Cortical formation abnormalities on foetal MR imaging: a proposed classification system trialled on 356 cases from Italian and UK centres

Andrea Righini, Maurilio Genovese, Cecilia Parazzini, Mariasavina Severino, Elisa Scola, Lorenzo Pinelli, Giorgio Conte, Ignazio Derrico, Marco Di Maurizio, Giacomo Talenti, Laura Mandefield, Deborah Jarvis, Giovanni Palumbo, Renzo Guerrini, Andrea Rossi, Fabio Triulzi, Paul D Griffiths

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To formulate a classification system for foetal cortical formation abnormalities (CFAs) based on in utero magnetic resonance (iuMR) appearances and trial it in 356 cases.

METHODS: This retrospective study included all cases of foetal CFA diagnosed between 2000 and 2017 from seven centres in Italy and UK. All of the studies were reviewed by a panel of paediatric neuroradiologists experienced in iuMR with the aid of an algorithm designed to categorise the abnormalities.

RESULTS: Consensus expert review confirmed 356 foetuses with CFA and the first level of classification distinguished bilateral CFA (229/356-64%) from unilateral CFA (127/356-36%) cases with sub-classification of the bilateral cases into asymmetric (65/356-18%) and symmetric (164/356-46%) involvement. There was a statistically significant excess of foetuses with small head size, e.g. 17% of the cohort had a bi-parietal diameter < 3rd centile. There was a small but statistically significant excess of males in the cohort. Further categorisation was made on fine anatomical structure.

CONCLUSIONS: It is often not possible to classify foetal CFA using the principles and nomenclature used in paediatric neuroradiology. We have created a classification system for foetal CFA based on the analysis of 356 cases and believe that this will assist future research designed to correlate ante-natal and post-natal imaging features and understand the clinical sequelae of CFA described in utero.

KEY POINTS: • We describe a morphological classification system of foetal brain cortical formation abnormalities that can be used in clinical practice. • This classification system can be used in future research studies to evaluate the long-term imaging and clinical outcomes of foetal brain cortical formation abnormalities in 17- to 38-week gestational age range. • The practical value of the work is in providing a framework and language to look for imaging clues that may differentiate between different CFA in further studies.

Original languageEnglish
Pages (from-to)5250-5260
Number of pages11
JournalEuropean Radiology
Issue number10
Publication statusPublished - Oct 2020


  • Brain/diagnostic imaging
  • Cohort Studies
  • Female
  • Fetus/diagnostic imaging
  • Gestational Age
  • Humans
  • Italy
  • Magnetic Resonance Imaging/methods
  • Male
  • Nervous System Malformations/classification
  • Pregnancy
  • Prenatal Diagnosis/methods
  • Retrospective Studies
  • United Kingdom


Dive into the research topics of 'Cortical formation abnormalities on foetal MR imaging: a proposed classification system trialled on 356 cases from Italian and UK centres'. Together they form a unique fingerprint.

Cite this