Objective: In order to provide aid for prenatal counseling in fetal isolated ventriculomegaly (IVM) on ultrasound, we recorded the latest long-term clinical and imaging outcomes of children with a mean age of 7.2 years (range 2.1-14.6). Methods: In 72 fetuses with IVM, diagnosed between 1999 and 2011, the measurement quality of atrial diameter was reviewed in the axial plane. We assessed the association of characteristics of IVM with outcome parameters in the cohort and in subgroups. Prognostic values of significant associations were reported by receiver operating characteristic curve analysis. Results: Cerebral anomalies were diagnosed postnatally in 42% and genetic disorders in 12% of 45 live births. Significant associations of outcome parameters were found between the degree of IVM and genetic disorders (p = 0.017) with an area under the curve (AUC) of 0.866, and between progression of IVM and motor impairment (p = 0.024) with an AUC of 0.789. No significant correlation was found with the other assessed outcome parameters. Furthermore, our subgroup analysis clearly showed that, if cerebral or genetic anomalies are not found postnatally, a favorable outcome may be expected. Discussion: Diameter and progression in IVM are not significantly associated with most outcome parameters. Cerebral anomalies and genetic disorders may contribute to an unfavorable outcome.

Keywords:
Cerebral ventriculomegaly, Prenatal diagnosis, Prenatal counseling, Fetus, Neurosonography, Fetal magnetic resonance imaging, Developmental outcome
1.
Sethna F, Tennant PWG, Rankin J, Robson SC: Prevalence, natural history, and clinical outcome of mild to moderate ventriculomegaly. Obstet Gynecol 2011;4:867-876.
2.
Hannon T, Tennant PWG, Rankin J, Robson C: Epidemiology, natural history, progression, and postnatal outcome of severe fetal ventriculomegaly. Obstet Gynecol 2012;120:1345-1353.
3.
Beeghly M, Ware J, Soul J, Du Plessis A, Khwaja O, Senapati GM, Robson CD, Robertson RL, Pousssaint TY, Barnewolt CE, Feldman HA, Estroff JA, Levine D: Neurodevelopmental outcome of fetuses referred for ventriculomegaly. Ultrasound Obstet Gynecol 2010;35:405-416.
4.
Weichert J, Hartge D, Krapp M, Germer U, Gembruch U, Axt-Fliedner R: Prevalence, characteristics and perinatal outcome of fetal ventriculomegaly in 29,000 pregnancies followed at a single institution. Fetal Diagn Ther 2010;27:142-148.
5.
Rouleau C, Gasner A, Bigi N, Couture A, Perez MJ, Blanchet P, Faure JM, Rivier F, Boulot P, Laquerrière A, Encha-Razavi F: Prevalence and timing of pregnancy termination for brain malformations. Arch Dis Child Fetal Neonatal Ed 2011;96:F360-F364.
6.
Cardoza JD, Goldstein RB, Filly RA: Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium. Pediatr Radiol 1988;169:711-714.
7.
International Society of Ultrasound in Obstetrics and Gynecology: Sonographic examination of the fetal central nervous system: guidelines for performing the “basic examination” and the “fetal neurosonogram.” Ultrasound Obstet Gynecol 2007;29:109-116.
8.
Guibaud L: Fetal cerebral ventricular measurement and ventriculomegaly: time for procedure standardization. Ultrasound Obstet Gynecol 2009;34:127-130.
9.
Goodman R: The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997;38:581-586.
10.
Levine MI: Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 1981;56:900-904.
11.
Largo RH, Pfister D, Molinari L, Kundu S, Lipp A, Duc G: Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years. Dev Med Child Neurol 1989;31:440-456.
12.
Gaglioti P, Danelon D, Bontempo S, Mombrò M, Cardaropoli S, Todros T: Fetal cerebral ventriculomegaly: outcome in 176 cases. Ultrasound Obstet Gynecol 2005;25:372-377.
13.
Falip C, Blanc N, Maes E, Zaccaria I, Oury JF, Sebag G, Garel G: Postnatal clinical and imaging follow-up of infants with prenatal isolated mild ventriculomegaly: a series of 101 cases. Pediatr Radiol 2007;37:981-989.
14.
Leitner Y, Stolar O, Rotstein M, Todedano H, Harel S, Bitchonsky O, Ben-Adani L, Miller E, Ben-Sira L: The neurocognitive outcome of mild isolated fetal ventriculomegaly verified by prenatal magnetic resonance imaging. Am J Obstet Gynecol 2009;201:215.e1-e6.
15.
Melchiorre K, Bhide A, Gika AD, Pilu G, Papageorghiou AT: Counseling in isolated mild fetal ventriculomegaly. Ultrasound Obstet Gynecol 2009;34:212-224.
16.
D'Addario V, Pinto V, Di Cagno L, Pintucci A: Sonographic diagnosis of fetal cerebral ventriculomegaly: an update. J Matern Fetal Neonat Med 2007;20:7-14.
17.
Tatli B, Özer I, Ekici B, Kalelioglu I, Has R, Eraslan E, Yüksel A: Neurodevelopmental outcome of 31 patients with borderline fetal ventriculomegaly. Clin Neurol Neurosurg 2012;114:969-971.
18.
Ouahba J, Luton D, Vuillard E, Garel C, Gressens P, Blanc N, Elmaleh M, Evrard P, Oury JF: Prenatal isolated mild ventriculomegaly: outcome in 167 cases. BJOG 2006;113:1072-1079.
19.
Kennelly MM, Cooley SM, McParland PJ: Natural history of apparently isolated severe fetal ventriculomegaly: perinatal survival and neurodevelopmental outcome. Prenat Diagn 2009;29:1135-1140.
20.
Gómez-Arriaga P, Herraiz I, Puente JM, Zamora-Crespo B, Núñez-Enamorado N, Galindo A: Mid-term neurodevelopmental outcome in isolated mild ventriculomegaly diagnosed in fetal life. Fetal Diagn Ther 2012;31:12-18.
21.
Breeze ACG, Alexander PMA, Murdoch EM, Missfelder-Lobos HH, Hackett GA, Lees CC: Obstetric and neonatal outcomes in severe fetal ventriculomegaly. Prenat Diagn 2007;27:124-129.
22.
Garne E, Loane M, Addor MC, Boyd PA, Barisic I, Dolk H: Congenital hydrocephalus - prevalence, prenatal diagnosis and outcome of pregnancy in four European regions. Eur J Paediatr Neurol 2010;14:150-155.
23.
Breeze ACG, Dey PK, Lees CC, Hackett GA, Smith GCS, Murdoch EM: Obstetric and neonatal outcomes in apparently isolated mild fetal ventriculomegaly. J Perinat Med 2005;33:236-240.
24.
Devaseelan P, Cardwell C, Bell B, Ong S: Prognosis of isolated mild to moderate fetal cerebral ventriculomegaly: a systematic review. J Perinat Med 2010;38:401-409.
25.
Pagani G, Thilaganathan B, Prefumo F: Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014;44:254-260.
26.
Baffero GM, Crovetto F, Fabietti I, Boito S, Fogliani R, Fumagalli M, Triulzi F, Mosca F, Fedele L, Persico N: Prenatal ultrasound predictors of postnatal major cerebral abnormalities in fetuses with apparently isolated mild ventriculomegaly. Prenat Diagn 2015;35:783-788.
27.
Prayer D, Malinger G, Brugger PC, Cassady C, De Catte L, De Keersmaecker B, Fernandes GL, Glanc P, Goncalves LF, Gruber GM, Laifer-Narin S, Lee W, Millischer A-E, Molho M, Neelavalli J, Platt L, Pugash D, Ramaekers P, Salomon LJ, Sanz M, Timor-Tritsch IE, Tutschek B, Twickler D, Weber M, Ximenes R, Raine-Fenning N: ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 2017;49:671-680.
28.
Guibaud L, Lacalm A: Etiological diagnostic tools to elucidate “isolated” ventriculomegaly. Ultrasound Obstet Gynecol 2015;46:1-11.
29.
Griffiths PD, Reeves MJ, Morris JE, Mason G, Russel SA, Paley MNJ, Whitby EH: A prospective study of fetuses with isolated ventriculomegaly investigated by antenatal sonography and in utero MR imaging. AJNR Am J Neuroradiol 2010;31:106-111.
30.
Joo JG, Toth Z, Beke A, Papp C, Toth-Pal E, Csaba A, Szigeti Z, Rab A, Papp Z: Etiology, prenatal diagnostics and outcome of ventriculomegaly in 230 cases. Fetal Diagn Ther 2008;24:254-263.
31.
Kutuk MS, Ozgun MT, Uludag S, Dolanbay M, Poyrazoglu HG, Tas M: Postnatal outcome of isolated, nonprogressive, mild borderline fetal ventriculomegaly. Childs Nerv Syst 2013;29:803-808.
32.
Nicolaides KH, Berry S, Snijders RJ, Thorpe-Beeston JG, Gosden C: Fetal lateral cerebral ventriculomegaly: associated malformations and chromosomal defects. Fetal Diagn Ther 1990;5:5-14.
33.
Martillotti G, Rypens F, David M, Catalfamo N, Dubé J, Taillefer C, Lachance C, Audibert F: Association between fetal cerebral ventriculomegaly and platelet alloimmunization. Fetal Diagn Ther 2017;42:35-42.
34.
Karl K, Kainer F, Heling KS, Chaoui R: Fetale Neurosonografie: die erweiterte Untersuchung des ZNS beim Fetus. Ultraschall Med 2011;32:342-361.
35.
Bornstein E, Monteagudo A, Timor-Tritsch IE: 3D and 4D fetal neuroscan: sharing the know-how and tricks of the trade. Ultrasound Clin 2008;3:517-528.
36.
Martinez-Zamora MA, Borrell A, Borobio V, Gonce A, Perez M, Botet F, Nadal A, Albert A, Puerto B, Fortuny A: False positives in the prenatal ultrasound screening of fetal structural anomalies. Prenat Diagn 2007;27:18-22.
37.
Levine D, Feldman HA, Kazan Tannus JF, Estoff JA, Magnino M, Robson CD, Poussaint TY, Barnewolt CE, Mehta TS, Robertson RL: Frequency and cause of disagreements in diagnoses for fetuses referred for ventriculomegaly. Radiology 2008;247:516-527.
38.
Benacerraf BR, Shipp TD, Bromley B, Levine D: What does magnetic resonance imaging add to the prenatal sonographic diagnosis of ventriculomegaly? J Ultrasound Med 2007;26:1513-1522.
39.
Salomon LJ, Ouahba J, Delezoide A, Vuillard E, Oury J, Sebag G, Garel C: Third-trimester fetal MRI in isolated 10- to 12-mm ventriculomegaly: is it worth it? BJOG 2006;113:942-947.
40.
Shaowei Y, Quan N, Jing C, Jesse L, Caixa L: Contribution of MRI to detect further anomalies in fetal ventriculomegaly. Fetal Diagn Ther 2010;27:20-24.
41.
Malinger G, Ben-Siras L, Lev D, Ben-Aroya Z, Kidron D, Lerman-Sagie T: Fetal brain imaging: a comparison between magnetic resonance imaging and dedicated neurosonography. Ultrasound Obstet Gynecol 2004;23:333-340.
42.
Paladini D, Quarantelli M, Sglavo G, Pastore G, Cavallaro A, D'Armiento MR, Salvatore M, Nappi C: Accuracy of neurosonography and MRI in clinical management of fetuses referred with central nervous system abnormalities. Ultrasound Obstet Gynecol 2014;44:188-196.
43.
Parazzini C, Righini A, Doneda C, Arrigoni F, Rustico M, Lanna M, Triulzi F: Is fetal magnetic resonance imaging indicated when ultrasound isolated mild ventriculomegaly is present in pregnancies with no risk factors? Prenat Diagn 2012;32:752-757.
44.
Sadan S, Malinger G, Schweiger A, Leb D, Lerman-Sagie T: Neuropsychological outcome of children with asymmetric ventricles or unilateral mild ventriculomegaly identified in utero. BJOG 2007;114:596-602.
45.
Atad-Rapoport M, Schweiger A, Lev D, Sadan-Strul S, Malinger G, Lerman-Sagie T: Neuropsychological follow-up at school age of children with asymmetric ventricles or unilateral ventriculomegaly identified in utero. BJOG 2015;122:932-938.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.