Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

Jared M. Pisapia, Martin Rozycki, Hamed Akbari, Spyridon Bakas, Jayesh P. Thawani, Julie S. Moldenhauer, Phillip B. Storm, Deborah M. Zarnow, Christos Davatzikos, Gregory G. Heuer

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV. METHODS The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test. RESULTS Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p < 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p < 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p < 0.0001) or FOHR and 3D VS (r = 0.842, p < 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p < 0.0001) than with FOHR (r = 0.674, p < 0.0001; p < 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r > 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results. CONCLUSIONS Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.

Original languageEnglish (US)
Pages (from-to)300-306
Number of pages7
JournalJournal of neurosurgery. Pediatrics
Volume19
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

Horns
Gestational Age
Subarachnoid Space
Cerebral Ventricles
Lateral Ventricles
Proxy
Dilatation
Software
Cross-Sectional Studies

Keywords

  • AD = atrial diameter
  • atrial diameter
  • CHOP = Children's Hospital of Philadelphia
  • correlation
  • CSF = cerebrospinal fluid
  • fetal magnetic resonance imaging
  • fetal ventriculomegaly
  • FOHR = frontooccipital horn ratio
  • frontooccipital horn ratio
  • FV = fetal ventriculomegaly
  • GA = gestational age
  • hydrocephalus
  • VS = ventricle size

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pisapia, J. M., Rozycki, M., Akbari, H., Bakas, S., Thawani, J. P., Moldenhauer, J. S., ... Heuer, G. G. (2017). Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly. Journal of neurosurgery. Pediatrics, 19(3), 300-306. https://doi.org/10.3171/2016.9.PEDS16210

Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly. / Pisapia, Jared M.; Rozycki, Martin; Akbari, Hamed; Bakas, Spyridon; Thawani, Jayesh P.; Moldenhauer, Julie S.; Storm, Phillip B.; Zarnow, Deborah M.; Davatzikos, Christos; Heuer, Gregory G.

In: Journal of neurosurgery. Pediatrics, Vol. 19, No. 3, 01.03.2017, p. 300-306.

Research output: Contribution to journalArticle

Pisapia, JM, Rozycki, M, Akbari, H, Bakas, S, Thawani, JP, Moldenhauer, JS, Storm, PB, Zarnow, DM, Davatzikos, C & Heuer, GG 2017, 'Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly', Journal of neurosurgery. Pediatrics, vol. 19, no. 3, pp. 300-306. https://doi.org/10.3171/2016.9.PEDS16210
Pisapia, Jared M. ; Rozycki, Martin ; Akbari, Hamed ; Bakas, Spyridon ; Thawani, Jayesh P. ; Moldenhauer, Julie S. ; Storm, Phillip B. ; Zarnow, Deborah M. ; Davatzikos, Christos ; Heuer, Gregory G. / Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly. In: Journal of neurosurgery. Pediatrics. 2017 ; Vol. 19, No. 3. pp. 300-306.
@article{b14475ff844b418fab1f8f2bed95fd21,
title = "Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly",
abstract = "OBJECTIVE Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV. METHODS The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test. RESULTS Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p < 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p < 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p < 0.0001) or FOHR and 3D VS (r = 0.842, p < 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p < 0.0001) than with FOHR (r = 0.674, p < 0.0001; p < 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r > 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results. CONCLUSIONS Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.",
keywords = "AD = atrial diameter, atrial diameter, CHOP = Children's Hospital of Philadelphia, correlation, CSF = cerebrospinal fluid, fetal magnetic resonance imaging, fetal ventriculomegaly, FOHR = frontooccipital horn ratio, frontooccipital horn ratio, FV = fetal ventriculomegaly, GA = gestational age, hydrocephalus, VS = ventricle size",
author = "Pisapia, {Jared M.} and Martin Rozycki and Hamed Akbari and Spyridon Bakas and Thawani, {Jayesh P.} and Moldenhauer, {Julie S.} and Storm, {Phillip B.} and Zarnow, {Deborah M.} and Christos Davatzikos and Heuer, {Gregory G.}",
year = "2017",
month = "3",
day = "1",
doi = "10.3171/2016.9.PEDS16210",
language = "English (US)",
volume = "19",
pages = "300--306",
journal = "Journal of Neurosurgery: Pediatrics",
issn = "1933-0707",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

AU - Pisapia, Jared M.

AU - Rozycki, Martin

AU - Akbari, Hamed

AU - Bakas, Spyridon

AU - Thawani, Jayesh P.

AU - Moldenhauer, Julie S.

AU - Storm, Phillip B.

AU - Zarnow, Deborah M.

AU - Davatzikos, Christos

AU - Heuer, Gregory G.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - OBJECTIVE Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV. METHODS The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test. RESULTS Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p < 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p < 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p < 0.0001) or FOHR and 3D VS (r = 0.842, p < 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p < 0.0001) than with FOHR (r = 0.674, p < 0.0001; p < 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r > 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results. CONCLUSIONS Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.

AB - OBJECTIVE Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV. METHODS The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test. RESULTS Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p < 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p < 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p < 0.0001) or FOHR and 3D VS (r = 0.842, p < 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p < 0.0001) than with FOHR (r = 0.674, p < 0.0001; p < 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r > 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results. CONCLUSIONS Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.

KW - AD = atrial diameter

KW - atrial diameter

KW - CHOP = Children's Hospital of Philadelphia

KW - correlation

KW - CSF = cerebrospinal fluid

KW - fetal magnetic resonance imaging

KW - fetal ventriculomegaly

KW - FOHR = frontooccipital horn ratio

KW - frontooccipital horn ratio

KW - FV = fetal ventriculomegaly

KW - GA = gestational age

KW - hydrocephalus

KW - VS = ventricle size

UR - http://www.scopus.com/inward/record.url?scp=85015599019&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015599019&partnerID=8YFLogxK

U2 - 10.3171/2016.9.PEDS16210

DO - 10.3171/2016.9.PEDS16210

M3 - Article

VL - 19

SP - 300

EP - 306

JO - Journal of Neurosurgery: Pediatrics

JF - Journal of Neurosurgery: Pediatrics

SN - 1933-0707

IS - 3

ER -