Ultrasound Obstet Gynecol 2011; 37: 290295

Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.8882

Neurodevelopmental outcome following prenatal diagnosis

of an isolated anomaly of the corpus callosum
R. MANGIONE*, N. FRIES*, P. GODARD*, C. CAPRON, V. MIRLESSE*, D. LACOMBE
and M. DUYME
*Coll`ege Francais dEchographie Ftale (CFEF), France; University of Montpellier 3, Montpellier, France; CNRS, University of
Montpellier1-Nmes, Montpellier, France; Maternity Bichat, Paris, France; Department of Medical Genetics, University of Bordeaux 2,
CHU Bordeaux, Bordeaux, France

K E Y W O R D S: corpus callosum anomaly; neurological development; outcome; parental questionnaire; prenatal diagnosis

ABSTRACT
Objectives To assess the ability of prenatal ultrasound
and magnetic resonance imaging (MRI) to diagnose
isolated anomalies of the corpus callosum (ACC) and
to further document the long-term prognosis following
diagnosis.
Methods This was a prospective casecontrol study
carried out between 1999 and 2004. Diagnosis was
made by a combination of ultrasound and MRI. All
infants were examined by a neuropediatrician and parents
consented to answer questionnaires (CDI, Iretons Child
Developmental Inventory) in 22 cases, which were
matched with 44 control infants. The CDI was used to
assess neurodevelopmental outcome in cases and controls.
Mean DQ-CDI (development quotient calculated from
CDI) values and frequencies of abnormal results were
compared between groups, and a meta-analysis of
previous studies was performed.
Results The diagnosis of ACC was made prenatally and
confirmed postnatally in 175 cases. The diagnosis was
thought to be isolated ACC in 88/175 (50%) cases.
Sixty of these 88 cases (68%) underwent termination
of pregnancy and one died in utero. Twenty-seven were
liveborn, of which 26 were followed up for a median
of 50 (range, 3074) months. Additional anomalies
were diagnosed postnatally in four (15%) of these 26
neonates. The control group was significantly better
(P < 0.05) compared with the cases diagnosed prenatally
with isolated ACC with respect to gross motor, fine
motor, language comprehension, numbers and general
development, and it was marginally better for letters
(P = 0.066). Seven of 26 (27%) (95% CI, 1346%)
infants with ACC over the age of 30 months had

neurodevelopmental delay, compared with only one

case with borderline developmental delay among the 44
controls (P = 0.006).
Conclusion Prenatal diagnosis of ACC by a combination
of ultrasound and MRI is reliable. However, the isolated
nature of the anomaly could only be assessed in 85%
of our cases. Since counseling is provided at the time
of prenatal diagnosis, our population of isolated ACC
included the cases that were missed prenatally as being
ACC with associated anomalies. A meta-analysis of
nine studies suggests that the development of children
diagnosed prenatally with isolated ACC is normal in up
to 70% (CI 95%, 5683%) of cases. This means that
the prospective risk of neurodevelopmental delay for a
fetus with ACC described as isolated prenatally is 27%,
compared with 15% for an infant whose diagnosis of
isolated ACC is confirmed postnatally. Copyright 2011
ISUOG. Published by John Wiley & Sons, Ltd.

INTRODUCTION
The corpus callosum (CC) is the main interhemispheric
commissure and is responsible for the transfer of motor,
sensorial and cognitive information between the two
brain hemispheres. Anomalies of the CC (ACC) include
complete and partial agenesis as well as hypoplasia1 . The
prevalence of ACC, which is difficult to assess in the
general population due to recruiting bias, ranges from 1.8
to 7 per 10 000 births within population-based registries
of birth defects, but is up to 23% in neuropediatric
populations2 5 . ACC can be isolated or associated with
other cerebral and extracerebral abnormalities, including
chromosomal anomalies and genetic syndromes. They

Correspondence to: Dr R. Mangione, Polyclinique Bordeaux Nord Aquitaine, Department of Women Imaging, 15 rue Claude Boucher,
33000 Bordeaux, France (e-mail: R1mang@aol.com)
Accepted: 27 October 2010

Copyright 2011 ISUOG. Published by John Wiley & Sons, Ltd.

ORIGINAL PAPER

Anomaly of corpus callosum and neurodevelopment

could also result from fetal infections or in-utero exposure
to teratogens3 7 . ACC may be amenable to prenatal
diagnosis based on direct and indirect signs on prenatal
ultrasound from 20 weeks onwards7,8 . The prenatal
diagnosis of hypoplasia and partial agenesis is more
difficult than that of complete agenesis, but is feasible
by targeted sonography9 . Although each type of ACC is
likely to reflect a distinct malformative spectrum, they
seem to share the same neurodevelopmental prognosis
when they are isolated6,9 . In the presence of associated
anomalies, the prognosis depends largely on these
anomalies and whether they lead to severe mental
and psychomotor retardation4,6,10 12 . However, even in
isolated ACC a wide range of outcomes has been reported,
from completely normal4,13,14 to severely impaired7,12
neurodevelopment, through to epilepsy or behavioral
disorders15,16 . This heterogeneity can be explained at least
in part by the difficulty in confirming the isolated nature
of ACC prenatally, the small size of usually retrospective
studies and the lack of standardization in the follow-up
of affected infants7,8,17,18 . The reported percentage of
liveborn children with ACC and with a normal outcome
varies, therefore, between 25% and 100% (Table 1).
We aimed to assess the ability of prenatal ultrasound
and magnetic resonance imaging (MRI) to diagnose
isolated ACC and to further document the long-term
prognosis following diagnosis. We reviewed the neurodevelopmental outcome of affected children between
30 months and 6 years of age in order to contribute further to the cumulative but still limited evidence in the
literature (Table 1)4,6 8,14,17,19 21.

SUBJECTS AND METHODS

This prospective casecontrol study was carried out
between 1999 and 2004 by the Coll`ege Francais
dechographie Ftale (CFEF). The CFEF is a national
network of perinatal ultrasonologists, each of whom
performs more than 1000 prenatal examinations every
year. There were 37 participating centers which, during
the study period, reported prospectively into a central
database all cases of ACC suspected antenatally as well
as pre- and postnatal management of these cases. The
diagnosis was made by a combination of ultrasound
from 20 weeks onwards and prenatal MRI performed at
around 32 weeks of gestation in all cases continuing with
the pregnancy. The diagnosis was reassessed postnatally
by transfontanellar ultrasound.
The isolated nature of the ACC was defined by the
absence of other neurological (including ventriculomegaly
> 15 mm) and extraneurological anomalies observed on a
detailed prenatal morphological ultrasound examination,
as well as on MRI carried out at around 32 weeks and
standard karyotype testing. Postnatally, we considered
that the ACC was isolated when there was no morphological, chromosomal or genetic anomaly discovered
during the examination carried out just after birth.
All infants were examined by a neuropediatrician and
parents consented to answering questionnaires (French

Copyright 2011 ISUOG. Published by John Wiley & Sons, Ltd.

291

translation of the CDI, Iretons Child Developmental

Inventory22 ) in 22 cases. In addition, each of these
infants was matched postnatally for age, gender and
socioeconomic status with two control infants. This
control group consisted of children who did not present
with any pre- or postnatal anomaly, selected from
a national population-based study focusing on child
neurodevelopment using the CDI22 . The control group
was created during the same period as that during which
the ACC cases were being collected22 .

Outcome measures
The CDI23,24 is one of the parental questionnaires
recommended by the American Academy of Pediatrics25 ,
and has both high sensitivity (80100%) and high
specificity (9496%) for screening for severe as well
as borderline neuropsychological disorders26 28 . In
addition, the CDI is an assessment level tool designed to be
used in children whose neuropsychological development is
either questionable or delayed24 . From it, a development
quotient, the DQ-CDI, is calculated. The French version
of the CDI has a sensitivity of 84% and specificity of
92%, and the DQ-CDI correlates well with the IQ WPPSI
test (Wechlser preschool and primary scale of intelligence,
intelligence quotient) (r = 0.85)22 .
The CDI consists of a set of statements describing the
childs behavior. The parent must tick Yes or No for
each statement in the answer grid according to what his
child does or does not do. Each Yes answer scores 1
point, and the score obtained for each scale is calculated
by totalling the number of points. Scores were then
transformed into developmental age according to French
normal values22 and then into the DQ-CDI, defined as
development age/chronological age 100. As for the IQ
WIPPSI29 , the average was 100 and the SD was 15 for the
general population. The 10th percentile for the DQ-CDI
was 80. Developmental delay was defined as DQ-CDI
< 79, with borderline retardation defined as DQ-CDI
between 79 and 70 and mental retardation defined as
DQ-CDI < 7029 .

Statistical analysis
Mean DQ-CDI values were compared between the ACC
and control groups by ANOVA (analysis of variance)
and the Yates corrected chi-square test was used for
comparisons of frequencies of abnormal results. A metaanalysis of previous studies was carried out using Stats
Direct software (version 2.7.3) (StatsDirect Ltd, Cheshire,
UK) (Table 1).

RESULTS
During the study period, the diagnosis of ACC was
suspected prenatally in 175 cases on ultrasound and MRI;
their outcome is summarized in Figure 1. The diagnosis
was confirmed postnatally in all cases by transfontanellar

Ultrasound Obstet Gynecol 2011; 37: 290295.

Mangione et al.
5/7; 71 (2996)
23/27; 85 (4898)
1/4; 25 (890)
13/16; 81 (3092)
6/9; 66
4/7; 57
6/8; 75 (3597)
6/6; 100 (56100)
3/3; 100 (56100)
3/7; 43 (1081)
11/20; 55 (3177)
19/26; 73 (5486)
0
5
0
By 2 years: 1
By 4 years: 8
By 6 years: 10
1
0
0
8
0
0
2 y (6 m8 y)
29 m (birth11 y)
4 y (27 y)
4 y (28 y)

Ultrasound Obstet Gynecol 2011; 37: 290295.

0
0
0
19
NA
60
19
1
0
When necessary
16
27
9
6
3
15
20
27
Volpe et al.8 (2006)
Pisani et al.4 (2006)
Ramelli et al.14 (2006)
Fratelli et al.7 (2007)
Chadie et al.6 (2008)
This study

19
9
3
117
20
175

1
0
0
0
4
4

NA
NA
14
17
7
30
4
17
14
70
14
17
Vergani et al.20 (1994)
Gupta and Lilford21 (1995)*
Rapp et al.17 (2002)
Moutard et al.19 (2003)

Reference

Liveborn

2
3
2
0

Prenatal MRI
performed
( n)
Diagnosed non-isolated
postnatally
Total ACC
( n)

Prenatal diagnosis isolated ACC (n)

Table 1 Prenatal prognosis of isolated anomalies of the corpus callosum: review of the literature

3 y (16 y)
5 y (216 y)
5 y (210 y)
3 y (25 y)
6 y (316 y)
4 y (3074 m)

Copyright 2011 ISUOG. Published by John Wiley & Sons, Ltd.

0
4
4
NA

ACC have been amenable to prenatal ultrasound diagnosis

for at least 15 years12,19 . The neurodevelopmental
outcome of ACC associated with other anomalies is
generally described as dismal, while that of isolated
ACC is considered to be better, although not consistently
normal. However, there have been only relatively few
cases reported over the last 15 years that document
reliably the performance of prenatal diagnosis using a
combination of ultrasound and fetal MRI to confirm the
isolated nature of ACC and to predict the outcome of
cases with isolated ACC (Table 1).

TOP ACC
isolated
( n)

*Includes the study by Pilu et al.18 (1993), 11 children aged 6 months to 11 years, 9 (82%) of whom were normal. Used for meta-analysis. MRI, magnetic resonance imaging; NA, not available; m,
months; TOP, termination of pregnancy; y, years.

Normal
evolution
(n; % (95% CI))
Lost to
follow-up
( n)
Duration of
follow-up (median
(range))

292
175 fetuses
with ACC

88 isolated
- 53 complete agenesis
- 23 partial agenesis
- 12 hypoplasia

1 IUFD

27
liveborn

26 followed
up

60 TOP

1
excluded

87 with associated anomalies

- 59 complete agenesis
- 14 partial agenesis
- 14 hypoplasia

3 IUFD

5 neonatal
deaths

14
liveborn

2 lost to
follow-up

70 TOP

7 followed
up

Figure 1 Outcome of pregnancies with fetal anomalies of the corpus

callosum (ACC). IUFD, intrauterine fetal death; TOP, termination
of pregnancy. * Excluded because age 14 months at assessment.

ultrasound examination. The diagnosis was thought to

be isolated ACC, including normal karyotype, in 88/175
(50%) cases prenatally. Of these, 27 cases were liveborn.
One child of less than 30 months at the time of evaluation
was excluded from long-term follow-up analysis; 26
(30%) were followed up to a median age of 50 (range,
3074) months. In four of the 26 (15%) liveborn neonates
thought prenatally to have isolated ACC, additional
anomalies were diagnosed postnatally (Table 2).
All infants with isolated ACC diagnosed prenatally
were examined by a neuropediatrician and in 22 cases
the parents consented to answering questionnaires. These
cases were matched postnatally for age, gender and socioeconomic status with 44 control infants and DQ-CDIs
were calculated for both groups. Significant differences
(P < 0.05) were found between cases diagnosed prenatally
with isolated ACC and controls for gross motor, fine
motor, language comprehension, numbers and general
development DQs (Table 3).
Among the 26 infants diagnosed with isolated ACC
antenatally, seven (27%) (95% CI, 1346%) had
neurodevelopmental delay, including three of the four
children wrongly diagnosed with isolated ACC prenatally
and then diagnosed as non-isolated ACC postnatally.
In contrast, only one of the 44 control children had
borderline developmental delay (P = 0.006; odds ratio,
15.84 (95% CI, 1.82138).

DISCUSSION

Anomaly of corpus callosum and neurodevelopment

293

Table 2 Characteristics of children with a prenatal diagnosis of isolated anomalies of the corpus callosum (ACC)
ACC type
Gender

Prenatal
diagnosis

Postnatal
diagnosis

Associated deformities
diagnosed postnatally

Developmental
assessment

Age at assessment
(months)

F
M

Complete
Complete

Complete
Complete

No
No

112
77

59
48

104
100
116

Normal
Borderline
development
Normal
Normal
Normal
Normal
Retarded
Normal
Normal
Normal
Normal
Normal
Borderline
development
Normal
Normal
N/A*

M
F
F
F
M
M
M
F
M
M
M

Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete

Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Partial

No
No
No
No
No
No
No
No
No
No
No

85
97
89
107
47
104
95
NPE
NPE
NPE
76

M
F
M

Complete
Complete
Partial

Hypoplasia
Partial
Complete

No
No
No

F
F

Partial
Partial

Partial
Partial

No
No

134
93

Normal
Normal

35
44

Partial

Partial

No

100

Normal

66

M
M
M

Partial
Hypoplasia
Hypoplasia

Complete
Hypoplasia
Hypoplasia

No
No
No

NPE
108
91

Retarded
Normal
Normal

60
57
45

Hypoplasia

Hypoplasia

No

108

Normal

66

Complete

Complete

28

Retarded

58

Complete

Complete

63

Retarded

51

Partial

Partial

20

Retarded

71

Complete

Complete

Congenital
torticollis
Congenital
torticollis, LV
over 15 mm
Non-ketotic,
hyperglycinemia
Peters anomaly

111

Normal

72

DQ-CDI

74
50
33
30
32
55
39
36
48
60
47
57
56
14

Comments
Convulsions

Squinting
Squinting
Prematurity (33 weeks)
Squinting
Squinting

Difficulty in
swallowing

Persistence of right
umbilical vein
PROM at 6 months,
prematurity (33
weeks) umbilical
cord prolapse
33 weeks premature,
pre-eclampsia

Neonatal respiratory
distress, hypotonia
Moderate IUGR,
myopia
Swallowing disorder,
squinting, autism

Severe fixed
encephalopathy

*Under 30 months at time of evaluation; excluded from long-term follow-up analysis. Complete, complete agenesis; DQ-CDI, development
quotient from Child Developmental Inventory; F, female; IUGR, intrauterine growth restriction; LV, lateral ventricles; M, male; N/A, not
applicable; NPE, neuropediatric examination without parental questionnaire; Partial, partial agenesis; PROM, premature rupture of
membranes.

The aims of our study were: first, to review

the ability of a combination of antenatal ultrasound
and MRI to diagnose isolated forms of ACC, and
second, to contribute to knowledge of the long-term
prognosis of isolated ACC diagnosed prenatally, in a
prospective population-based study performed within a
national network of multidisciplinary centers for prenatal
diagnosis.
Overall, 15% of cases thought to be isolated proved
to be associated with other abnormalities after birth.
The severity of the anomaly diagnosed as well as
the uncertainty regarding associated anomalies led to
termination of over two thirds of cases. Prenatal
counseling should take into account this uncertainty

Copyright 2011 ISUOG. Published by John Wiley & Sons, Ltd.

surrounding the diagnosis of associated anomalies, with

reports of between 5 and 20% of cases diagnosed
prenatally with isolated ACC proving to be nonisolated cases3,6,17 (Table 1). In the neurodevelopmental
assessment of this population, we therefore deliberately
took into account cases of ACC with associated anomalies
that were thought to have been isolated prenatally
because counseling is provided at the time of prenatal
diagnosis.
The meta-analysis of nine previously published studies
(Table 1) suggests that the development of children
diagnosed prenatally with isolated ACC is normal in up
to 70% (95% CI, 5683%) of cases. Including our series
suggests it is normal in 71% (95% CI, 6379%) of cases.

Ultrasound Obstet Gynecol 2011; 37: 290295.

Mangione et al.

294
Table 3 Development quotient (DQ) scores according to developmental area
DQ score (mean (SD))
Developmental area
Social
Autonomy
Gross motor
Fine motor
Expressive language
Language comprehension
Letters*
Numbers
General development

Prenatal isolated ACC group

(n = 22)

Control group
(n = 44)

96.0 (33.3)
97.4 (36.0)
88.9 (27.6)
88.4 (26.4)
93.0 (33.9)
85.9 (26.2)
88.8 (31.0)
86.9 (27.1)
88.5 (27.7)

104.4 (23.0)
99.8 (16.7)
100.3 (18.2)
99.5 (10.8)
103.0 (21.4)
101.3 (21.7)
100.0 (12.9)
102.5 (14.6)
100.4 (9.9)

0.233
0.706
0.049
0.018
0.148
0.014
0.066
0.003
0.013

*For letters, test valid only for children above 38 months; number of subjects for this variable was 18 for ACC group and 36 for control
group. Six children in ACC group and one control had a general DQ score < 80 (Yates corrected chi-square = 6.40, d.f. = 1, P = 0.01).
Significant.

Our study found that the risk of neurodevelopmental

delay in a fetus with ACC described prenatally as
being isolated was 27%, whereas it was 15% for an
infant whose diagnosis of isolated ACC was confirmed
postnatally.
Although the heterogeneity of the populations studied
should favor center-based statistics at the time of
prenatal counseling, in very few centers could sufficient
numbers of these rare cases be gathered, and these
overall figures might prove useful for counseling in
these difficult cases. Our series reports on children up
to the age of 6 years, whereas some psychopathological
or cognitive disorders can only be evaluated later in
life. Several studies evoked the hypothesis that subtle
problems or deficits in neurodevelopment might appear
with increased age15,19,30 33 . Furthermore, it is possible
that using more specific psychometric tools to explore the
interhemispheric relationship, focusing on visuospatial or
verbal difficulties, might highlight certain types of specific
deficit which do not hinder general development. Research
on genome restructuring using the comparative genomic
hybridization array technique should, in the near future,
make it possible to characterize further anomalies that
are not amenable to prenatal imaging34 . In our series,
eye abnormalities in a case of Peters syndrome (OMIM
#148 300), subtle and progressive anomalies of the cornea
not amenable to prenatal diagnosis, were missed in one
case that was diagnosed in utero as being isolated. This
emphasizes that the diagnosis of isolated ACC calls for
thorough genetic counseling, which may in turn lead to
further prenatal investigations to confirm whether ACC
is, in fact, isolated.

ACKNOWLEDGMENTS
Thanks are due to Micheline Bisaro (psychologist), for her
contribution and her help with this study, Teresa Sawyers,
for translation, and all sonographers who participated in
this study: C. Talmant, M. Althuser, D. Moeglin, B.
Maugey, J.G. Martin, C. Courtiol, M. Aubron, J.P. Bault,

Copyright 2011 ISUOG. Published by John Wiley & Sons, Ltd.

B. Laplanche, E. Bensad, G. Haddad, N. Bigi, F. Atger,

H. Laurichesse, G. Gerves, B. Jouitteau, O. Castaing, O.
Buisson, E. Julien, M. P. Legac, P. Morcel, F. Rauch, E.
Vidalo, C. Lepinard, A. Sauvadet, M. Yvinec, C. Massias,
T. Tomasella, S. Chouchene, A. Laurent, F. Poisson, D.
Marchal, G. Neveux, M. Moulis, M. H. Vignelongue, M.
Wetzel, B. Picard and D. Leduff.

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