Showing papers by "Elisenda Eixarch published in 2023"
TL;DR: In this paper , the authors describe longitudinal changes of central nervous system anomalies before and after prenatal open spina bifida repair and evaluate their relationship with postnatal neurologic outcomes.
Abstract: Open spina bifida is associated with central nervous system anomalies such as abnormal corpus callosum and heterotopias. However, the impact of prenatal surgery over these structures remains unclear.This study aimed to describe longitudinal changes of central nervous system anomalies before and after prenatal open spina bifida repair and to evaluate their relationship with postnatal neurologic outcomes.Retrospective cohort study of fetuses with open spina bifida who underwent percutaneous fetoscopic repair from January 2009 to August 2020. All women had presurgical and postsurgical fetal magnetic resonance imaging, at an average of 1 week before and 4 weeks after surgery, respectively. We evaluated defect characteristics in the presurgical magnetic resonance images; and fetal head biometry, clivus supraocciput angle, and the presence of structural central nervous system anomalies, such as abnormalities in corpus callosum, heterotopias, ventriculomegaly, and hindbrain herniation, in both presurgical and postsurgical magnetic resonance images. Neurologic assessment was performed using the Pediatric Evaluation of Disability Inventory scale in children who were 12 months or older, covering 3 different sections, namely self-care, mobility, and social and cognitive function.A total of 46 fetuses were evaluated. Presurgery and postsurgery magnetic resonance imaging were performed at a median gestational age of 25.3 and 30.6 weeks, with a median interval of 0.8 weeks before surgery, and 4.0 weeks after surgery. There was a 70% reduction in hindbrain herniation (100% vs 32.6%; P<.001), and a normalization of the clivus supraocciput angle after surgery (55.3 [48.8-61.0] vs 79.9 [75.2-85.4]; P<.001). No significant increase in abnormal corpus callosum (50.0% vs 58.7%; P=.157) or heterotopia (10.8% vs 13.0%; P=.706) was observed. Ventricular dilation was higher after surgery (15.6 [12.7-18.1] vs 18.8 [13.7-22.9] mm; P<.001), with a higher proportion of severe ventricular dilation after surgery (≥15mm) (52.2% vs 67.4%; P=.020). Thirty-four children underwent neurologic assessment, with 50% presenting a global optimal Pediatric Evaluation of Disability Inventory result and 100% presenting a normal social and cognitive function. Children with optimal global Pediatric Evaluation of Disability Inventory presented a lower rate of presurgical anomalies in corpus callosum and severe ventriculomegaly. When analyzed as independent variables to global Pediatric Evaluation of Disability Inventory scale, the presence of abnormal corpus callosum and severe ventriculomegaly showed an odds ratio of 27.7 (P=.025; 95% confidence interval, 1.53-500.71) for a suboptimal result.Prenatal open spina bifida repair did not change the proportion of abnormal corpus callosum nor heterotopias after surgery. The combination of presurgical abnormal corpus callosum and severe ventricular dilation (≥15 mm) is associated with an increased risk of suboptimal neurodevelopment.
1 citations
TL;DR: In this paper , the main objective is to evaluate the protective effects of maternal supplementation with docosahexaenoic acid (DHA) and lactoferrin (Lf) on the fetal brain and in the placenta structure in a rabbit model of Intrauterine growth restriction.
Abstract: The main objective is to evaluate the protective effects of maternal supplementation with docosahexaenoic acid (DHA) and lactoferrin (Lf) on the fetal brain and in the placenta structure in a rabbit model of Intrauterine growth restriction (IUGR).
1 citations
TL;DR: In this paper , the influence of intraamniotic infection and/or inflammation (IAI) on fetal cortical development was assessed by neurosonography by measuring depth (mm) of the Sylvian fissure, parieto-occipital, cingulate and calcarine sulci within the first 72h after admission and, in non-exposed women, at a similar gestational age.
TL;DR: In this paper , a machine learning framework for automated image quality assessment tailored to fetal brain MRI is proposed, which extracts an ensemble of quality metrics that are then used to predict experts' ratings.
Abstract: Quality control (QC) has long been considered essential to guarantee the reliability of neuroimaging studies. It is particularly important for fetal brain MRI, where large and unpredictable fetal motion can lead to substantial artifacts in the acquired images. Existing methods for fetal brain quality assessment operate at the \textit{slice} level, and fail to get a comprehensive picture of the quality of an image, that can only be achieved by looking at the \textit{entire} brain volume. In this work, we propose FetMRQC, a machine learning framework for automated image quality assessment tailored to fetal brain MRI, which extracts an ensemble of quality metrics that are then used to predict experts' ratings. Based on the manual ratings of more than 1000 low-resolution stacks acquired across two different institutions, we show that, compared with existing quality metrics, FetMRQC is able to generalize out-of-domain, while being interpretable and data efficient. We also release a novel manual quality rating tool designed to facilitate and optimize quality rating of fetal brain images. Our tool, along with all the code to generate, train and evaluate the model will be released upon acceptance of the paper.
TL;DR: In this paper , a cascaded deep learning network is proposed for 3D image registration, which computes small, incremental deformations to the moving image to align it precisely with the fixed image.
Abstract: Accurate segmentation of fetal brain magnetic resonance images is crucial for analyzing fetal brain development and detecting potential neurodevelopmental abnormalities. Traditional deep learning-based automatic segmentation, although effective, requires extensive training data with ground-truth labels, typically produced by clinicians through a time-consuming annotation process. To overcome this challenge, we propose a novel unsupervised segmentation method based on multi-atlas segmentation, that accurately segments multiple tissues without relying on labeled data for training. Our method employs a cascaded deep learning network for 3D image registration, which computes small, incremental deformations to the moving image to align it precisely with the fixed image. This cascaded network can then be used to register multiple annotated images with the image to be segmented, and combine the propagated labels to form a refined segmentation. Our experiments demonstrate that the proposed cascaded architecture outperforms the state-of-the-art registration methods that were tested. Furthermore, the derived segmentation method achieves similar performance and inference time to nnU-Net while only using a small subset of annotated data for the multi-atlas segmentation task and none for training the network. Our pipeline for registration and multi-atlas segmentation is publicly available at https://github.com/ValBcn/CasReg.
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TL;DR: It is suggested that changes in sulcal length may be a sign indicating a higher risk of altered neurodevelopment, and that fetal nomograms for specific brain structures are required in order to apply these imaging biomarkers in clinical practice.
TL;DR: In this article , the development of an artificial placenta (AP) system in sheep with learning curve and main bottlenecks to allow survival up to one week was described.
Abstract: Objective: To describe the development of an artificial placenta (AP) system in sheep with learning curve and main bottlenecks to allow survival up to one week. Methods: A total of 28 fetal sheep were transferred to an AP system at 110–115 days of gestation. The survival goal in the AP system was increased progressively in three consecutive study groups: 1–3 h (n = 8), 4–24 h (n = 10) and 48–168 h (n = 10). Duration of cannulation procedure, technical complications, pH, lactate, extracorporeal circulation (EC) circuit flows, fetal heart rate, and outcomes across experiments were compared. Results: There was a progressive reduction in cannulation complications (75%, 50% and 0%, p = 0.004), improvement in initial pH (7.20 ± 0.06, 7.31 ± 0.04 and 7.33 ± 0.02, p = 0.161), and increment in the rate of experiments reaching survival goal (25%, 70% and 80%, p = 0.045). In the first two groups, cannulation accidents, air bubbles in the extracorporeal circuit, and thrombotic complications were the most common cause of AP system failure. Conclusions: Achieving a reproducible experimental setting for an AP system is extremely challenging, time- and effort-consuming, and requires a highly multidisciplinary team. As a result of the learning curve, we achieved reproducible transition and survival up to 7 days. Extended survival requires improving instrumentation with custom-designed devices.
TL;DR: In this article , the cortical maturation pattern in fetuses with cytomegalovirus infection with mild or no abnormalities on ultrasound (US) and MRI, and to establish possible differences compared with healthy controls, was assessed by magnetic resonance imaging (MRI).
Abstract: To assess by magnetic resonance imaging (MRI) the cortical maturation pattern in fetuses with cytomegalovirus (CMV) infection with mild or no abnormalities on ultrasound (US) and MRI, and to establish possible differences compared with healthy controls.
TL;DR: In this article , the authors evaluated the correlation of periventricular echogenic halo (halo sign) with histopathological findings and its association with other brain imaging abnormalities in fetuses with cytomegalovirus (CMV) infection.
Abstract: To evaluate the correlation of periventricular echogenic halo (halo sign) with histopathological findings and its association with other brain imaging abnormalities in fetuses with cytomegalovirus (CMV) infection.
TL;DR: In this article , the authors describe the acute cardiovascular adaptation after connection to an artificial placenta (AP) in fetal sheep, as measured by ultrasound and invasive hemodynamics, and demonstrate that the AP resulted in a transient fetal hemodynamic response that tended to normalize over hours.
Abstract: OBJECTIVE
To describe the acute cardiovascular adaptation after connection to an artificial placenta (AP) in fetal sheep, as measured by ultrasound and invasive hemodynamics.
METHODS
An experimental study of 12 fetal lambs (109-117 days), which were transferred to an AP system (pumpless circuit with umbilical cord connection). The study was designed to collect in utero and post-cannulation measures in all animals. The six first consecutive fetuses were instrumented with intravascular catheters and perivascular probes to obtain key physiological invasive data, including arterial and venous intravascular pressures as well as arterial and venous perivascular blood flows. These experiments aimed at 1-3 hours survival. The second set of 6 fetuses were not instrumented and belonged to experiments aiming at 3-24 hours survival. Echocardiography-derived anatomical and functional measurements were collected in most animals, as well as the blood flow and pre-membrane and post-membrane pressures measured in the AP system. These data were acquired at different stages of our experimental setting, namely, in utero, 5', 30' (instrumented animals) and in utero, 30' and 180' (non-instrumented animals) after transfer into the AP system.
RESULTS
There was a reduced pulsatility index in the umbilical artery (UA-PI in utero median 1.36 (IQR 1.06-1.5) vs. 30' 0.38 (0.31-0.5) vs. 180' 0.36 (0.29-0.41), p<0.001) and ductus venosus, together with increased umbilical venous peak velocity and flow (UV peak velocity in utero 20.3 cm/s (18.2-22.4) vs. 5' 39 cm/s (30.7-43.2) vs. 180' 43 cm/s (34-54), p<0.001) becoming pulsatile after connection. Intravascular measures showed transiently increased arterial and venous pressures (mean arterial pressure in utero 43 mmHg (35-54) vs. 5' 72 mmHg (61-77) vs. 30' 58 mmHg (50-64), p=0.02) and fetal heart rate (in utero 145 bpm (142-156) vs. 30' 188 bpm (171-209) vs. 180' 175 bpm (165-190), p=0.001). The fetal heart structure and function was mainly preserved (right fractional area change in utero 36% (34-40.9) vs. 30' 38% (30-40) vs. 180' 37% (33.3-40), p=0.807).
CONCLUSIONS
Connection to an AP resulted in a transient fetal hemodynamic response that tended to normalize over hours. In this short-term evaluation, cardiac structure and function was preserved. However, the system results in non-physiologically elevated venous pressure and pulsatile flow, which should be corrected to avoid later impairment in cardiac function. This article is protected by copyright. All rights reserved.