Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Fetal Diagn Ther 2013;33:122–129 DOI: 10.1159/000346566 Fetal Brain MRI Texture Analysis Identifies Different Microstructural Patterns in Adequate and Small for Gestational Age Fetuses at Term M. Sanz-Cortés a F. Figueras a E. Bonet-Carne b N. Padilla a V. Tenorio a N. Bargalló c I. Amat-Roldan b Eduard Gratacós a a Maternal-Fetal Medicine Department, ICGON, Hospital Clínic, Universitat de Barcelona, Fetal and Perinatal Medicine Research Group, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), b Transmural Biotech SL, and c Department of Radiology Hospital Clinic, Centre de Diagnostic per la Imatge, Hospital Clínic, Barcelona, Spain Introduction An estimated 1 in 10 children suffer from neurodevel- opmental problems, most of which are considered to be of prenatal origin [1, 2]. Intrauterine growth restriction (IUGR) has long been considered among the main causes of neurodevelopmental problems. IUGR affects 5–8% of all pregnancies [3] and is a major contributor to perina- tal mortality and morbidity. Most instances of IUGR are secondary to placental insufficiency [4] which causes a prolonged disturbance in fetal oxygen and nutrient sup- ply and subsequently a deleterious effect on brain devel- opment [5]. An increasing amount of evidence has shown a strong association of IUGR with long-term neu- rological morbidity [6–10] and brain macro- and micro- structure differences [11–15]. Neurodevelopmental im- pairment is not exclusive of severe IUGR but it also oc- curs in late-onset forms, often referred to as small for gestational age (SGA) [16–19]. For a long time consid- ered a benign condition [20], it is increasingly accepted that the diagnostic label of SGA is largely composed by late forms of true IUGR. SGA fetuses are associated with signs of brain redistribution [16, 21–24] and poorer peri- natal outcome [21, 24–28]. In addition, neonates and in- fants born SGA have an impaired neurodevelopment, as Key Words Fetal MRI · Intrauterine growth restriction · Small for gestational age · Texture analysis Abstract Objectives: We tested the hypothesis whether a texture analysis (TA) algorithm applied to MRI brain images identi- fied different patterns in small for gestational age (SGA) fe- tuses as compared with adequate for gestational age (AGA). Study Design: MRI was performed on 83 SGA and 70 AGA at 37 weeks’ GA. Texture features were quantified in the frontal lobe, basal ganglia, mesencephalon, cerebellum and cingu- lum. A classification algorithm based on discriminative models was used to correlate texture features with clinical diagnosis. Results: Region of interest delineation in all areas was achieved in 61 SGA (12 vasodilated) and 52 AGA; this was the sample for TA feature extraction which allowed clas- sifying SGA from AGA with accuracies ranging from 90.9 to 98.9% in SGA versus AGA comparison and from 93.6 to 100% in vasodilated SGA versus AGA comparison. Conclu- sions: This study demonstrates that TA can detect brain dif- ferences in SGA fetuses. This supports the existence of brain microstructural changes in SGA fetuses. Copyright © 2013 S. Karger AG, Basel Received: July 4, 2012 Accepted after revision: December 11, 2012 Published online: February 6, 2013 Magdalena Sanz-Cortés Maternal-Fetal Medicine Department Hospital Clínic – Maternitat Sabino de Arana, 1, ES–08028 Barcelona (Spain) E-Mail msanz1  @  clinic.ub.es © 2013 S. Karger AG, Basel 1015–3837/13/0332–0122$38.00/0 Accessible online at: www.karger.com/fdt Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 9/16/2013 1:37:53 PM