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Cederlund F, Axelsson O, Desmond S, Amini H, Wikström J. Magnetic resonance imaging in the second trimester as a complement to ultrasound for diagnosis of fetal anomalies. Acta Radiol Open 2024; 13:20584601241248820. [PMID: 38737558 PMCID: PMC11088812 DOI: 10.1177/20584601241248820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Fetal ultrasound has limitations, especially if the patient is obese or in cases with oligohydramnios. Magnetic resonance imaging (MRI) can then be used as a complement, but only few studies have focused on examinations in the second trimester. Purpose To validate MRI as a complement to diagnose fetal anomalies in the second trimester. Material and Methods This retrospective study retrieved data from January 2008 to July 2012 from the Fetal Medicine Unit and Department of Radiology at Uppsala University Hospital. Ultrasound and MRI findings were reviewed in 121 fetuses in relation to the final diagnosis, including postpartum follow-up and autopsy results. Results Of the 121 fetuses, 51 (42%) had a CNS anomaly and 70 (58%) a non-CNS anomaly diagnosed or suspected. MRI provided additional information in 21% of all cases without changing the management and revealed information that changed the management of the pregnancy in 13%. When a CNS anomaly was detected or suspected, the MRI provided additional information in 22% and changed the management in 10%. The corresponding figures for non-CNS cases were 21% and 16%, respectively. The proportion of cases with additional information that changed the management was especially high in patients with a BMI >30 kg/m2 (25%) and in patients with oligohydramnios (38%). In five cases in category III, false-positive ultrasound findings were identified. Conclusions MRI in the second trimester complements ultrasound and improves diagnosis of fetal CNS- and non-CNS anomalies especially when oligohydramnios or maternal obesity is present.
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Affiliation(s)
- Frida Cederlund
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Ove Axelsson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Sara Desmond
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Hashem Amini
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
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2
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Fetal magnetic resonance imaging (MRI) enhances the diagnosis of congenital body anomalies. J Pediatr Surg 2022; 57:239-244. [PMID: 34823845 DOI: 10.1016/j.jpedsurg.2021.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/21/2022]
Abstract
AIMS We sought to assess variability and concordance between fetal MRI and ultrasound (USS) in the evaluation of fetal body abnormalities. METHODS All fetal body anomalies reported on F-MRI within the iFIND database (http://www.ifindproject.com) were included. Differences in findings regarding anomalies on contemporaneous USS were explored. Three clinical specialists evaluated each case independently, and the anomaly severity was graded: as "insignificant" to "lethal". The value of MRI in alteration of either antenatal or postnatal care was established. RESULTS Fifty-four cases were identified consisting of 5 healthy controls, 37 with USS-identified body anomalies, and 12 with known CNS or cardiac anomalies. In fetuses with a known body anomaly, information on the MRI was relevant to change the clinical course in 59% of cases. There was also an incidental detection rate of 7% in fetuses with known cardiac or CNS anomalies, or 1.5% of normal control, although these were rarely clinically relevant. Importantly, fetuses undergoing MRI for cardiac concerns did have major anomalies that were missed (one case of oesophageal atresia and two cases of ARM). CONCLUSIONS In cases where fetal anomalies are suspected, F-MRI is a valuable means of further characterizing anomalies and may detect additional anomalies in fetuses with recognized cardiac or CNS anomalies. In fetuses with a recognized body anomaly, more than half of those scanned by MRI had information available which changed clinical management. Importantly there were also incidental findings in healthy control fetuses, so the management of these needs to be recognized in fetal MRI research. LEVEL OF EVIDENCE II, Prospective cohort study.
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3
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Randhawa HS, Randhawa J, More A, Jain A. Utility of Fetal Magnetic Resonance Imaging After Ultrasound in Differentiating Dicephalic Dibrachius Dipus Twin Gestation From Craniopagus Parasiticus. Cureus 2021; 13:e19444. [PMID: 34912595 PMCID: PMC8664277 DOI: 10.7759/cureus.19444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/06/2022] Open
Abstract
Conjoined twins represent a very rare congenital anomaly, and the dicephalic dibrachius dipus (DDD) type of conjoined twinning is so rare that the exact prevalence is unknown. Only a few published case studies have mentioned this anomaly. Not enough data are available where antenatal ultrasonography (USG) and MRI have been employed in the workup of such cases. This study describes the case of a 24-year-old woman who came to our department for an anomaly scan at 25 weeks of gestation and was diagnosed with a dicephalic type of conjoined twinning with multiple anomalies. However, USG could not differentiate between DDD twinning and craniopagus parasiticus; hence, the patient was referred for fetal MRI. On MRI, the diagnosis of DDD was confirmed. In craniopagus parasiticus twinning, the surgical removal of the parasitic head can allow an everyday life. However, DDD twinning with multiple anomalies is not compatible with life, and the mother was thoroughly explained the grave prognosis. In such doubtful cases, fetal MRI should always be employed to ascertain the diagnosis for proper management and counseling.
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Affiliation(s)
- Harneet S Randhawa
- Radiology, Sassoon General Hospital, Pune, IND.,Radiology, Government Medical College, Baramati, IND
| | - Jasneet Randhawa
- Medicine, Fortis Escorts Hospital, Amritsar, IND.,Medicine, Aulakh Hospital, Amritsar, IND
| | - Akshay More
- Interventional Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Akshay Jain
- Radiology, Government Medical College, Kolhapur, IND
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4
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Sussman BL, Chopra P, Poder L, Bulas DI, Burger I, Feldstein VA, Laifer-Narin SL, Oliver ER, Strachowski LM, Wang EY, Winter T, Zelop CM, Glanc P. ACR Appropriateness Criteria® Second and Third Trimester Screening for Fetal Anomaly. J Am Coll Radiol 2021; 18:S189-S198. [PMID: 33958112 DOI: 10.1016/j.jacr.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
The Appropriateness Criteria for the imaging screening of second and third trimester fetuses for anomalies are presented for fetuses that are low risk, high risk, have had soft markers detected on ultrasound, and have had major anomalies detected on ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont.
| | - Prajna Chopra
- Research Author, The University of Vermont Medical Center, Burlington, Vermont
| | - Liina Poder
- Panel Chair, University of California San Francisco, San Francisco, California
| | - Dorothy I Bulas
- Children's National Hospital and George Washington University, Washington, District of Columbia, Chair, ACR International Outreach Committee, Director, Fetal Imaging Prenatal Pediatric Institute, Childrens National Hospital
| | | | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, American College of Obstetricians and Gynecologists
| | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York, American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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5
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Matthew J, Skelton E, Story L, Davidson A, Knight CL, Gupta C, Pasupathy D, Rutherford M. MRI-Derived Fetal Weight Estimation in the Midpregnancy Fetus: A Method Comparison Study. Fetal Diagn Ther 2021; 48:708-719. [PMID: 34818233 PMCID: PMC7614116 DOI: 10.1159/000519115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/12/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to compare the standard ultrasound (US) estimated fetal weight (EFW) and MRI volume-derived methods for the midtrimester fetus. METHODS Twenty-five paired US and MRI scans had the EFW calculated (gestational age [GA] range = 20-26 weeks). The intra- and interobserver variability of each method was assessed (2 operators/modality). A small sub-analysis was performed on 5 fetuses who were delivered preterm (mean GA 29 +3 weeks) and compared to the actual birthweight. RESULTS Two MRI volumetry EFW formulae under-measured compared to US by -10.9% and -14.5% in the midpregnancy fetus (p < 0.001) but had excellent intra- and interobserver agreement (intraclass correlation coefficient = 0.998 and 0.993). In the preterm fetus, the mean relative difference (MRD) between the MRI volume-derived EFW (MRI-EFW) and actual expected birthweight (at the scan GA) was -13.7% (-159.0 g, 95% CI: -341.7 to 23.7 g) and -17.1% (-204.6 g, 95% CI: -380.4 to -28.8 g), for the 2 MRI formulae. The MRD was smaller for US at 5.3% (69.8 g, 95% CI: -34.3 to 173.9). CONCLUSIONS MRI-EFW results should be interpreted with caution in midpregnancy. Despite excellent observer agreement with MRI volumetry, refinement of the EFW formula is needed in the second trimester, for the small and for the GA and preterm fetus to compensate for lower fetal densities.
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Affiliation(s)
- Jacqueline Matthew
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Emily Skelton
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Lisa Story
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Alice Davidson
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Caroline L. Knight
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Chandni Gupta
- North Tees and Hartlepool NHS Foundation Trust, London, UK
| | - Dharmintra Pasupathy
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mary Rutherford
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
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6
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Tavares de Sousa M, Hecher K, Kording F, Yamamura J, Lenz A, Adam G, Bannas P, Schoennagel BP. Fetal dynamic magnetic resonance imaging using Doppler ultrasound gating for the assessment of the aortic isthmus: A feasibility study. Acta Obstet Gynecol Scand 2020; 100:67-73. [PMID: 32649773 DOI: 10.1111/aogs.13957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cardiovascular magnetic resonance imaging (MRI) is established in cardiac evaluation in postnatal life, but its application to the fetus has been hampered by technical limitations. We aimed to investigate the feasibility of dynamic MRI of the fetal aortic isthmus using a magnetic resonance-compatible Doppler ultrasound device for cardiac gating. MATERIAL AND METHODS This prospective study included 19 fetuses at a median gestational age of 32.3 weeks (range 26-38 weeks). Imaging of the fetal aortic isthmus was assessed by (a) dynamic steady-state free precession MRI using a magnetic resonance-compatible Doppler ultrasound device for cardiac gating and (b) echocardiography. Diameters of the aortic isthmus were compared by two blinded observers. Magnetic resonance image quality was assessed independently by two observers using a four-point scale (1 = low quality, 4 = high quality). Furthermore, we performed four-dimensional flow MRI of the fetal aorta in three of these fetuses. RESULTS The Doppler ultrasound device for cardiac gating allowed successful dynamic MRI examinations of the aortic isthmus in 18/19 (95%) fetuses. Evaluation of the fetal aortic isthmus was possible by both MRI (15/18, 83%) and echocardiography (16/18, 89%) (P < .05). Diameters of the aortic isthmus were concordant for MRI (3.8 ± 0.9 mm) and echocardiography (4.0 ± 1.1 mm), with a variability of 10.8% (bias -2.3%, 95% limits of agreement -23.9% to 19.3%). Overall magnetic resonance image quality was good (score 4 in 67% and score 3 in 23%) with good inter-observer agreement (κ = 0.75; 95% CI 0.5-1). Fetal four-dimensional flow MRI allowed visualization of aortic flow dynamics. CONCLUSIONS Doppler ultrasound-gating allows dynamic MRI of the fetal aorta with the potential to serve as a complementary imaging tool in cases where echocardiography is inconclusive.
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Affiliation(s)
- Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Chalouhi GE, Millischer AÉ, Mahallati H, Siauve N, Melbourne A, Grevent D, Vinit N, Heidet L, Aigrain Y, Ville Y, Blanc T, Salomon LJ. The use of fetal MRI for renal and urogenital tract anomalies. Prenat Diagn 2019; 40:100-109. [PMID: 31736096 DOI: 10.1002/pd.5610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
Abstract
Fetal anomalies are detected in approximately 2% of all fetuses and, among these, genitourinary tract abnormalities account for 30% to 50% of all structural anomalies present at birth. Although ultrasound remains the first line diagnostic modality, fetal MRI provides important additional structural and functional information, especially with the development of faster sequences and the use of functional sequences. The added value of MRI-based imaging is three-fold: (a) improvement of diagnostic accuracy by adequate morphological examination, (b) detection of additional anomalies, and (c) in addition, MRI has the potential to provide information regarding renal function. In this review, we describe the role of fetal MRI in the anatomical evaluation of renal and urogenital tract anomalies, and we also touch upon the contribution of functional MRI to the diagnostic workup of these conditions.
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Affiliation(s)
- Gihad E Chalouhi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Division of Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.,Université de Paris, Paris, France
| | - Anne-Élodie Millischer
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Houman Mahallati
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Nathalie Siauve
- Imagerie Médicale, Hôpital Louis Mourier APHP, Colombes, France
| | - Andrew Melbourne
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Grevent
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Nicolas Vinit
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Laurence Heidet
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Pediatric Nephrology Department, Hôpital Universitaire Necker-Enfants Malades, Sorbonne Paris Cité University, Paris, France
| | - Yves Aigrain
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Yves Ville
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Institut Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Université de Paris, Paris, France
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8
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Fazecas TM, Araujo Júnior E, Werner H, Daltro P, Peixoto AB, Lima GM, Barbosa AD. Applicability of Magnetic Resonance Imaging in the Assessment of Fetal Urinary Tract Malformations. Can Assoc Radiol J 2019; 70:83-95. [PMID: 30691568 DOI: 10.1016/j.carj.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/09/2018] [Accepted: 10/20/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To assess the applicability of magnetic resonance imaging (MRI) to complement ultrasound in the diagnosis of fetal urinary tract anomalies. METHODS This was a retrospective cohort study that included 41 women between 19 weeks and 37 weeks and 6 days of gestation carrying fetuses with malformations of the urinary tract which were initially diagnosed by ultrasound and then referred for MRI. In all cases, the diagnosis was confirmed after birth either through imaging or autopsy. A surface coil was positioned over the abdomen and T2-weighted sequences were obtained in the axial, coronal, and sagittal planes; T1 in at least one plane; and three-dimensional (3-D) TRUFI in fetuses with dilatation of the urinary tract. RESULTS Mean gestational age at the time of MRI examination was 28.21 weeks. The rapid T2 sequences allowed all the anomalies of the fetal urinary tract to be assessed, whereas 3-D TRUFI sequencing proved very useful in evaluating anomalies involving dilatation of the urinary tract. The signs of pulmonary hypoplasia characterized by hypointense signal in the T2-weighted sequences were identified in 13 of the 41 fetuses. CONCLUSION MRI confirmed and added information to the ultrasound regarding fetal urinary tract anomalies, as well as information related to the other associated malformations, their progress in the prenatal period, and possible postnatal prognosis.
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Affiliation(s)
- Tatiana Mendonça Fazecas
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil; Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Pedro Daltro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Glaucia Macedo Lima
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Adauto Dutra Barbosa
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil
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9
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Castro P, Paula Matos A, Werner H, Fazecas T, Nogueira R, Daltro P, Araujo Júnior E. Prenatal diagnosis of suprarenal mass by magnetic resonance imaging: a case series. J Matern Fetal Neonatal Med 2018; 32:3882-3886. [PMID: 29712514 DOI: 10.1080/14767058.2018.1471679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The aim of this study was to evaluate the perinatal outcomes and postnatal follow-up of prenatally diagnosed suprarenal masses (SRMs) evaluated by magnetic resonance imaging (MRI). Methods: Thirteen fetuses with SRMs detected during routine prenatal ultrasound screening were evaluated by MRI between February 2007 and May 2015. The prenatal characteristics of the masses, complications of the pregnancies, and related malformations were collected as the postnatal clinical, radiological, and pathological data. Results: The median gestational age at MRI was 30 weeks (18-41), and birth weight was 3285 (1700-3750) g. The mean follow-up period was 6 years (1.3-10). We observed 69.2% of the masses, which were predominantly cystic (69.2%), located on the left side. Associated malformations were found in 23% of the fetuses, with congenital heart defects being more prevalent. During the pregnancy, 15.4% of the fetuses had involution of the SRM, and one fetus had surgical treatment and different ultrasound and MRI diagnoses. Of the 69.2% of the cases, spontaneous resolution occurred in 30.7% during the first year of life and 38.4% the masses presented without modifications or signs of regression since the neonatal period. Conclusions: Prenatal SRMs were associated with congenital heart defects. Spontaneous regression and absence of modifications in the masses were commonly observed in the long-term follow-up of the SRMs.
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Affiliation(s)
- Pedro Castro
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Ana Paula Matos
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Heron Werner
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Tatiana Fazecas
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Renata Nogueira
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Pedro Daltro
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Edward Araujo Júnior
- b Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
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10
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Abstract
Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.
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11
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Marusik C, Frykholm C, Ericson K, Wikström J, Axelsson O. Diagnosis of placental mesenchymal dysplasia with magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:410-412. [PMID: 27062337 DOI: 10.1002/uog.15930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Affiliation(s)
- C Marusik
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - C Frykholm
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - K Ericson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - J Wikström
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - O Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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12
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Gonçalves LF, Lee W, Mody S, Shetty A, Sangi-Haghpeykar H, Romero R. Diagnostic accuracy of ultrasonography and magnetic resonance imaging for the detection of fetal anomalies: a blinded case-control study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:185-192. [PMID: 26444861 PMCID: PMC5987216 DOI: 10.1002/uog.15774] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/23/2015] [Accepted: 09/26/2015] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To compare the accuracy of two-dimensional ultrasound (2D-US), three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) for the diagnosis of congenital anomalies without prior knowledge of indications and previous imaging findings. METHODS This was a prospective, blinded case-control study comprising women with a singleton pregnancy with fetal congenital abnormalities identified on clinical ultrasound and those with an uncomplicated pregnancy. All women volunteered to undergo 2D-US, 3D-US and MRI, which were performed at one institution. Different examiners at a collaborating institution performed image interpretation. Sensitivity and specificity of the three imaging methods were calculated for individual anomalies, based on postnatal imaging and/or autopsy as the definitive diagnosis. Diagnostic confidence was graded on a four-point Likert scale. RESULTS A total of 157 singleton pregnancies were enrolled, however nine cases were excluded owing to incomplete outcome, resulting in 148 fetuses (58 cases and 90 controls) included in the final analysis. Among cases, 13 (22.4%) had central nervous system (CNS) anomalies, 40 (69.0%) had non-CNS anomalies and five (8.6%) had both CNS and non-CNS anomalies. The main findings were: (1) MRI was more sensitive than 3D-US for diagnosing CNS anomalies (MRI, 88.9% (16/18) vs 3D-US, 66.7% (12/18) vs 2D-US, 72.2% (13/18); McNemar's test for MRI vs 3D-US: P = 0.046); (2) MRI provided additional information affecting prognosis and/or counseling in 22.2% (4/18) of fetuses with CNS anomalies; (3) 2D-US, 3D-US and MRI had similar sensitivity for diagnosing non-CNS anomalies; (4) specificity for all anomalies was highest for 3D-US (MRI, 85.6% (77/90) vs 3D-US, 94.4% (85/90) vs 2D-US, 92.2% (83/90); McNemar's test for MRI vs 3D-US: P = 0.03); and (5) the confidence of MRI for ruling out certain CNS abnormalities (usually questionable for cortical dysplasias or hemorrhage) that were not confirmed after delivery was lower than it was for 2D-US and 3D-US. CONCLUSIONS MRI was more sensitive than ultrasonography and provided additional information that changed prognosis, counseling or management in 22.2% of fetuses with CNS anomalies. False-positive diagnoses for subtle CNS findings were higher with MRI than with ultrasonography. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L. F. Gonçalves
- Department of Obstetrics and Gynecology, Division of Fetal Imaging, Oakland University William Beaumont Hospital School of Medicine, Rochester, MI, USA
- Department of Radiology, Division of Pediatric Radiology, Oakland University William Beaumont Hospital School of Medicine, Rochester, MI, USA
| | - W. Lee
- Department of Obstetrics and Gynecology, Division of Women’s and Fetal Imaging, Baylor College of Medicine, Houston, TX, USA
| | - S. Mody
- Department of Radiology, Division of Pediatric Radiology, Children’s Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - A. Shetty
- Department of Obstetrics and Gynecology, Division of Women’s and Fetal Imaging, Baylor College of Medicine, Houston, TX, USA
| | - H. Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R. Romero
- Perinatology Research Branch, Eunice Kennedy Shriver NICHD/NIH/DHHS, Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Wataganara T, Ebrashy A, Aliyu LD, Moreira de Sa RA, Pooh R, Kurjak A, Sen C, Adra A, Stanojevic M. Fetal magnetic resonance imaging and ultrasound. J Perinat Med 2016; 44:533-42. [PMID: 27092644 DOI: 10.1515/jpm-2015-0226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has been increasingly adopted in obstetrics practice in the past three decades. MRI aids prenatal ultrasound and improves diagnostic accuracy for selected maternal and fetal conditions. However, it should be considered only when high-quality ultrasound cannot provide certain information that affects the counseling, prenatal intervention, pregnancy course, and delivery plan. Major indications of fetal MRI include, but are not restricted to, morbidly adherent placenta, selected cases of fetal brain anomalies, thoracic lesions (especially in severe congenital diaphragmatic hernia), and soft tissue tumors at head and neck regions of the fetus. For fetal anatomy assessment, a 1.5-Tesla machine with a fast T2-weighted single-shot technique is recommended for image requisition of common fetal abnormalities. Individual judgment needs to be applied when considering usage of a 3-Tesla machine. Gadolinium MRI contrast is not recommended during pregnancy. MRI should be avoided in the first half of pregnancy due to small fetal structures and motion artifacts. Assessment of fetal cerebral cortex can be achieved with MRI in the third trimester. MRI is a viable research tool for noninvasive interrogation of the fetus and the placenta.
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14
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Brix L, Ringgaard S, Sandager P, Petersen OB, Sørensen TS, Lundorf E, Stausbøl-Grøn B. Overcoming foetal motion using interactive real-time magnetic resonance imaging. Clin Physiol Funct Imaging 2016; 37:717-722. [PMID: 27005484 DOI: 10.1111/cpf.12364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Foetal MRI has become an established image modality in the prenatal diagnosis of CNS anomalies, but image quality can be severely affected by foetal movements. The objective was to overcome these inherent motion problems by applying interactive real-time MRI and to evaluate the diagnostic usefulness of the applied real-time MRI sequence in relation to standard protocols. METHODS Ten healthy foetuses (gestation week 21·3 ± 0·5) were scanned using a system, which allowed visual feedback and interactive slice positioning in real time. The data were compared to a control group of 14 healthy foetuses (gestation week 21·0 ± 0·8) who had previously been scanned using standard MRI. Comparisons were carried out by two radiologists with regard to cerebral anthropometric sizes, presence of important brain structures, degree of movement, clinical image value, image quality and ability to obtain correct slice planes. RESULTS Two out of eight anthropometric sizes were statistically different between the two groups. Representation of cerebral structures was found in 70-100% in the real-time group. No statistically differences were found in clinical image value and image quality. The mean ability to obtain optimal slice planes was higher in the real-time group, but it was not significant. CONCLUSION Imaging of the foetal brain using the proposed interactive real-time MRI system is a promising alternative to traditional foetal MRI for anthropometrics or as a supplement for the representation of foetal brain structures in cases in which foetal motion causes challenges in relation to obtaining optimal slice planes using conventional MRI techniques.
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Affiliation(s)
- Lau Brix
- Department of Procurement & Clinical Engineering, Region Midt, Aarhus N, Denmark.,MR Research Centre, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Thomas Sangild Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Computer Science, Aarhus University, Aarhus N, Denmark
| | - Erik Lundorf
- MR Research Centre, Aarhus University Hospital, Aarhus N, Denmark
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Debost-Legrand A, Goumy C, Laurichesse-Delmas H, Déchelotte P, Perthus I, Francannet C, Lémery D, Gallot D. Prenatal diagnosis of the VACTERL association using routine ultrasound examination. ACTA ACUST UNITED AC 2015; 103:880-6. [DOI: 10.1002/bdra.23346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Debost-Legrand
- Service de Santé Publique, CHU Clermont-Ferrand; Clermont-Ferrand France
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
| | - Carole Goumy
- Service de Cytogénétique Médicale; CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Hélène Laurichesse-Delmas
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
- Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Pierre Déchelotte
- Anatomie Pathologique; CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Isabelle Perthus
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
- CEMC-Auvergne; Clermont-Ferrand France
- Génétique Médicale, CHU Clermont-Ferrand; Clermont-Ferrand France
| | | | - Didier Lémery
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
- Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Denis Gallot
- Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand; Clermont-Ferrand France
- R2D2-EA7281; Clermont Université, Université d'Auvergne; Clermont-Ferrand France
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Role of magnetic resonance imaging in the prenatal diagnosis of gastrointestinal fetal anomalies. Radiol Med 2014; 120:393-403. [PMID: 25348138 DOI: 10.1007/s11547-014-0464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/05/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE This study was done to evaluate the role of fetal magnetic resonance imaging (MRI) in the study of gastrointestinal malformations in comparison to prenatal ultrasound (US). MATERIALS AND METHODS A prospective (2010-2012) study of 38 fetal MRI scans was performed on 38 fetuses between 24 and 38 weeks of gestation. All the fetuses had a US diagnosis of gastrointestinal anomalies. T2-weighted HASTE, T1-weighted fast gradient echo, TrueFISP and diffusion-weighted images of the fetal abdomen were obtained on a 1.5-Tesla magnet. All fetal MRI diagnoses were compared with postnatal US findings, autopsy or surgical reports. RESULTS Fetal MRI was able to confirm the sonographic findings in nine of 38 fetuses (23.7%), to provide additional information in 23 of 38 fetuses (60.6%), to exclude the US diagnosis in five cases (5.2%) and to change it in two cases (5.2%). It was not able to characterize a case of gastric duplication and a case of abdominal cystic lymphangioma (5.2%). CONCLUSIONS Fetal MRI can be used as a complementary imaging modality to US in prenatal evaluation of gastrointestinal anomalies and can be considered a valuable tool not only for confirming or excluding but also for providing additional information to fetal ultrasonographic findings.
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Debost-Legrand A, Laurichesse-Delmas H, Francannet C, Perthus I, Lémery D, Gallot D, Vendittelli F. False positive morphologic diagnoses at the anomaly scan: marginal or real problem, a population-based cohort study. BMC Pregnancy Childbirth 2014; 14:112. [PMID: 24655605 PMCID: PMC3994389 DOI: 10.1186/1471-2393-14-112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 02/14/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Congenital malformations occur in 3-4% of live births. Their prenatal detection is performed by ultrasound screening. Any announcement about a suspected malformation is a source of stress for the parents, and misdiagnosis during ultrasound screening can lead to expensive and sometimes iatrogenic medical interventions. In this study, we aim to determine the false-positive rate, first overall and then by anatomical system, of ultrasound screening for congenital malformations in the second and third trimesters of pregnancy. METHODS Our sample includes all children born between 1 January, 2006, and 31 December, 2009, in the French region of Auvergne, whose mother had a prenatal ultrasound diagnosis of a congenital malformation during the second or third trimester of pregnancy confirmed by a follow-up ultrasound examination by an expert consultant ultrasonographer. The study included 526 fetuses, divided in 3 groups: false positives, diagnostic misclassifications, and true positives. The rates of false positives and diagnostic misclassifications were calculated for the sample as a whole and then by anatomical system. RESULTS Overall, the false-positive rate was 8.8% and the rate of diagnostic misclassification 9.2%. The highest false-positive rates were found for renal and gastrointestinal tract malformations, and the highest diagnostic misclassification rates for cerebral and cardiac malformations. The diagnostic misclassification rate was significantly higher than the false-positive rate for cardiac malformations. CONCLUSION The false-positive rate during prenatal ultrasound is not insignificant; these misdiagnoses cause psychological stress for the parents and overmedicalisation of the pregnancy and the child.
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Affiliation(s)
- Anne Debost-Legrand
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Place Lucie et Raymond Aubrac, Clermont-Ferrand, Cedex1 63003, France
| | - Hélène Laurichesse-Delmas
- Pôle de Gynécologie-Obstétrique et Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - Christine Francannet
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Perthus
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
- CEMC-Auvergne, Agence Régionale de Santé d’Auvergne, InVS, INSERM, Clermont-Ferrand, France
| | - Didier Lémery
- Pôle de Gynécologie-Obstétrique et Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
- AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de Médecine RTH Laennec, Lyon, France
| | - Denis Gallot
- Pôle de Gynécologie-Obstétrique et Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- R2D2-EA7281, Clermont Université, Université d’Auvergne, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Pôle de Gynécologie-Obstétrique et Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
- AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de Médecine RTH Laennec, Lyon, France
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Millischer AE, Sonigo P, Ville Y, Brunelle F, Boddaert N, Salomon LJ. Standardized fetal anatomical examination using magnetic resonance imaging: a feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:553-559. [PMID: 23349068 DOI: 10.1002/uog.12415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/03/2013] [Accepted: 01/11/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine whether a standard complete fetal anatomical survey, as recommended for ultrasound examination guidelines, is feasible using a standardized magnetic resonance imaging (MRI) protocol. METHODS Based on guidelines for ultrasound examination, we created a specific MRI protocol for fetal anatomical survey. This protocol was then tested prospectively in 100 women undergoing fetal MRI examination for various specific indications at a median gestational age of 30 weeks. The feasibility of using MRI to perform the fetal anatomical survey was analyzed by two reviewers (A and B) based on 26 predefined anatomical criteria, yielding a score ranging from 0 to 26 (26 meaning successful complete anatomical study). Reproducibility was analyzed using percentage agreement and modified kappa statistics. RESULTS The mean score for the standardized MRI anatomical survey was 24.6 (SD, 1.4; range, 15-26) for Reviewer A and 24.2 (SD, 1.7; range, 15-26) for Reviewer B (P = 0.1). Twenty-two, two and two criteria could be assessed in > 95%, 80-95% and < 80% of cases by Reviewer A and 19, four and three criteria could be assessed in > 95%, 80-95% and < 80% of cases by Reviewer B. For both reviewers, the two most difficult criteria to evaluate were aorta and pulmonary artery. Inter-reviewer agreement was above 90% for 22 of the 26 anatomical criteria and adjusted kappa coefficients for each criterion demonstrated good, moderate and poor agreement for 22, two and two criteria, respectively. CONCLUSION Our data support the hypothesis that standardized fetal anatomical examination might be achieved and reproducible using MRI, although improvement is required for the cardiac part of the examination.
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Affiliation(s)
- A E Millischer
- Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Abstract
Fetal MRI is now a well-established imaging modality for the diagnostic evaluation of fetuses with congenital anomalies. In this article, the authors provide a brief overview of the physical principles involved in fetal MRI imaging, the sequences that are used in clinical practice today, current indications, and limitations. A review of current evidence supports the following indications for fetal MRI: suspected central nervous system anomalies, neck and oropharyngeal masses, diaphragmatic hernia, abdominal masses or bowel pathology not fully characterized by ultrasonography, and suspected fetal infection. Other indications should be decided on a case-by-case basis with close collaboration between the departments of maternal-fetal medicine and radiology. More research is needed to determine the role of fetal MRI in functional neuroimaging at higher magnetic field strengths (3T).
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Kul S, Korkmaz HAA, Cansu A, Dinc H, Ahmetoglu A, Guven S, Imamoglu M. Contribution of MRI to ultrasound in the diagnosis of fetal anomalies. J Magn Reson Imaging 2011; 35:882-90. [DOI: 10.1002/jmri.23502] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/19/2011] [Indexed: 11/10/2022] Open
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