231-2093975*

216-1935707*
218-2117359
209-1267181*
221-1041460
ongoing pregnancy
200-2139750
284-1947026
293-2013523*
356-805244372*
339-2034481*
220-1991156
247-805226622* 206-2122083
Vermis fully
formed but
small
IV ventricle closed
MR Imaging of the Fetal Cerebellar Vermis in Utero: Criteria for Abnormal
Development, with Ultrasonographic and Clinicopathologic Correlation
A Robinson, S Blaser, A Toi, D Chitayat, W Halliday, M Gundogan, S Pantazi, G Ryan
The Hospital for Sick Children Departments of Diagnostic Imaging, Clinical & Metabolic Genetics and Neuropathology
Mount Sinai Hospital Departments of Medical Imaging, Prenatal Diagnosis & Medical Genetics and Obstetrics & Gynaecology
The University of Toronto, Ontario, Canada
J ouberts
(Prototype for congenital vermian hypoplasia)
US Image for this case courtesy of Dr. Phyllis Glanc
Womens College Campus, Sunnybrook and Womens College Hospital, Toronto
MR at 25 weeks
Rhombencephalosynapsis
Images for this case courtesy of Dr. Anne Michelle Fink
Department of Radiology, The University of Melbourne, Royal Children's and Royal Women's Hospitals, Melbourne, Australia.
Vermian fusion anomalies
ongoing pregnancy
cortical heterotopias
developmental delay
micrencephaly
fetal demise
congenital muscular
dystrophy
fetal demise
Early developmental arrest
fetal demise
cyst ovoid
cyst trapezoid
cyst trefoil
US
US
US
US
US
US
US (axial view)
US
cyst ovoid
Postnatal MR
MR at 26 weeks
no fastigial point or
primary fissure
normal follow-up
fastigium & lobulation normal
Mega cisterna magna: vermis fully formed
US
MR at 22 weeks
MR at 34 weeks
MR at 22 weeks
MR at 23 weeks
small gap in inferior
vermis
no fastigial point or
primary fissure
MR at 20 weeks
cyst keyhole
US
cyst trapezoid
Postnatal MR
deaf but otherwise
normal development
Arrest at 12-14 weeks
Vermis incomplete
IV ventricle uncovered
Arrest at 16 weeks
Inferior vermian hypoplasia
IV ventricle covered
US
vermis small
inferiorly
bilateral cochlear
dysplasia
Postnatal CT
IV ventricle closed
arachnoid cyst normal follow-up
fastigium & lobulation abnormal due to extrinsic compression
Postnatal MR US
cyst crescentic
molar toothshape
of brainstem
folia continuous
across midline
MR (axial view)
MR at 20 weeks
MR at 36 weeks
MR at 29 weeks MR at 28 weeks
cisterna magna
measures too large
ongoing pregnancy
small transcerebellar
diameter
Arachnoid cyst: vermis fully formed
IV ventricle wide &
abnormal shape
MR at 21 weeks Postnatal US
minimally increased
angle, small gap
216-1935707
fetal demise
MR at 21 weeks
cyst trapezoid
less dysplatic vermis
Postmortem MR US
cyst trefoil
MR at 21 weeks
small gap inferiorly
maybe normal
fetal demise
trapezoid
ovoid
trefoil
keyhole
normal
omega
too coronal
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Pseudo Dandy-Walker variant
US scan plane too coronal gives false appearance
Dandy-Walker Spectrum: Degree of vermian dysplasia (not cyst size) determines prognosis
Dandy-Walker Spectrum features:
Vermian dysplasia or hypoplasia
4
th
ventricle dilated or encysted
Tegmentovermian angle increased
Cisterna magna enlarged
These three fetuses with Dandy-Walker variant had different
outcomes the varying associated anomalies and genetic &
chromosomal abnormalities make counselling difficult
Dandy-Walker
variant
This fetus (a) had
other congenital
anomalies
=Wolf-Hirschhorn
syndrome
a
c
b
Dandy-Walker
variant
These 2 (b,c) had no
other anomalies
. . . neuropathology
and autopsy MRI
were normal
Dandy-Walker
Malformation PLUS
Cerebellopontine
hypoplasia . . .
poor outcome expected
Classic Dandy-Walker
Malformation
Vermis small & poorly
lobulated . . .
but better outcome
than for fetus above
Dandy-Walker
Malformation MINUS
Less vermian dysplasia
. . . even better outcome
*Note: Rhombic lip forms
cerebellum and cochlear
nucleus, rhombencephalon
induces otocyst.
cerebellar and labyrinthine
anomalies often coexist
US
vermis closed
normal follow-up