Imaging of fetal intracranial hemorrhage

Introduction Prenatal diagnosis of intracranial hemorrhage has been widely reported. Hemorrhages may occur either within the cerebral ventricles, subdural space or infratentorial fossa. The incidence is suggested as 1:10,000. Predisposing factors include maternal trauma and coagulation disorders, eclampsia, abruptio placentae, twin-to-twin-transfusion syndrome, alloimmune thrombocytopenia, congenital infections. The prenatal diagnosis by either sonography or magnetic resonance imaging (MRI) has been described. However, in comparison to US, MRI is much more sensitive in detecting different kinds and stages of blood breakdown products (BBP) from early bleeding to old blood residuals. The aim of this study was to evaluate the sonographic and MRI appearance of fetal intracranial hemorrhage in relation in its location and to review outcome of fetal intracranial hemorrhage. Materials and methods Reviewed of five reports with fetal intracranial hemorrhage (2014–2015) diagnosed with ultrasound and MR imaging. MR imaging was performed with a 1.5-T in all cases. MR imaging axial single-shot echo-planar diffusion-weighted imaging sections and GE T1 weighted imaging were performed (2 cases). The results were correlated with the pathology results and postnatal imaging. Intraventricular hemorrhages were categorized following the classification commonly used in neonates as follows: –grade I: limited to subependymal matrix; –grade II: clear spill-over to ventricles, but filling less than 50% of the lateral ventricle and without ventriculomegaly; –grade III: spill-over to the ventricle, with flooding of 50% or more of one or both lateral ventricles andventriculomegaly; –grade IV: grades I, II or III with hemorrhage in a large part of the periventricular parenchyma. Results Of our 5 fetuses, intraventricular hemorrhage in 4 cases, intraparenchymal hemorrhage was detected in one case associated with cerebellar hemorrhage in 2 cases. Conclusion Fetal US and MRI can be used to identify the location of the hemorrhage. In ventricle, within the cerebral parenchyma, of the germinal matrix and in subdural space.