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Balani A, Sidpra J, Sudhakar S, Biswas A, Öztekin Ö, Capra V, Catala M, Copp AJ, Kumar N, Johal N, Tahir MZ, Thompson D, Pang D, Mirsky DM, Ho ML, Huisman TAGM, Rossi A, Mankad K. International Consensus Statement on the Radiological Evaluation of Dysraphic Malformations of the Spine and Spinal Cord. AJNR Am J Neuroradiol 2024:ajnr.A8117. [PMID: 38360788 DOI: 10.3174/ajnr.a8117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/13/2023] [Indexed: 02/17/2024]
Abstract
Dysraphic malformations of the spine and spinal cord (DMSSC) represent a spectrum of common congenital anomalies typically (though not exclusively) affecting the lower spinal segments. These may be responsible for varying degrees of neurologic, orthopedic, and urologic morbidity. With advances in neuroimaging, it is now possible to better diagnose and evaluate these disorders both prenatally and postnatally. Neuroimaging, performed at the right time and with technique optimization, is integral in guiding clinical management. However, the terminology used to describe these lesions has become increasingly confusing, and there is a lack of consensus regarding the essential radiologic features and their clinical weighting. This variability in radiologic practice risks unstructured decision making and increases the likelihood of suboptimal, less informed clinical management. In this manuscript, the first of a series of consensus statements, we outline a standardized international consensus statement for the radiologic evaluation of children with suspected DMSSC derived from a critical review of the literature, and the collective clinical experience of a multinational group of experts. We provide recommendations for plain radiography, sonography, CT, and MR imaging in the evaluation of DMSSC with an emphasis on technique of imaging and imaging protocols.
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Affiliation(s)
- Ankit Balani
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jai Sidpra
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Sniya Sudhakar
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Asthik Biswas
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Özgür Öztekin
- Department of Neuroradiology (Ö.Ö.), Izmir Bakircay University, Izmir, Turkey
| | - Valeria Capra
- Medical Genetics Unit (V.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martin Catala
- Laboratoire de Biologie du Développement (M.C.), UMR 7622 de Sorbonne Université et du CNRS, ERL 1156 de l'INSERM et Institut de Biologie Paris Seine, Paris, France
| | - Andrew J Copp
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neetu Kumar
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Navroop Johal
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Zubair Tahir
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dominic Thompson
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dachling Pang
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Paediatric Neurosurgery (D.P.), University of California, Davis, Davis, California
| | - David M Mirsky
- Department of Radiology (D.M.M.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mai-Lan Ho
- Department of Radiology (M.-L.H.), Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology (T.A.G.M.H.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andrea Rossi
- Neuroradiology Unit (A.R.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (A.R.), University of Genoa, Genoa, Italy
| | - Kshitij Mankad
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
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Tang X, Bai G, Wang H, Guo F, Yin H. A comparison of the accuracy of fetal magnetic resonance imaging and ultrasonography for the diagnosis of fetal congenital malformations of the spine and spinal cord. Prenat Diagn 2022; 42:1295-1302. [PMID: 35808906 DOI: 10.1002/pd.6209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To determine the diagnostic value of fetal magnetic resonance imaging (MRI) for congenital spine/spinal cord malformations. METHODS This single-center retrospective study included 120 cases of fetal spine/spinal cord abnormalities detected using fetal ultrasonography (US) and further examined by fetal MRI between 2016 and 2020. Cases were divided into three groups (congenital spine, spinal cord, and spine + spinal cord malformations) based on US assessment. We analyzed the accuracy of fetal US and MRI relative to postnatal imaging. RESULTS The diagnostic accuracy of fetal MRI for fetal spinal cord, spine, and spine + spinal cord malformations was 86.2% (25/29), 89.4% (42/47), and 86.3% (38/44), respectively, and the corresponding rates for fetal US were 51.7% (15/29), 87.2% (41/47), and 68.2% (30/44). The diagnostic accuracy did not differ between fetal MRI and US for congenital spine malformations (P > 0.05); for congenital spinal cord malformations and congenital spine+spinal cord malformations, the diagnostic accuracy was significantly higher for fetal MRI than for fetal US (P < 0.05). CONCLUSIONS Fetal MRI is effective in the assessment of congenital spine/spinal cord malformations. It can yield information that supplements US findings, especially for congenital spinal cord malformations, and can improve the accuracy of fetal diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xing Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Guoyan Bai
- Department of Clinical Laboratory, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, PR China
| | - Hong Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
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Nagaraj UD, Venkatesan C, Bierbrauer KS, Kline-Fath BM. Value of pre- and postnatal magnetic resonance imaging in the evaluation of congenital central nervous system anomalies. Pediatr Radiol 2022; 52:802-816. [PMID: 34232351 DOI: 10.1007/s00247-021-05137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Fetal MRI and neonatal MRI of the central nervous system (CNS) are complementary tools that can help to accurately counsel and direct the management of children with anomalies of the central nervous system. Postnatal MRI can add to fetal MRI by allowing for monitoring of changes in the severity of disease, better delineation of a suspected prenatal anomaly, evaluation for secondary pathologies related to the primary diagnosis, and surgical management direction. In this review we discuss the roles of fetal and neonatal MRI in the diagnosis and treatment of congenital anomalies of the CNS through a series of case examples and how both are important in patient management.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Charu Venkatesan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karin S Bierbrauer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Mufti N, Sacco A, Aertsen M, Ushakov F, Ourselin S, Thomson D, Deprest J, Melbourne A, David AL. What brain abnormalities can magnetic resonance imaging detect in foetal and early neonatal spina bifida: a systematic review. Neuroradiology 2022; 64:233-245. [PMID: 34792623 PMCID: PMC8789702 DOI: 10.1007/s00234-021-02853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound. METHODS Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible. RESULTS Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse. CONCLUSION MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Adalina Sacco
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Fred Ushakov
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Sebastian Ourselin
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Dominic Thomson
- Paediatric Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
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Abstract
Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.
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Affiliation(s)
- Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Prayer D, Deprest J. The use of MRI in fetal conditions amenable for antenatal management. Prenat Diagn 2020; 40:3-5. [PMID: 31860748 DOI: 10.1002/pd.5629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Development and Regeneration, Cluster Woman and Child, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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