Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis: insights from a multicentre study

Giorgio Conte, Luca Caschera, Cecilia Parazzini, Claudia Cinnante, Giana Izzo, Giacomo Talenti, Mariasavina Severino, Francesca Ormitti, Giovanni Palumbo, Lorenzo Pinelli, Amanda Antonelli, Lucia Manganaro, Simona Boito, Andrea Rossi, Fabio Triulzi, Andrea Righini

Research output: Contribution to journalArticle

Abstract

Objectives: We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV). Methods: This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated). Results: Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7%). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21% (95% CI, 60.4–96.6%), specificity of 80.8% (95% CI, 60.6–93.4%), positive predictive value of 76% (95% CI, 58.7–87.8%), and negative predictive value of 87.5% (95% CI, 70.9–95.2%). Conclusions: MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases. Key Points: • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the “cerebellar tail sign” has a sensitivity of 84.21% (95% CI, 60.4–96.6%) and specificity of 80.8% (95% CI, 60.6–93.4%) in predicting the persistence of the vermian rotation at imaging follow-up.

Original languageEnglish
JournalEuropean Radiology
DOIs
Publication statusAccepted/In press - Jan 1 2020

Fingerprint

Multicenter Studies
Magnetic Resonance Imaging
Brain Stem
Pregnancy
Cisterna Magna
Fetus
Posterior Cranial Fossa
Cerebellar Vermis
Cerebellum
Observational Studies

Keywords

  • Brain
  • Cerebellar vermis
  • Foetus
  • Magnetic resonance imaging
  • Posterior cranial fossa

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis : insights from a multicentre study. / Conte, Giorgio; Caschera, Luca; Parazzini, Cecilia; Cinnante, Claudia; Izzo, Giana; Talenti, Giacomo; Severino, Mariasavina; Ormitti, Francesca; Palumbo, Giovanni; Pinelli, Lorenzo; Antonelli, Amanda; Manganaro, Lucia; Boito, Simona; Rossi, Andrea; Triulzi, Fabio; Righini, Andrea.

In: European Radiology, 01.01.2020.

Research output: Contribution to journalArticle

@article{4197dde60aba4ef2b54c088b6e4f3810,
title = "Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis: insights from a multicentre study",
abstract = "Objectives: We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV). Methods: This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated). Results: Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7{\%}). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21{\%} (95{\%} CI, 60.4–96.6{\%}), specificity of 80.8{\%} (95{\%} CI, 60.6–93.4{\%}), positive predictive value of 76{\%} (95{\%} CI, 58.7–87.8{\%}), and negative predictive value of 87.5{\%} (95{\%} CI, 70.9–95.2{\%}). Conclusions: MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases. Key Points: • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the “cerebellar tail sign” has a sensitivity of 84.21{\%} (95{\%} CI, 60.4–96.6{\%}) and specificity of 80.8{\%} (95{\%} CI, 60.6–93.4{\%}) in predicting the persistence of the vermian rotation at imaging follow-up.",
keywords = "Brain, Cerebellar vermis, Foetus, Magnetic resonance imaging, Posterior cranial fossa",
author = "Giorgio Conte and Luca Caschera and Cecilia Parazzini and Claudia Cinnante and Giana Izzo and Giacomo Talenti and Mariasavina Severino and Francesca Ormitti and Giovanni Palumbo and Lorenzo Pinelli and Amanda Antonelli and Lucia Manganaro and Simona Boito and Andrea Rossi and Fabio Triulzi and Andrea Righini",
year = "2020",
month = "1",
day = "1",
doi = "10.1007/s00330-019-06538-5",
language = "English",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis

T2 - insights from a multicentre study

AU - Conte, Giorgio

AU - Caschera, Luca

AU - Parazzini, Cecilia

AU - Cinnante, Claudia

AU - Izzo, Giana

AU - Talenti, Giacomo

AU - Severino, Mariasavina

AU - Ormitti, Francesca

AU - Palumbo, Giovanni

AU - Pinelli, Lorenzo

AU - Antonelli, Amanda

AU - Manganaro, Lucia

AU - Boito, Simona

AU - Rossi, Andrea

AU - Triulzi, Fabio

AU - Righini, Andrea

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objectives: We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV). Methods: This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated). Results: Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7%). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21% (95% CI, 60.4–96.6%), specificity of 80.8% (95% CI, 60.6–93.4%), positive predictive value of 76% (95% CI, 58.7–87.8%), and negative predictive value of 87.5% (95% CI, 70.9–95.2%). Conclusions: MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases. Key Points: • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the “cerebellar tail sign” has a sensitivity of 84.21% (95% CI, 60.4–96.6%) and specificity of 80.8% (95% CI, 60.6–93.4%) in predicting the persistence of the vermian rotation at imaging follow-up.

AB - Objectives: We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV). Methods: This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated). Results: Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7%). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21% (95% CI, 60.4–96.6%), specificity of 80.8% (95% CI, 60.6–93.4%), positive predictive value of 76% (95% CI, 58.7–87.8%), and negative predictive value of 87.5% (95% CI, 70.9–95.2%). Conclusions: MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases. Key Points: • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the “cerebellar tail sign” has a sensitivity of 84.21% (95% CI, 60.4–96.6%) and specificity of 80.8% (95% CI, 60.6–93.4%) in predicting the persistence of the vermian rotation at imaging follow-up.

KW - Brain

KW - Cerebellar vermis

KW - Foetus

KW - Magnetic resonance imaging

KW - Posterior cranial fossa

UR - http://www.scopus.com/inward/record.url?scp=85077288954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077288954&partnerID=8YFLogxK

U2 - 10.1007/s00330-019-06538-5

DO - 10.1007/s00330-019-06538-5

M3 - Article

AN - SCOPUS:85077288954

JO - European Radiology

JF - European Radiology

SN - 0938-7994

ER -