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Background <p>This study aimed to evaluate cortical maturation and fissure development using fetal neurosonography in fetuses with severe fetal growth restriction (FGR) and to investigate the relationship between cerebral hemodynamic adaptation, assessed by middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR) and fetal brain morphology.</p> Methods <p>This prospective case–control study included 164 singleton pregnancies (<i>n</i> = 82 per group) between 29 and 34 weeks of gestation, comprising 82 fetuses with severe FGR (estimated fetal weight below the 3rd percentile) and 82 gestational age–matched healthy controls. Neurosonographic evaluation included measurements of Sylvian fissure, parieto-occipital fissure, and calcarine fissure depths, as well as corpus callosum length and cerebellar vermian dimensions. Doppler parameters, including umbilical artery and MCA PI, CPR were recorded. Correlations between MCA PI, CPR and neurosonographic measurements were analyzed within the FGR group.</p> Results <p>Fetuses with FGR demonstrated significantly reduced Sylvian fissure depth (10.32 ± 1.71&#xa0;mm vs. 11.79 ± 1.95&#xa0;mm; <i>p</i> &lt; 0.001) and calcarine fissure depth (8.07 ± 1.38&#xa0;mm vs. 8.44 ± 1.24&#xa0;mm; <i>p</i> = 0.043) compared with controls. No significant differences were observed in corpus callosum length, cerebellar vermian dimensions, or parieto-occipital fissure depth. Within the FGR group, significant inverse correlations were identified between MCA PI and calcarine fissure depth (<i>r</i> = − 0.415; <i>p</i> &lt; 0.001), corpus callosum length (<i>r</i> = − 0.343; <i>p</i> = 0.003), vermian length (<i>r</i> = − 0.333; <i>p</i> = 0.004), and vermian anteroposterior depth (<i>r</i> = − 0.261; <i>p</i> = 0.027).</p> Conclusion <p>Our findings demonstrate that severe FGR is associated with delayed prenatal development of the Sylvian and calcarine fissures. Moreover, the observed inverse correlations between MCA PI values and selected neuroanatomical parameters may reflect region-specific cerebral hemodynamic adaptation and cortical remodeling associated with chronic placental insufficiency, rather than true accelerated or preserved maturation.</p>

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Impaired cortical fissure development in severe fetal growth restriction and correlation with cerebral hemodynamic adaptation: a prospective case–control study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Büşra Tsakır,
  • Gül Alkan Bülbül,
  • Elif Ayan Avcı,
  • Hasan Berkan Sayal,
  • And Yavuz

摘要

Background

This study aimed to evaluate cortical maturation and fissure development using fetal neurosonography in fetuses with severe fetal growth restriction (FGR) and to investigate the relationship between cerebral hemodynamic adaptation, assessed by middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR) and fetal brain morphology.

Methods

This prospective case–control study included 164 singleton pregnancies (n = 82 per group) between 29 and 34 weeks of gestation, comprising 82 fetuses with severe FGR (estimated fetal weight below the 3rd percentile) and 82 gestational age–matched healthy controls. Neurosonographic evaluation included measurements of Sylvian fissure, parieto-occipital fissure, and calcarine fissure depths, as well as corpus callosum length and cerebellar vermian dimensions. Doppler parameters, including umbilical artery and MCA PI, CPR were recorded. Correlations between MCA PI, CPR and neurosonographic measurements were analyzed within the FGR group.

Results

Fetuses with FGR demonstrated significantly reduced Sylvian fissure depth (10.32 ± 1.71 mm vs. 11.79 ± 1.95 mm; p < 0.001) and calcarine fissure depth (8.07 ± 1.38 mm vs. 8.44 ± 1.24 mm; p = 0.043) compared with controls. No significant differences were observed in corpus callosum length, cerebellar vermian dimensions, or parieto-occipital fissure depth. Within the FGR group, significant inverse correlations were identified between MCA PI and calcarine fissure depth (r = − 0.415; p < 0.001), corpus callosum length (r = − 0.343; p = 0.003), vermian length (r = − 0.333; p = 0.004), and vermian anteroposterior depth (r = − 0.261; p = 0.027).

Conclusion

Our findings demonstrate that severe FGR is associated with delayed prenatal development of the Sylvian and calcarine fissures. Moreover, the observed inverse correlations between MCA PI values and selected neuroanatomical parameters may reflect region-specific cerebral hemodynamic adaptation and cortical remodeling associated with chronic placental insufficiency, rather than true accelerated or preserved maturation.