Structural intracranial abnormalities and brain volumes in foetuses with congenital heart disease.

AIM: Emerging data suggest an increased risk of intracranial abnormalities in foetuses with congenital heart disease (CHD). The aim of this study is to assess the prevalence of intracranial abnormalities recognised on in utero magnetic resonance imaging (iuMRI) in foetuses with CHD. We will also assess the potential effect on prognostication and measure the brain volumes.

MATERIALS AND

METHODS

Ninety-four pregnant women carrying foetuses with a CHD were studied. All of the foetuses had no evidence of a structural intracranial abnormality on ultrasonography. The women had routine iuMRI and 3D-volume imaging of the foetal brain. The effect on prognostication of any intracranial abnormality shown on iuMRI was judged by experienced foetal medicine and paediatric cardiology experts.

RESULTS

Intracranial abnormalities were present in 11/94 foetuses (11.7%, 95% CI: 6.7%-19.8%) but it was judged that the results would have had an effect on clinical management in only 1/11 foetuses. Brain volumes of foetuses with CHD were statistically significantly smaller compared with normal foetuses (mean z-score in foetuses with CHD and no intracranial abnormality: -1.07 ± 1.25, P < .001).

CONCLUSION

There is a relatively high rate of intracranial abnormalities detectable on iuMRI in foetuses with CHD but only a small effect on prognostication from detecting the abnormalities. We believe that our work does not support routine iuMRI of the brain in foetuses with CHD. There is, however, strong support for the thesis that foetuses with CHD have smaller brain volume when compared with normal foetuses.