CLINICAL ARTICLE Fetal brain magnetic resonance imaging and long-term neurodevelopmental impairment Vladimir Banović a, ⁎, Snježana Škrablin a , Maja Banović a , Marko Radoš b , Snježana Gverić-Ahmetašević c , Ivan Babić a a Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia b Department of Radiology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia c Department of Neonatology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia abstract article info Article history: Received 23 July 2013 Received in revised form 7 December 2013 Accepted 25 February 2014 Keywords: Fetal brain injury Fetal brain magnetic resonance imaging Long-term neurodevelopmental impairment Objective: To determine the incidence of fetal brain injury by fetal brain magnetic resonance imaging (MRI) in pregnancies complicated with preterm labor (PL), preterm premature rupture of the membranes (PPROM), and intrauterine growth restriction (IUGR), and to compare fetal brain MRI with prenatal surveillance methods, and with immediate and long-term neurodevelopmental outcome. Methods: Between February 2007 and January 2009, high-risk pregnancies were analyzed by MRI at 1.5 Tesla after 24 weeks of gestation at the Clinical Hospital Center Zagreb, Croatia. Long-term outcome was defined as neurodevelopmental outcome at 24 months. Results: Among 70 pregnancies analyzed, 40.0% had abnormal fetal brain MRI. The highest inci- dence occurred in the PL group. There was no correlation between abnormal MRI and fetal surveillance methods (ultrasound, Doppler blood flow analysis, cardiotocography, biophysical profile) or immediate neonatal outcome (1-minute Apgar score, umbilical cord pH). Via MRI, fetal brain injury would have been diagnosed for 45.7% of fetuses with a long-term neurodevelopmental handicap. Binary logistic regression showed that, as compared with other surveillance methods, fetal brain MRI was the best predictor of long-term neurodevelopmental disability. Conclusion: PL, IUGR, and PPROM were associated with an early intrauterine CNS insult that was not accurately detected by existing prenatal testing options. © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Preterm labor (PL), intrauterine growth restriction (IUGR), and pre- term premature rupture of the membranes (PPROM) are frequently as- sociated with significant neurologic, cognitive, and behavioral problems in newborns [1,2]. Women with PL, IUGR or PPROM may or may not have outcomes with complications related to a common etiology. All of these groups have potential common threads within the “preterm birth syndrome” [3]. It is thought that pathophysiologic mechanisms underlying the occurrence of PL, IUGR, and PPROM somehow predis- pose the fetus to brain injury [4,5]. It is not known whether these inju- ries are the consequence of presumed hypoxic insults or other possible causes. According to current evidence, most long-term neurologic impairments originate from prenatal rather than intrapartum and neo- natal insults [4]. Prediction of neurodevelopmental outcomes in PL, IUGR, and PPROM is among the clinical challenges of modern fetal medicine. There is reasonable doubt about whether currently used methods (e.g. fetal ultrasound, cardiotocography [CTG], biophysical profile) are sufficient to diagnose fetuses at risk. Recent advancements in magnetic resonance imaging (MRI) technology have provided means for better identification of brain lesions or maldevelopment. The aim of the present study was to determine the incidence of fetal brain injury via fetal brain MRI in pregnancies complicated with PL, PPROM, and IUGR, and to compare the MRI results with those of conventional prenatal surveillance methods (ultrasound, biophysical profile, and CTG), and with immediate and long-term neurodevelopmental outcome. 2. Materials and methods In a study conducted at the Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Croatia, from February 1, 2007, to January 31, 2009, high-risk pregnancies were analyzed by fetal MRI after 24 weeks of gestation. The Clinical Hospital Center and Medical School and University of Zagreb Ethics Committees approved the study, and all patients gave written informed consent. All pregnancies were complicated with IUGR, PPROM, or PL. PPROM was defined as rupture of amniotic membranes before 37 weeks of pregnancy. IUGR was defined as fetal weight below the International Journal of Gynecology and Obstetrics 125 (2014) 237–240 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Petrova 13, 10 000 Zagreb, Croatia. Tel.: +385 14604616; fax: +385 14633512. E-mail address: vladimir.banovic2@zg.t-com.hr (V. Banović). http://dx.doi.org/10.1016/j.ijgo.2013.12.007 0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo