A Magnetic Resonance Template for Normal Cerebellar Development in the Human Fetus

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Abstract
Although ultrasound is the primary imaging modality for prenatal anatomic evaluation, some central nervous system malformations may be better defined with high-resolution magnetic resonance imaging (MRI). MRI allows us to visualize the features of brain development that were previously only seen histologically by embryologists and anatomists. Although there are several reports of the postnatal development of the cerebellum as revealed on magnetic resonance (MR) images, systematic MR studies of cerebellar development during the fetal period are lacking. Our objective was to use high-resolution MRI to provide a template of cerebellar development during the late first and early second trimesters, a period when the diagnosis of congenital malformations is most medicoethically relevant. The MR findings were then correlated with histological data. Twenty-six normal formalin-fixed fetal specimens with a gestational age of 9 to 24 weeks were examined with high-resolution MRI using a conventional clinical magnet and pulse sequences. The MR findings were correlated with the whole-mount histological specimens catalogued in a well-known fetal atlas. Resolution of the morphological features of cerebellar development in fetuses greater than 10 weeks gestational age was possible. Development of the rhombic lips, vermis, fourth ventricular roof, foramen of Magendie, and the cerebellar fissures was documented. Development of the cerebellum as revealed on MR images lagged behind the known stages of development by as much as 5 weeks. Features of cerebellar histogenesis were beyond the resolution of MRI. However, differences in signal intensity between gray and white matter of the developing cerebellum were detected and are postulated to represent differences in cellularity and water content of the constituent tissues. Direct correlation of MR images of fetuses during the late first and early second trimesters with anatomic atlases could result in a mistaken diagnosis of delayed or abnormal development of the posterior fossa contents because of a time lag in the detection of structures on MR images. An MR template of normal cerebellar development would be useful to avoid confusion of normal development with abnormal development and to identify the expected developmental features when provided the estimated gestational age of a fetus.