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Comparison of prenatal and postnatal MRI findings in the evaluation of intrauterine CNS anomalies requiring postnatal neurosurgical treatment

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Abstract

Aim

To assess the diagnostic capability of fetal magnetic resonance imaging (MRI) in children suspected antenatally to harbor central nervous system (CNS) defects that require immediate postnatal neurosurgical treatment.

Materials and methods

Between 2003 and 2005, 13 fetal MRI scans were performed in mothers suspected to have fetuses with congenital CNS defects that would require surgery soon after birth. Comparisons between antenatal and postnatal scans were made with emphasis on diagnostic accuracy of antenatal examinations.

Results

All mothers were scanned using heavily T2-weighted fat-saturated sequences, allowing rapid acquisitions to avoid movement artefacts. Imaging quality was satisfactory in all patients. Diagnoses made antenatally were: myelomeningocele in seven, meningocele in one, diastematomyelia in one, occipital meningocele in one, and isolated hydrocephalus in three children. Of the seven children with antenatal diagnosis of myelomeningocele, one proved to have spinal lipoma postnatally. The patient who antenatally was diagnosed with meningocele proved to have spinal lipoma postnatally. These two were early antenatal MR scans. Antenatal diagnosis of hydrocephalus was made in five of the six confirmed myelomeningocele patients, which was verified postnatally. Antenatal diagnosis of Chiari II malformation was made in all six confirmed myelomeningocele patients. The antenatal diagnoses of occipital meningo-encephalocele and isolated hydrocephalus were verified postnatally. Antenatal diagnosis of diastematomyelia was not verified postnatally.

Conclusion

Fetal MRI scanning is an effective, noninvasive method of assessing in-utero CNS abnormalities. The diagnostic accuracy has improved to allow prediction of clinical outcome and counseling for possible treatment, but is not perfect yet to allow counseling for termination of pregnancy.

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References

  1. The National Radiological Protection Board ad hoc advisory group on nuclear magnetic resonance clinical imaging (1983) Revised guidelines on acceptable limits of exposure during nuclear magnetic resonance clinical imaging. Br J Radiol 56:974–977

    Google Scholar 

  2. Shellock F, Kanal E (1991) Policies, guidelines and recommendations for MR imaging safety and patient management. J Magn Reson Imaging 1:97–100

    Article  PubMed  CAS  Google Scholar 

  3. Leung E, Sgouros S, Williams S, Johnson K (2002) Spinal lipoma misinterpreted as a meningocele on antenatal MRI scan in a baby girl. Childs Nervous Syst 18:361–363

    CAS  Google Scholar 

  4. Smith F, Adam A, Phillips W (1983) NMR-imaging in pregnancy. Lancet 1:61–62

    Article  PubMed  CAS  Google Scholar 

  5. Johnson IR, Symonds EM, Kean DM, Worthington BS, Broughton Pipkin F, Hawkes RC, Gygnell M (1984) Imaging the pregnant human uterus with nuclear magnetic resonance. Am J Obstet Gynecol 148:1136–1139

    PubMed  CAS  Google Scholar 

  6. McCarthy SM, Filly RA, Stark DD, Callen PW, Golbus MS, Hricak H (1985) Magnetic resonance imaging of fetal anomalies in-utero: early experience. AJR 145:677–682

    PubMed  CAS  Google Scholar 

  7. Weinreb JC, Lowe TW, Cohen JM, Kutler M (1985) Human fetal anatomy: MR imaging. Radiology 157:715–720

    PubMed  CAS  Google Scholar 

  8. Stark D, McCarthy S, Filly R, Callen P, Hricak H, Parer J (1985) Intrauterine growth retardation: evaluation by magnetic resonance—work in progress. Radiology 155:425–427

    PubMed  CAS  Google Scholar 

  9. Hata T, Makihara K, Aoki S, Hata K, Kutao M (1990) Magnetic resonance imaging of the fetus: initial experience. Gynecol Obstet Invest 29:255–258

    Article  PubMed  CAS  Google Scholar 

  10. Lowe T, Weinreb J, Santos-Ramos R, Cunningham F (1985) Magnetic resonance imaging in human pregnancy. Obstet Gynecol 66:629–633

    PubMed  CAS  Google Scholar 

  11. Angtuaco T, Shah H, Mattison D, Quirk J (1992) MR imaging in high-risk obstetric patients: a valuable component to US. Radio Graphics 12:91–109

    CAS  Google Scholar 

  12. Ismail KM, Ashworth JR, Martin WL, Chapman S, McHugo J, Whittle MJ, Kilby MD (2002) Fetal magnetic resonance imaging in prenatal diagnosis of central nervous system abnormalities: 3-year experience. J Matern Fetal Neonatal Med 12:185–190

    Article  PubMed  CAS  Google Scholar 

  13. Clewell WH, Manco-Johnson ML, Manchester DK (1986) Diagnosis and management of fetal hydrocephalus. Clin Obstet Gynecol 29:514–522

    Article  PubMed  CAS  Google Scholar 

  14. Hill LM, Brukle R, Gehrking WC (1983) The prenatal detection of congenital malformations by ultrasonography. Mayo Clin Proc 58:805–826

    PubMed  CAS  Google Scholar 

  15. Hill MC, Lande IM, Larsen LW Jr (1988) Prenatal diagnosis of fetal anomalies using ultrasound and MRI. Radiol Clin North Am 26:287–307

    PubMed  CAS  Google Scholar 

  16. Glick PL, Harrison MR, Nakayama DK, Edwards MSB, Filly RA, Chinn DH, Callen PN, Wilson SL, Golbus MS (1984) Management of ventriculomegaly in the fetus. J Paediatr 105:97–105

    Article  CAS  Google Scholar 

  17. Tulipan N, Hernanz-Schulman M, Bruner JP (1998) Reduced hindbrain herniation after intrauterine myelomeningocele repair: a report of four cases. Paeditr Neurosurg 29:274–278

    Article  CAS  Google Scholar 

  18. Mansfield P, Stehling MK, Ordidge RJ, Coxon R, Chapman B, Blamire A, Gibbs P, Johnson IR, Symonds EM, Worthington BS et al (1990) Echo-planar imaging of the human fetus in utero at 0.5T. Br J Radiol 63:833–841

    Article  PubMed  CAS  Google Scholar 

  19. Kubik-Hunch RA (1998) Prenatal diagnosis of fetal malformations by ultrasound MRI. Prenat Diagn 18:1205–1208

    Article  Google Scholar 

  20. Pilu G, Perolo A, Falco P, Visentin A, Gabrielli S, Bovicelli L (2000) Ultrasound of the fetal central nervous system. Curr Opin Obstet Gynecol 12:93–103

    Article  PubMed  CAS  Google Scholar 

  21. Lair-Milan F, Gelot A, Baron JM, Lewin F, André C, Adamsbaum C (1997) Prenatal MRI of the brain. Retrospective study apropos of 34 tests. J Radiol 78:499–505 (French)

    PubMed  CAS  Google Scholar 

  22. Luks FI (2000) Requirements for fetal surgery. Eur J Obstet Gynecol 92:115–118

    Article  CAS  Google Scholar 

  23. Oi S (1999) Prerequisites for fetal neurosurgery: management of CNS anomalies toward the 21st century. Crit Rev Neurosurg 28:252–261

    Article  Google Scholar 

  24. Simon EM (2000) Fast MRI of fetal CNS anomalies in utero. AJNR AM J Neuroradiol 21:1688–1698

    PubMed  CAS  Google Scholar 

  25. Sutton LN, Adzick NS, Bilanuk LT, Johnson MP, Crombleholme TM, Flake AW (1999) Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele. JAMA 282:1826–1831

    Article  PubMed  CAS  Google Scholar 

  26. Griffiths PD, Paley MN, Whitby EH (2003) MR imaging technology of the fetal brain and spine: a maturing technology. Ann Acad Med Singapore 32:483–489

    PubMed  CAS  Google Scholar 

  27. Levine D, Barnes PD, Abbott J, Wong GP, Edelman R (1999) Fetal CNS anomalies revealed with ultrasound MR imaging. Am J Obstet Gynecol 180:174

    Article  Google Scholar 

  28. Griffiths PD, Widjaja E, Paley MNJ, Whitby EH (2006) Imaging the fetal spine using in utero MR: diagnostic accuracy and impact on management. Pediatr Radiol 36:927–933

    Article  PubMed  Google Scholar 

  29. Whitby EH, Paley MN, Spring A, Rutter S, Davies NP, Wilkinson ID, Griffiths PD (2005) Comparison of ultrasound and magnetic resonance imaging in 100 singleton pregnancies with suspected brain abnormalities. BJOG 112:784–792

    Google Scholar 

  30. Sonigo PC, Rypens FF, Carteret M, Delezoide A, Brunelle FO (1998) MRI imaging of fetal cerebral anomalies. Paediatr Radiol 28:212–222

    Article  CAS  Google Scholar 

  31. Mangels KJ, Tulipan N, Tsao LY, Alarscon J, Bruner JP (2000) Fetal MRI in the evaluation of intrauterine myelomeningocele. Paediatr Neurosurg 32:124–131

    Article  CAS  Google Scholar 

  32. Patel M, Filly A, Hersh D, Goldstein R (1994) Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome. Radiology 192:759–764

    PubMed  CAS  Google Scholar 

  33. Nyberg D, Mack L, Hirsch J, Pagon R, Shepard T (1987) Fetal hydrocephalus: sonographic detection and clinical significance of associated anomalies. Radiology 163:187–191

    PubMed  CAS  Google Scholar 

  34. Pretorius D, Davis K, Manco-Johnson M, Manchester D, Meier P, Clewell W (1985) Clinical course of fetal hydrocephalus: 40 cases. AJR 144:827–831

    PubMed  CAS  Google Scholar 

  35. Chervenak F, Duncan C, Ment L (1984) Outcome of fetal ventriculomegaly. Lancet 2:179–181

    Article  PubMed  CAS  Google Scholar 

  36. Goldstein R, LaPidus A, Filly R, Cardoza J (1990) Mild lateral cerebral ventricular dilatation in utero; clinical significance and prognosis. Radiology 176:237–242

    PubMed  CAS  Google Scholar 

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Acknowledgement

We would like to acknowledge Dr. J. McHugo for contributing significantly in the antenatal and postnatal management of the patients included in this paper.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK

    A. Papadias & S. Sgouros

  2. Department of Neuroradiology, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK

    C. Miller

  3. Department of Fetal Medicine, Birmingham Women’s Hospital, Birmingham, B15 2TG, UK

    W. L. Martin & M. D. Kilby

Authors
  1. A. Papadias
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  2. C. Miller
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  3. W. L. Martin
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  4. M. D. Kilby
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  5. S. Sgouros
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Corresponding author

Correspondence to S. Sgouros.

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Papadias, A., Miller, C., Martin, W.L. et al. Comparison of prenatal and postnatal MRI findings in the evaluation of intrauterine CNS anomalies requiring postnatal neurosurgical treatment. Childs Nerv Syst 24, 185–192 (2008). https://doi.org/10.1007/s00381-007-0452-0

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  • DOI: https://doi.org/10.1007/s00381-007-0452-0

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