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Aboughalia H, Noda S, Chapman T, Revzin MV, Deutsch GH, Browd SR, Katz DS, Moshiri M. Multimodality Imaging Evaluation of Fetal Spine Anomalies with Postnatal Correlation. Radiographics 2021; 41:2176-2192. [PMID: 34723699 DOI: 10.1148/rg.2021210066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Congenital anomalies of the spine are associated with substantial morbidity in the perinatal period and may affect the rest of the patient's life. Accurate early diagnosis of spinal abnormalities during fetal imaging allows prenatal, perinatal, and postnatal treatment planning, which can substantially affect functional outcomes. The most common and clinically relevant congenital anomalies of the spine fall into three broad categories: spinal dysraphism, segmentation and fusion anomalies of the vertebral column, and sacrococcygeal teratomas. Spinal dysraphism is further categorized into one of two subtypes: open spinal dysraphism and closed spinal dysraphism. The latter category is further subdivided into those with and without subcutaneous masses. Open spinal dysraphism is an emergency and must be closed at birth because of the risk of infection. In utero closure is also offered at some fetal centers. Sacrococcygeal teratomas are the most common fetal pelvic masses and the prognosis is variable. Finally, vertebral body anomalies are categorized into formation (butterfly and hemivertebrae) and segmentation (block vertebrae) anomalies. Although appropriate evaluation of the fetal spine begins with US, which is the initial screening modality of choice, MRI is increasingly important as a problem-solving tool, especially given the recent advances in fetal MRI, its availability, and the complexity of fetal interventions. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hassan Aboughalia
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Sakura Noda
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Teresa Chapman
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Margarita V Revzin
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Gail H Deutsch
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Samuel R Browd
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
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Aertsen M, Diogo MC, Dymarkowski S, Deprest J, Prayer D. Fetal MRI for dummies: what the fetal medicine specialist should know about acquisitions and sequences. Prenat Diagn 2019; 40:6-17. [PMID: 31618472 DOI: 10.1002/pd.5579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022]
Abstract
Fetal MRI is an increasingly used tool in the field of prenatal diagnosis. While US remains the first line screening tool, as an adjuvant imaging tool, MRI has been proven to increase diagnostic accuracy and change patient counseling. Further, there are instances when US may not be sufficient for diagnosis. As a multidisciplinary field, it is important that every person involved in the referral, diagnosis, counseling and treatment of the patients is familiar with the basic principles, indications and findings of fetal MRI. The purpose of the current paper is to equip radiologists and non-radiologists with basic MRI principles and essential topics in patient preparation and provide illustrative examples of when fetal MRI may be used. This aims to aid the referring clinician in better selecting and improve patient counseling prior to arrival in the radiology department and, ultimately, patient care.
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Affiliation(s)
- Michael Aertsen
- Department of Imaging and Pathology, Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Mariana C Diogo
- Department of Image Guided Therapy, University Clinic for Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Steven Dymarkowski
- Department of Imaging and Pathology, Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Academic Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
| | - Daniela Prayer
- Department of Image Guided Therapy, University Clinic for Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
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Orman G, Tijssen MP, Seyfert D, Gassner I, Huisman TA. Ultrasound to Evaluate Neonatal Spinal Dysraphism: A First‐Line Alternative to CT and MRI. J Neuroimaging 2019; 29:553-564. [DOI: 10.1111/jon.12649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of RadiologyTexas Children's Hospital and Baylor College of Medicine Houston TX
| | - Maud P.M Tijssen
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins University School of Medicine Baltimore MD
- Department of RadiologyMaastricht University Medical Center Maastricht The Netherlands
| | - Donna Seyfert
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins University School of Medicine Baltimore MD
| | - Ingmar Gassner
- Department of RadiologyInnsbruck Medical University Innsbruck Austria
| | - Thierry A.G.M. Huisman
- Edward B. Singleton Department of RadiologyTexas Children's Hospital and Baylor College of Medicine Houston TX
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins University School of Medicine Baltimore MD
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Use of Magnetic Resonance Imaging in Evaluating Fetal Brain and Abdomen Malformations during Pregnancy. ACTA ACUST UNITED AC 2019; 55:medicina55020055. [PMID: 30781564 PMCID: PMC6410250 DOI: 10.3390/medicina55020055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/06/2019] [Accepted: 02/11/2019] [Indexed: 01/07/2023]
Abstract
Magnetic resonance imaging (MRI) is used as a clarifying technique after a high-resolution ultrasound examination during pregnancy. Combining ultrasound with MRI, additional diagnostic information is obtained or ultrasound diagnosis is frequently corrected. High spatial resolution provides accurate radiological imaging of internal organs and widens possibilities for detecting perinatal development disorders. The safety of MRI and the use of intravenous contrast agent gadolinium are discussed in this article. There is no currently available evidence that MRI is harmful to the fetus, although not enough research has been carried out to prove enduring safety. MRI should be performed when the benefit outweighs the potential side effects. The narrative review includes several clinical cases of fetal MRI performed in Vilnius University Hospital Santaros Clinics.
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Value of Fetal MRI in the Era of Fetal Therapy for Management of Abnormalities Involving the Chest, Abdomen, or Pelvis. AJR Am J Roentgenol 2018. [DOI: 10.2214/ajr.17.18948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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6
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Shrot S, Johnson CT, Golden WC, Baschat AA, Bullard JE, Tekes A, Poretti A, Dunn E, Huisman TA. Persistent Extreme Hyperextension of the Fetal Neck: Clinical and Neuroimaging Findings. J Neuroimaging 2018; 28:278-282. [DOI: 10.1111/jon.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shai Shrot
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of Diagnostic ImagingSheba Medical Center Ramat‐Gan Israel
| | - Clark T. Johnson
- Department of Gynecology & ObstetricsJohns Hopkins University School of Medicine Baltimore MD
| | - W. Christopher Golden
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Ahmet A. Baschat
- Center for Fetal TherapyDepartment of ObstetricsGynecology, and Reproductive SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Janine E. Bullard
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Aylin Tekes
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Andrea Poretti
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of NeurogeneticsKennedy Krieger Institute Baltimore MD
| | - Emily Dunn
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Thierry A.G.M. Huisman
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
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Cavalheiro S, da Costa MDS, Mendonça JN, Dastoli PA, Suriano IC, Barbosa MM, Moron AF. Antenatal management of fetal neurosurgical diseases. Childs Nerv Syst 2017; 33:1125-1141. [PMID: 28555310 PMCID: PMC5496971 DOI: 10.1007/s00381-017-3442-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022]
Abstract
The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.
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Affiliation(s)
- Sergio Cavalheiro
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil.
| | - Marcos Devanir Silva da Costa
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Jardel Nicacio Mendonça
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Patricia Alesssandra Dastoli
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Italo Capraro Suriano
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Mauricio Mendes Barbosa
- Department of Gynecology and Obstetrics, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Antonio Fernandes Moron
- Department of Gynecology and Obstetrics, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
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8
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Shankar P, Zamora C, Castillo M. Congenital malformations of the brain and spine. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:1121-1137. [PMID: 27430461 DOI: 10.1016/b978-0-444-53486-6.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter we briefly address the most common congenital brain and spinal anomalies as well as their most salient imaging, especially magnetic resonance, findings. Some of them, such as Chiari II, and open spinal defects, have become relatively rare due to their detection in utero and repair of the spinal malformation. Regardless of the type of brain anomaly, the most common clinical symptoms are mental retardation, hydrocephalus, and seizure; the latter two may need to be surgically and medically addressed. The most commonly found spinal congenital anomalies include the filum terminale lipoma which is generally asymptomatic and incidental and the caudal regression syndrome for which no primary treatment exists. Any spinal congenital anomaly may present in adulthood as a consequence of spinal cord tethering and/or development of syringomyelia.
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Affiliation(s)
- Prashant Shankar
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
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9
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The role of imaging in the diagnosis and management of renal stone disease in pregnancy. Clin Radiol 2015; 70:1462-71. [DOI: 10.1016/j.crad.2015.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/22/2015] [Accepted: 09/03/2015] [Indexed: 02/03/2023]
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10
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Dar SA, Johal SC, Marino MJ, Singh AD. Prenatal diagnosis of colobomatous microphthalmos. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e22-5. [PMID: 25942066 DOI: 10.3928/01913913-20150421-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022]
Abstract
Optic nerve coloboma and microphthalmos with colobomatous cyst are rare congenital anomalies that are difficult to detect on prenatal ultrasonography and magnetic resonance imaging. Only four cases of optic nerve coloboma and two cases of microphthalmos with colobomatous cyst have been detected on prenatal imaging. The authors report a case of a fetus initially suspected to have retinoblastoma of the right eye on prenatal ultrasonography who was later diagnosed as having microphthalmos on fetal magnetic resonance imaging. Following delivery, she was noted to have microphthalmos with colobomatous cyst of the right eye and optic nerve coloboma of the left eye. The authors also review the prenatal ocular imaging findings of the differential diagnosis.
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11
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Hugele F, Dumont C, Boulot P, Couture A, Prodhomme O. Does prenatal MRI enhance fetal diagnosis of intra-abdominal cysts? Prenat Diagn 2015; 35:669-74. [DOI: 10.1002/pd.4590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Florence Hugele
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Coralie Dumont
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Pierre Boulot
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Alain Couture
- Service de radiologie pédiatrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Olivier Prodhomme
- Service de radiologie pédiatrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
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12
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Feldman N, Melcer Y, Levinsohn-Tavor O, Orenstein A, Svirsky R, Herman A, Maymon R. Prenatal ultrasound charts of orbital total axial length measurement (TAL): a valuable data for correct fetal eye malformation assessment. Prenat Diagn 2015; 35:558-63. [DOI: 10.1002/pd.4572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Noa Feldman
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center; Zerifin Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center; Zerifin Israel
| | - Orna Levinsohn-Tavor
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center; Zerifin Israel
| | - Adi Orenstein
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center; Zerifin Israel
| | - Ran Svirsky
- Institute of Medical Genetics; Sourasky Medical Center; Tel-Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Arie Herman
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center; Zerifin Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center; Zerifin Israel
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13
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Gholipour A, Estroff JA, Barnewolt CE, Robertson RL, Grant PE, Gagoski B, Warfield SK, Afacan O, Connolly SA, Neil JJ, Wolfberg A, Mulkern RV. Fetal MRI: A Technical Update with Educational Aspirations. CONCEPTS IN MAGNETIC RESONANCE. PART A, BRIDGING EDUCATION AND RESEARCH 2014; 43:237-266. [PMID: 26225129 PMCID: PMC4515352 DOI: 10.1002/cmr.a.21321] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Fetal magnetic resonance imaging (MRI) examinations have become well-established procedures at many institutions and can serve as useful adjuncts to ultrasound (US) exams when diagnostic doubts remain after US. Due to fetal motion, however, fetal MRI exams are challenging and require the MR scanner to be used in a somewhat different mode than that employed for more routine clinical studies. Herein we review the techniques most commonly used, and those that are available, for fetal MRI with an emphasis on the physics of the techniques and how to deploy them to improve success rates for fetal MRI exams. By far the most common technique employed is single-shot T2-weighted imaging due to its excellent tissue contrast and relative immunity to fetal motion. Despite the significant challenges involved, however, many of the other techniques commonly employed in conventional neuro- and body MRI such as T1 and T2*-weighted imaging, diffusion and perfusion weighted imaging, as well as spectroscopic methods remain of interest for fetal MR applications. An effort to understand the strengths and limitations of these basic methods within the context of fetal MRI is made in order to optimize their use and facilitate implementation of technical improvements for the further development of fetal MR imaging, both in acquisition and post-processing strategies.
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Affiliation(s)
- Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judith A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard L Robertson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Borjan Gagoski
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey J Neil
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Wolfberg
- Boston Maternal Fetal Medicine, Boston, Massachusetts, USA
| | - Robert V Mulkern
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
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14
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Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, Spencer J. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 2013; 23:3485-500. [DOI: 10.1007/s00330-013-2987-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/10/2013] [Accepted: 07/13/2013] [Indexed: 12/19/2022]
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15
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Mailath-Pokorny M, Kasprian G, Mitter C, Schöpf V, Nemec U, Prayer D. Magnetic resonance methods in fetal neurology. Semin Fetal Neonatal Med 2012; 17:278-84. [PMID: 22749691 DOI: 10.1016/j.siny.2012.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Fetal magnetic resonance imaging (MRI) has become an established clinical adjunct for the in-vivo evaluation of human brain development. Normal fetal brain maturation can be studied with MRI from the 18th week of gestation to term and relies primarily on T2-weighted sequences. Recently diffusion-weighted sequences have gained importance in the structural assessment of the fetal brain. Diffusion-weighted imaging provides quantitative information about water motion and tissue microstructure and has applications for both developmental and destructive brain processes. Advanced magnetic resonance techniques, such as spectroscopy, might be used to demonstrate metabolites that are involved in brain maturation, though their development is still in the early stages. Using fetal MRI in addition to prenatal ultrasound, morphological, metabolic, and functional assessment of the fetus can be achieved. The latter is not only based on observation of fetal movements as an indirect sign of activity of the fetal brain but also on direct visualization of fetal brain activity, adding a new component to fetal neurology. This article provides an overview of the MRI methods used for fetal neurologic evaluation, focusing on normal and abnormal early brain development.
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Affiliation(s)
- M Mailath-Pokorny
- Medical University of Vienna, Department of Obstetrics and Gynecology, Vienna, Austria.
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16
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Huisman TAGM, Rossi A, Tortori-Donati P. MR imaging of neonatal spinal dysraphia: what to consider? Magn Reson Imaging Clin N Am 2012; 20:45-61. [PMID: 22118592 DOI: 10.1016/j.mric.2011.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The development of the spinal canal and its contents is highly complex and involves multiple programmed anatomic and functional developmental and maturational processes. Correct and detailed knowledge about spinal malformations is essential to understand and recognize these lesions early (preferably prenatally) to counsel parents during pregnancy, to plan possible intrauterine treatments, and to make decisions about the mode of delivery and the immediate postnatal treatment. This article discusses the imaging findings of the most frequently encountered neonatal spinal malformations and correlates these findings with the relevant embryologic processes. The presented classification is based on a correlation of clinical, neuroradiologic, and embryologic data.
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Affiliation(s)
- Thierry A G M Huisman
- Division of Pediatric Radiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Nelson, Baltimore, MD 21287-0842, USA.
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17
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Huisman TA. Fetal Magnetic Resonance Imaging of the Brain: Is Ventriculomegaly the Tip of the Syndromal Iceberg? Semin Ultrasound CT MR 2011; 32:491-509. [DOI: 10.1053/j.sult.2011.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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18
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Kline-Fath BM, Calvo-Garcia MA. Prenatal Imaging of Congenital Malformations of the Brain. Semin Ultrasound CT MR 2011; 32:167-88. [DOI: 10.1053/j.sult.2011.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Abstract
Fetal magnetic resonance imaging (MRI) has become established as part of clinical practice in many centres worldwide especially when visualization of the central nervous system pathology is required. In this review we summarize the recent literature and provide an overview of fetal development and the commonly encountered fetal pathologies visualized with MRI and illustrated with numerous MR images. We aim to convey the role of fetal MRI in clinical practice and its value as an additional investigation alongside ultrasound yet emphasize the need for caution when interpreting fetal MR images especially where experience is limited.
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Affiliation(s)
- Roobin P Jokhi
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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20
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Non-invasive imaging of intracranial pediatric vascular lesions. Childs Nerv Syst 2010; 26:1275-95. [PMID: 20596870 DOI: 10.1007/s00381-010-1203-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The goal of this review is to discuss the different non-invasive imaging techniques as well as the age-specific pediatric vascular pathologies and their imaging features. MATERIAL AND METHODS Ultrasound, computed tomography, and magnetic resonance imaging features of pediatric ischemic stroke, intracranial hemorrhage, aneurysms, cavernomas, developmental venous anomalies, and arteriovenous malformations are presented. In addition, multiple non-invasive angiographic techniques (CT and MR angiography) and functional MRI sequences (diffusion, perfusion, and susceptibility-weighted imaging) are discussed. CONCLUSION Neurovascular imaging plays a central role in the early, sensitive, and specific diagnosis of pediatric intracranial vascular disorders. A detailed knowledge of the quality and exact angioarchitecture of pediatric vascular pathologies as well as their impact on the cerebral hemo-dynamics is essential to guide and monitor treatment options and to predict functional outcome.
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21
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Daltro P, Werner H, Gasparetto TD, Domingues RC, Rodrigues L, Marchiori E, Gasparetto EL. Congenital chest malformations: a multimodality approach with emphasis on fetal MR imaging. Radiographics 2010; 30:385-95. [PMID: 20228324 DOI: 10.1148/rg.302095113] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Congenital chest malformations can range from small and asymptomatic entities to large space-occupying masses that require immediate surgical treatment. They may affect the foregut, pulmonary airway, and vasculature. Hybrid conditions are commonly seen, with interrelated chest malformations having various radiologic and pathologic features. An understanding of the in utero complications associated with fetal chest masses is essential for appropriate monitoring during pregnancy, treatment recommendations, and delivery management. Technologic advances have greatly improved the diagnosis of fetal anomalies. Congenital chest malformations are usually evaluated in the prenatal period with fetal sonography, but fetal magnetic resonance (MR) imaging is a well-established modality that is used as an adjunct technique in difficult diagnostic situations. MR imaging can provide excellent tissue contrast with more accurate analysis of the fetal anatomy and superior differentiation between the abnormalitites and adjacent structures, thereby allowing early planning of prenatal management.
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Affiliation(s)
- Pedro Daltro
- Clinica de DiagnOstico por Imagem, Av das Amé ricas 4666, Sala 325, Rio de Janeiro, RJ 22631004, Brazil
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22
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Abstract
PURPOSE OF REVIEW Fetal magnetic resonance imaging (MRI) is a relatively new clinical application but is becoming increasingly used in fetal medicine in combination with the established technique of antenatal ultrasound. A review of the literature to date provides information for clinicians to help assess which patients they should be referring for fetal MRI and what additional information to ultrasound they can obtain. RECENT FINDINGS This review covers recent articles on practical aspects of imaging, MR findings in common disorders and comparisons with ultrasound. It includes information on current applications for fetal MRI, new sequence acquisitions and postprocessing techniques. Fetal motion is the single most important barrier to improving image data. SUMMARY Fetal MR has become an established tool for assessing the fetal brain. It provides complementary information to ultrasound. However, further optimization of this technique is still required to ensure it is exploited to the full in fetal medicine.
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