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Research ArticlePediatrics

Characteristic MR Imaging Findings of the Neonatal Brain in RASopathies

M.N. Cizmeci, M. Lequin, K.D. Lichtenbelt, D. Chitayat, P. Kannu, A.G. James, F. Groenendaal, E. Chakkarapani, S. Blaser and L.S. de Vries
American Journal of Neuroradiology June 2018, 39 (6) 1146-1152; DOI: https://doi.org/10.3174/ajnr.A5611
M.N. Cizmeci
aFrom the Departments of Neonatology (M.N.C., F.G., L.S.d.V.)
cBrain Center Rudolf Magnus (M.N.C., F.G., L.S.d.V.)
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M. Lequin
bPediatric Radiology (M.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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K.D. Lichtenbelt
dDepartment of Medical Genetics (K.D.L.), University Medical Center Utrecht, Utrecht, the Netherlands
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D. Chitayat
eDivisions of Clinical and Metabolic Genetics (D.C., P.K.)
hDepartments of Obstetrics and Gynecology, Laboratory Medicine, Pathobiology and Molecular Genetics (D.C.), University of Toronto, Toronto, Canada
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P. Kannu
eDivisions of Clinical and Metabolic Genetics (D.C., P.K.)
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A.G. James
fNeonatology (A.G.J.)
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F. Groenendaal
aFrom the Departments of Neonatology (M.N.C., F.G., L.S.d.V.)
cBrain Center Rudolf Magnus (M.N.C., F.G., L.S.d.V.)
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E. Chakkarapani
iDivision of Neonatology (E.C.), School of Clinical Sciences, St Michael's Hospital, University of Bristol, Bristol, UK.
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S. Blaser
gNeuroradiology (S.B.), Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Canada
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L.S. de Vries
aFrom the Departments of Neonatology (M.N.C., F.G., L.S.d.V.)
cBrain Center Rudolf Magnus (M.N.C., F.G., L.S.d.V.)
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    Fig 1.

    Measurement techniques used in the study. A, Preterm neonate, gestational age 35 weeks 6 days. T1-weighted MR image shows measurement of the vermis height from the culmen to the uvular lobule on the midsagittal image. B and C, Preterm neonate, gestational age 30 weeks 6 days. T2-weighted MR images show the cerebellar diameter measurement at the widest points of the cerebellum on axial and coronal images, respectively. D, Preterm neonate, gestational age 33 weeks 4 days. T1-weighted image shows cranial base angle measurement with the fonticulus frontalis used as the anterior landmark; midsella, as the vertex point; and the distal tip of the ossified clivus, as the terminal point. E, Measurement of the tentorial angle between the Twining line and a line drawn through tentorium cerebelli with tuberculum sella used as the originating point. F, T1-weighted MR image shows measurement of the infratentorial angle, using a line originating from the midsella drawn through the midpoint of the dural reflection of the torcula herophili to the inner cortex, and a line drawn between the midsella and basion.

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    Fig 2.

    Characteristic MR imaging findings of neonates with a RASopathy. A, Preterm neonate, gestational age 28 weeks 6 days, MR imaging performed at postmenstrual age 30 weeks 5 days. T2-weighted midsagittal MR image shows a vertical tentorium and splenium of the corpus callosum. B, Preterm neonate, gestational age 34 weeks 2 days. T2-weighted axial MR image demonstrates the presence of hemorrhagic and cystic lesions in the peripheral regions of the cerebellum. C, Preterm neonate, gestational age 34 weeks 2 days. T2-weighted axial MR imaging shows a mildly enlarged extracerebral space with severe white matter injury, which evolved into extensive cysts. D, Preterm neonate, gestational age 34 weeks. Axial T2-weighted MR image shows a severely enlarged extracerebral space, punctate white matter lesions, and a small amount of blood in the lateral ventricles.

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    Fig 3.

    Boxplot graphs show the comparison of the vermis height (top left), cranial base angle (top right), tentorial angle (bottom left), and infratentorial angle (bottom right) between infants with a RASopathy and the control group.

Tables

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  • Clinical characteristics and MRI angle measurements and assessments

    Group 1 (n = 16)Group 2 (n = 32)P Valuea
    Gestational age (mean) (wk)35.6 ± 4.237.3 ± 4.5.1b
    Postmenstrual age at MRI (mean) (wk)37.6 ± 4.839.8 ± 6.5.2b
    Vermis height (mean) (mm)20.5 ± 4.423.7 ± 3.9.01be
    Transcerebellar diameter (mean)
        Axial48.6 ± 9.152.3 ± 9.8.2b
        Coronal48.8 ± 9.652.7 ± 9.7.2b
    Cranial base angle (mean)130.3° ± 4.0°134.8° ± 5.3°.005ce
    Tentorial angle (mean)55.4° ± 3.4°46.6° ± 5.8°<.001ce
    Infratentorial angle (mean)52.2° ± 6.5°47.7° ± 4.0°.001be
    Intraventricular hemorrhage (No.) (%)8 (47)0 (0)<.001de
    Cerebellar abnormality (No.) (%)9 (56)0 (0)<.001de
        Hemorrhagic lesion6 (67)
        Hemorrhagic-cystic lesion3 (33)
    Enlarged extracerebral space (No.) (%)13 (81)0 (0)<.001de
        Mild10 (77)
        Severe3 (23)
    Delayed cortical gyrification (No.) (%)12 (75)0 (0)<.001de
    WMI after cerebral hemorrhage (No.) (%)9 (56)0 (0)<.001de
        Punctate white matter lesion7 (78)
        Cystic lesion2 (22)
    Abnormality in DWI (n = 12) (No.) (%)7 (58)-
        Focal restriction6 (86)
        Extensive restriction1 (14)
    Corpus callosum abnormality (No.) (%)4 (25)0 (0)<.001de
        Vertical appearance3 (75)
        Hypoplasia1 (25)
    • Note:—WMI indicates white matter injury.

    • ↵a Adjusted for gestational age as appropriate.

    • ↵b Mann-Whitney U test.

    • ↵c T test.

    • ↵d Fisher exact test.

    • ↵e Significant.

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American Journal of Neuroradiology: 39 (6)
American Journal of Neuroradiology
Vol. 39, Issue 6
1 Jun 2018
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M.N. Cizmeci, M. Lequin, K.D. Lichtenbelt, D. Chitayat, P. Kannu, A.G. James, F. Groenendaal, E. Chakkarapani, S. Blaser, L.S. de Vries
Characteristic MR Imaging Findings of the Neonatal Brain in RASopathies
American Journal of Neuroradiology Jun 2018, 39 (6) 1146-1152; DOI: 10.3174/ajnr.A5611

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Characteristic MR Imaging Findings of the Neonatal Brain in RASopathies
M.N. Cizmeci, M. Lequin, K.D. Lichtenbelt, D. Chitayat, P. Kannu, A.G. James, F. Groenendaal, E. Chakkarapani, S. Blaser, L.S. de Vries
American Journal of Neuroradiology Jun 2018, 39 (6) 1146-1152; DOI: 10.3174/ajnr.A5611
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