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<meta name="DC.Title" content="Fetal and Neonatal MRI Predictors of Aggressive Early Clinical Course in Vein of Galen Malformation" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6585" />
<meta name="DC.Date" content="2020-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Neonates with vein of Galen malformations are split into 2 cohorts: one needing urgent neonatal embolization, with relatively high mortality and morbidity even with expert care, and a cohort in which embolization can be deferred until infancy, with far better prognosis. We aimed to identify brain MR imaging characteristics obtained from fetal and early neonatal scans that can predict the clinical presentation.

MATERIALS AND METHODS: Patients with vein of Galen malformations were stratified into a neonatal at-risk cohort if the patient needed urgent neonatal intervention or if neonatal death occurred; or an infantile treatment cohort if they were stable enough not to require treatment until &gt;1 month of age. Twelve vascular MR imaging parameters, measured by 2 independent observers, were systematically correlated with the need for early neonatal intervention and/or neonatal mortality.

RESULTS: A total of 32 neonatal patients (21 patients in the neonatal at-risk cohort, 11 in the infantile treatment cohort) were identified. Maximal mediolateral diameter (area under the curve  = 0.866, P  &lt; .001) and cross-sectional area (area under the curve = 0.836, P  = .002 ) at the narrowest point of the straight or falcine sinus were most predictive of clinical evolution into the neonatal at-risk cohort. There were 15 patients who had fetal MRIs (10 in the neonatal at-risk cohort and 5 in the infantile treatment cohort). Here too, maximal mediolateral diameter (area under the curve = 0.980, P  = .003) and cross-sectional area (area under the curve  = 0.941, P  = .007) at the narrowest point of the straight or falcine sinus were highly predictive of the neonatal at-risk cohort.

CONCLUSIONS: Early neonatal and fetal MR imaging can be readily used for accurate early risk stratification, assisting in directing resources, timing treatment decisions, and identifying appropriate cohorts for novel interventions.

AUC
:   area under the curve
BA-MD
:   basilar artery maximal diameter
CC
:   craniocaudal diameter
ICA-MD
:   internal carotid artery maximal diameter
IT
:   infantile treatment cohort
NAR
:   neonatal at-risk cohort
ROC
:   receiver operating characteristic
Sig-MD
:   sigmoid sinus maximal diameter
SS-A
:   straight sinus cross-sectional area at the narrowest point of the straight or falcine sinus
SS-MD
:   straight sinus maximal diameter at the narrowest point of the straight or falcine sinus
SS-P
:   straight sinus outer perimeter at the narrowest point of the straight or falcine sinus
VOGM
:   vein of Galen malformations" />
<meta name="DC.Contributor" content="L. Arko" />
<meta name="DC.Contributor" content="M. Lambrych" />
<meta name="DC.Contributor" content="A. Montaser" />
<meta name="DC.Contributor" content="D Zurakowski" />
<meta name="DC.Contributor" content="D.B. Orbach" />
<meta name="article:published_time" content="2020-06-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="Fetal and Neonatal MRI Predictors of Aggressive Early Clinical Course in Vein of Galen Malformation" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Neonates with vein of Galen malformations are split into 2 cohorts: one needing urgent neonatal embolization, with relatively high mortality and morbidity even with expert care, and a cohort in which embolization can be deferred until infancy, with far better prognosis. We aimed to identify brain MR imaging characteristics obtained from fetal and early neonatal scans that can predict the clinical presentation.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Patients with vein of Galen malformations were stratified into a neonatal at-risk cohort if the patient needed urgent neonatal intervention or if neonatal death occurred; or an infantile treatment cohort if they were stable enough not to require treatment until &amp;gt;1 month of age. Twelve vascular MR imaging parameters, measured by 2 independent observers, were systematically correlated with the need for early neonatal intervention and/or neonatal mortality.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;A total of 32 neonatal patients (21 patients in the neonatal at-risk cohort, 11 in the infantile treatment cohort) were identified. Maximal mediolateral diameter (area under the curve  = 0.866, &lt;i&gt;P &lt;/i&gt;&amp;lt; .001) and cross-sectional area (area under the curve = 0.836, &lt;i&gt;P &lt;/i&gt;= .002&lt;i&gt;)&lt;/i&gt; at the narrowest point of the straight or falcine sinus were most predictive of clinical evolution into the neonatal at-risk cohort. There were 15 patients who had fetal MRIs (10 in the neonatal at-risk cohort and 5 in the infantile treatment cohort). Here too, maximal mediolateral diameter (area under the curve = 0.980, &lt;i&gt;P &lt;/i&gt;= .003) and cross-sectional area (area under the curve  = 0.941, &lt;i&gt;P &lt;/i&gt;= .007) at the narrowest point of the straight or falcine sinus were highly predictive of the neonatal at-risk cohort.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Early neonatal and fetal MR imaging can be readily used for accurate early risk stratification, assisting in directing resources, timing treatment decisions, and identifying appropriate cohorts for novel interventions.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="L. Arko" />
<meta name="citation_author_institution" content="aFrom the Departments of Neurosurgery (L.A., M.L., A.M., D.B.O.)" />
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<meta name="citation_author" content="M. Lambrych" />
<meta name="citation_author_institution" content="aFrom the Departments of Neurosurgery (L.A., M.L., A.M., D.B.O.)" />
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<meta name="citation_author" content="A. Montaser" />
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<meta name="citation_author" content="D Zurakowski" />
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<meta name="twitter:title" content="Fetal and Neonatal MRI Predictors of Aggressive Early Clinical Course in Vein of Galen Malformation" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Neonates with vein of Galen malformations are split into 2 cohorts: one needing urgent neonatal embolization, with relatively high mortality and morbidity even with expert care, and a cohort in which embolization can be deferred until infancy, with far better prognosis. We aimed to identify brain MR imaging characteristics obtained from fetal and early neonatal scans that can predict the clinical presentation.

MATERIALS AND METHODS: Patients with vein of Galen malformations were stratified into a neonatal at-risk cohort if the patient needed urgent neonatal intervention or if neonatal death occurred; or an infantile treatment cohort if they were stable enough not to require treatment until &gt;1 month of age. Twelve vascular MR imaging parameters, measured by 2 independent observers, were systematically correlated with the need for early neonatal intervention and/or neonatal mortality.

RESULTS: A total of 32 neonatal patients (21 patients in the neonatal at-risk cohort, 11 in the infantile treatment cohort) were identified. Maximal mediolateral diameter (area under the curve  = 0.866, P  &lt; .001) and cross-sectional area (area under the curve = 0.836, P  = .002 ) at the narrowest point of the straight or falcine sinus were most predictive of clinical evolution into the neonatal at-risk cohort. There were 15 patients who had fetal MRIs (10 in the neonatal at-risk cohort and 5 in the infantile treatment cohort). Here too, maximal mediolateral diameter (area under the curve = 0.980, P  = .003) and cross-sectional area (area under the curve  = 0.941, P  = .007) at the narrowest point of the straight or falcine sinus were highly predictive of the neonatal at-risk cohort.

CONCLUSIONS: Early neonatal and fetal MR imaging can be readily used for accurate early risk stratification, assisting in directing resources, timing treatment decisions, and identifying appropriate cohorts for novel interventions.

AUC
:   area under the curve
BA-MD
:   basilar artery maximal diameter
CC
:   craniocaudal diameter
ICA-MD
:   internal carotid artery maximal diameter
IT
:   infantile treatment cohort
NAR
:   neonatal at-risk cohort
ROC
:   receiver operating characteristic
Sig-MD
:   sigmoid sinus maximal diameter
SS-A
:   straight sinus cross-sectional area at the narrowest point of the straight or falcine sinus
SS-MD
:   straight sinus maximal diameter at the narrowest point of the straight or falcine sinus
SS-P
:   straight sinus outer perimeter at the narrowest point of the straight or falcine sinus
VOGM
:   vein of Galen malformations" />
<meta name="og-title" property="og:title" content="Fetal and Neonatal MRI Predictors of Aggressive Early Clinical Course in Vein of Galen Malformation" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/6/1105" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Neonates with vein of Galen malformations are split into 2 cohorts: one needing urgent neonatal embolization, with relatively high mortality and morbidity even with expert care, and a cohort in which embolization can be deferred until infancy, with far better prognosis. We aimed to identify brain MR imaging characteristics obtained from fetal and early neonatal scans that can predict the clinical presentation.

MATERIALS AND METHODS: Patients with vein of Galen malformations were stratified into a neonatal at-risk cohort if the patient needed urgent neonatal intervention or if neonatal death occurred; or an infantile treatment cohort if they were stable enough not to require treatment until &gt;1 month of age. Twelve vascular MR imaging parameters, measured by 2 independent observers, were systematically correlated with the need for early neonatal intervention and/or neonatal mortality.

RESULTS: A total of 32 neonatal patients (21 patients in the neonatal at-risk cohort, 11 in the infantile treatment cohort) were identified. Maximal mediolateral diameter (area under the curve  = 0.866, P  &lt; .001) and cross-sectional area (area under the curve = 0.836, P  = .002 ) at the narrowest point of the straight or falcine sinus were most predictive of clinical evolution into the neonatal at-risk cohort. There were 15 patients who had fetal MRIs (10 in the neonatal at-risk cohort and 5 in the infantile treatment cohort). Here too, maximal mediolateral diameter (area under the curve = 0.980, P  = .003) and cross-sectional area (area under the curve  = 0.941, P  = .007) at the narrowest point of the straight or falcine sinus were highly predictive of the neonatal at-risk cohort.

CONCLUSIONS: Early neonatal and fetal MR imaging can be readily used for accurate early risk stratification, assisting in directing resources, timing treatment decisions, and identifying appropriate cohorts for novel interventions.

AUC
:   area under the curve
BA-MD
:   basilar artery maximal diameter
CC
:   craniocaudal diameter
ICA-MD
:   internal carotid artery maximal diameter
IT
:   infantile treatment cohort
NAR
:   neonatal at-risk cohort
ROC
:   receiver operating characteristic
Sig-MD
:   sigmoid sinus maximal diameter
SS-A
:   straight sinus cross-sectional area at the narrowest point of the straight or falcine sinus
SS-MD
:   straight sinus maximal diameter at the narrowest point of the straight or falcine sinus
SS-P
:   straight sinus outer perimeter at the narrowest point of the straight or falcine sinus
VOGM
:   vein of Galen malformations" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L. Arko</span>, <span class="highwire-citation-author" data-delta="1">M. Lambrych</span>, <span class="highwire-citation-author" data-delta="2">A. Montaser</span>, <span class="highwire-citation-author" data-delta="3">D Zurakowski</span> and <span class="highwire-citation-author" data-delta="4">D.B. Orbach</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1105-1111; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6585 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1105-1111; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6585 </span></div>
  
  
  
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      <div class="highwire-cite-title">Fetal and Neonatal MRI Predictors of Aggressive Early Clinical Course in Vein of Galen Malformation</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Arko</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Lambrych</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Montaser</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D</span> <span class="nlm-surname">Zurakowski</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Orbach</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1105-1111; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6585 </span></div>
  
  
  
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