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Raaby L, Lou S, Lodberg Ivarsen RR, Sørensen J, Larsen OH, Vogel I. Has the introduction of increased genetic prenatal testing affected rates of termination of pregnancy due to fetal abnormality? Prenat Diagn 2024; 44:280-288. [PMID: 38348952 DOI: 10.1002/pd.6526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 03/16/2024]
Abstract
OBJECTIVE Genetic high-resolution analyses and improved diagnostic imaging have impacted the ability to detect fetal disorders. It is unknown if this resulted in an alteration in the number of terminations of pregnancy due to fetal anomalies (TOPFA). The objective was to describe the incidence and indication of TOPFA. METHODS A descriptive study based on records from the Regional Abortion Council in the Central Denmark Region from 2008 to 2021 consisting of 1895 TOPFA. RESULTS A consistent incidence of TOPFA was observed, accounting for 0.96% of the total births during that period. When examining fetal indications, there was a small increase in the occurrence of genetic aberrations, primarily caused by deletions, duplications, and single nucleotide variations, whereas the number of chromosomal aberrations remained stable. Of 35.5% of the cases with malformations, the central nervous system was the most affected organ system, followed by malformations of the heart 29.6%. Overall, the total number of cases remained stable. DISCUSSION AND CONCLUSION Unexpectedly, despite the development of new diagnostic tools, the incidence of TOPFA from 2008 to 2021 remained stable. However, the number of cases with genetic aberrations increased. This may be attributed to increased genetic testing for fetuses with identified malformations, resulting in more accurate diagnoses.
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Affiliation(s)
- Line Raaby
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | | | - Jette Sørensen
- Department of Social Medicine and Rehabilitation, The secretariat of Regional Abortion Council, Gødstrup Hospital, Herning, Denmark
| | - Ole Halfdan Larsen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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2
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Bookstein S, Nachmias N, Katorza E. Agreement between Fetal Brain Ultrasonography and Magnetic Resonance Imaging in the Measurements of the Corpus Callosum and Transverse Cerebellar Diameter. Diagnostics (Basel) 2024; 14:366. [PMID: 38396405 PMCID: PMC10887730 DOI: 10.3390/diagnostics14040366] [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: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
As the use of magnetic resonance imaging of the fetal brain has evolved, the need to understand its efficiency in the biometry of the fetal brain has broadened. This study aimed to assess the level of agreement and correlation between the two cardinal imaging methods of fetal neuroimaging, ultrasonography (US) and magnetic resonance imaging (MRI), by measuring the corpus callosum (CC) and transverse cerebellar diameter (TCD) in terms of length and percentile. Measurements of CC and TCD length and percentile were documented over a 7-year span in a tertiary referral medical center. All US and MRI examinations were performed in the customary planes and subcategorized by valid reference charts. Exclusion and inclusion criteria were set before the collection and processing of the data. A total of 156 fetuses out of 483 were included in the study. A positive, strong correlation and agreement were found (r = 0.78; ICC = 0.76) between US and MRI in TCD measurements. For CC length measurement, a moderate correlation and moderate agreement (r = 0.51; ICC = 0.49) between US and MRI was observed. TCD and CC percentiles had lower levels of correlation and agreement compared with the length variables. Our study indicates good agreement between MRI and US in the assessment of TCD measurement as a part of antenatal neuroimaging. Furthermore, while the two techniques are not always compatible, they are complementary methods.
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Affiliation(s)
- Shai Bookstein
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Derech Sheba 2, Ramat Gan 5262000, Israel; (S.B.); (N.N.)
- Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel Aviv 6139001, Israel
| | - Noy Nachmias
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Derech Sheba 2, Ramat Gan 5262000, Israel; (S.B.); (N.N.)
- Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel Aviv 6139001, Israel
| | - Eldad Katorza
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Derech Sheba 2, Ramat Gan 5262000, Israel; (S.B.); (N.N.)
- Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel Aviv 6139001, Israel
- Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel-Hashomer, Derech Sheba 2, Ramat Gan 5262000, Israel
- Arrow Program for Medical Research Education, Chaim Sheba Medical Center, Tel-Hashomer, Derech Sheba 2, Ramat Gan 5262000, Israel
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3
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Payette K, Li HB, de Dumast P, Licandro R, Ji H, Siddiquee MMR, Xu D, Myronenko A, Liu H, Pei Y, Wang L, Peng Y, Xie J, Zhang H, Dong G, Fu H, Wang G, Rieu Z, Kim D, Kim HG, Karimi D, Gholipour A, Torres HR, Oliveira B, Vilaça JL, Lin Y, Avisdris N, Ben-Zvi O, Bashat DB, Fidon L, Aertsen M, Vercauteren T, Sobotka D, Langs G, Alenyà M, Villanueva MI, Camara O, Fadida BS, Joskowicz L, Weibin L, Yi L, Xuesong L, Mazher M, Qayyum A, Puig D, Kebiri H, Zhang Z, Xu X, Wu D, Liao K, Wu Y, Chen J, Xu Y, Zhao L, Vasung L, Menze B, Cuadra MB, Jakab A. Fetal brain tissue annotation and segmentation challenge results. Med Image Anal 2023; 88:102833. [PMID: 37267773 DOI: 10.1016/j.media.2023.102833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 06/04/2023]
Abstract
In-utero fetal MRI is emerging as an important tool in the diagnosis and analysis of the developing human brain. Automatic segmentation of the developing fetal brain is a vital step in the quantitative analysis of prenatal neurodevelopment both in the research and clinical context. However, manual segmentation of cerebral structures is time-consuming and prone to error and inter-observer variability. Therefore, we organized the Fetal Tissue Annotation (FeTA) Challenge in 2021 in order to encourage the development of automatic segmentation algorithms on an international level. The challenge utilized FeTA Dataset, an open dataset of fetal brain MRI reconstructions segmented into seven different tissues (external cerebrospinal fluid, gray matter, white matter, ventricles, cerebellum, brainstem, deep gray matter). 20 international teams participated in this challenge, submitting a total of 21 algorithms for evaluation. In this paper, we provide a detailed analysis of the results from both a technical and clinical perspective. All participants relied on deep learning methods, mainly U-Nets, with some variability present in the network architecture, optimization, and image pre- and post-processing. The majority of teams used existing medical imaging deep learning frameworks. The main differences between the submissions were the fine tuning done during training, and the specific pre- and post-processing steps performed. The challenge results showed that almost all submissions performed similarly. Four of the top five teams used ensemble learning methods. However, one team's algorithm performed significantly superior to the other submissions, and consisted of an asymmetrical U-Net network architecture. This paper provides a first of its kind benchmark for future automatic multi-tissue segmentation algorithms for the developing human brain in utero.
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Affiliation(s)
- Kelly Payette
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
| | - Hongwei Bran Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland; Department of Informatics, Technical University of Munich, Munich, Germany
| | - Priscille de Dumast
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM, Center for Biomedical Imaging, Lausanne, Switzerland
| | - Roxane Licandro
- Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, United States; Department of Biomedical Imaging and Image-guided Therapy, Computational Imaging Research Lab (CIR), Medical University of Vienna, Vienna, Austria
| | - Hui Ji
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | - Hao Liu
- Shanghai Jiaotong University, China
| | | | | | - Ying Peng
- School of Computer Science, Shaanxi Normal University, Xi'an 710119, China
| | - Juanying Xie
- School of Computer Science, Shaanxi Normal University, Xi'an 710119, China
| | - Huiquan Zhang
- School of Computer Science, Shaanxi Normal University, Xi'an 710119, China
| | - Guiming Dong
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Fu
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - ZunHyan Rieu
- Research Institute, NEUROPHET Inc., Seoul 06247, South Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc., Seoul 06247, South Korea
| | - Hyun Gi Kim
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul 06247, South Korea
| | - Davood Karimi
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ali Gholipour
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Helena R Torres
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga Guimarães, Portugal
| | - Bruno Oliveira
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga Guimarães, Portugal
| | - João L Vilaça
- 2Ai - School of Technology, IPCA, Barcelos, Portugal
| | - Yang Lin
- Department of Computer Science, Hong Kong University of Science and Technology, China
| | - Netanell Avisdris
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel; Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Israel
| | - Ori Ben-Zvi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Dafna Ben Bashat
- Sagol School of Neuroscience, Tel Aviv University, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Lucas Fidon
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, United Kingdom
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, United Kingdom
| | - Daniel Sobotka
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mireia Alenyà
- BCN-MedTech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Inmaculada Villanueva
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Oscar Camara
- BCN-MedTech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bella Specktor Fadida
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel
| | - Liao Weibin
- School of Computer Science, Beijing Institute of Technology, China
| | - Lv Yi
- School of Computer Science, Beijing Institute of Technology, China
| | - Li Xuesong
- School of Computer Science, Beijing Institute of Technology, China
| | - Moona Mazher
- Department of Computer Engineering and Mathematics, University Rovira i Virgili,Spain
| | | | - Domenec Puig
- Department of Computer Engineering and Mathematics, University Rovira i Virgili,Spain
| | - Hamza Kebiri
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM, Center for Biomedical Imaging, Lausanne, Switzerland
| | - Zelin Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Xinyi Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | | | - Yixuan Wu
- Zhejiang University, Hangzhou, China
| | | | - Yunzhi Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Li Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Lana Vasung
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, United States; Department of Pediatrics, Harvard Medical School, United States
| | - Bjoern Menze
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Meritxell Bach Cuadra
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM, Center for Biomedical Imaging, Lausanne, Switzerland
| | - Andras Jakab
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland; University Research Priority Project Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zürich, Zurich, Switzerland
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4
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Paternostro C, Springer S, Kasprian G, Yerlikaya-Schatten G, Reischer T. Clinical Course and Outcome of Prenatally Detected 22q11.2 Deletion Syndrome-A Retrospective Analysis. Diagnostics (Basel) 2023; 13:2244. [PMID: 37443638 DOI: 10.3390/diagnostics13132244] [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: 05/31/2023] [Revised: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
The 22q11.2 deletion syndrome (22q11.2 DS) is known as the most common microdeletion syndrome. Due to its variable clinical phenotype, prenatal diagnosis can be challenging. The aim of this retrospective study was to evaluate the clinical course and pregnancy outcome of cases with prenatally diagnosed 22q11.2 deletion syndrome (DS) as well as to evaluate the role of prenatal magnetic resonance imaging (MRI) and postmortem examination. In total, 21 cases who underwent prenatal ultrasound examination and pregnancy care at the Department of Obstetrics and Gynecology at the Medical University of Vienna between 2012 and 2022 were included. The majority of the cases were genetically diagnosed using fluorescent in situ hybridization (FISH). The median gestational age (GA) at genetic diagnosis was 23.0 weeks (IQR 21.4-24.8 weeks). CHDs were detected in all fetuses and the most common extracardiac manifestation was thymus hypo/aplasia followed by genitourinary anomalies. Prenatal magnetic resonance imaging (MRI) revealed additional diagnostic information in three of ten cases. Overall, 14 patients opted for drug-induced TOP, of which 9 cases had a feticide prior to the induction of labor. The majority of craniofacial malformations were only detected by autopsy. In conclusion, the majority of cases prenatally diagnosed with 22q11.2 DS had an absent or hypoplastic thymus noted antenatally in addition to the detected CHD, and almost half of the cases had another extracardiac malformation of predominantly genitourinary origin. Furthermore, prenatal MRIs confirmed previously detected malformations, but only provided additional diagnostic information in three out of ten cases, whereas postmortem examination diagnosed most of the craniofacial anomalies and should always be conducted, serving as an important quality indicator for prenatal imaging.
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Affiliation(s)
- Chiara Paternostro
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Stephanie Springer
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Gülen Yerlikaya-Schatten
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Theresa Reischer
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Vienna, Austria
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Wang Y, Fu F, Lei T, Zhen L, Deng Q, Zhou H, Ma C, Cheng K, Huang R, Li R, Yu Q, Li L, Han J, Yang X, Li D, Liao C. Genetic diagnosis of fetal microcephaly at a single tertiary center in China. Front Genet 2023; 14:1112153. [PMID: 37229200 PMCID: PMC10203430 DOI: 10.3389/fgene.2023.1112153] [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: 11/30/2022] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Microcephaly is common in patients with neuropsychiatric problems, and it is usually closely related to genetic causes. However, studies on chromosomal abnormalities and single-gene disorders associated with fetal microcephaly are limited. Objective: We investigated the cytogenetic and monogenic risks of fetal microcephaly and evaluated their pregnancy outcomes. Methods: We performed a clinical evaluation, high-resolution chromosomal microarray analysis (CMA), and trio exome sequencing (ES) on 224 fetuses with prenatal microcephaly and closely followed the pregnancy outcome and prognosis. Results: Among 224 cases of prenatal fetal microcephaly, the diagnosis rate was 3.74% (7/187) for CMA and 19.14% (31/162) for trio-ES. Exome sequencing identified 31 pathogenic or likely pathogenic (P/LP) single nucleotide variants (SNVs) in 25 genes associated with fetal structural abnormalities in 37 microcephaly fetuses; 19 (61.29%) of which occurred de novo. Variants of unknown significance (VUS) was found in 33/162 (20.3%) fetuses. The gene variant involved included the single gene MPCH 2 and MPCH 11, which is associated with human microcephaly, and HDAC8, TUBGCP6, NIPBL, FANCI, PDHA1, UBE3A, CASK, TUBB2A, PEX1, PPFIBP1, KNL1, SLC26A4, SKIV2L, COL1A2, EBP, ANKRD11, MYO18B, OSGEP, ZEB2, TRIO, CLCN5, CASK, and LAGE3. The live birth rate of fetal microcephaly in the syndromic microcephaly group was significantly higher than that in the primary microcephaly group [62.9% (117/186) vs 31.56% (12/38), p = 0.000]. Conclusion: We conducted a prenatal study by conducting CMA and ES for the genetic analysis of fetal microcephaly cases. CMA and ES had a high diagnostic rate for the genetic causes of fetal microcephaly cases. In this study, we also identified 14 novel variants, which expanded the disease spectrum of microcephaly-related genes.
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Affiliation(s)
- You Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fang Fu
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tingying Lei
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Zhen
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiong Deng
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hang Zhou
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chunling Ma
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ken Cheng
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Ruibin Huang
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ru Li
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiuxia Yu
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lushan Li
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin Han
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xin Yang
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dongzhi Li
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Can Liao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Machado-Rivas F, Cortes-Albornoz MC, Afacan O, Bedoya MA, Calixto C, Choi JJ, Ruggiero M, Gholipour A, Jaimes C. Fetal MRI at 3 T: Principles to Optimize Success. Radiographics 2023; 43:e220141. [PMID: 36995947 PMCID: PMC10091224 DOI: 10.1148/rg.220141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 03/31/2023]
Abstract
Fetal MRI has emerged as a cornerstone of prenatal imaging, helping to establish the correct diagnosis in pregnancies affected by congenital anomalies. In the past decade, 3 T imaging was introduced as an alternative to increase the signal-to-noise ratio (SNR) of the pulse sequences and improve anatomic detail. However, imaging at a higher field strength is not without challenges. Many artifacts that are barely appreciable at 1.5 T are amplified at 3 T. A systematic approach to imaging at 3 T that incorporates appropriate patient positioning, a thoughtful protocol design, and sequence optimization minimizes the impact of these artifacts and allows radiologists to reap the benefits of the increased SNR. The sequences used are the same at both field strengths and include single-shot T2-weighted, balanced steady-state free-precession, three-dimensional T1-weighted spoiled gradient-echo, and echo-planar imaging. Synergistic use of these acquisitions to sample various tissue contrasts and in various planes provides valuable information about fetal anatomy and pathologic conditions. In the authors' experience, fetal imaging at 3 T outperforms imaging at 1.5 T for most indications when performed under optimal circumstances. The authors condense the cumulative experience of fetal imaging specialists and MRI technologists who practice at a large referral center into a guideline covering all major aspects of fetal MRI at 3 T, from patient preparation to image interpretation. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Fedel Machado-Rivas
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Maria Camila Cortes-Albornoz
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Onur Afacan
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Maria Alejandra Bedoya
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Camilo Calixto
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Jungwhan John Choi
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Matthew Ruggiero
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Ali Gholipour
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
| | - Camilo Jaimes
- From the Department of Radiology, Boston Children’s Hospital,
300 Longwood Ave, Boston, MA 02215 (F.M.R., M.C.C.A., O.A., M.A.B., C.C., M.R.,
A.G., C.J.); Department of Radiology, Harvard Medical School, Boston, Mass
(J.J.C.); and Department of Radiology, Cincinnati Children’s Hospital,
Cincinnati, Ohio (F.M.R., M.C.C.A., O.A., M.A.B., C.C., A.G., C.J.)
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7
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Griffiths PD, Jarvis D, Mooney C, Campbell MJ. Sex differences in fetal intracranial volumes assessed by in utero MR imaging. Biol Sex Differ 2023; 14:13. [PMID: 36922874 PMCID: PMC10015831 DOI: 10.1186/s13293-023-00497-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The primary aim of the study is to test the null hypothesis that there are no statistically significant differences in intracranial volumes between male and female fetuses. Furthermore, we have studied the symmetry of the cerebral hemispheres in the cohort of low-risk fetuses. METHODS 200 normal fetuses between 18 and 37 gestational weeks (gw) were included in the cohort and all had in utero MR, consisting of routine and 3D-volume imaging. The surfaces of the cerebral ventricles, brain and internal table of the skull were outlined manually and volume measurements were obtained of ventricles (VV), brain parenchyma (BPV), extraaxial CSF spaces (EAV) and the total intracranial volume (TICV). The changes in those values were studied over the gestational range, along with potential gender differences and asymmetries of the cerebral hemispheres. RESULTS BPV and VV increased steadily from 18 to 37 gestational weeks, and as a result TICV also increased steadily over that period. TICV and BPV increased at a statistically significantly greater rate in male relative to female fetuses after 24gw. The greater VV in male fetuses was apparent earlier, but the rate of increase was similar for male and female fetuses. There was no difference between the genders in the left and right hemispherical volumes, and they remained symmetrical over the age range measured. CONCLUSIONS We have described the growth of the major intracranial compartments in fetuses between 18 and 37gw. We have shown a number of statistically different features between male and female fetuses, but we have not detected any asymmetry in volumes of the fetal cerebral hemispheres.
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Affiliation(s)
| | - Deborah Jarvis
- Academic Radiology, University of Sheffield, Sheffield, UK
| | - Cara Mooney
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael J Campbell
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
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8
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Dütemeyer V, Cannie MM, Badr DA, Kadji C, Carlin A, Jani JC. Prevalence of and risk factors for failure of fetal magnetic resonance imaging due to maternal claustrophobia or malaise. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:392-398. [PMID: 36773302 DOI: 10.1002/uog.26045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for failure of fetal magnetic resonance imaging (MRI) due to maternal claustrophobia or malaise. METHODS This retrospective cohort study included pregnant women who underwent fetal MRI for clinical indications or research purposes between January 2012 and December 2019 at a single center. One group included patients who completed the entire examination and the other group inlcuded patients who interrupted their MRI examination due to claustrophobia/malaise. We estimated the rate of MRI failure due to maternal claustrophobia/malaise and compared maternal and clinical variables between the two groups. Multiple logistic regression analysis was performed to identify independent risk factors for claustrophobia/malaise during MRI examination in pregnancy. RESULTS Among 3413 patients who agreed to undergo fetal MRI, the prevalence of failure because of claustrophobia or malaise was 2.1%. The rate of claustrophobia/malaise in patients who underwent MRI for a clinical indication was lower compared to that in patients who underwent MRI for research purposes only (0.6% (4/696) vs 2.4% (65/2678); P = 0.003). Fetal MRI performed for research purposes only (adjusted odds ratio (aOR), 0.05 (95% CI, 0.01-0.48); P = 0.003), higher maternal age (aOR, 1.07 (95% CI, 1.02-1.12); P = 0.003) and later gestational age at the time of fetal MRI (aOR, 1.46 (95% CI, 1.16-2.04); P = 0.008) were independent risk factors for claustrophobia/malaise. Shorter fetal MRI duration (aOR, 0.77 (95% CI, 0.63-0.88); P = 0.001) was also associated with claustrophobia/malaise during the procedure. Body mass index, ethnic origin, multiple pregnancy, being parous and size of the magnetic bore were not associated with MRI failure due to claustrophobia/malaise. CONCLUSION The rate of fetal MRI failure due to claustrophobia or malaise was found to be low, particularly when the examination was performed for a clinical indication, and should not be considered a common problem in the pregnant population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Dütemeyer
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
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9
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Ryan GA, Start AO, Cathcart B, Hughes H, Denona B, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Robinson I, Colleran G, McParland P, McAuliffe FM. Prenatal findings and associated survival rates in fetal ventriculomegaly: A prospective observational study. Int J Gynaecol Obstet 2022; 159:891-897. [PMID: 35373343 PMCID: PMC9790218 DOI: 10.1002/ijgo.14206] [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] [Received: 10/13/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Fetal ventriculomegaly is associated with varying degrees of genetic and structural abnormalities. The objective was to present the experience of fetal ventriculomegaly in a large European center in relation to: 1. grade of ventriculomegaly; 2. additional chromosomal/structural abnormalities; and 3. perinatal survival rates. METHODS This was a prospective observational study of patients referred with fetal ventriculomegaly from January 2011 to July 2020. Data were obtained from the hospital database and analyzed to determine the rate of isolated ventriculomegaly, associated structural abnormalities, chromosomal/genetic abnormalities, and survival rates. Data were stratified into three groups; mild (Vp = 10-12 mm), moderate (Vp = 13-15 mm) and severe (Vp > 15 mm) ventriculomegaly. RESULTS There were 213 fetuses included for analysis. Of these 42.7% had mild ventriculomegaly, 44.6% severe and 12.7% had moderate ventriculomegaly. Initial ultrasound assessment reported isolated ventriculomegaly in 45.5% fetuses, with additional structural abnormalities in 54.5%. The rate of chromosomal/genetic abnormalities was high,16.4%. After all investigations, the true rate of isolated VM was 36.1%. The overall survival was 85.6%. Survival was higher for those with isolated VM across all groups (P < 0.05). CONCLUSION Ventriculomegaly is a complex condition and patients should be counselled that even with apparently isolated VM, there remains the possibility of additional genetic and/or structural problems being diagnosed in up to 10% of fetuses.
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Affiliation(s)
- Gillian A. Ryan
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Alexander O. Start
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Barbara Cathcart
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Heather Hughes
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | | | - Shane Higgins
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Siobhan Corcoran
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Jennifer Walsh
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Stephen Carroll
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Rhona Mahony
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Darach Crimmins
- Neurosurgery DepartmentChildren's University HospitalDublinIreland,UCD School of MedicineUniversity College DublinIreland
| | - John Caird
- Neurosurgery DepartmentChildren's University HospitalDublinIreland
| | - Ian Robinson
- Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Gabrielle Colleran
- UCD School of MedicineUniversity College DublinIreland,Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Peter McParland
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
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10
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Moradi B, Badraqe N, Rahimi Sharbaf F, Firouznia K, Shirazi M, Kazemi MA, Rahimi R. Early detection of ischemic brain injuries by diffusion-weighted imaging after radiofrequency ablation for fetal reduction in monochorionic pregnancies. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1288-1296. [PMID: 35635295 DOI: 10.1002/jcu.23237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This study aimed to investigate the additional advantages of magnetic resonance imaging (MRI), particularly diffusion-weighted imaging (DWI) over fetal ultrasound in the detection of acute ischemic cerebral injuries in complicated monochorionic (MC) pregnancies that underwent selective reduction by radiofrequency ablation (RFA). METHODS This prospective cohort study was conducted on 40 women with complicated MC pregnancies who were treated by RFA. Fetal brain imaging by DWI and conventional MRI was performed either in the early (within 10 days after RFA) or late phase (after 3-6 weeks) in the surviving fetuses to detect both acute and chronic ischemic injuries. The presence of anemia after RFA was also evaluated by Doppler ultrasound. RESULTS Overall, 13 of the total 43 fetuses (30.23%) demonstrated MRI abnormalities with normal brain ultrasound results including germinal matrix hemorrhage (GMH), extensive cerebral ischemia, and mild ventriculomegaly. Although seven fetuses with GMH eventually survived, fetuses that demonstrated ischemic lesions and ventriculomegaly on MRI died in the uterus. CONCLUSION The absence of abnormal cerebral lesions or anemia on ultrasound and Doppler exams does not necessarily rule out fetal brain ischemia. Performing early MRI, particularly DWI seems to be a reasonable option for detection of early intracranial ischemic changes and better management of complicated multiple pregnancies which were treated by RFA.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Badraqe
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahimi Sharbaf
- Maternal, Fetal and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahil Rahimi
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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11
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Powers AM, White C, Neuberger I, Maloney JA, Stence NV, Mirsky D. Fetal MRI Neuroradiology: Indications. Clin Perinatol 2022; 49:573-586. [PMID: 36113923 DOI: 10.1016/j.clp.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal MRI is a safe, noninvasive examination of the fetus and placenta, a complement to ultrasonography. MRI provides detailed CNS evaluation, including depicting parenchymal architecture and posterior fossa morphology, and is key in prenatal assessment of spinal dysraphism, neck masses, and ventriculomegaly. Fetal MRI is typically performed after 22 weeks gestation, and ultrafast T1 and T2-weighted MRI sequences are the core of the exam, with advanced sequences such as diffusion weighted imaging used for specific questions. The fetal brain grows and develops rapidly, and familiarity with gestational age specific norms is essential to MRI interpretation.
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Affiliation(s)
- Andria M Powers
- Children's Hospital and Medical Center, University of Nebraska Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Christina White
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - John A Maloney
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
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12
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Guimaraes CVA, Dahmoush HM. Fetal Brain Anatomy. Neuroimaging Clin N Am 2022; 32:663-681. [PMID: 35843668 DOI: 10.1016/j.nic.2022.04.009] [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] [Indexed: 11/19/2022]
Abstract
"Fetal brain development has been well studied, allowing for an ample knowledge of the normal changes that occur during gestation. Imaging modalities used to evaluate the fetal central nervous system (CNS) include ultrasound and MRI. MRI is the most accurate imaging modality for parenchymal evaluation and depiction of developmental CNS anomalies. The depiction of CNS abnormalities in a fetus can only be accurately made when there is an understanding of its normal development. This article reviews the expected normal fetal brain anatomy and development during gestation. Additional anatomic structures seen on brain imaging sequences are also reviewed."
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Affiliation(s)
- Carolina V A Guimaraes
- Division Chief of Pediatric Radiology, Department of Radiology, University of North Carolina, School of Medicine, 2006 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7510, USA.
| | - Hisham M Dahmoush
- Department of Radiology, Stanford School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94304, USA
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13
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Ogenyi P, Chiegwu HU, England A, Akanegbu UE, Ogbonna OS, Abubakar A, Luntsi G, Zira DJ, Dauda M. Appraisal of trimester-specific fetal heart rate and its role in gestational age prediction. Radiography (Lond) 2022; 28:926-932. [PMID: 35820355 DOI: 10.1016/j.radi.2022.06.015] [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: 01/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate and report normal sonographic FHR values among low-risk singleton women across the three trimesters of pregnancy and determine FHR role in gestational age prediction. METHOD A prospective cross-sectional study of 2727 low-risk singleton pregnant women was undertaken. FHR measurements were obtained by a consultant radiologist and three experienced sonographers using transabdominal approach from January 2019 to December 2020. Two FHR measurements were taken for each participant. The fetal lie and presentation were also documented in the first trimester. Data were analysed using SPSS version 24 (IBM, Armonk, NY, USA). RESULT The maternal mean ± SD age was 25.8 ± 6.5 years and mean FHR for first, second and third trimesters were 151 ± 16, 145 ± 6 and 125±6 bpm respectively. The mean ± SD gestational age were 10 ± 2, 19 ± 3 and 34 ± 2 weeks for the first, second and third trimester respectively. Using ANOVA, there were statistically significant differences in FHR across the three trimesters (p ≤ 0.05). A positive correlation existed between maternal age and FHR (r = 0.57, p ≤ 0.05). CONCLUSION This study has established normal values for FHR in first, second and third trimester respectively. Referring physicians, radiologists, sonographers, obstetricians and gynaecologists may consider FHR of (135-167) bpm (139-151) bpm and (119-131) bpm as normal FHR ranges for the first, second and third trimester respectively. This study has also revealed the possibility of gestational age prediction using FHR with the equation [Gestational Age = 87.8 - (0.47) FHR]. IMPLICATIONS FOR PRACTICE This paper provides the most up-to-date sonographic FHR recommendations for fetal management. More importantly, findings from this study also suggests that ultrasound practitioners can use FHR measurements as a reliable alternative for fetal dating.
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Affiliation(s)
- P Ogenyi
- Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - H U Chiegwu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A England
- School of Medicine, University College Cork, Ireland
| | - U E Akanegbu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - O S Ogbonna
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A Abubakar
- Department of Radiography, University of Maiduguri, Nigeria
| | - G Luntsi
- Department of Radiography, University of Maiduguri, Nigeria
| | - D J Zira
- Department of Radiography, Federal University Lafia, Nigeria
| | - M Dauda
- Department of Medical Physics, Nasarawa State University, Keffi, Nigeria
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14
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Adiyaman D, Öztekin Ö, Kuyucu M, Atakul BK, Toklu G, Aykut İ, Yıldırım AGŞ, Özeren M, Öztekin D. Contribution of fetal magnetic resonance imaging in the evaluation of neurosonographically detected cases of isolated mild and moderate cerebral ventriculomegaly. J Obstet Gynaecol Res 2022; 48:2314-2324. [PMID: 35778980 DOI: 10.1111/jog.15344] [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: 02/13/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to present the contribution of prenatal magnetic resonance imaging (MRI) in the diagnosis of fetuses that were previously identified as isolated mild and moderate cerebral ventriculomegaly (VM) by ultrasound (US). METHODS The data between February 2013 and August 2020 were collected for women who were diagnosed with isolated mild or moderate fetal VM by US and subsequently underwent a fetal MRI. RESULTS Among 321 women, 21 (6.5%) had a clinically important additional finding after MRI. Twelve of 276 (4.3%) fetuses with mild VM and 9 of 45 (20%) with moderate VM had turned out to have additional central nervous system abnormalities. Additional findings were detected more in fetuses with moderate VM, mothers with an anterior-located placenta, and mothers with higher body mass indexes (BMIs) with statistical significance (p = 0.001, p = 0.013, p = 0.036, respectively). The most common additional MRI finding was grade 3 or 4 germinal matrix hemorrhage, which was detected in 11 of 21 fetuses (52.3%). CONCLUSIONS Considering the countries' health policies, prenatal MRI would contribute mostly to the diagnosis of fetuses with moderate VM, pregnancies with anterior-located placenta, and mothers with high BMIs. According to our data, we believe that MRI will be valuable, especially in the diagnosis of grade 3 and 4 intracranial hemorrhage group.
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Affiliation(s)
- Duygu Adiyaman
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Özgür Öztekin
- Faculty of Medicine, Department of Radiology, Bakırcay University, Izmir, Turkey
| | - Melda Kuyucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Bahar K Atakul
- Izmir University of Economics, Faculty of Medicine, Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Izmir, Turkey
| | - Gizem Toklu
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - İsmail Aykut
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkım G Ş Yıldırım
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Özeren
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Deniz Öztekin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Bakırcay University, Izmir, Turkey
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15
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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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16
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Abstract
Brain asymmetry is a hallmark of the human brain. Recent studies report a certain degree of abnormal asymmetry of brain lateralization between left and right brain hemispheres can be associated with many neuropsychiatric conditions. In this regard, some questions need answers. First, the accelerated brain asymmetry is programmed during the pre-natal period that can be called “accelerated brain decline clock”. Second, can we find the right biomarkers to predict these changes? Moreover, can we establish the dynamics of these changes in order to identify the right time window for proper interventions that can reverse or limit the neurological decline? To find answers to these questions, we performed a systematic online search for the last 10 years in databases using keywords. Conclusion: we need to establish the right in vitro model that meets human conditions as much as possible. New biomarkers are necessary to establish the “good” or the “bad” borders of brain asymmetry at the epigenetic and functional level as early as possible.
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17
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Hornberger LK, McBrien A. Extracardiac Pathology in Fetal Heart Disease: What You See Is Not Always What You Get. J Am Coll Cardiol 2021; 78:2323-2325. [PMID: 34857094 DOI: 10.1016/j.jacc.2021.09.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Lisa K Hornberger
- Fetal and Neonatal Cardiology Program, Pediatric Cardiology, Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Angela McBrien
- Fetal and Neonatal Cardiology Program, Pediatric Cardiology, Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada. https://twitter.com/angmcbrien
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18
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Romaniello R, Arrigoni F, De Salvo P, Bonaglia MC, Panzeri E, Bassi MT, Parazzini C, Righini A, Borgatti R. Long-term follow-up in a cohort of children with isolated corpus callosum agenesis at fetal MRI. Ann Clin Transl Neurol 2021; 8:2280-2288. [PMID: 34850608 PMCID: PMC8670314 DOI: 10.1002/acn3.51484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective This long‐term retrospective follow‐up study aimed to address the knowledge gap between prenatal diagnosis of complete isolated Agenesis of Corpus Callosum (cACC) at fetal MRI and postnatal neurodevelopmental outcome to improve prenatal counseling for parents. Methods Data on fetuses with isolated cACC from a single‐center MRI database built up in two decades were considered. Detailed postnatal clinical, neuropsychological evaluations were performed and descriptions of available neuroradiological and genetic data were provided. Results Following a detailed neuropsychological evaluation and a long‐term follow‐up, the subsequent results emerged: 38 school‐aged children (older than 6 years) of 50 (aged 2.5‐15 years) showed normal intellectual functions (50%), intellectual disability (21%), and borderline intelligence quotient (29%). Deficits in motor functions (58%), executive functions (37%), language (61%), memory abilities (58%), and academic performances (53%) were found. Twenty‐one percent of participants showed behavioral difficulties. Almost half of the participants underwent rehabilitation. Additional findings (21%) were detected at postnatal brain MRI, and a significant association between additional findings at postnatal imaging and abnormal neurodevelopmental outcome was observed. Interpretations This study supports the view that children with prenatal diagnosis of isolated cACC may present with several degrees of neurologic and neuropsychological impairment which become more evident only in their second decade of life. Postnatal MRI and detailed genetic analysis may add crucial information to prenatal data and substantially influence final judgment on the outcome and orient clinical management and counseling.
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Affiliation(s)
- Romina Romaniello
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Patrizia De Salvo
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Maria Clara Bonaglia
- Cytogenetics Laboratory, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Elena Panzeri
- Laboratory of Molecular Biology, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Maria Teresa Bassi
- Laboratory of Molecular Biology, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Cecilia Parazzini
- Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Andrea Righini
- Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Milan, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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19
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Papaioannou G, Klein W, Cassart M, Garel C. Indications for magnetic resonance imaging of the fetal central nervous system: recommendations from the European Society of Paediatric Radiology Fetal Task Force. Pediatr Radiol 2021; 51:2105-2114. [PMID: 34137935 DOI: 10.1007/s00247-021-05104-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/25/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
Fetal central nervous system MRI is a well-established method to complement a high-quality fetal ultrasound and to clarify sonographically detected abnormalities in complex pregnancies. However, there is still worldwide heterogeneity and confusion regarding the indications of fetal central nervous system MRI, which has roots in differences among countries regarding the performance of ultrasound examinations and legislation on pregnancy termination. The purpose of this article is to clarify the indications for fetal central nervous system MRI by focusing on the ultrasound findings that guide further investigation with MRI and highlight the strengths and the weaknesses of each modality on imaging the fetal central nervous system.
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Affiliation(s)
- Georgia Papaioannou
- Department of Pediatric Radiology, Mitera Maternity and Children's Hospital, 6 Erythrou Stavrou str, Maroussi, 15123, Athens, Greece.
| | - Willemijn Klein
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud Medical Center, Nijmegen, Netherlands
| | - Marie Cassart
- Department of Radiology and Fetal Medicine, Iris South Hospitals, Brussels, Belgium
| | - Catherine Garel
- Department of Radiology, Armand-Trousseau Hospital, Paris, France
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20
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Duan J, Wang JC, Li HX, Guo L, Ma LK. 1.5T magnetic resonance imaging in evaluating fetal head and abdomen malformations: a preliminary study. Am J Transl Res 2021; 13:9063-9069. [PMID: 34540019 PMCID: PMC8430194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is increasingly used in the diagnosis of fetal malformations. The purpose of this study was to determine the diagnostic value of 1.5T MRI in fetal head and abdominal malformations. METHODS A total of 132 pregnant women admitted to Shijiazhuang NO.4 Hospital were included and divided into a control group (CG; n=63) and a research group (RG; n=69) according to different prenatal examination methods. Patients in CG were given ultrasound, while those in RG underwent 1.5T MRI examination. The image quality of 1.5T MRI in different amniotic fluid, different gestational weeks with normal amniotic fluid and different fetal positions with normal amniotic fluid were compared. The detection rate and diagnostic value of the two methods were also compared, with the histological and pathological results as the gold standard. RESULTS The image quality of 1.5T MRI was not affected by different gestational age with normal amniotic fluid, different fetal positions with normal amniotic fluid, or different amniotic fluid, indicating the feasibility of 1.5T MRI in fetal malformation examination. Histopathological diagnosis revealed 39 cases of head and abdominal deformities in CG and 50 cases in RG. Based on the results of ultrasound examination, there were 32 cases of deformities and 31 of non-deformities in CG. In RG, 1.5T MRI revealed 48 malformations and 21 non-malformations. The sensitivity, specificity, accuracy, missed diagnosis and misdiagnosis rates were 82.05%, 75.00%, 79.37%, 17.95% and 25.00% respectively in CG where ultrasonography was performed, and were 96.00%, 94.74%, 95.65%, 4.00% and 5.26% respectively in RG where 1.5T MRI was performed. The data identified significant differences in sensitivity, accuracy and missed diagnosis between RG and CG. CONCLUSION 1.5T MRI is effective in diagnosing fetal head and abdominal malformations.
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Affiliation(s)
- Jun Duan
- Radiology Department, Shijiazhuang NO. 4 Hospital (The Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University)Shijiazhuang 050000, Hebei, China
| | - Jin-Cai Wang
- Radiology Department, Shijiazhuang NO. 4 Hospital (The Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University)Shijiazhuang 050000, Hebei, China
| | - Hui-Xian Li
- Thoracic Surgery, Shijiazhuang People’s HospitalShijiazhuang 050000, Hebei, China
| | - Ling Guo
- Radiology Department, Shijiazhuang NO. 4 Hospital (The Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University)Shijiazhuang 050000, Hebei, China
| | - Li-Ke Ma
- Internal Medicine-Cardiovascular Department, Shijiazhuang No. 3 HospitalShijiazhuang 050000, Hebei, China
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21
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Griffiths PD, Jarvis D, Mooney C, Mason G, Dean AF. Post-mortem confirmation of fetal brain abnormalities: challenges highlighted by the MERIDIAN cohort study. BJOG 2021; 128:1174-1182. [PMID: 33249730 DOI: 10.1111/1471-0528.16609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess and analyse the concordance between post-mortem findings and in utero magnetic resonance imaging (iuMRI) in the MERIDIAN (MRI to enhance the diagnosis of fetal developmental brain abnormalities in utero) cohort. DESIGN Prospective cohort study. SETTING Fetal medicine units in the UK. POPULATION Pregnant women with a diagnosis of fetal brain abnormality identified on ultrasound at 18 weeks of gestation or later. METHODS All pregnancies from the MERIDIAN study that resulted in a abortion were included and the rate of uptake and success of post-mortem examinations were calculated. In the cases in which diagnostic information about the fetal brain was obtained by post-mortem, the results were compared with the diagnoses from iuMRI. MAIN OUTCOME MEASURE Outcome reference diagnosis from post-mortem examination. RESULTS A total of 155 from 823 pregnancies (19%) ended in a termination of pregnancy and 71 (46%) had post-mortem brain examinations, 62 of which were diagnostically adequate. Hence, the overall rate of successful post-mortem investigation was 40%, and for those cases there was a concordance rate of 84% between iuMRI and post-mortem examination. Detailed information is provided when the results of the post-mortem examination and the iuMRI study differed. CONCLUSIONS We have shown tissue-validation of radiological diagnosis is hampered by a low rate of post-mortem studies in fetuses aborted with brain abnormalities, a situation further compounded by a 12% rate of autopsy being technically unsuccessful. The agreement between iuMRI and post-mortem findings is high, but our analysis of the discrepant cases provides valuable clues for improving how we provide information for parents. TWEETABLE ABSTRACT: iuMRI should be considered a reliable indicator of fetal brain abnormalities when post-mortem is not performed.
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Affiliation(s)
- P D Griffiths
- Academic Unit of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - D Jarvis
- Academic Unit of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - C Mooney
- Clinical Trials Research Unit (CTRU), School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Mason
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A F Dean
- Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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22
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Wang Y, Zhou J, Deng M, Xiang X, Zhu X. Utility of Magnetic Resonance Imaging in Diagnosis of Prenatal Non-Visualization of the Fetal Gallbladder: A Case-Series Study. Med Sci Monit 2021; 27:e927474. [PMID: 33397840 PMCID: PMC7796068 DOI: 10.12659/msm.927474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to assess the utility of magnetic resonance imaging (MRI) in the diagnosis of prenatal non-visualization of the fetal gallbladder (PNVGB). MATERIAL AND METHODS The clinical data of 32 pregnant women with PNVGB who underwent MRI examination during the second and third trimester of pregnancy were collected and their outcomes were analyzed. RESULTS MRI showed that 26 patients (81.3%) had isolated PNVGB and 6 (18.8%) had additional malformations. In 26 patients with isolated PNVGB, 7 were found in the gallbladder on MRI and 4 were found on subsequent ultrasonography. One patient had termination of pregnancy (TOP) and 1 patient was lost to follow-up; the remaining 24 patients were known to deliver a healthy child. Among the 6 patients with additional malformations, 3 terminated their pregnancies due to combined severe abnormalities: 1 patient with horseshoe kidney and 1 with fetal echogenic bowel both had a healthy child, while 1 with fetal growth restriction (FGR) delivered a child who walked on tiptoe. CONCLUSIONS MRI contributes to identifying PNVGB detected or suspected by ultrasonography.
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Affiliation(s)
- Yuanhe Wang
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jinling Zhou
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Meixiang Deng
- Department of Radiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xiaomiao Xiang
- Ultrasonic Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xiaojun Zhu
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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23
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Linh LT, Duc NM, Nhung NTH, My TTT, Luu DT, Lenh BV. Detecting Fetal Central Nervous System Anomalies Using Magnetic Resonance Imaging and Ultrasound. Med Arch 2021; 75:45-49. [PMID: 34012199 PMCID: PMC8116073 DOI: 10.5455/medarh.2021.75.45-49] [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] [Indexed: 11/06/2022] Open
Abstract
Background: Most fetal abnormalities can be detected on ultrasound, the evaluation of fetal CNS abnormalities can be limited by various factors, including obesity, polyhydramnios, multiple pregnancies, and increased cranial ossification during the third trimester. Objective: This study aimed to evaluate the ability to detect fetal central nervous system (CNS) anomalies using in utero magnetic resonance imaging (iuMRI) and ultrasound (US) techniques. Methods: This prospective study was approved by the institutional review board (Ref: 2968/QĐ-ĐHYHN dated 11 July 2019), and the requirement to obtain the informed consent of patients was waived. This study included 66 fetuses with diagnosed or suspected CNS abnormalities based on the results of a prenatal screening US performed at the antenatal diagnosis center of the Central Obstetrics and Gynecology Hospital. All pregnant women with a suspected diagnosis of abnormal fetal CNS on US underwent 1.5-Tesla iuMRI within 14 days of the US at Hanoi Medical University Hospital between June 2019 and June 2020. Cohen’s kappa coefficient (κ) was used to determine the agreement between US and iuMRI findings. Results: A total of 66 pregnant women were examined, including 66 fetuses, for which 79 abnormalities were detected by US and 98 abnormalities were detected by iuMRI. The average gestational age was 29 weeks and 6 days. The comparison of iuMRI and US findings revealed similar diagnoses for 71 abnormalities (67%) and different diagnoses for 35 abnormalities (33%). The level of agreement between US and iuMRI was almost perfect for ventriculomegaly and cystic lesions, with κ values 0.87 and 0.84, respectively. The level of agreement between US and iuMRI was the weakest for hemorrhage, with a κ value 0 (no agreement), and cortical abnormalities, with a κ value of 0.46 (weak agreement). Conclusion: The level of agreement between US and iuMRI diagnoses was almost perfect for the detection of ventriculomegaly and was weakest for the detection of hemorrhage and cortical abnormalities, which were abnormalities detected by iuMRI but not by ultrasound.
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Affiliation(s)
- Le Tuan Linh
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Thieu-Thi Tra My
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Doan Tien Luu
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Bui Van Lenh
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
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24
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Choi JJ, Yang E, Soul JS, Jaimes C. Fetal magnetic resonance imaging: supratentorial brain malformations. Pediatr Radiol 2020; 50:1934-1947. [PMID: 33252760 DOI: 10.1007/s00247-020-04696-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Abstract
Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence of events that occurs during prenatal brain development; this includes familiarity with the processes of hemispheric cleavage, formation of interhemispheric commissures, neuro-glial proliferation and migration, and cortical folding. Disruption of these processes results in malformations observed on fetal MRI including holoprosencephaly, callosal agenesis, heterotopic gray matter, lissencephaly and other malformations of cortical development (focal cortical dysplasia, polymicrogyria). The radiologist should also be familiar with findings that have high association with specific conditions affecting the central nervous system or other organ systems. This review summarizes and illustrates common patterns of supratentorial brain malformations and emphasizes aspects that are important to patient care.
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Affiliation(s)
- Jungwhan John Choi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Janet S Soul
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
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25
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Gafner M, Fried S, Gosher N, Jeddah D, Sade EK, Barzilay E, Mayer A, Katorza E. Fetal Brain Biometry: Is there an Agreement among Ultrasound, MRI and the Measurements at Birth? Eur J Radiol 2020; 133:109369. [PMID: 33126174 DOI: 10.1016/j.ejrad.2020.109369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Measurement of the fetal brain can be achieved by different modalities, we aimed to assess the agreement between these methods and the head circumference at birth. METHODS A retrospective study conducted between 2011-2018 at a tertiary referral medical center. Sonographic head circumference (HC), 2D MRI bi-parietal diameter (BPD) and occipito-frontal diameter (OFD), 3D MRI supra-tentorial volume (STV), and head circumference (HC) at birth were measured and converted into centiles according to gestational age. Spearman's rank correlation coefficient was used to assess the correlation between the modalities. RESULTS A total of 88 fetuses were included. Mean gestational age at the time of fetal US and brain MRI acquisition were 34.4 ± 2.8 and 34.6 ± 2.6 weeks, respectively. A correlation was found between prenatal sonographic HC and the 3D MRI STV centiles (Rs = 0.859, p < 0.001), the BPD in 2D MRI (Rs = 0.813, p < 0.001), and the OFD in 2D MRI (Rs = 0.840, p < 0.001). Sonographic HC, OFD on 2D MRI, and STV on 3D MRI were all found to be correlated with the HC at birth (Rs = 0.865, p < 0.001; Rs 0.816, p < 0.001; Rs = 0.825, p < 0.001, respectively). CONCLUSIONS There is a statistically significant agreement among the different prenatal clinically used modalities for measuring fetal brain and the head circumference at birth, however, this correlation is not perfect. Further study is needed to investigate the long-term prognosis of these fetuses.
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Affiliation(s)
- Michal Gafner
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Shalev Fried
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noa Gosher
- Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Danielle Jeddah
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eliel Kedar Sade
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Arnaldo Mayer
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Diagnostic Radiology, Sheba Medical Center, Ramat-Gan, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Diagnostic Radiology, Sheba Medical Center, Ramat-Gan, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
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26
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Wilson M, Muir K, Reddy D, Webster R, Kapoor C, Miller E. Prognostic Accuracy of Fetal MRI in Predicting Postnatal Neurodevelopmental Outcome. AJNR Am J Neuroradiol 2020; 41:2146-2154. [PMID: 32943421 DOI: 10.3174/ajnr.a6770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE The superior diagnostic accuracy of fetal MR imaging in detecting fetal brain abnormalities has been previously demonstrated; however, the ability of fetal MR imaging to prognosticate postnatal outcome is not well-studied. We performed a retrospective analysis to determine the prognostic accuracy of fetal MR imaging in predicting postnatal neurodevelopmental outcome. MATERIALS AND METHODS We identified all fetal MR imaging performed at the Children's Hospital of Eastern Ontario during a 10-year period and assessed agreement between prenatal prognosis and postnatal outcome. Prenatal prognosis was determined by a pediatric neurologist who reviewed the fetal MR imaging report and categorized each pregnancy as having a favorable, indeterminate, or poor prognosis. Assessment of postnatal neurodevelopmental outcome was made solely on the basis of the child's Gross Motor Function Classification System score and whether the child developed epilepsy. Postnatal outcome was categorized as favorable, intermediate, or poor. We also assessed the diagnostic accuracy of fetal MR imaging by comparing prenatal and postnatal imaging diagnoses. RESULTS We reviewed 145 fetal MR images: 114 were included in the assessment of diagnostic accuracy, and 104 were included in the assessment of prognostic accuracy. There was 93.0% agreement between prenatal and postnatal imaging diagnoses. Prognosis was favorable in 44.2%, indeterminate in 50.0%, and poor in 5.8% of pregnancies. There was 93.5% agreement between a favorable prenatal prognosis and a favorable postnatal outcome. CONCLUSIONS A favorable prenatal prognosis is highly predictive of a favorable postnatal outcome. Further studies are required to better understand the role of fetal MR imaging in prognosticating postnatal development, particularly in pregnancies with indeterminate and poor prognoses.
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Affiliation(s)
- M Wilson
- From the Department of Medical Imaging (M.W., C.K., E.M.).,Department of Neurology (M.W.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Muir
- Pediatric Neurology (K.M.)
| | - D Reddy
- Research Institute (D.R., R.W.), Children's Hospital of Eastern Ontario, University of Ottawa,Ottawa, Ontario, Canada
| | - R Webster
- Research Institute (D.R., R.W.), Children's Hospital of Eastern Ontario, University of Ottawa,Ottawa, Ontario, Canada
| | - C Kapoor
- From the Department of Medical Imaging (M.W., C.K., E.M.)
| | - E Miller
- From the Department of Medical Imaging (M.W., C.K., E.M.)
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27
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Snyder E. Current Value of Fetal MRI in Prenatal Diagnosis. J Magn Reson Imaging 2020; 52:1569-1570. [PMID: 32338791 DOI: 10.1002/jmri.27178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Elizabeth Snyder
- Department of Pediatric Radiology, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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28
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Hart AR, Embleton ND, Bradburn M, Connolly DJA, Mandefield L, Mooney C, Griffiths PD. Accuracy of in-utero MRI to detect fetal brain abnormalities and prognosticate developmental outcome: postnatal follow-up of the MERIDIAN cohort. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:131-140. [PMID: 31786091 PMCID: PMC6988445 DOI: 10.1016/s2352-4642(19)30349-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In utero MRI (iuMRI) detects fetal brain abnormalities more accurately than ultrasonography and provides additional clinical information in around half of pregnancies. We aimed to study whether postnatal neuroimaging after age 6 months changes the diagnostic accuracy of iuMRI and its ability to predict developmental outcome. METHODS Families enrolled in the MERIDIAN study whose child survived to age 3 years were invited to have a case note review and assessment of developmental outcome with the Bayley Scales of Infant and Toddler Development, the Ages and Stages Questionnaire, or both. A paediatric neuroradiologist, masked to the iuMRI results, reviewed the postnatal neuroimaging if the clinical report differed from iuMRI findings. Diagnostic accuracy was recalculated. A paediatric neurologist and neonatologist categorised participants' development as normal, at risk, or abnormal, and the ability of iuMRI and ultrasonography to predict developmental outcome were assessed. FINDINGS 210 participants had case note review, of whom 81 (39%) had additional investigations after age 6 months. The diagnostic accuracy of iuMRI remained higher than ultrasonography (proportion of correct cases was 529 [92%] of 574 vs 387 [67%] of 574; absolute difference 25%, 95% CI 21 to 29; p<0·0001). Developmental outcome data were analysed in 156 participants, and 111 (71%) were categorised as normal or at risk. Of these 111 participants, prognosis was normal or favourable for 56 (51%) using ultrasonography and for 76 (69%) using iuMRI (difference in specificity 18%, 95% CI 7 to 29; p=0·0008). No statistically significant difference was seen in infants with abnormal outcome (difference in sensitivity 4%, 95% CI -10 to 19; p=0·73). INTERPRETATION iuMRI remains the optimal tool to identify fetal brain abnormalities. It is less accurate when used to predict developmental outcome, although better than ultrasonography for identifying children with normal outcome. Further work is needed to determine how the prognostic abilities of iuMRI can be improved. FUNDING National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Anthony R Hart
- Department of Paediatric and Perinatal Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel J A Connolly
- Department of Paediatric Neuroradiology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK
| | - Laura Mandefield
- Clinical Trials Research Unit, School Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cara Mooney
- Clinical Trials Research Unit, School Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Paul D Griffiths
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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