E1427. Fetal Brain Destructive Lesions: Antenatal and Perinatal Imaging
  1. Aline Camargo; Penn State Health Milton S. Hershey Medical Center
  2. Sparsh Gola; Penn State Health Milton S. Hershey Medical Center
  3. Sangam Kanekar; Penn State Health Milton S. Hershey Medical Center
Brain injury in mature and premature infants is of enormous public health importance because of the large number of such infants who survive with a serious neurodevelopmental disability, including major cognitive deficits and motor disability. Besides encephalopathy of prematurity (or PVL), various acquired or congenital malformation can lead to destructive brain lesions. With the increasing understanding of our knowledge regarding the neurogenetics of brain development, identifying these malformations is of critical importance to the long-term developmental effects on the child and to the parents in regard to their future pregnancy.

Educational Goals / Teaching Points
To classify and discuss the pathology and pathogenesis of the fetal brain destructive lesions. To highlight the imaging findings and diagnostic pearls for these specific diagnoses in the antenatal and perinatal period.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We retrospectively reviewed the imaging studies from our PACS system of 122 patients with the fetal brain destructive lesions, which forms the basis of this exhibit. All patients had an antenatal ultrasound. In addition, 36 patients also had a fetal MRI. All patients had CT and/or MRI scan of the brain in the perinatal period. For easy understanding, this exhibit is classified under the following categories: encephalopathy of prematurity, hypoxic-ischemic injury, toxic and metabolic disorders, congenital infection-TORCH, brain damage due to vascular malformation (vein of Galen malformation, AVM, Cavernous malformation, Capillary telangiectasia), maternal causes (maternal or fetal coagulation disorders, maternal hypoxia-trauma, sepsis, Hg, mechanical conditions placenta praevia, complications of monochorionic twin pregnancies-TTTS, chorioamnionitis), tumors (teratoma, astrocytomas, lipomas, choroid plexus papillomas (CPP), PNET, ATRT, desmoplastic infantile tumors), and congenital anomalies (corpus callosal dysgenesis; holoprosencephaly; hydranencephaly, posterior fossa Anomalies).

With the increasing understanding of the neurogenetics of the congenital malformation of the brain, identifying of the developmental malformations and encephalopathy of prematurity are of vital importance, to decide about its recurrence in the future pregnancies and if possible treat them intrauterine to decrease the damage to the developing neural structures. We discuss the neurogenetics, pathogenesis and imaging appearance of the fetal destructive lesions of the brain in this exhibit.