{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:52:04Z","timestamp":1791564724230,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,3]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n \n Myelomeningocele (MMC) is associated with significant alterations of the brain microstructure, which can impair long\u2010term neurodevelopmental outcomes. By measuring the random displacement of water molecules within the brain, magnetic resonance imaging (MRI)\u2010based diffusion\u2010weighted imaging (DWI) can provide objective metrics, such as apparent diffusion coefficient (ADC) values, which allow the fetal brain microstructure to be characterized. The aim of this study was to compare prenatal brain ADC values, obtained using MRI\u2010DWI, between infants with prenatally repaired MMC who had normal\n vs<\/jats:italic>\n impaired neurodevelopmental outcomes, assessed \u2265\u200918 months of age.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective study included children who underwent prenatal MMC repair using either a fetoscopic or open\u2010hysterotomy surgical approach between July 2012 and June 2022, at a single tertiary hospital. A 1.5\u2010Tesla MRI\u2010DWI scan of the fetal brain was performed using standard departmental protocols 6\u2009weeks after surgery. ADC values were measured in the right and left hemispheric white matter of the frontal, parietal, temporal and occipital lobes, as well as within the basal ganglia, pons, cerebellar hemispheres and vermis. Neurodevelopment was evaluated by a developmental pediatrician at or after 18\u2009months of age, using the Capute Scales (Clinical Adaptive Test (CAT) for problem\u2010solving skills and fine motor skills and Clinical Linguistic and Auditory Milestone Scale (CLAMS) test for language) and the gross motor domain of the Revised Gesell Developmental Schedules. The Developmental Profile\u20103 (DP\u20103) test was also conducted during parental interview at or after 18\u2009months of age, which evaluates five qualities of development: physical, adaptive behavior, social\u2013emotional, cognitive and communication skills. Developmental quotients were calculated as: (age equivalent on Capute Scales, gross motor or DP\u20103 test\/age at assessment)\u2009\u00d7\u2009100. A normal developmental quotient score was defined as \u2265\u200985 and a score of <\u200985 indicated neurodevelopmental impairment (NDI), compared with reference values. ADC values measured in each brain region were compared between children who later had a normal developmental quotient score\n vs<\/jats:italic>\n those with a score <\u200985, using the Mann\u2013Whitney\n U<\/jats:italic>\n \u2010test and logistic regression analysis, adjusting for the child's age at the time of neurodevelopmental testing, gestational age at the time of MRI\u2010DWI and gestational age at delivery.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 50 children were included (39 that underwent prenatal fetoscopic repair and 11 that underwent prenatal open\u2010hysterotomy repair). A prenatal MRI\u2010DWI scan was performed after surgery at a median of 30.9 (interquartile range (IQR), 30.5\u201331.4)\u2009weeks' gestation. The Capute Scales and gross motor scores were available in 31\/50 (62.0%) and 29\/50 (58.0%) cases, respectively, and were obtained at a median age of 23.0 (IQR, 18.0\u201325.5)\u2009months and 23.0 (IQR, 21.0\u201326.2)\u2009months, respectively. Among these cases, 22\/31 (71.0%), 19\/31 (61.3%) and 3\/29 (10.3%) scored \u2265\u200985 on the CLAMS test, CAT and gross motor test, respectively. The DP\u20103 test score was available in 42\/50 (84.0%) children and was conducted at a median age of 24.5 (IQR, 19.0\u201326.7)\u2009months. Among these children, 18\/42 (42.9%), 28\/42 (66.7%), 38\/42 (90.5%), 35\/42 (83.3%) and 33\/42 (78.6%) had a score \u2265\u200985 for the physical, adaptive behavior, social\u2013emotional, cognitive and communication domains, respectively. After adjustment, fetal ADC values obtained 6\u2009weeks after surgery were significantly higher in all fetal brain regions studied (\n P<\/jats:italic>\n \u2009<\u20090.05 for all), except for the vermis (\n P<\/jats:italic>\n \u2009=\u20090.12) and pons (\n P<\/jats:italic>\n \u2009=\u20090.05), in infants who later had a CLAMS test score indicating NDI compared to those with a score \u2265\u200985. Additionally, fetal ADC values were significantly higher in all fetal brain regions, except for the left temporal lobe (\n P<\/jats:italic>\n \u2009=\u20090.05), left occipital lobe (\n P<\/jats:italic>\n \u2009=\u20090.06), pons (\n P<\/jats:italic>\n \u2009=\u20090.30), right and left cerebellum (\n P<\/jats:italic>\n \u2009=\u20090.55 and 0.24, respectively) and vermis (\n P<\/jats:italic>\n \u2009=\u20090.76), in infants who later had a CAT score indicating NDI compared to those with a normal score. Fetal ADC values were also significantly higher in the parietal and temporal lobes as well as in the pons (\n P<\/jats:italic>\n \u2009<\u20090.05 for all) in infants who later had a DP\u20103 cognitive and communication score indicating NDI compared to those with a normal score. There was no difference in fetal ADC values in any of the brain regions studied between children with scores indicating normal\n vs<\/jats:italic>\n impaired neurodevelopment on the gross motor test, the DP\u20103 physical, adaptive behavior and social\u2013emotional domains or the DP\u20103 general development\u00a0score.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Infants with NDI in problem\u2010solving, cognitive and communication skills exhibited significant differences in their brain microstructure, as demonstrated by higher ADC values measured\n in utero<\/jats:italic>\n 6\u2009weeks after prenatal MMC repair, compared to those with normal neurodevelopmental outcomes as assessed at or after 18\u2009months of age. These findings have significant clinical implications, especially for the early identification and management of children at risk for NDI after prenatal MMC repair. \u00a9 2026 The Author(s).\n Ultrasound in Obstetrics & Gynecology<\/jats:italic>\n published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/uog.70170","type":"journal-article","created":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T22:34:00Z","timestamp":1769380440000},"page":"329-340","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between fetal brain diffusion\u2010weighted imaging and postnatal neurodevelopmental outcome after prenatal myelomeningocele repair"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-2054","authenticated-orcid":false,"given":"R.","family":"Corroenne","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. A. G. M.","family":"Huisman","sequence":"additional","affiliation":[{"name":"Edward B. Singleton Department of Radiology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-7965","authenticated-orcid":false,"given":"A. A.","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0431-5280","authenticated-orcid":false,"given":"J. L.","family":"Munoz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston TX USA"},{"name":"Division of Developmental Medicine Department of Pediatrics, University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston TX USA"},{"name":"Division of Developmental Medicine Department of Pediatrics, University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. V.","family":"Donepudi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7887-5737","authenticated-orcid":false,"given":"M. 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