RPS 1711 - Foetal and paediatric neuroimaging: unveiling the youthful brain

Author Block: P. Kienast, M. Stuempflen, J. Tischer, A. Taymourtash, G. Langs, D. Prayer, G. Kasprian; Vienna/AT
Purpose: Around 10-20% of women in Europe consume alcohol during pregnancy, leading to negative neurodevelopmental outcomes such as fetal alcohol spectrum disorders (FASD). Although the harmful impact of alcohol on neuronal development during pregnancy is well-established, studies on its effects during the prenatal phase remain limited.
This study evaluates prenatal changes in fetal gyrification resulting from maternal alcohol consumption using automated surface measurements from fetal MRI data.
Methods or Background: This study involved 500 fetal MRI examinations where mothers were asked about their alcohol consumption habits using tools like PRAMS and TACE. The brains were denoised, motion-corrected, and segmented for 3D reconstruction. Gyrification indices were calculated, and asymmetry of the cerebral cortex was quantified. Neurotypical alcohol-affected cases were compared with healthy control cases.
Results or Findings: The study finally included 22 alcohol-exposed fetuses (mean gestational-age [GW] 27.61 ± 3.94 weeks) and 22 non-alcohol-exposed control fetuses (mean GW 27.57 ± 3.94 weeks), matched in a 1:1 ratio. Of the mothers in the alcohol-exposed group, 17 consumed only small amounts of alcohol (<14 grams per week). The typical asymmetry observed in the temporal lobes of the fetal brain was significantly diminished (p=0.48, 95% CI -2.24 to -0.01) in fetuses exposed to alcohol.
Conclusion: Alcohol consumption during pregnancy impacts the development of the fetal brain, with alterations observable in temporal brain asymmetry through fetal MRI. These findings align with studies linking prenatal brain asymmetry to language development in childhood, which is frequently impaired in children diagnosed with FASD . These structural changes are found even in cases of small alcohol consumption.
Limitations: A potential limitation of the study is the relatively small sample size, which may limit the ability to detect more subtle effects of low-level alcohol exposure on fetal brain development.
Funding for this study: The sponsor is the Medical University of Vienna.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the local IRB.

Author Block: G. Abaci, G. Biechele, S. Schläger, F. Obereisenbuchner, K. Förster, A. Flemmer, J. Ricke, A. Hilgendorff, S. Stöcklein; Munich/DE
Purpose: The aim of our study was to compare intracranial volume (ICV), brain volume (BV), and the volumes of the inner cerebral fluid (iCSF) and outer cerebral fluid spaces (oCSF) of preterm brorn infants with age-matched fetuses and to assess the impact of postnatal therapies including ventilation.
Methods or Background: Preterm born infants and fetuses were matched for gestational age (± 4 days), ranging from 32 to 39 weeks' gestation (GW). 26 preterm infants and 26 age-matched fetuses without reported brain pathology underwent MRI. Anatomical T2-weighted brain images were analyzed by manual segmentation.
Results or Findings: Preterm infants were characterized by reduced ICV (p= 0.005), BV (p= 0.007) and oCSF volumes (p= 0.074) when compared to age-matched fetuses undergoing prenatal imaging, whereas ICV-corrected BV (BV/ICV, p= 0.385), oCSF (oCSF/ICV, p= 0.568) and total CSF (total CSF/ICV, p= 0.274) did not differ significantly between the two groups.
When considering postnatal therapies, more days of noninvasive positive pressure ventilation were associated with higher corrected values for oCSF (oCSF/ICV, p= 0.0392), and total CSF (total CSF/ICV, p= 0.0282) as well as lower corrected values for BV (BV/ICV, p= 0.0282).
Conclusion: Preterm infants showed reduced ICV, BV and oCSF volumes compared to age-matched fetuses in utero. CSF volumes in preterm infants were impacted by postnatal therapy, potentially indiciating that intrathoracic pressure might influence venous return and CSF reabsorption into the venous system. In conclusion, brain and CSF volumes are impacted by prematurity and associated therapeutic strategies. Potential mechanisms underlying these efffects and their implications for ex utero versus in utero brain development need to be further investigated.
Limitations: Retrospective design
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Lmu 207-33

Author Block: I. P. Voicu, C. D'Orazio, E. Piccirilli, F. Dotta, P. Toma, G. S. Colafati; Rome/IT
Purpose: Differentiating pediatric posterior fossa (PF) tumors medulloblastoma (MB), ependymoma (EP) and pilocytic astrocytoma (PA) remains relevant, because of prognostic implications. Diffusion kurtosis imaging (DKI) has not been investigated for pediatric PF tumors. Whole-tumor based (VOI) segmentations may improve repeatability compared to conventional region-of-interest (ROI) approaches. Our purpose was to compare repeatability between ROI and VOI measurements and assess DKI accuracy in discriminating among pediatric PF tumors with machine learning (ML) techniques.
Methods or Background: We retrospectively analyzed 34 children (M, F, mean age 7.48 years) with PF tumors who underwent preoperative MRI on a 3 Tesla magnet, including DKI. For each patient, two neuroradiologists segmented the whole solid tumor, the ROI of area of maximum tumor diameter and a small 5 mm ROI. The automated analysis pipeline included inter-observer variability (coefficient of variation- COV), and machine learning (ML) analyses. We estimated DKI accuracy with MANOVA analysis. We applied SMOTE to balance the dataset and performed a Random Forest (RF) machine learning classification analysis based on all DKI metrics from the SMOTE dataset ( 70/30 for the training and testing cohort).
Results or Findings: Tumor histology included medulloblastoma (15), pilocytic astrocytoma (14) and ependymoma (5). VOI-based measurements presented lower variability than ROI-based measurements. DKI-derived metrics discriminated accurately between PF tumors. SMOTE generated a balanced dataset with 45 instances (34 original and 11 synthetic, 10 EP and 1 PA). ML analysis yielded accuracy of 0.928, correctly predicting all but one lesion in the testing set.
Conclusion: VOI-based measurements presented improved repeatability compared to ROI-based measurements. ML techniques based on DKI-derived metrics are useful for discrimination of pediatric PF tumors.
Limitations: The study was approved by Institutional Review Board (IRB) of Bambino Gesù Children’s Hos-pital (RAP-2024-0001). T
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by Institutional Review Board (IRB) of Bambino Gesù Children’s Hos-pital (RAP-2024-0001).

Author Block: B. Yildirim, R. J. Serger, S. Zensen, H. Styczen, M. Schüßler, M. Forsting, C. Deuschl, M. Opitz, D. Bos; Essen/DE
Purpose: The standard modality for the diagnosis of ventriculoperitoneal (VP) shunt failure is the radiographic shunt series (RSS). However, ultra-low dose computed tomography (ULD-CT) offers lower radiation exposure compared to RSS. The aim of this study was to compare the radiation doses of RSS and ULD-CT on photon-counting CT (PCCT) in the diagnosis of mechanical shunt failure in human phantom models and to demonstrate the diagnostic performance of ULD-CT.
Methods or Background: VP shunts with different mechanical complications were placed on human phantom models corresponding to ages of 1, 5, 10 and 30 years. RSS and ULD-CT on PCCT scans based on topograms with tube currents ranging from 10 and 55 mAs (Sn100 kV) were performed on each phantom. Effective doses of RSS in pediatric phantoms were estimated by using the conversion factors of Seidenbusch (2006, 2008 and 2009). Effective doses of ULD-CT were estimated according to ICRP 103.
Results or Findings: ULD-CT demonstrated lower effective doses compared to RSS for phantoms representing ages of 5, 10 and 30 years, while successfully detecting mechanical VP shunt complications in all cases. However, higher effective doses were assessed for ULD-CT scans of the 1-year phantom in comparison to RSS. The effective doses for radiographic RSS and ULD-CT (using the lowest dose by utilizing 10 mAs topograms), respectively, were as follows: 1 year: 0.056 vs. 0.104 mSv; 5 year: 0.186 vs. 0.092 mSv; 10 year: 0.240 vs. 0.082 mSv; 30 year: 0.641 vs. 0.050 mSv.
Conclusion: ULD-CT is a potentially superior alternative to radiographic shunt series for the detection of mechanical VP shunt complications in patients aged 5 years and above, which is particularly relevant in children due to reduction of the radiation risk.
Limitations: Phantom study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Ethics committee approval was not required.

Author Block: A. D. Piersson¹, E. K. Effah², B. Brusah³, S. T. Quartei⁴, H. Mumuni⁵, A. Akanchimayoro³, L. Jones⁶, K. Dzefi-Tettey⁴, M. R. Asamani⁷; ¹York/UK, ²Obuasi/GH, ³Cape Coast/GH, ⁴Accra/GH, ⁵Tamale/GH, ⁶Virginia, VA/US, ⁷Michigan, MI/US
Purpose: In this study, we assessed the following – 3rd trimester estimated foetal weight (EFW), prevalence of multimorbidity across body systems, and a 6-year trend in birth outcomes in a mining community, exposed to Galamsey, a term used to define illegal small-scale and artisanal gold mining.
Methods or Background: We compared 3rd trimester estimated foetal weight on ultrasound systems between pregnant women (≥ 18 years old) with singleton pregnancies living in a mining (n = 181) and non-mining communities (n = 260). Then, we compared health problems across body systems in another two groups (mining, n = 507; non-mining, n = 127). Further, we analyzed a 6-year trend in birth outcomes in the mining community located in Obuasi, Ashanti Region in Ghana.
Results or Findings: Overall, women living in the mining area showed significantly higher 3rd-trimester EFW than those living in a non-mining community (mining: 2.95+/-0.66 kg; non-mining: 2.72+/-0.04 kg; p = 0.0002). Women living in the mining community showed a higher prevalence of morbidities in 8 body regions/conditions than those living in the non-mining community. A sub-analysis of the prevalence of the 8 body regions/conditions among women in the two communities showed significant difference (p = 0.016). A 6-year trend in birth outcomes showed increasing rates of stillbirth varying between 1.69% and 2.90%, a relatively low record of congenital anomalies, and a relatively high record of newborn complications.
Conclusion: Our preliminary findings suggest a potential link between maternal exposure to mining-related environmental factors and adverse perinatal outcomes, including increased foetal growth, a higher prevalence of maternal morbidities, rising stillbirth rates, and increased newborn complications. Further study is warranted to investigate the underlying mechanisms and long-term health implications for both mother and child.
Limitations: Our study did not provide quantitative maternal blood or environmental measurements of heavy metal exposures.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical Clearance - UCCIRB/EXT/2022/30