Apparent diffusion coefficient assessment of brain development in normal fetuses and ventriculomegaly

Diffusion neuro-MRI has benefited significantly from sophisticated pre-processing procedures aimed at improving image quality and diagnostic. In this work, diffusion-weighted imaging (DWI) was used with artifact correction and the apparent diffusion coefficient (ADC) was quantified to investigate fetal brain development. The DWI protocol was designed in order to limit the acquisition time and to estimate ADC without perfusion bias. The ADC in normal fetal brains was compared to cases with isolated ventriculomegaly (VM), a common fetal disease whose DWI studies are still scarce. DWI was performed in 58 singleton fetuses (Gestational age (GA) range: 19–38w) at 1.5T. In 31 cases, VM was diagnosed on ultrasound. DW-Spin Echo EPI with b-values = 50, 200, 700 s/mm2 along three orthogonal axes was used. All images were corrected for noise, Gibbs-ringing, and motion artifacts. The signal-to-noise ratio (SNR) was calculated and the ADC was measured with a linear least-squared algorithm. A multi-way ANOVA was used to evaluate differences in ADC between normal and VM cases and between second and third trimester in different brain regions. Correlation between ADC and GA was assessed with linear and quadratic regression analysis. Noise and artifact correction considerably increased SNR and the goodness-of-fit. ADC measurements were significantly different between second and third trimester in centrum semiovale, frontal white matter, thalamus, cerebellum and pons of both normal and VM brains (p ≤ 0.03). ADC values were significantly different between normal and VM in centrum semiovale and frontal white matter (p ≤ 0.02). ADC values in centrum semiovale, thalamus, cerebellum and pons linearly decreased with GA both in normal and VM brains, while a quadratic relation with GA was found in basal ganglia and occipital white matter of normal brains and in frontal white matter of VM (p ≤ 0.02). ADC values in all fetal brain regions were lower than those reported in literature where DWI with b = 0 was performed. Conversely, they were in agreement with the results of other authors who measured perfusion and diffusion contributions separately. By optimizing our DWI protocol we achieved an unbiased quantification of brain ADC in reasonable scan time. Our findings suggested that ADC can be a useful biomarker of brain abnormalities associated with VM.