MR Imaging Features Of Fetal Intracranial Hemorrhage And Follow-up

Objective:Fetal intracranial hemorrhage(ICH)is a rare stroke in prenatal life.Prognosis of ICH fetus was reported to have a relation with hemorrhagic severity in some papers.However,those documents were confined by limited case number and majority of them were based on ultrasonic inspection.The characteristics of fetal ICH,such as spatiotemporal distribution,bleeding origin,association between hemorrhage and coexistent intracranial anomalies,have been poorly understood.Prenatal diagnosis of fetal ICH mainly depends on ultrasonography and magnetic resonance imaging(MRI)and the latter has been proved to have superiority in the diagnosis of fetal brain anomalies.Based on a relative large case series,this paper investigate the characteristics of fetal ICH by MRI,thus providing reference for antenatal diagnosis,counseling and further clinical management.Methods:From January 2011 to October 2018,medical records of fetuses with ICH detected by MRI in our institution were successively collected to analyze general characteristics of the condition(such as onset period,hemorrhagic location,coexistent intracranial anomalies and so on).Depending on hemorrhagic location,all cases were divided into periventricular hemorrhage-intraventricular hemorrhage(PVH-IVH)group and Non-PVH-IVH group to make a between-group contrast with respect to baseline and MRI appearance.Besides,Logistic regression was used to explore the association between hemorrhagic properties and coexistent intracranial anomalies.Pregnancy and postnatal outcome were also followed up.Results:(1)120 cases were included for analysis.Among them,bleeding onset between late second trimester and early third trimester was common.Subtentorial hemorrhage was detected earlier than supratentorial hemorrhage in most situation.Periventricular and intraventricular area above tentorium of cerebellum was the common hemorrhagic location(79.17%).Fetal ICH was detected in subacute stage in 80.00%of cases while presented as single hemorrhagic lesion in 58.33%of cases.Median of maximal transverse section of hemorrhage that can be measured was 238mm~2.The most common coexistent anomaly of fetal ICH was ventriculomegaly(50.83%).Apart from that,40.00%of fetal ICH coexisted with other intracranial abnormalities.(2)While the proportion of ventriculomegaly was higher in PVH-IVH group than in Non-PVH-IVH group(60.00%vs 16.00%,P<0.001),other intracranial anomalies distributed more in the latter group than in the former group(34.74%vs 60.00%,P=0.022).PVH-IVH or not was associated with the occurrence of ventriculomegaly(OR=7.875,95%CI[2.505,24.755])and other intracranial anomalies(OR=0.355,95%CI[0.114,0.887]).(3)Among nine cases of livebirth with prenatal ICH,there were seven cases of PVH-IVH and two cases of Non-PVH-IVH.In two cases infant with prenatal grade 1 and grade 2 IVH respectively presented with growth backward and in another case newborn with grade 4 IVH died in a week after birth.Two cases of non-PVH-IVH infants did not reveal obvious abnormality during follow up period.Conclusions:Onset period of fetal ICH and its appearance on prenatal MRI display prominent general characteristics.Additional intracranial anomalies are not uncommon and its distribution associate with hemorrhagic location.PVH-IVH origins from germinal matrix in most situation and its prognosis can be roughly predicted by IVH grading.The possibility of vascular malformation origin should be aware in Non-PVH-IVH and further research is needed to explore its prognosis.