CHD fetus show smaller volume of frontal lobe and thalamus. Hemodynamic factors may play an important role in this abnormal development.