Reproducibility of Diffusion MRI‐Based Tractography in the Fetal Brain

Background Tractography based on diffusion MRI (dMRI) is a useful tool to study white matter of the developing brain. However, its application in fetal brains is limited due to motion artifacts and low resolution of in utero dMRI, leading to reduced reliability, which was scarcely investigated in previous studies. Purpose To identify reliably traceable fibers in fetal brains and assess whether reproducibility varies with gestational age (GA) and varies between brain regions. Study Type Prospective cohort study. Subjects A total of 44 healthy fetuses with GAs between 25 and 37 (31 ± 6). Field Strength/Sequence 3‐T, diffusion‐weighted echo‐planar imaging sequence (2–5 repeated dMRI scans within the same session per subject). Assessment We fitted dMRI with constrained spherical deconvolution model and conducted tractography on eight fibers. We extracted volume, fractional anisotropy, and fiber count for each fiber and assessed the reproducibility of these metrics between repeated scans within each subject. Data were divided into two age‐based subgroups (≤30 weeks, N = 28, and >30 weeks, N = 16) for further tests. Statistical Tests The reproducibility were compared between fibers by analysis of variance and two‐sample t tests. Multiple comparisons were corrected by the false discovery rate (5% was accepted). Results The reproducibility of the anterior thalamic radiation, inferior longitudinal fasciculus (ILF), genu of the corpus callosum (GCC), and body of the corpus callosum (BCC) significantly decreased with advancing GA (correlation coefficient = 0.525–0.823), as confirmed by group comparisons between fetuses in early GA (≤30 weeks) and late GA (>30 weeks) groups. Corticospinal tract, inferior fronto‐occipital fasciculus, and GCC showed high reproducibility for fiber count (weighted dice average = 0.846 vs. 0.814), while BCC and ILF exhibited the lowest reproducibility in both age groups. Data Conclusion The study indicates that the reliability of fetal brain tractography depends on GA and varies among different fibers. Level of Evidence 2 Technical Efficacy Stage 2