Altered Gyrification in Fetal Growth Restriction with Prenatal Magnetic Resonance Images

Motivation: Fetal growth restriction (FGR) is highly associated with adverse outcomes. While reduced brain volume is associated with FGR, knowledge regarding cortical developmental is scarce. Goal(s): We aimed to quantitatively assess differences in brain volumes and cortical folding patterns between FGR and appropriate-for gestational-age (AGA) fetuses, and between FGR with normal and abnormal pulsatile-index (PI) measured by Doppler-US in the middle-cerebral-artery (MCA). Approach: Gyrification and brain volume were computed using an automatic method based on T2-weighted MRI. Results: Significant reduction of brain volume and gyrification were detected in FGR compared with AGA, and in gyrification in fetuses with abnormal MCA-PI. Impact: Reduced gyrification in FGR fetuses can offer insights into the pathomechanism linking abnormal MCA-PI, cortical development, and postnatal outcomes. This may enable marker for assessing the severity of restriction and facilitate pregnancy management by determining the optimal time for delivery.