Intracranial hemorrhage and additional anomalies detected on prenatal magnetic resonance imaging: a large, retrospective study in two tertiary medical institutions

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Methods We retrospectively reviewed MR images of foetuses with ICH on screening ultrasound (US) on picture archiving communication system (PACS) servers within a nearly five-year period from two medical tertiary centres. The indications, main abnormal findings and coexistent anomalies were recorded by two experienced radiologists with census readings. Results We recruited 81 cases (average gestational week, 28.0 ± 5.0 weeks) with prenatal MR imaging, including 71 singleton pregnancies and 10 monochromic twin pregnancies. Predominant coexistent anomalies were ventriculomegaly (35.8%), holoprosencephaly or porencephaly (13.6%) and enlarged posterior fossa/ or posterior fossa cyst (7%) in the lesion-based evaluation. The number of haemorrhagic lesions and the occurrence of the detected complications did not show a correlation with the size of the haematoma. The mass effect of ICH was more commonly observed in foetuses with a large for gestational age (GA) than in foetuses with a small for GA. Conclusion Prenatal MR imaging could better show ICH morphology and associated abnormal findings. As a complementary tool of US, MR imaging could help with prenatal counselling and treatment selection after birth. Health sciences/Medical research/Outcomes research Health sciences/Risk factors Foetus Magnetic resonance imaging Intracranial hemorrhages Foetal malformation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Intracranial haemorrhage (ICH) in the foetus is a rare condition with a prevalence of 1/100,000 to 1/1000 in the reported literature [ 1 ]. The exact aetiology of foetal brain haemorrhage is unknown. A pregnant woman will not experience any symptoms during an intracranial bleeding process in the foetal brain. It is difficult to detect ICH as early as possible, meaning that the prognoses of these foetuses may be dismal [ 2 – 3 ]. Ultrasonography (US) is the first-choice modality to screen out these suspected abnormal findings [ 4 ]. Some subtle lesions are occasionally missed due to either shielding by the calvaria or an uncooperative foetal head position [ 5 ]. As a reliable complimentary tool to US, magnetic resonance imaging (MRI) can depict intracranial anatomic structures well and show multiple system anomalies in one scanning plane [ 6 – 8 ]. Unlike MRI characteristics detected in infants or adults, imaging characteristics of foetal ICH vary depending on when and where the haemorrhagic components occur [ 9 ]. Coexistent malformations also complicate an accurate diagnosis and evaluation of these abnormal findings on prenatal MRI [ 10 ]. To date, reports in the literature on foetal ICH are alarmingly limited, especially in a relatively large cohort study [ 11 , 12 ]. Knowledge of the MRI signs and abnormal findings will help clinicians perform prenatal counselling and treatment selection at term. Therefore, our purpose in this research is threefold: (1) to describe the primary and secondary MRI characteristics of foetal ICH on prenatal MRI in a large cohort sample from two independent tertiary centres; (2) to summarize the clinical indications and complications for all foetuses with ICH and analyse whether the volume of a haematoma affects the occurrence of coexistent complications detected on MRI; and (3) to correlate these MRI findings with the postnatal outcomes of the foetuses and some follow-up infants. Methods Study population Our institutional review board approved this retrospective study. The flow chart of the selected samples was as follows: first, we retrieved foetal head MR scans from picture archiving communication systems (PACS) in our institution from Jan. 2015 to Dec. 2019 and from another institution from Jan. 2014 to Dec. 2019. All of these foetuses underwent MR examination for suspected abnormal central nervous system findings on US or MR performed in a referring hospital. The exclusion criteria included normal findings and only ventriculomegaly reports on MR. Other anomalies (agenesis of the corpus callosum, intracranial tumours, lip/palate cleft, etc.) or developmental abnormal findings (arachnoid cyst, lymphangioma, vascular malformations, etc.) detected on MR were also excluded. Finally, 81 pregnancies were included in this retrospective study (45 pregnancies in our institution and 36 pregnancies in another institution, Fig. 1 ). The gestational age (GA) of all foetuses was verified by the date of the last menstrual period and the US findings in the early trimester. Among them, 10 were twin pregnancies, and the others were singleton pregnancies (Table 1 ). Table 1 Imaging, demographic and perinatal characteristics (N = 81) Maternal age in year ( mean ± SD, range) 29.3 ± 4.7 (21–43) GA in week (mean ± SD, range) 28.0 ± 5.0 (21–40) Sex (male/female, n %) 39 (48.1%)/42 (51.9%) Mass effect (present/absent, n %) 13 (16.0%)/68 (83.9%) Multiple/single lesions, n (%) 28/53, 52.8% Bigeminal/ singleton pregnancy, n (%) 10/71, 14.1% Clinical indications (n %) Intracranial hemorrhage 15 (18.5%) Ventriculomegaly 16 (19.8%) Hydrocephalus 8 (9.9%) Cerebellum/posterior fossa malformation 5 (6.2%) Others (agenesis of corpus callosum, low spinal cord, tethered cord syndrome, TTTs, TAPs, etc.) 37 (45.7%) Complications* (n %) Ventriculomegaly 29 (35.8%) Porencephaly or holoprosencephaly 11 (13.6%) Enlarged posterior fossa/ or posterior fossa cyst 7 (8.6%) Agenesis of corpus callosum 2 (2.5%) Cerebellar dysplasia/hypoplasia 2 (2.5%) Hydrocephalus 9 (11.1%) Others (gyri malformation, hydrops fetalis , subependymal cyst, low spinal cord, hydrops fetalis) 11 (13.6%) Outcomes Termination of pregnancy or selective reduction 34 (42.0%) Dead birth or fetal demise 3 (3.7%) Live birth 21 (25.9%) Loss to follow-up 23 (28.4%) *Some fetuses had multiple complications MRI acquisition and interpretation In our hospital, all the examinations were performed without sedation. MRI was performed using a 1.5-T magnetic resonance imaging system with a phased array coil (Magnetom Avanto, Siemens). Conventional MRI protocols used for fetal evaluation included axial/sagittal/coronal half-Fourier acquisition of a single-shot turbo spin (HASTE), and axial/sagittal/coronal true-fast-imaging steady-state precession (True-FISP) sequences. Acquisition parameters for the HASTE sequence were as follows: repetition time (TR) = 1350 ms, echo time (TE) = 92 ms, field of view (FOV) = 400 mm, voxel size: 1.4 × 1.1 × 4.0 mm, flip angle = 170°, matrix = 384 × 256, slice thickness = 4 mm, gap = 0.8 mm, acquisition time = 20-25s. The parameters for the True-FISP sequence were as follows: TR = 3.87 ms, TE = 1.68 ms, FOV = 400 mm, voxel size: 1.7 ×1.6 × 4.0 mm, flip angle = 60°, matrix = 256 × 144, slice thickness = 4 mm, gap = 0.4 mm, and acquisition time = 10-20s. Diffusion-weighted imaging (DWI) was performed in the axial plane using a two-dimensional echo-planar imaging sequence and parallel acquisition technique, with b values of 0, 100, and 500 s/mm 2 . For all MRI sequences, the specific absorption ratio value was controlled under 2.0 W/kg. In another hospital, MR was performed using a 1.5-T MR system (Optima MR 360, GE) with an 8-channel phased-array cardiac coil using the breath-hold technique. The detailed parameters were as follows: fast imaging applying a steady-state acquisition (FIESTA) sequence, TR = 4.4 ms, TE = minimum, FOV = 380 × 380 mm, matrix = 224 × 224, slice thickness/interslice gap = 6/0 mm, bandwidth = 83.13 Hz/pixel; sagittal fast spin-echo (FSE) T2WI, TE = 61 ms; TR = 3000 ms; thickness = 7 mm; gap = 5 mm; FOV = 36 cm; matrix = 320 × 224; number of excitations (NEX) = 2; band = 41. 7 Hz/pixel. Axial T1WI, TE = 11 ms; TR = 830 ms; thickness = 7 mm; gap = 5 mm; FOV = 36 cm; matrix = 320 × 192; NEX = 2; band = 41. 7 Hz/pixel. DWI sequence, b values = 800 s/mm 2 ,TE = 78 ms; TR = 4100 ms; thickness = 8 mm; gap = 6 mm; FOV = 36 cm; matrix = 96 × 128; NEX = 6. All fetal MRI scans were independently assessed by two experienced radiologists (both with more than 10 years of experience in fetal MRI knowledge) at the PACS terminal server. Image quality was assessed in the following four grades: excellent (grade 4: excellent diagnostic image quality without fetal motion artifacts), good (grade 3: moderate artifacts but adequate diagnostic quality), poor (grade 2: moderate motion artifacts affecting the assessment of the brain), and unacceptable (grade 1: motion artifacts that severely affect image quality and diagnostic ability). On T1WI, the amniotic fluid, pelvic wall muscle, and subcutaneous fat signals were similar in hypo-, iso-, and hyper-intensity; on T2WI, the pelvic bone, pelvic wall muscle, and amniotic fluid signals were similar hypo-, iso-, and hyper-intensity; and on b = 800 s/mm 2 DWI images, the amniotic fluid and brain parenchyma signals were similar in hypo-, iso-intensity. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations by including a statement in the methods section to this effect. All conclusions required consensual agreement between the observers. The MRI images were assessed, including (1) the presence of ICH, (2) the location of ICH and the area of the lesion, and (3) the grade of the IVH. The location of the non-GM-IVH was defined as a haematoma or its debris occurring in the cerebellum, subdural space or corpus callosum. GM-IVH was graded according to the modified Papile classification[ 13 ]. The volume of intracranial haematoma was measured by one radiologist based on the reported methods in a previous study [ 14 ]. Other coexistent malformations, including ventriculomegaly, holoprosencephaly, hydrocephalus, cerebellar malformations, porencephaly, dilated posterior fossa, agenesis of corpus callosum, etc. were also recorded case-by-case (Table 1 ). Postnatal follow-up All newborns delivered were evaluated by a pediatrician and an obstetrician. Demographic characteristics and perinatal factors were recorded, including fetal sex, birth weight, mode of delivery, and Apgar score (1 to 10). The clinical course included motor (reduced or asymmetric muscle tone or strength), intellectual (mental retardation or cerebral palsy) and cognitive function (visual or auditory impairment). Statistical analysis Continuous variables are reported as median ± standard deviation and were compared by Student's t-test. Categorical variables are reported as percentages and were compared by chi-square and Fisher's exact tests. All analyses were performed using SPSS (version 23.0, IBM). Values of p < 0.05 were considered statistically significant. Results General information Eighty-one pregnant women with 71 singletons (average GA: 28.5 ± 5.0, 21–40 weeks) and 10 monochromic twin pregnancies (average GA: 24.3 ± 2.5, 21–30 weeks) were recruited in this study and underwent prenatal MR imaging. The mean GA for all included pregnancies was 28.0 ± 5.0 (21–40) weeks. Foetus sex differences were not seen in this selected sample (39 males versus 42 females). The main clinical indications for further MR evaluation included intracranial haemorrhage (18.5%), ventriculomegaly (19.8%) and hydrocephalus (9.9%) (Table 1 ). MRI findings On MR imaging, most ICH in foetuses appeared as a relatively high signal on T1WI (62/81, 76.5%), an intermediate signal on T2WI (46/81, 56.8%) and a high signal on DWI (65/81, 80.2%) in the foetus-based evaluation. The frequency of foetal ICH and their average sizes across gestation are shown in Fig. 1 . In this study, GM-IVH (Fig. 2 ) was seen in 72 pregnancies (average GA: 28.0 ± 4.9 weeks), cerebellar haematoma in 6 pregnancies (average GA: 24.6 ± 1.14 weeks) and haematoma of the corpus callosum (average GA: 36.0 ± 1.0 weeks) in 3 pregnancies. The average volumes of the haematoma for the GM-IVH, cerebellum and corpus callosum were 3.62 ± 7.9, 0.30 ± 0.21 and 0.44 ± 0.26 mm 3 , respectively (Table 2 ). The volume of haemorrhagic components across the various anatomic sites did not differ at the statistical level (p = 0.705. There were 47 foetuses with ICH (average size: 1.43 ± 3.35 cm 3 ) less than 28 GWs and 34 foetuses with ICH (average size: 6.10 ± 10.83 cm 3 ) more than 28 GWs. The numbers of haemorrhagic lesions and the occurrence of detected complications did not show any dependence on the size of the haematoma (Table 3 ). However, for foetuses with a large GA, the mass effect of the haematoma could be more easily observed due to its relatively large volume (p = 0.031). Thirty-seven foetuses with ICH had one coexistent malformation or abnormal finding, 20 had multiple complications and 23 had no complications on MR imaging. Ventriculomegaly (35.8%, Fig. 3 ), holoprosencephaly or porencephaly (13.6%, Fig. 3 ) and enlarged posterior fossa/or posterior fossa cysts (7%) were the three most commonly detected abnormal findings in the lesion-based evaluation. There were 20 ICH fetuses with more than one malformation, including 4 fetuses with three coexistent malformations. There were 20 foetuses with ICH having more than one and 4 foetuses having three coexistent malformations. Brain infarction (Fig. 2 ) and edema (Fig. 4 ) were also encountered as rare complications related to foetal ICH in this study group. Table 2 MR imaging characteristics of fetal intracranial parenchyma hemorrhage across various anatomic sites on fetus-based evaluation GM-IVH Corpus callosum Cerebellum P value Total 72 3 6 Average GA 28.0 ± 4.9 36.0 ± 1.0 24.6 ± 1.14 0.007 Average Size(cm 3 )* 3.62 ± 7.9 0.44 ± 0.26 0.30 ± 0.21 0.705 Grade 2.59 ± 1.1 - - Observed Mass effect 12 - 1 # 0.149 Coexistent malformation (Num. %) 56 (77.8%) - - 0.003 GM-IVH, germinal matrix intraventricular hemorrhage;* the lesion could not be outlined in six cases; # this case also had GM-IVH Table 3 The detected complications associated with intracranial hemorrhage in fetuses on MR Imaging by various size and gestational weeks’ group. ≤ 28 GW (N = 47) > 28 GW (N = 34) Total Average hemorrhagic area size (1.43 ± 3.35cm 3 ) Average hemorrhagic area size (6.10 ± 10.83 cm 3 ) 5 5 Complications (Num.) Single 25 0 17 6 Multiple 19 2 4 2 p value 0.874 Mass effect (Num.) Observed 4 0 4 4 Non-observed 38 2 16 2 p value 0.031 Outcomes (Num.) Live 9 0 10 2 TOP/fetus reduction 21 2 10 1 Dead birth/fetal demise 1 0 1 1 p value 0.296 Outcomes and follow-up of liveborn foetuses Overall, in the present study, 21 livebirths (Fig. 5 ), 34 TOP, 1 stillbirth and 2 foetal deaths were recorded. The other pregnancies’ final outcomes were lost. One live infant with ICH detected on prenatal MR imaging from a singleton pregnancy had definite neurological symptoms (Fig. 6 ). His chromosomal microarray analysis results revealed a de novo mutation of PLOD1, which is associated with Ehlers–Danlos syndrome. One case of hydrops fetalis with alloimmune haemolysis was also detected. The volume of haemorrhagic components did not show a correlation with the final outcome in the present study. All indications, MR findings, complications and outcomes for twin pregnancies are shown in Table 4 . One pregnant woman with a twin anaemia-polycythemia sequence (Taps) delivered both healthy infants (Fig. 7 ). One pregnancy with twin-twin transfusion syndrome (TTTs) stage 4, reduction surgery performed for one foetus and expectation treatment for another with hydrops fetalis was applied. In one TTT stage 1 twin pregnancy, one foetus was in utero dead, and another foetus was a live birth with premature delivery (Fig. 8 ). After thoroughly evaluating the intrauterine conditions, the TOP procedure was performed in three twin pregnancies. Table 4 Summaries of imaging findings and fetuses outcomes in the monochorionic twin pregnancies (N = 10) with ICH detected on MR. MRI findings Outcomes Indication Location Size (cm 3 ) Complications Case No. 1 sIUGR GM-IVH 0.45 VM, porencephaly Loss to follow-up 2 TAPs GM-IVH 1.48 VM, ascites, hydrops fetalis Both live births (Fig. 1 ) 3 TTTS stage4 GM-IVH 0.16 Hydrops fetalis One small fetus with selective reduction; the other fetus having hydrops fetalis with expecting delivery 4 TTTS stage3 GM-IVH, Cerebellum 0.98 VM TOP 5 TTTS stage1 GM-IVH 0.38 Hydrops fetalis Fetal demise in one fetus; another one was live birth in premature delivery (Fig. 3 ) 6 TTTS stage4, sIUGR GM-IVH 0.12 VM TOP 7 TTTS stage3, sIUGR GM-IVH 0.57 VM, porencephaly Loss to follow-up 8 Selective fetus reduction GM-IVH 0.18 TOP 9 IVF GM-IVH 0.89 Hydropericardium, ascites, hydrops fetalis Loss to follow-up 10 TTTs stage3, sIUGR GM-IVH 0.47 Loss to follow-up sIUGR, selective fetal in-utero growth restriction; TAPs, twin anemia-polycythemia sequence; TTTS, twin-twin transfusion syndrome; IVF, in vitro fertilization; GM-IVH, germinal matrix intraventricular haemorrhage; VM, ventriculomegaly; TOP, termination of pregnancy Discussion We conducted a retrospective study reviewing MRI characteristics in foetuses with ICH and their co-occurrence abnormal findings in a large cohort sample from two tertiary centres. We found that foetal ICH could occur at any time across gestation and had various appearances depending on the onset time as observed on MR imaging. GM-IVH was the most common site of the intracranial bleeding. Ventriculomegaly (29 cases) was the most common coexistent abnormal finding on MRI, followed by porencephaly or holoprosencephaly (11 cases) and enlarged posterior fossa/or posterior fossa cysts (7 cases) in the present studied samples. We did not find a correlation between the haematoma volume and the final outcome. It has been reported that ICH is more often detected in premature infants than in prenatal life [ 1 ]. However, even if detected, the prognoses for these foetuses are dismal. Foetal ICH can be identified with both in utero US and MR imaging. The advantages of MR include better soft tissue resolution and simultaneous evaluation of multisystem malformations in one scan [ 15 ]. On foetal MR, the characteristics of ICH show an atypical signal because ICH is occasionally detected or suspected on routine US screening of pregnancies. At this time, foetuses will exhibit no specific symptoms. In this study, most ICHs were magnified as relatively high signals on T1WI, intermediate signals on T2WI and high signals on DWI. The margin of the haematoma could be better outlined on DWI (Fig. 4 – 6 .) than in the other two protocols. Furthermore, we also calculated the size of the haemorrhagic components in each case (similar results were not reported in the previously published literature) and found that the volume of the detected haematoma seemed larger in the late gestation than in the early gestation. However, the volume of the haematoma did not show a significant difference across either the gestation or the anatomic compartments at the statistical level. In one study, the authors reported that GM-IVH occurred more frequently and later in pregnancy than non-GM haemorrhage [ 16 ]. In our study, both GM-IVH and cerebellum [ 17 ] bleeding occurred in early pregnancy, and corpus callosum haemorrhage was only detected in later pregnancy. However, due to the limited number of included samples, this needs to be validated in a larger sample. Many causes could be responsible for foetal ICH, including infectious disease, maternal drug exposure, alloimmune thrombocytopenia, maternal trauma, coagulation disorders, twin-to-twin transfusion syndrome (TTTs), etc. [ 18 ]. A genetic disorder should be taken into account as the potential cause for many indeterminate cases. In the present study, we only performed gene analysis in one case (Fig. 6 ). For all 10 twin pregnancies in the included samples, TTTs was the most common indication for foetal ICH evaluation [ 19 ]. In terms of coexistent complications, 42 (51.8%) cases had abnormal findings apart from ventriculomegaly on in utero MR. For singleton pregnancies, 3 foetuses with ICH had gyri malformations, 1 foetus had TCS, and 13 foetuses with porencephaly were observed in this study. For twin pregnancies, hydrops foetalis was the most commonly detected abnormal finding, although this complication may not be associated with foetal ICH itself. Furthermore, in this study, the number of haemorrhagic lesions did not show a correlation with the haematoma volume but had some correlations with the haematoma mass effect itself. In the present study, 58 pregnancies had the final outcome recorded by either correspondence with the involved patients or by searching the inpatient medical records through a stillhospital information system. Among them, 1 stillbirth and 2 foetal deaths (one in a singleton and one in a twin pregnancy) were recorded. Additionally, the volume of haemorrhagic components did not show a correlation with the final outcome in the present study [ 17 ]. Neurodevelopmental outcomes were not evaluated owing to the short follow-up period. Comparatively, twin pregnancies have more complicated complications and poor prognoses [ 20 ]. On the one hand, these pregnancies had predisposed disease (herein, TTTs are the underlying aetiology); on the other hand, some invasive reduction surgery was performed for foetuses with growth restriction. A large amount of haematoma was not observed in this cohort of twin pregnancies on prenatal MR. Our study has some limitations. First, a relatively small number of infants were followed up after birth. A longer follow-up time will help better assess the neurodevelopmental outcome for foetuses with ICH in utero . A high rate of termination of pregnancy can underestimate the occurrence of adverse outcomes. Second, in this study, 1.5T MR equipment was applied. Although it has not yet been well evaluated for intrauterine examinations, 3.0T foetal MR with a high signal-to-noise ratio and fast scanning protocols may improve the image resolution [ 21 ]. Future studies will help to clarify the differences in imaging characteristics in foetal ICH between these two MR strengths. Conclusion Prenatal MR imaging could better show the ICH morphology and the associated abnormal findings. As a complementary tool of US, MR imaging could help with prenatal counselling and treatment selection after birth. Abbreviations ICH Intracranial haemorrhage GM-IVH Germinal matrix intraventricular haemorrhage MRI Magnetic resonance imaging HASTE Half-Fourier single-shot turbo spin echo DWI Diffusion-weighted imaging US Ultrasound VM Ventriculomegaly GA Gestational age GW Gestational week TOP Termination of pregnancy FIESTA Fast imaging employing steady-state acquisition sIUGR, Selective in-utero growth restriction TAPs Twin anemia-polycythemia sequence TTTS Twin-twin transfusion syndrome IVF In vitro fertilization Declarations Authors’ contributions H. Zhang and G. Zhang designed of the whole study; X. Liu and Y. Lu performed the experiments and analyzed the raw data; T. Wang prepared US reports; H. Zhu collected clinical data; Y. Bai performed statistical analysis; X. Liu and Y. Lu wrote the first draft; H. Zhang and G. Zhang revised and wrote the manuscript finally. Consent to participate The requirement for the informed consent of all participants was waived (IRB No.2020-138). The signed consent for further MR scan was obtained from each pregnancy when have indeterminate anomalies on screening ultrasound. This consent will comprehensively tell each pregnancy that indications, contraindications, advantages, limitations and potential medical use on MR imaging. Consent to publish Verbal informed consent for publication was obtained from the pregnancies to usage these clinical and imaging data (Figure 2- 8). Ethics approval Obstetrics and Gynecological hospital, Medical College, Fudan University of institutional review board approved the study and the requirement for the informed consent of all participants was waived by Obstetrics and Gynecological hospital, Medical College, Fudan University institutional review board Competing interests The authors declare that they have no competing interests. Availability of data and materials The authors declare that all data supporting the findings of this study are available within the article. 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Ann Neurol 2021, 89(4):813–822. Moldenhauer JS, Johnson MP: Diagnosis and Management of Complicated Monochorionic Twins. Clin Obstet Gynecol 2015, 58(3):632–642. Di Mascio D, Khalil A, D'Amico A, Buca D, Benedetti Panici P, Flacco ME, Manzoli L, Liberati M, Nappi L, Berghella V et al : Outcome of twin-twin transfusion syndrome according to Quintero stage of disease: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2020, 56(6):811–820. Neelavalli J, Krishnamurthy U, Jella PK, Mody SS, Yadav BK, Hendershot K, Hernandez-Andrade E, Yeo L, Cabrera MD, Haacke EM et al : Magnetic resonance angiography of fetal vasculature at 3.0 T. European Radiology 2016, 26(12):4570–4576. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3243838","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":228214164,"identity":"8fe0a72a-245b-4f45-848f-3a527b2e2021","order_by":0,"name":"Xuefen Liu","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xuefen","middleName":"","lastName":"Liu","suffix":""},{"id":228214165,"identity":"3840b826-32bf-4a99-8c53-a2931d332842","order_by":1,"name":"Yuanyuan Lu","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Lu","suffix":""},{"id":228214166,"identity":"8ac7a307-831f-4d6b-9f1b-dee05be3a3af","order_by":2,"name":"Tianping W","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tianping","middleName":"","lastName":"W","suffix":""},{"id":228214167,"identity":"248c6cb9-9345-48b0-8d8a-2803b8614b69","order_by":3,"name":"Hao Zhu","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Zhu","suffix":""},{"id":228214168,"identity":"40f810f7-75cc-41fc-abd7-c647f33c3013","order_by":4,"name":"Yu Bai","email":"","orcid":"","institution":"Duke University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Bai","suffix":""},{"id":228214169,"identity":"291d324c-8110-48dd-83aa-3368a9bf3f74","order_by":5,"name":"Guofu Zhang","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guofu","middleName":"","lastName":"Zhang","suffix":""},{"id":228214170,"identity":"85e6522d-bd61-4a64-b829-17910b249451","order_by":6,"name":"He Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDACCSBmbGDgsT/e2PiggiGBeC0yDGcOHzY4Q4oWG4YbaWkSRGmRn9387OHXHTY8jDNyzCoO1KQlbjjAfOzjFwa7PFxaGOccMzeWPZPGw8zzxuzGgWM5QC1sybNlGJKLcWlhlkgwk5ZsO8zDxp5jdvtjQwVQC48xswTDgcQGHFrYJNK/AbX85+FhyDErOEiMFh6JHDPJj20HeCQ40tIYDjbkgLUwfsCjRUIip0yasS2Zx4Dn8GGJA8fSjGceZktmZjBIxqlFfkb6NsmfbXb2BuyNjR8O1CTL9h1vPsz4o8IOpxZwEPAgcRwXHAaJGOBRDwSMP5A49vINaCKjYBSMglEw4gEAIcRdtbFrkVwAAAAASUVORK5CYII=","orcid":"","institution":"Fudan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"He","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2023-08-08 03:29:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3243838/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3243838/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":42166807,"identity":"e1ed44b2-1142-4cc8-aebd-2f9d2ba40c23","added_by":"auto","created_at":"2023-08-25 21:40:29","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88593,"visible":true,"origin":"","legend":"\u003cp\u003eThe frequency of foetal ICH and their average sizes across gestation in the present included samples.\u003c/p\u003e","description":"","filename":"fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/0c1a874e8e305f122b368872.jpg"},{"id":42166268,"identity":"1a2a5fe7-5a81-4934-bbe7-8e80c8a9e6a3","added_by":"auto","created_at":"2023-08-25 21:24:29","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":101495,"visible":true,"origin":"","legend":"\u003cp\u003eA 28-GW singleton pregnancy. The GM-IVH components (arrow) were detected on T1WI (A), T2WI (B) and DWI (C). On the upper plane, a patchy high signal (arrowhead) indicating early cerebral infarction in the frontal-parietal lobe was also displayed on DWI (D), which did not show any abnormal signal on the corresponding T2WI (E).\u003c/p\u003e","description":"","filename":"fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/cf47ec957ea717345f26d5f4.jpg"},{"id":42166724,"identity":"40ee03d4-fabb-40f9-a863-4711b18a9a00","added_by":"auto","created_at":"2023-08-25 21:32:29","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":99718,"visible":true,"origin":"","legend":"\u003cp\u003eA 25-GW singleton pregnancy. The GM-IVH mainly seen on one side of the lateral ventricle with both obvious enlargement of the ipsilateral posterior horn of the lateral ventricle and thinness of the adjacent grey matter in the occipital lobe on T1WI (A), T2WI (B) and DWI (C). The porencephaly was also seen in theoccipital lobe (arrowhead). The TOP procedure was performed.\u003c/p\u003e","description":"","filename":"fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/a5071a8a1a9a8f5a1ebb68bb.jpg"},{"id":42166269,"identity":"400e894c-006a-4e51-b881-4b1de6a54506","added_by":"auto","created_at":"2023-08-25 21:24:29","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":92989,"visible":true,"origin":"","legend":"\u003cp\u003eA 22-GW singleton pregnancy. Adiffuse iso-hyperintensity signal was seen in both cerebral hemispheres with diffuse loss of grey–white differentiation and effacement of the sulci on HASTE (A-B). The occipital lobe, thalamus and brainstem (arrowhead) mostly displayed isohypointensity signals on T2WI (B), slightly high signals on T1WI (C) and extremely restricted signalson DWI (D). All of these signs indicated postbleeding changes with diffuse cerebral oedema in the brain parenchyma. The TOP procedure was performed.\u003c/p\u003e","description":"","filename":"fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/31189444376937a5d52d5af4.jpg"},{"id":42166727,"identity":"333e7bfe-e65d-4538-81cc-0589d4f06aff","added_by":"auto","created_at":"2023-08-25 21:32:29","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":113667,"visible":true,"origin":"","legend":"\u003cp\u003eA 37-GW singleton pregnancy. The haemorrhagic components on one side of the lateral ventricle (arrow) displayed an intermediate signal on T2WI (A-B), aslightly high signal on T1WI (C) and an extremely high signal (D) on DWI. Obstructive hydrocephalus was mainly seen above the tentorium, indicting cerebral aqueduct stenosis (B). Fourteen months of follow-up after birth did not report any perceptible neurological sequelae.\u003c/p\u003e","description":"","filename":"fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/58af5ad826557d3490490f5d.jpg"},{"id":42166726,"identity":"41f7481a-547d-4b16-a456-4340081fe098","added_by":"auto","created_at":"2023-08-25 21:32:29","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":96055,"visible":true,"origin":"","legend":"\u003cp\u003eA 37-GW singleton pregnancy. A giant GM-IVH haematoma had shifted the midline a little on T2WI (A) and T1WI (A). The volume of the involved cerebral parenchyma decreased more than on the normal side (arrowhead). This character can be seen more clearly on DWI images (C). This case also had TCS syndrome (not shown). After birth, a V-P shunting procedure at 2 months old was performed. The main symptoms included muscle weakness with normal defecation function.\u003c/p\u003e","description":"","filename":"fig.6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/e18b486100603105123c335c.jpg"},{"id":42166272,"identity":"705e4c46-49e8-4c8f-b99e-c176385fdd9f","added_by":"auto","created_at":"2023-08-25 21:24:29","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":140741,"visible":true,"origin":"","legend":"\u003cp\u003eA 25-GW monochorionic twin pregnancy. One foetus had haemorrhagic components in the lateral ventricle on FIESTA images (A). GM-IVH displayed an extremely low signal on both T2WI (B) and DWI (C). Note that the ascites and hydrops foetalis are shown (arrow). On seven-week follow-up MR (D-F), this foetus grew as well as the normal foetusaccording to the estimated growth trend (D), and both the ascites and haemorrhage components largely resolved (E-F). The patient had a caesarean delivery at 35 GW (birth weight: 2220 g/1890 g, 1-minute Apgar score: 9/9).\u003c/p\u003e","description":"","filename":"fig.7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/36817e8d20261934cfe9c927.jpg"},{"id":42166274,"identity":"b3dada48-b1d7-4770-b061-67ded9cac948","added_by":"auto","created_at":"2023-08-25 21:24:29","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":144044,"visible":true,"origin":"","legend":"\u003cp\u003eA 25-GW TTTS stage 1 foetus in monochorionic twin pregnancy. One foetus had bleeding components (A) in the lateral ventricle on FIESTA images. Notethat pleural effusion and ascites are shown (arrow). The band of the low signal in the adjacent parenchyma was also detected on the SS FSE image (B) and DWI (C). On three-week follow-up MR (D-F), both pleural effusion and ascites continued to grow (D). The haemorrhage components in the ventricle seemed to be resolved to some extent (E/F). However, subsequent US did not detect a foetal heartbeat and confirmed intrauterine foetal death. The other foetus (not shown) was delivered at 31 GW (birth weight:1205 g, 1 minute Apgar score: 9).\u003c/p\u003e","description":"","filename":"fig.8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/78dcb5a9d2e8607b95da32fc.jpg"},{"id":46901148,"identity":"5b7a6c48-e254-4287-af20-24e67c1966ec","added_by":"auto","created_at":"2023-11-22 07:08:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":771655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/c85949a3-85b8-4c57-bd0e-ce2e3db70bca.pdf"},{"id":42166276,"identity":"449a1c8a-dcc6-4dff-978a-141740d208a8","added_by":"auto","created_at":"2023-08-25 21:24:29","extension":"docx","order_by":11,"title":"","display":"","copyAsset":false,"role":"supplement","size":13114,"visible":true,"origin":"","legend":"","description":"","filename":"Highlights.docx","url":"https://assets-eu.researchsquare.com/files/rs-3243838/v1/12ae759f6c89742012508ec5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intracranial hemorrhage and additional anomalies detected on prenatal magnetic resonance imaging: a large, retrospective study in two tertiary medical institutions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntracranial haemorrhage (ICH) in the foetus is a rare condition with a prevalence of 1/100,000 to 1/1000 in the reported literature [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The exact aetiology of foetal brain haemorrhage is unknown. A pregnant woman will not experience any symptoms during an intracranial bleeding process in the foetal brain. It is difficult to detect ICH as early as possible, meaning that the prognoses of these foetuses may be dismal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Ultrasonography (US) is the first-choice modality to screen out these suspected abnormal findings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Some subtle lesions are occasionally missed due to either shielding by the calvaria or an uncooperative foetal head position [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As a reliable complimentary tool to US, magnetic resonance imaging (MRI) can depict intracranial anatomic structures well and show multiple system anomalies in one scanning plane [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Unlike MRI characteristics detected in infants or adults, imaging characteristics of foetal ICH vary depending on when and where the haemorrhagic components occur [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Coexistent malformations also complicate an accurate diagnosis and evaluation of these abnormal findings on prenatal MRI [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To date, reports in the literature on foetal ICH are alarmingly limited, especially in a relatively large cohort study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Knowledge of the MRI signs and abnormal findings will help clinicians perform prenatal counselling and treatment selection at term.\u003c/p\u003e \u003cp\u003eTherefore, our purpose in this research is threefold: (1) to describe the primary and secondary MRI characteristics of foetal ICH on prenatal MRI in a large cohort sample from two independent tertiary centres; (2) to summarize the clinical indications and complications for all foetuses with ICH and analyse whether the volume of a haematoma affects the occurrence of coexistent complications detected on MRI; and (3) to correlate these MRI findings with the postnatal outcomes of the foetuses and some follow-up infants.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003e Our institutional review board approved this retrospective study. The flow chart of the selected samples was as follows: first, we retrieved foetal head MR scans from picture archiving communication systems (PACS) in our institution from Jan. 2015 to Dec. 2019 and from another institution from Jan. 2014 to Dec. 2019. All of these foetuses underwent MR examination for suspected abnormal central nervous system findings on US or MR performed in a referring hospital. The exclusion criteria included normal findings and only ventriculomegaly reports on MR. Other anomalies (agenesis of the corpus callosum, intracranial tumours, lip/palate cleft, etc.) or developmental abnormal findings (arachnoid cyst, lymphangioma, vascular malformations, etc.) detected on MR were also excluded. Finally, 81 pregnancies were included in this retrospective study (45 pregnancies in our institution and 36 pregnancies in another institution, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The gestational age (GA) of all foetuses was verified by the date of the last menstrual period and the US findings in the early trimester. Among them, 10 were twin pregnancies, and the others were singleton pregnancies (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImaging, demographic and perinatal characteristics (N\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age in year ( mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 (21\u0026ndash;43)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA in week (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 (21\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male/female, n %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (48.1%)/42 (51.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMass effect (present/absent, n %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (16.0%)/68 (83.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple/single lesions, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28/53, 52.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBigeminal/ singleton pregnancy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/71, 14.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical indications (n %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntracranial hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentriculomegaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (19.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebellum/posterior fossa malformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers (agenesis of corpus callosum, low spinal cord, tethered cord syndrome, TTTs, TAPs, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications* (n %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentriculomegaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePorencephaly or holoprosencephaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnlarged posterior fossa/ or posterior fossa cyst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgenesis of corpus callosum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebellar dysplasia/hypoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers (gyri malformation, hydrops fetalis\u003c/p\u003e \u003cp\u003e, subependymal cyst, low spinal cord, hydrops fetalis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTermination of pregnancy or selective reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDead birth or fetal demise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLive birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss to follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e*Some fetuses had multiple complications\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMRI acquisition and interpretation\u003c/h2\u003e \u003cp\u003eIn our hospital, all the examinations were performed without sedation. MRI was performed using a 1.5-T magnetic resonance imaging system with a phased array coil (Magnetom Avanto, Siemens). Conventional MRI protocols used for fetal evaluation included axial/sagittal/coronal half-Fourier acquisition of a single-shot turbo spin (HASTE), and axial/sagittal/coronal true-fast-imaging steady-state precession (True-FISP) sequences. Acquisition parameters for the HASTE sequence were as follows: repetition time (TR)\u0026thinsp;=\u0026thinsp;1350 ms, echo time (TE)\u0026thinsp;=\u0026thinsp;92 ms, field of view (FOV)\u0026thinsp;=\u0026thinsp;400 mm, voxel size: 1.4 \u0026times; 1.1 \u0026times; 4.0 mm, flip angle\u0026thinsp;=\u0026thinsp;170\u0026deg;, matrix\u0026thinsp;=\u0026thinsp;384 \u0026times; 256, slice thickness\u0026thinsp;=\u0026thinsp;4 mm, gap\u0026thinsp;=\u0026thinsp;0.8 mm, acquisition time\u0026thinsp;=\u0026thinsp;20-25s. The parameters for the True-FISP sequence were as follows: TR\u0026thinsp;=\u0026thinsp;3.87 ms, TE\u0026thinsp;=\u0026thinsp;1.68 ms, FOV\u0026thinsp;=\u0026thinsp;400 mm, voxel size: 1.7 \u0026times;1.6 \u0026times; 4.0 mm, flip angle\u0026thinsp;=\u0026thinsp;60\u0026deg;, matrix\u0026thinsp;=\u0026thinsp;256 \u0026times; 144, slice thickness\u0026thinsp;=\u0026thinsp;4 mm, gap\u0026thinsp;=\u0026thinsp;0.4 mm, and acquisition time\u0026thinsp;=\u0026thinsp;10-20s. Diffusion-weighted imaging (DWI) was performed in the axial plane using a two-dimensional echo-planar imaging sequence and parallel acquisition technique, with b values of 0, 100, and 500 s/mm\u003csup\u003e2\u003c/sup\u003e. For all MRI sequences, the specific absorption ratio value was controlled under 2.0 W/kg.\u003c/p\u003e \u003cp\u003eIn another hospital, MR was performed using a 1.5-T MR system (Optima MR 360, GE) with an 8-channel phased-array cardiac coil using the breath-hold technique. The detailed parameters were as follows: fast imaging applying a steady-state acquisition (FIESTA) sequence, TR\u0026thinsp;=\u0026thinsp;4.4 ms, TE\u0026thinsp;=\u0026thinsp;minimum, FOV\u0026thinsp;=\u0026thinsp;380 \u0026times; 380 mm, matrix\u0026thinsp;=\u0026thinsp;224 \u0026times; 224, slice thickness/interslice gap\u0026thinsp;=\u0026thinsp;6/0 mm, bandwidth\u0026thinsp;=\u0026thinsp;83.13 Hz/pixel; sagittal fast spin-echo (FSE) T2WI, TE\u0026thinsp;=\u0026thinsp;61 ms; TR\u0026thinsp;=\u0026thinsp;3000 ms; thickness\u0026thinsp;=\u0026thinsp;7 mm; gap\u0026thinsp;=\u0026thinsp;5 mm; FOV\u0026thinsp;=\u0026thinsp;36 cm; matrix\u0026thinsp;=\u0026thinsp;320 \u0026times; 224; number of excitations (NEX)\u0026thinsp;=\u0026thinsp;2; band\u0026thinsp;=\u0026thinsp;41. 7 Hz/pixel. Axial T1WI, TE\u0026thinsp;=\u0026thinsp;11 ms; TR\u0026thinsp;=\u0026thinsp;830 ms; thickness\u0026thinsp;=\u0026thinsp;7 mm; gap\u0026thinsp;=\u0026thinsp;5 mm; FOV\u0026thinsp;=\u0026thinsp;36 cm; matrix\u0026thinsp;=\u0026thinsp;320 \u0026times; 192; NEX\u0026thinsp;=\u0026thinsp;2; band\u0026thinsp;=\u0026thinsp;41. 7 Hz/pixel. DWI sequence, b values\u0026thinsp;=\u0026thinsp;800 s/mm\u003csup\u003e2\u003c/sup\u003e,TE\u0026thinsp;=\u0026thinsp;78 ms; TR\u0026thinsp;=\u0026thinsp;4100 ms; thickness\u0026thinsp;=\u0026thinsp;8 mm; gap\u0026thinsp;=\u0026thinsp;6 mm; FOV\u0026thinsp;=\u0026thinsp;36 cm; matrix\u0026thinsp;=\u0026thinsp;96 \u0026times; 128; NEX\u0026thinsp;=\u0026thinsp;6.\u003c/p\u003e \u003cp\u003eAll fetal MRI scans were independently assessed by two experienced radiologists (both with more than 10 years of experience in fetal MRI knowledge) at the PACS terminal server. Image quality was assessed in the following four grades: excellent (grade 4: excellent diagnostic image quality without fetal motion artifacts), good (grade 3: moderate artifacts but adequate diagnostic quality), poor (grade 2: moderate motion artifacts affecting the assessment of the brain), and unacceptable (grade 1: motion artifacts that severely affect image quality and diagnostic ability). On T1WI, the amniotic fluid, pelvic wall muscle, and subcutaneous fat signals were similar in hypo-, iso-, and hyper-intensity; on T2WI, the pelvic bone, pelvic wall muscle, and amniotic fluid signals were similar hypo-, iso-, and hyper-intensity; and on b\u0026thinsp;=\u0026thinsp;800 s/mm\u003csup\u003e2\u003c/sup\u003e DWI images, the amniotic fluid and brain parenchyma signals were similar in hypo-, iso-intensity.\u003c/p\u003e \u003cp\u003eWe confirmed that all methods were performed in accordance with the relevant guidelines and regulations by including a statement in the \u003cspan refid=\"Sec2\" class=\"InternalRef\"\u003emethods\u003c/span\u003e section to this effect. All conclusions required consensual agreement between the observers. The MRI images were assessed, including (1) the presence of ICH, (2) the location of ICH and the area of the lesion, and (3) the grade of the IVH. The location of the non-GM-IVH was defined as a haematoma or its debris occurring in the cerebellum, subdural space or corpus callosum. GM-IVH was graded according to the modified Papile classification[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The volume of intracranial haematoma was measured by one radiologist based on the reported methods in a previous study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Other coexistent malformations, including ventriculomegaly, holoprosencephaly, hydrocephalus, cerebellar malformations, porencephaly, dilated posterior fossa, agenesis of corpus callosum, etc. were also recorded case-by-case (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePostnatal follow-up\u003c/h2\u003e \u003cp\u003eAll newborns delivered were evaluated by a pediatrician and an obstetrician. Demographic characteristics and perinatal factors were recorded, including fetal sex, birth weight, mode of delivery, and Apgar score (1 to 10). The clinical course included motor (reduced or asymmetric muscle tone or strength), intellectual (mental retardation or cerebral palsy) and cognitive function (visual or auditory impairment).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are reported as median\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and were compared by Student's t-test. Categorical variables are reported as percentages and were compared by chi-square and Fisher's exact tests. All analyses were performed using SPSS (version 23.0, IBM). Values of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eGeneral information\u003c/h2\u003e \u003cp\u003eEighty-one pregnant women with 71 singletons (average GA: 28.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0, 21\u0026ndash;40 weeks) and 10 monochromic twin pregnancies (average GA: 24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5, 21\u0026ndash;30 weeks) were recruited in this study and underwent prenatal MR imaging. The mean GA for all included pregnancies was 28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 (21\u0026ndash;40) weeks. Foetus sex differences were not seen in this selected sample (39 males versus 42 females). The main clinical indications for further MR evaluation included intracranial haemorrhage (18.5%), ventriculomegaly (19.8%) and hydrocephalus (9.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMRI findings\u003c/h2\u003e \u003cp\u003eOn MR imaging, most ICH in foetuses appeared as a relatively high signal on T1WI (62/81, 76.5%), an intermediate signal on T2WI (46/81, 56.8%) and a high signal on DWI (65/81, 80.2%) in the foetus-based evaluation. The frequency of foetal ICH and their average sizes across gestation are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In this study, GM-IVH (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was seen in 72 pregnancies (average GA: 28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9 weeks), cerebellar haematoma in 6 pregnancies (average GA: 24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 weeks) and haematoma of the corpus callosum (average GA: 36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 weeks) in 3 pregnancies. The average volumes of the haematoma for the GM-IVH, cerebellum and corpus callosum were 3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9, 0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 and 0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26 mm\u003csup\u003e3\u003c/sup\u003e, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The volume of haemorrhagic components across the various anatomic sites did not differ at the statistical level (p\u0026thinsp;=\u0026thinsp;0.705. There were 47 foetuses with ICH (average size: 1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35 cm\u003csup\u003e3\u003c/sup\u003e) less than 28 GWs and 34 foetuses with ICH (average size: 6.10\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83 cm\u003csup\u003e3\u003c/sup\u003e) more than 28 GWs. The numbers of haemorrhagic lesions and the occurrence of detected complications did not show any dependence on the size of the haematoma (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, for foetuses with a large GA, the mass effect of the haematoma could be more easily observed due to its relatively large volume (p\u0026thinsp;=\u0026thinsp;0.031). Thirty-seven foetuses with ICH had one coexistent malformation or abnormal finding, 20 had multiple complications and 23 had no complications on MR imaging. Ventriculomegaly (35.8%, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), holoprosencephaly or porencephaly (13.6%, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) and enlarged posterior fossa/or posterior fossa cysts (7%) were the three most commonly detected abnormal findings in the lesion-based evaluation. There were 20 ICH fetuses with more than one malformation, including 4 fetuses with three coexistent malformations. There were 20 foetuses with ICH having more than one and 4 foetuses having three coexistent malformations. Brain infarction (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and edema (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) were also encountered as rare complications related to foetal ICH in this study group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMR imaging characteristics of fetal intracranial parenchyma hemorrhage across various anatomic sites on fetus-based evaluation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorpus callosum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCerebellum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage GA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage Size(cm\u003csup\u003e3\u003c/sup\u003e)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObserved Mass effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoexistent malformation (Num. %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eGM-IVH, germinal matrix intraventricular hemorrhage;* the lesion could not be outlined in six cases; \u003csup\u003e#\u003c/sup\u003ethis case also had GM-IVH\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe detected complications associated with intracranial hemorrhage in fetuses on MR Imaging by various size and gestational weeks\u0026rsquo; group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;28 GW (N\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;28 GW (N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAverage hemorrhagic area size (1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAverage hemorrhagic area size (6.10\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83 cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;=5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications (Num.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMass effect (Num.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes (Num.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTOP/fetus reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDead birth/fetal demise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes and follow-up of liveborn foetuses\u003c/h2\u003e \u003cp\u003eOverall, in the present study, 21 livebirths (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), 34 TOP, 1 stillbirth and 2 foetal deaths were recorded. The other pregnancies\u0026rsquo; final outcomes were lost. One live infant with ICH detected on prenatal MR imaging from a singleton pregnancy had definite neurological symptoms (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). His chromosomal microarray analysis results revealed a de novo mutation of PLOD1, which is associated with Ehlers\u0026ndash;Danlos syndrome. One case of hydrops fetalis with alloimmune haemolysis was also detected. The volume of haemorrhagic components did not show a correlation with the final outcome in the present study. All indications, MR findings, complications and outcomes for twin pregnancies are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. One pregnant woman with a twin anaemia-polycythemia sequence (Taps) delivered both healthy infants (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). One pregnancy with twin-twin transfusion syndrome (TTTs) stage 4, reduction surgery performed for one foetus and expectation treatment for another with hydrops fetalis was applied. In one TTT stage 1 twin pregnancy, one foetus was in utero dead, and another foetus was a live birth with premature delivery (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). After thoroughly evaluating the intrauterine conditions, the TOP procedure was performed in three twin pregnancies.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummaries of imaging findings and fetuses outcomes in the monochorionic twin pregnancies (N\u0026thinsp;=\u0026thinsp;10) with ICH detected on MR.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMRI findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSize (cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase No.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esIUGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVM, porencephaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLoss to follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVM, ascites, hydrops fetalis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBoth live births (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTTS stage4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHydrops fetalis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOne small fetus with selective reduction; the other fetus having hydrops fetalis with expecting delivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTTS stage3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH, Cerebellum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTOP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTTS stage1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHydrops fetalis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFetal demise in one fetus; another one was live birth in premature delivery (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTTS stage4, sIUGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTOP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTTS stage3, sIUGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVM, porencephaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLoss to follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelective fetus reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTOP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIVF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHydropericardium, ascites, hydrops fetalis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLoss to follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTTs stage3, sIUGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGM-IVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLoss to follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003esIUGR, selective fetal in-utero growth restriction; TAPs, twin anemia-polycythemia sequence; TTTS, twin-twin transfusion syndrome; IVF, in vitro fertilization; GM-IVH, germinal matrix intraventricular haemorrhage; VM, ventriculomegaly; TOP, termination of pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e We conducted a retrospective study reviewing MRI characteristics in foetuses with ICH and their co-occurrence abnormal findings in a large cohort sample from two tertiary centres. We found that foetal ICH could occur at any time across gestation and had various appearances depending on the onset time as observed on MR imaging. GM-IVH was the most common site of the intracranial bleeding. Ventriculomegaly (29 cases) was the most common coexistent abnormal finding on MRI, followed by porencephaly or holoprosencephaly (11 cases) and enlarged posterior fossa/or posterior fossa cysts (7 cases) in the present studied samples. We did not find a correlation between the haematoma volume and the final outcome.\u003c/p\u003e \u003cp\u003eIt has been reported that ICH is more often detected in premature infants than in prenatal life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, even if detected, the prognoses for these foetuses are dismal. Foetal ICH can be identified with both in utero US and MR imaging. The advantages of MR include better soft tissue resolution and simultaneous evaluation of multisystem malformations in one scan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. On foetal MR, the characteristics of ICH show an atypical signal because ICH is occasionally detected or suspected on routine US screening of pregnancies. At this time, foetuses will exhibit no specific symptoms. In this study, most ICHs were magnified as relatively high signals on T1WI, intermediate signals on T2WI and high signals on DWI. The margin of the haematoma could be better outlined on DWI (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.) than in the other two protocols. Furthermore, we also calculated the size of the haemorrhagic components in each case (similar results were not reported in the previously published literature) and found that the volume of the detected haematoma seemed larger in the late gestation than in the early gestation. However, the volume of the haematoma did not show a significant difference across either the gestation or the anatomic compartments at the statistical level. In one study, the authors reported that GM-IVH occurred more frequently and later in pregnancy than non-GM haemorrhage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study, both GM-IVH and cerebellum [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] bleeding occurred in early pregnancy, and corpus callosum haemorrhage was only detected in later pregnancy. However, due to the limited number of included samples, this needs to be validated in a larger sample.\u003c/p\u003e \u003cp\u003eMany causes could be responsible for foetal ICH, including infectious disease, maternal drug exposure, alloimmune thrombocytopenia, maternal trauma, coagulation disorders, twin-to-twin transfusion syndrome (TTTs), etc. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A genetic disorder should be taken into account as the potential cause for many indeterminate cases. In the present study, we only performed gene analysis in one case (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). For all 10 twin pregnancies in the included samples, TTTs was the most common indication for foetal ICH evaluation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In terms of coexistent complications, 42 (51.8%) cases had abnormal findings apart from ventriculomegaly on in utero MR. For singleton pregnancies, 3 foetuses with ICH had gyri malformations, 1 foetus had TCS, and 13 foetuses with porencephaly were observed in this study. For twin pregnancies, hydrops foetalis was the most commonly detected abnormal finding, although this complication may not be associated with foetal ICH itself. Furthermore, in this study, the number of haemorrhagic lesions did not show a correlation with the haematoma volume but had some correlations with the haematoma mass effect itself. In the present study, 58 pregnancies had the final outcome recorded by either correspondence with the involved patients or by searching the inpatient medical records through a stillhospital information system. Among them, 1 stillbirth and 2 foetal deaths (one in a singleton and one in a twin pregnancy) were recorded. Additionally, the volume of haemorrhagic components did not show a correlation with the final outcome in the present study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Neurodevelopmental outcomes were not evaluated owing to the short follow-up period. Comparatively, twin pregnancies have more complicated complications and poor prognoses [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. On the one hand, these pregnancies had predisposed disease (herein, TTTs are the underlying aetiology); on the other hand, some invasive reduction surgery was performed for foetuses with growth restriction. A large amount of haematoma was not observed in this cohort of twin pregnancies on prenatal MR.\u003c/p\u003e \u003cp\u003eOur study has some limitations. First, a relatively small number of infants were followed up after birth. A longer follow-up time will help better assess the neurodevelopmental outcome for foetuses with ICH \u003cem\u003ein utero\u003c/em\u003e. A high rate of termination of pregnancy can underestimate the occurrence of adverse outcomes. Second, in this study, 1.5T MR equipment was applied. Although it has not yet been well evaluated for intrauterine examinations, 3.0T foetal MR with a high signal-to-noise ratio and fast scanning protocols may improve the image resolution [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Future studies will help to clarify the differences in imaging characteristics in foetal ICH between these two MR strengths.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePrenatal MR imaging could better show the ICH morphology and the associated abnormal findings. As a complementary tool of US, MR imaging could help with prenatal counselling and treatment selection after birth.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eICH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Intracranial haemorrhage \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGM-IVH \u0026nbsp; \u0026nbsp; Germinal matrix intraventricular haemorrhage\u003c/p\u003e\n\u003cp\u003eMRI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Magnetic resonance imaging\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHASTE \u0026nbsp; \u0026nbsp; \u0026nbsp; Half-Fourier single-shot turbo spin echo\u003c/p\u003e\n\u003cp\u003eDWI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Diffusion-weighted imaging\u003c/p\u003e\n\u003cp\u003eUS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ultrasound\u003c/p\u003e\n\u003cp\u003eVM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ventriculomegaly\u003c/p\u003e\n\u003cp\u003eGA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Gestational age\u003c/p\u003e\n\u003cp\u003eGW \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gestational week\u003c/p\u003e\n\u003cp\u003eTOP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Termination of pregnancy\u003c/p\u003e\n\u003cp\u003eFIESTA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fast imaging employing steady-state acquisition\u003c/p\u003e\n\u003cp\u003esIUGR, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Selective in-utero growth restriction\u003c/p\u003e\n\u003cp\u003eTAPs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Twin anemia-polycythemia sequence\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;TTTS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Twin-twin transfusion syndrome\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;IVF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;In vitro fertilization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH. Zhang and G. Zhang designed of the whole study; X. Liu and Y. Lu performed the experiments and analyzed the raw data; T. Wang prepared US reports; H. Zhu collected clinical data; Y. Bai performed statistical analysis; X. Liu and Y. Lu wrote the first draft; H. Zhang and G. Zhang revised and wrote the manuscript finally.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe requirement for the informed consent of all participants was waived (IRB No.2020-138). The signed consent for further MR scan was obtained from each pregnancy when have indeterminate anomalies on screening ultrasound. This consent will comprehensively tell each pregnancy that indications, contraindications, advantages, limitations and potential medical use on MR imaging.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to publish\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eVerbal informed consent for publication was obtained from the pregnancies to usage these clinical and imaging data (Figure 2- 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObstetrics and Gynecological hospital, Medical College, Fudan University of institutional review board approved the study and the requirement for the informed consent of all participants was waived by Obstetrics and Gynecological hospital, Medical College, Fudan University institutional review board\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that all data supporting the findings of this study are available within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThis project is supported by Shanghai Natural Science Funding Project (No. 19ZR1407200, Receptor: Dr. Guofu Zhang).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCavaliere AF, Turrini I, Pallottini M, Vidiri A, Marchi L, Perelli F, Zaami S, Scambia G, Signore F: Genetic Profiling of Idiopathic Antenatal Intracranial Haemorrhage: What We Know? Genes (Basel) 2021, 12(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVergani P, Strobelt N, Locatelli A, Paterlini G, Tagliabue P, Parravicini E, Ghidini A: Clinical significance of fetal intracranial hemorrhage. Am J Obstet Gynecol 1996, 175(3 Pt 1):536\u0026ndash;543.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSileo FG, Zollner J, D'Antonio F, Islam S, Papageorghiou AT, Khalil A: Perinatal and long-term outcomes of fetal intracranial hemorrhage: systematic review and meta-analysis. \u003cem\u003eUltrasound Obstet Gynecol\u003c/em\u003e 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Knoop B, Zonnenberg I, Verbeke J, de Vries L, Pistorius L, van Weissenbruch MM, Vermeulen RJ, de Vries J: Additional value of advanced neurosonography and magnetic resonance imaging in fetuses at risk for brain damage. Ultrasound in Obstetrics \u0026amp; Gynecology 2020, 56(3):348\u0026ndash;358.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarim JN, Roberts NW, Salomon LJ, Papageorghiou AT: Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance. Ultrasound in Obstetrics \u0026amp; Gynecology 2017, 50(4):429\u0026ndash;441.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaladini D, Quarantelli M, Sglavo G, Pastore G, Cavallaro A, D'Armiento MR, Salvatore M, Nappi C: Accuracy of neurosonography and MRI in clinical management of fetuses referred with central nervous system abnormalities. Ultrasound in Obstetrics \u0026amp; Gynecology 2014, 44(2):188\u0026ndash;196.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanacan A, Ozgen B, Fadiloglu E, Unal C, Oguz KK, Beksac MS: Prenatal diagnosis of central nervous system abnormalities: Neurosonography versus fetal magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2020, 250:195\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManganaro L, Bernardo S, Antonelli A, Vinci V, Saldari M, Catalano C: Fetal MRI of the central nervous system: State-of-the-art. European Journal of Radiology 2017, 93:273\u0026ndash;283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang T, Wang J, Cai S, Zhang G, Sun T, Fu Z, Xiao X, Zhang H: Magnetic resonance imaging evaluation of foetal intracranial haemorrhage and the correlation with ultrasound findings and postnatal outcomes. Arch Gynecol Obstet 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller E, Orman G, Huisman T: Fetal MRI assessment of posterior fossa anomalies: A review. J Neuroimaging 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEpstein KN, Kline-Fath BM, Zhang B, Venkatesan C, Habli M, Dowd D, Nagaraj UD: Prenatal Evaluation of Intracranial Hemorrhage on Fetal MRI: A Retrospective Review. AJNR Am J Neuroradiol 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnyder EJ, Pruthi S, Hernanz-Schulman M: Characterization of germinal matrix hemorrhage in extremely premature infants: recognition of posterior location and diagnostic pitfalls. Pediatr Radiol 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarr R, De Jesus O, Shah SD, Borger J: Periventricular Hemorrhage-Intraventricular Hemorrhage. In: \u003cem\u003eStatPearls.\u003c/em\u003e edn. Treasure Island (FL): StatPearls Publishing Copyright \u0026copy; 2021, StatPearls Publishing LLC.; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao B, Jia WB, Zhang LY, Wang TZ: 1/2SH: A Simple, Accurate, and Reliable Method of Calculating the Hematoma Volume of Spontaneous Intracerebral Hemorrhage. Stroke 2020, 51(1):193\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuisman TA, Martin E, Kubik-Huch R, Marincek BJER: Fetal magnetic resonance imaging of the brain: technical considerations and normal brain development. Eur Radiol 2002, 12(8):1941\u0026ndash;1951.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanapo L, Whitehead MT, Bulas DI, Ahmadzia HK, Pesacreta L, Chang T, du Plessis A: Fetal intracranial hemorrhage: role of fetal MRI. Prenat Diagn 2017, 37(8):827\u0026ndash;836.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteggerda SJ, De Bru\u0026iuml;ne FT, van den Berg-Huysmans AA, Rijken M, Leijser LM, Walther FJ, van Wezel-Meijler G: Small cerebellar hemorrhage in preterm infants: perinatal and postnatal factors and outcome. Cerebellum 2013, 12(6):794\u0026ndash;801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHausman-Kedem M, Malinger G, Modai S, Kushner SA, Shiran SI, Ben-Sira L, Roth J, Constantini S, Fattal-Valevski A, Ben-Shachar S: Monogenic Causes of Apparently Idiopathic Perinatal Intracranial Hemorrhage. Ann Neurol 2021, 89(4):813\u0026ndash;822.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoldenhauer JS, Johnson MP: Diagnosis and Management of Complicated Monochorionic Twins. Clin Obstet Gynecol 2015, 58(3):632\u0026ndash;642.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Mascio D, Khalil A, D'Amico A, Buca D, Benedetti Panici P, Flacco ME, Manzoli L, Liberati M, Nappi L, Berghella V \u003cem\u003eet al\u003c/em\u003e: Outcome of twin-twin transfusion syndrome according to Quintero stage of disease: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2020, 56(6):811\u0026ndash;820.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeelavalli J, Krishnamurthy U, Jella PK, Mody SS, Yadav BK, Hendershot K, Hernandez-Andrade E, Yeo L, Cabrera MD, Haacke EM \u003cem\u003eet al\u003c/em\u003e: Magnetic resonance angiography of fetal vasculature at 3.0 T. European Radiology 2016, 26(12):4570\u0026ndash;4576.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Foetus, Magnetic resonance imaging, Intracranial hemorrhages, Foetal malformation","lastPublishedDoi":"10.21203/rs.3.rs-3243838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3243838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo clarify the prenatal magnetic resonance (MR) imaging characteristics of foetal intracranial haemorrhages (ICHs) in a large cohort and correlate them with birth outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively reviewed MR images of foetuses with ICH on screening ultrasound (US) on picture archiving communication system (PACS) servers within a nearly five-year period from two medical tertiary centres. The indications, main abnormal findings and coexistent anomalies were recorded by two experienced radiologists with census readings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe recruited 81 cases (average gestational week, 28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 weeks) with prenatal MR imaging, including 71 singleton pregnancies and 10 monochromic twin pregnancies. Predominant coexistent anomalies were ventriculomegaly (35.8%), holoprosencephaly or porencephaly (13.6%) and enlarged posterior fossa/ or posterior fossa cyst (7%) in the lesion-based evaluation. The number of haemorrhagic lesions and the occurrence of the detected complications did not show a correlation with the size of the haematoma. The mass effect of ICH was more commonly observed in foetuses with a large for gestational age (GA) than in foetuses with a small for GA.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePrenatal MR imaging could better show ICH morphology and associated abnormal findings. As a complementary tool of US, MR imaging could help with prenatal counselling and treatment selection after birth.\u003c/p\u003e","manuscriptTitle":"Intracranial hemorrhage and additional anomalies detected on prenatal magnetic resonance imaging: a large, retrospective study in two tertiary medical institutions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-25 21:24:24","doi":"10.21203/rs.3.rs-3243838/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29048986-0ac3-47de-8376-96e038ad13c8","owner":[],"postedDate":"August 25th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":24217262,"name":"Health sciences/Medical research/Outcomes research"},{"id":24217263,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2023-11-22T07:00:27+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-25 21:24:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3243838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3243838","identity":"rs-3243838","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}