Imaging study of fetal germinal matrix hemorrhage-intraventricular hemorrhage

doi:10.3877/cma.j.issn.1673-5250.2025.01.003

Objective

To investigate the imaging characteristics of fetal germinal matrix hemorrhage-intraventricular hemorrhages （GMH-IVH）and evaluate the diagnostic accuracy of three sequences of fetal brain MRI，including T1 high resolution isotropic volume examination（THRIVE），balanced turbo field echo（BTFE），and diffusion weighted imaging （DWI），and fetal brain ultrasonography for fetal GMH-IVH detection.

Methods

This study enrolled 40 fetuses ultimately diagnosed with GMH-IVH in West China Second University Hospital，Sichuan University from September 2014 to April 2022.Their prenatal ultrasonography showed fetal intracranial abnormalities and followed by fetal brain MRI for final diagnosis.A retrospective analysis was conducted to summarize and analyze the imaging characteristics of three fetal brain MRI sequences，including THRIVE，BTFE and DWI，and fetal brain ultrasonography，as well as imaging outcomes and postnatal clinical functional outcomes of some subjects.The chi-square test was employed to compare the diagnostic accuracy for fetal GMH-IVH of 3 fetal brain MRI sequences versus ultrasonography results，respectively.The study protocol complied with the WorldMedicalAssociationDeclaration ofHelsinki revised in 2013.

Results

①Among 40 GMH-IVH fetuses，21 cases （52.5%），4 cases（10.0%），9 cases （22.5%），and 5 cases （12.5%）were classified as gradesⅠ-ⅣGMH-IVH respectively.Ultrasonography detected the fewest cases across all grades，while THRIVE identified the most.②The diagnostic accuracy for fetal GMH-IVH of THRIVE，BTFE，DWI sequence and ultrasonography were 97.5%（39/40），87.5%（35/40），65.0%（26/40）and 32.5%（13/40），respectively.The diagnostic accuracy of THRIVE，BTFE and DWI was higher than that of ultrasonography，respectively，and the differences were statistically significant （χ²=37.14，P ＜0.001； χ²=25.21，P＜0.001； χ²=8.46，P=0.004）.③Fetal outcomes of 40 cases of GMH-IVH showed that 22 cases were induced abortion，15 cases were born，1 case was stillbirth and 2 cases were lost to follow-up.Five cases were reexamined by brain MRI in third trimester，which showed the hemorrhage was relieved to varying degrees.Among 15 live births，5 underwent brain MRI （only 3 completed）and the GriffithsMentalDevelopmentScales-Chinese（GDS-C）assessment：there was no obvious abnormal signal in the germinal matrix area of 3 children，but 2 of them still had different degrees of ventriculomegaly；two children had normal GDS-C test results，and the other three had different aspects of clinical dysfunction，such as motor retardation，etc..

Conclusions

THRIVE，BTFE，and DWI sequence of brain MRI providing critical diagnostic value of fetal GMH-IVH.Fetal GMH-IVH may be absorbed in the third trimester of pregnancy，but postnatal neurological sequelae may persist.

Key words: Fetus, Germinal matrix hemorrhage-intraventricular hemorrhages, Magnetic resonance imaging, Ultrasonography, Brain injuries

图1 3个颅脑MRI序列与超声诊断的GMH-IVH 不同级别胎儿数分布柱状图注：GMH-IVH 为生发基质-脑室内出血，THRIVE 为T1 容积内插梯度回波序列，DWI为弥散加权成像，BTFE 为超快速平衡稳态自由进动序列

表1 5例GMH-IVH 胎儿出生后GDS-C测试结果

儿童编号	粗大运动	个人社会	听力语言	手眼协调	视觉表现	实际推理
1	正常	落后	正常	落后	落后	正常
2	正常	正常	正常	正常	正常	—
3	正常	正常	落后	正常	正常	—
4	落后	落后	正常	落后	落后	优异
5	正常	正常	优异	正常	正常	—

表1 5例GMH-IVH 胎儿出生后GDS-C测试结果

儿童编号	粗大运动	个人社会	听力语言	手眼协调	视觉表现	实际推理
1	正常	落后	正常	落后	落后	正常
2	正常	正常	正常	正常	正常	—
3	正常	正常	落后	正常	正常	—
4	落后	落后	正常	落后	落后	优异
5	正常	正常	优异	正常	正常	—

图2 本研究胎儿1（胎龄为25⁺² 周）与胎儿2（胎龄为29⁺⁶ 周）GMH-IVH 的影像学图像［胎儿1、2 影像学图像分别为图2A～2F与图2G～2H；图2A、2G 为T2-TSE序列均呈现稍高信号并环状低信号（箭头所示）；图2B、2H 为THRIVE 序列呈现高信号（箭头所示）；图2C、2I为BTFE序列稍高信号并环状低信号（箭头所示）；图2D、2J为DWI序列b 值为800图像（箭头所示）；图2E、2K 为ADC图像，DWI图像显示弥散受限，ADC值降低（箭头所示）；图2F、2L 为超声图像，血块呈稍强回声团（箭头所示）］注：GMH-IVH 为生发基质-脑室内出血。T2-TSE为T2快速自旋回波序列，THRIVE 为T1容积内插梯度回波序列，BTFE 为超快速平衡稳态自由进动序列，DWI为弥散加权成像，ADC为表观弥散系数

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