51
|
Use of Magnetic Resonance Imaging in Evaluating Fetal Brain and Abdomen Malformations during Pregnancy. ACTA ACUST UNITED AC 2019; 55:medicina55020055. [PMID: 30781564 PMCID: PMC6410250 DOI: 10.3390/medicina55020055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/06/2019] [Accepted: 02/11/2019] [Indexed: 01/07/2023]
Abstract
Magnetic resonance imaging (MRI) is used as a clarifying technique after a high-resolution ultrasound examination during pregnancy. Combining ultrasound with MRI, additional diagnostic information is obtained or ultrasound diagnosis is frequently corrected. High spatial resolution provides accurate radiological imaging of internal organs and widens possibilities for detecting perinatal development disorders. The safety of MRI and the use of intravenous contrast agent gadolinium are discussed in this article. There is no currently available evidence that MRI is harmful to the fetus, although not enough research has been carried out to prove enduring safety. MRI should be performed when the benefit outweighs the potential side effects. The narrative review includes several clinical cases of fetal MRI performed in Vilnius University Hospital Santaros Clinics.
Collapse
|
52
|
Salavati N, Smies M, Ganzevoort W, Charles AK, Erwich JJ, Plösch T, Gordijn SJ. The Possible Role of Placental Morphometry in the Detection of Fetal Growth Restriction. Front Physiol 2019; 9:1884. [PMID: 30670983 PMCID: PMC6331677 DOI: 10.3389/fphys.2018.01884] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/12/2018] [Indexed: 01/08/2023] Open
Abstract
Fetal growth restriction (FGR) is often the result of placental insufficiency and is characterized by insufficient transplacental transport of nutrients and oxygen. The main underlying entities of placental insufficiency, the pathophysiologic mechanism, can broadly be divided into impairments in blood flow and exchange capacity over the syncytiovascular membranes of the fetal placenta villi. Fetal growth restriction is not synonymous with small for gestational age and techniques to distinguish between both are needed. Placental insufficiency has significant associations with adverse pregnancy outcomes (perinatal mortality and morbidity). Even in apparently healthy survivors, altered fetal programming may lead to long-term neurodevelopmental and metabolic effects. Although the concept of fetal growth restriction is well appreciated in contemporary obstetrics, the appropriate detection of FGR remains an issue in clinical practice. Several approaches have aimed to improve detection, e.g., uniform definition of FGR, use of Doppler ultrasound profiles and use of growth trajectories by ultrasound fetal biometry. However, the role of placental morphometry (placental dimensions/shape and weight) deserves further exploration. This review article covers the clinical relevance of placental morphometry during pregnancy and at birth to help recognize fetuses who are growth restricted. The assessment has wide intra- and interindividual variability with various consequences. Previous studies have shown that a small placental surface area and low placental weight are associated with a slower growth of the fetus. Parameters such as placental surface area, placental volume and placental weight in relation to birth weight can help to identify FGR. In the future, a model including sophisticated antenatal placental morphometry may prove to be a clinically useful method for screening or diagnosing growth restricted fetuses, in order to provide optimal monitoring.
Collapse
Affiliation(s)
- Nastaran Salavati
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maddy Smies
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Jan Jaap Erwich
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanne J. Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
53
|
Jaimes C, Delgado J, Cunnane MB, Hedrick HL, Adzick NS, Gee MS, Victoria T. Does 3-T fetal MRI induce adverse acoustic effects in the neonate? A preliminary study comparing postnatal auditory test performance of fetuses scanned at 1.5 and 3 T. Pediatr Radiol 2019; 49:37-45. [PMID: 30298210 DOI: 10.1007/s00247-018-4261-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/25/2018] [Accepted: 09/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fetal MRI at 3 T is associated with increased acoustic noise relative to 1.5 T. OBJECTIVE The goal of this study is to determine if there is an increased prevalence of congenital hearing loss in neonates who had a 3-T prenatal MR vs. those who had it at 1.5 T. MATERIALS AND METHODS We retrospectively identified all subjects who had 3-T fetal MRI between 2012 and 2016 and also underwent universal neonatal hearing screening within 60 days of birth. Fetuses with incomplete hearing screening, magnetic resonance imaging (MRI) studies at both field strengths or fetuses affected by conditions associated with hearing loss were excluded. A random group of controls scanned at 1.5 T was identified. Five subjects had repeat same-strength MRIs (one at 3 T and four at 1.5 T). The pass/fail rate of the transient otoacoustic emissions test and auditory brainstem response test were compared using the Fisher exact test. A logistic regression was performed to assess the effects of other known risk factors for congenital hearing loss. RESULTS Three hundred forty fetal MRI examinations were performed at 3 T, of which 62 met inclusion criteria. A control population of 1.5-T fetal MRI patients was created using the same exclusion criteria, with 62 patients randomly selected from the eligible population. The fail rates of transient otoacoustic emissions test for the 1.5-T and 3-T groups were 9.7% and 6.5%, respectively, and for the auditory brainstem response test were 3.2% and 1.6%, respectively. There was no significant difference in the fail rate of either test between groups (P=0.74 for transient otoacoustic emissions test, and P=0.8 for auditory brainstem response test). The median gestational age of the 3-T group was 30 weeks, 1 day, significantly higher (P<0.001) than the 1.5-T group (median gestational age: 20 weeks, 2 days). CONCLUSION Our findings suggest that the increase in noise associated with 3 T does not increase the rate of clinically detectable hearing abnormalities.
Collapse
Affiliation(s)
- Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge Delgado
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Holly L Hedrick
- Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - N Scott Adzick
- Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Teresa Victoria
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| |
Collapse
|
54
|
Shi H, Quan X, Liang W, Li X, Ai B, Liu H. Evaluation of Placental Perfusion Based on Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Its Predictive Value for Late-Onset Fetal Growth Restriction. Geburtshilfe Frauenheilkd 2018; 79:396-401. [PMID: 31000885 PMCID: PMC6461467 DOI: 10.1055/a-0717-5275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 01/21/2023] Open
Abstract
Objective
The aim of this study was to investigate placental blood perfusion in middle and late pregnancy and explore its predictive value for fetal growth restriction (FGR).
Methods
All pregnant women included in the study were examined using placental intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). Three IVIM parameters (D, f, D*) were obtained for each pregnant woman and analyzed using Image J software. Perfusion fraction f is a radiological marker of placental perfusion. The pulsatility index (PI) of the uterine artery is used to indirectly evaluate placental function.
Results
f-values were significantly lower in the late-onset FGR group compared to the normal late pregnancy group (19.07 vs. 27.78%). In addition, uterine artery PI values were markedly increased in the late-onset FGR group compared to the normal late pregnancy group (1.96 vs. 1.03), and neonatal weight was significantly lower in the late-onset FGR group (2.75 vs. 3.18 kg). There was a significant positive correlation between f-value, uterine artery PI and neonatal weight (r = 0.968, p < 0.01; r = 0.959, p < 0.01). There was a significant negative correlation between f-value and age of gestation (r = − 0.534, p < 0.01).
Conclusion
Perfusion fraction f was strongly correlated with uterine artery blood flow resistance as measured by color Doppler and had a certain predictive value for late-onset FGR.
Collapse
Affiliation(s)
- Hui Shi
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xianyue Quan
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Liang
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xinming Li
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Ai
- Department of Medical Image, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Hongsheng Liu
- Department of Medical Image, Guangzhou Women and Children's Medical Center, Guangzhou, China
| |
Collapse
|
55
|
Chapman T, Alazraki AL, Eklund MJ. A survey of pediatric diagnostic radiologists in North America: current practices in fetal magnetic resonance imaging. Pediatr Radiol 2018; 48:1924-1935. [PMID: 30178081 DOI: 10.1007/s00247-018-4236-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/30/2018] [Accepted: 08/10/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) is an imaging examination in evolution. Rapid developments over recent decades have led to better image quality, an increased number of examinations and greater impact on patient care. OBJECTIVE To gather data regarding current practices among established programs in North America and provide information to radiologists interested in implementing or growing a fetal MRI service. MATERIALS AND METHODS An electronic survey containing 15 questions relevant to the use of fetal MRI was submitted to pediatric radiologists and neuroradiologists. Items regarded scheduling and reporting logistics, magnet strength, patient positioning and patient preparation. Answers and comments were collected, and descriptive statistics were summarized. RESULTS One hundred and six survey responses were evaluated. Of the survey responses, 62/106 (58.5%) allow fetal MR scheduling any time during the day and 72/105 (68.6%) exclusively use 1.5-T strength platforms for fetal MRI, while only 7/105 (6.7%) use exclusively 3 T. Patient positioning is variable: supine, 40/106 (37.8%); left lateral decubitus, 22/106 (20.8%), and, patient's choice, 43/106 (40.6%). Of the centers responding, 51/104 (49.0%) require no particular fasting instructions, while 20/104 (19.2%) request the patient avoid caffeine before the scanning. CONCLUSION Logistical trends in performing fetal MRI may supplement the American College of Radiology's published technical standards and offer guidance to radiologists new to the field.
Collapse
Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, Mail Stop MA.07.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Adina L Alazraki
- Department of Radiology and Imaging Sciences,Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
56
|
van der Knoop BJ, Vermeulen RJ, Verbeke JIML, Pistorius LR, de Vries JIP. Fetal MRI, lower acceptance by women in research vs. clinical setting. J Perinat Med 2018; 46:983-990. [PMID: 29031020 DOI: 10.1515/jpm-2016-0360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/31/2017] [Indexed: 12/28/2022]
Abstract
AIM To determine acceptance of pregnant women to undergo fetal magnetic resonance imaging (MRI) examination in research and clinical setting. METHODS A prospective study included a research group [part of a study comparing brain ultrasound (US) to MRI in fetuses at risk for acquired brain damage] and a clinical group [fetuses with suspected (brain) anomalies after structural US examination] from 2011 to 2014. All women were advised to use sedatives. MRI declinations, use of sedation, MRI duration and imaging quality were compared between both groups. RESULTS Study participation was accepted in 57/104 (55%) research cases. Fetal MRI was performed in 34/104 (33%) research and 43/44 (98%) clinical cases. Reasons to decline study participation were MRI related in 41%, and participation was too burdensome in 46%. Acceptance was highest for indication infection and lowest in alloimmune thrombocytopenia and monochorionic twin pregnancy. Sedatives were used in 14/34 research and 43/43 clinical cases. Scan duration and quality were comparable (21 and 20 min in research and clinical cases, respectively, moderate/good quality in both groups). CONCLUSIONS Pregnant women consider MRI more burdensome than professionals realize. Two-third of women at risk for fetal brain damage decline MRI examination. Future studies should evaluate which information about fetal MRI is supportive.
Collapse
Affiliation(s)
- Bloeme J van der Knoop
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands, Tel.: +31 (0) 20 4443239 or +31 (0) 20 4444444, pager 6112, Fax: +31 (0) 20 4443333.,Neuroscience Campus, VU University, Amsterdam, The Netherlands
| | - Roland J Vermeulen
- Department of Child Neurology, VU University Medical Center, P.O. Box 7057,1007 MB Amsterdam, TheNetherlands
| | - Jonathan I M L Verbeke
- Department of Pediatric Radiology, VU University Medical Center, P.O. Box 7057,1007 MB Amsterdam, TheNetherlands
| | - Lourens R Pistorius
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, TheNetherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057,1007 MB Amsterdam, TheNetherlands.,Research Institute MOVE, VU University, Amsterdam, TheNetherlands
| |
Collapse
|
57
|
Paula Pinho Matos A, Teixeira Castro P, de Barros Duarte L, Dutra Moraes Barbosa A, Daltro P, Fazecas T, Nogueira R, Werner H, Araujo Júnior E. Prenatal diagnosis of cervical masses by magnetic resonance imaging and 3D virtual models: perinatal and long-term follow-up outcomes. J Matern Fetal Neonatal Med 2018; 33:2181-2189. [PMID: 30458651 DOI: 10.1080/14767058.2018.1543393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: To assess perinatal and long-term follow-up outcomes of fetal cervical masses diagnosed by three-dimensional (3D) magnetic resonance imaging (MRI) and 3D virtual models.Methods: This retrospective cohort study evaluated 15 pregnant women (age, 21-38 years) at 29-40 weeks of singleton gestation, whose fetuses exhibited congenital oral and cervical masses. These women were referred to our facility because of suspected fetal malformations on routine obstetric ultrasound, and the cases were confirmed, excluded, or complemented by MRI. Demographic data and perinatal and long-term follow-up outcomes were assessed.Results: Cervical masses were predominant in females (3:2), and the most frequent diagnosis was lymphatic-venous malformation (71%). The masses were cystic in 53.3% of the cases and solid in 46.7%. The esophagus and trachea were displaced in 46.6% of the cases. Associated malformations were diagnosed in 13.3% of the cases. There was complete agreement between prenatal MRI and postnatal diagnoses. Among the newborns, 40% had complications and 46.6% were admitted to the neonatal intensive care unit. Two infants died from complications due to epignathus. Surgical resection was performed in 33.3% of the cases, including complete resection in 26.6%. Sclerotherapy was administered to 53.3% of the cases, with complete remission achieved in 50% of these cases.Conclusion: Cervical masses diagnosed in the prenatal period had good postnatal outcomes except for cases of epignathus, which were associated with high mortality. MRI demonstrated the relationship between cervical masses and adjacent organs and allowed 3D virtual reconstruction of the airways. There was complete agreement between the prenatal diagnosis of cervical masses on MRI and postnatal diagnosis. Surgical treatment was effective in most cases, and sclerotherapy was satisfactory in cases with intrathoracic components.
Collapse
Affiliation(s)
- Ana Paula Pinho Matos
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil.,Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Brazil
| | - Pedro Teixeira Castro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil
| | | | | | - Pedro Daltro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil
| | - Tatiana Fazecas
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil
| | - Renata Nogueira
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| |
Collapse
|
58
|
Barzilai M, Avivi I, Amit O. Hematological malignancies during pregnancy. Mol Clin Oncol 2018; 10:3-9. [PMID: 30655971 DOI: 10.3892/mco.2018.1759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 06/26/2018] [Indexed: 12/27/2022] Open
Abstract
Hematological malignancy during pregnancy is a rare event, therefore most data on this issue is based on case studies, retrospective studies and expert opinion. The purpose of the present narrative review was to provide an overview of the diagnosis and recommended management of the most common hematological malignancies during pregnancy, based on current literature, with clinical cases, and discussion of the diagnostic and therapeutic options. The therapeutic consensus while coping with hematological malignancies in pregnancy is to salvage the mother, while trying to preserve pregnancy and avoid treatment-related-toxicity to the fetus. In most scenarios, particularly during late trimesters, the goal is to administer the same treatment as outside of pregnancy, if possible. Further research is needed for better evidence-based management.
Collapse
Affiliation(s)
- Merav Barzilai
- Hematology and Hemato-Oncology Division, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Irit Avivi
- Hematology and Hemato-Oncology Division, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Odelia Amit
- Hematology and Hemato-Oncology Division, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| |
Collapse
|
59
|
Hwuang E, Vidorreta M, Schwartz N, Moon BF, Kochar K, Tisdall MD, Detre JA, Witschey WRT. Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound. J Magn Reson Imaging 2018; 49:59-68. [PMID: 30390347 DOI: 10.1002/jmri.26229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine artery (UtA) hemodynamics might be used to predict risk of hypertensive pregnancy disorders, including preeclampsia and intrauterine growth restriction. PURPOSE OR HYPOTHESIS To determine the feasibility of 4D flow MRI in pregnant subjects by characterizing UtA anatomy, computing UtA flow, and comparing UtA velocity, and pulsatility and resistivity indices (PI, RI) with transabdominal Doppler ultrasound (US). STUDY TYPE Prospective cross-sectional study from June 6, 2016, to May 2, 2018. POPULATION OR SUBJECTS OR PHANTOM OR SPECIMEN OR ANIMAL MODEL Forty-one singleton pregnant subjects (age [range] = 27.0 ± 5.9 [18-41] years) in their second or third trimester. We additionally scanned three subjects who had prepregnancy diabetes or chronic hypertension. FIELD STRENGTH/SEQUENCE The subjects underwent UtA and placenta MRI using noncontrast angiography and 4D flow at 1.5T. ASSESSMENT UtA anatomy was described based on 4D flow-derived noncontrast angiography, while UtA flow properties were characterized by net flow, systolic/mean/diastolic velocity, PI and RI through examination of 4D flow data. PI and RI are standard hemodynamic parameters routinely reported on Doppler US. STATISTICAL TESTS Spearman's rank correlation, Wilcoxon signed rank tests, and Bland-Altman plots were used to preliminarily investigate the relationships between flow parameters, gestational age, and Doppler US. or RESULTS: 4D flow MRI and UtA flow quantification was feasible in all subjects. There was considerable heterogeneity in UtA geometry in each subject between left and right UtAs and between subjects. Mean 4D flow-based parameters were: mean bilateral flow rate = 605.6 ± 220.5 mL/min, PI = 0.72 ± 0.2, and RI = 0.47 ± 0.1. Bilateral flow did not change with gestational age. We found that MRI differed from US in terms of lower PI (mean difference -0.1) and RI (mean difference < -0.1) with Wilcoxon signed rank test P = 0.05 and P = 0.13, respectively. DATA CONCLUSION 4D flow MRI is a feasible approach for describing UtA anatomy and flow in pregnant subjects. LEVEL OF EVIDENCE Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:59-68.
Collapse
Affiliation(s)
- Eileen Hwuang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marta Vidorreta
- Siemens Healthineers, Tarrytown, New York, USA.,Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadav Schwartz
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirpal Kochar
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew Dylan Tisdall
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter R T Witschey
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
60
|
Abstract
Pediatric patients present emergently with a wide variety of infectious, inflammatory, congenital, traumatic, and neoplastic conditions. Imaging plays a crucial role in distinguishing among the potential diagnoses, as often, history and physical exam is limited in these young sick patients. Understanding the imaging appearance of the range of conditions which are commonly encountered and their potential complications, facilitates appropriate and expedient management. The radiologist must recognize the benefits of the various imaging modalities available and help the clinician choose among the possibilities depending on the clinical status of the patient.
Collapse
Affiliation(s)
- Jennifer Vaughn
- Boston Children's Hospital, Department of Radiology, Boston, MA.
| |
Collapse
|
61
|
Othman AIA, Ibrahim MEA, Mansour DY. Diagnostic accuracy of MRI criteria in predilection of morbidly adherent placenta. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
62
|
Jeremic K, Stefanovic A, Dotlic J, Kadija S, Kontic O, Gojnic M, Jeremic J, Kesic V. Cancer during pregnancy - clinical characteristics, treatment outcomes and prognosis for mothers and infants. J Perinat Med 2018; 46:35-45. [PMID: 28222037 DOI: 10.1515/jpm-2016-0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess which obstetrical characteristics and treatment improved outcomes and prognosis of pregnant women with malignancy. METHODS A prospective study, undertaken between 2005 and 2014, involving 35 pregnant women who were diagnosed with malignant tumors during pregnancy. Patients were followed-up for 1 year after delivery. The pregnancy course and outcome and parameters that could influence the condition of mother and fetus were evaluated. RESULTS Most malignancies were hematological, diagnosed in the second trimester and treated with combined therapy (surgery/adjuvant) after pregnancy. Most fetuses were in good state throughout pregnancy, but were delivered by caesarean section (CS) before term. Adjuvant therapy during pregnancy mostly caused transitory deterioration of fetal conditions. The majority of both mothers and infants were in a good state 12 months postpartum, although numerous mothers were still ill and on therapy. Surviving pregnancy and preventing tumors progression during pregnancy were the best predictors of mothers' future condition (P=0.022). High birthweight and term delivery were the most important factors for good outcome of the infants (P=0.001). CONCLUSIONS If the tumor is not progressing, pregnancy should be continued as long as possible to obtain adequate birthweight of the infant. Second trimester surgery is safe, while other therapies should preferably be applied after delivery.
Collapse
Affiliation(s)
- Katarina Jeremic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Aleksandar Stefanovic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Sasa Kadija
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Olivera Kontic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Miroslava Gojnic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Jelena Jeremic
- Clinic for Plastic and Reconstructive Surgery, Clinical Center of Serbia, Zvecanska 9, Belgrade, Serbia
| | - Vesna Kesic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| |
Collapse
|
63
|
Improving women's health in low-income and middle-income countries. Part II: the needs of diagnostic imaging. Nucl Med Commun 2018; 38:1024-1028. [PMID: 28953209 PMCID: PMC5704652 DOI: 10.1097/mnm.0000000000000752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
64
|
Whole-Body Magnetic Resonance Imaging in the Oncology Setting: An Overview and Update on Recent Advances. J Comput Assist Tomogr 2018; 43:66-75. [PMID: 30015799 DOI: 10.1097/rct.0000000000000772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Whole-body magnetic resonance imaging is becoming an important tool in oncology as a nonirradiating imaging technique since recent technological advances allowed the incorporation of high-quality imaging in an adequate time. Moreover, the noninjection of radioisotope/intravenous contrast, low cost compared with traditional nuclear medicine techniques, and fast acquisition times are another distinct feature. Thus, the purpose of this article is to review the whole-body magnetic resonance imaging protocol and its main applications in the oncology setting.
Collapse
|
65
|
Wu C, Bayer CL. Imaging placental function: current technology, clinical needs, and emerging modalities. ACTA ACUST UNITED AC 2018; 63:14TR01. [DOI: 10.1088/1361-6560/aaccd9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
66
|
Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
Collapse
Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
| |
Collapse
|
67
|
Lotfipour S, Jason M, Liu VJ, Helmy M, Hoonpongsimanont W, McCoy CE, Chakravarthy B. Latest Considerations in Diagnosis and Treatment of Appendicitis During Pregnancy. Clin Pract Cases Emerg Med 2018; 2:112-115. [PMID: 29849258 PMCID: PMC5965106 DOI: 10.5811/cpcem.2018.1.36218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 08/26/2017] [Accepted: 01/19/2018] [Indexed: 12/29/2022] Open
Abstract
Pregnancy can obscure signs and symptoms of acute appendicitis, making diagnosis challenging. Furthermore, avoiding radiation-based imaging due to fetal risk limits the diagnostic options clinicians have. Once appendicitis has been diagnosed, performing appendectomies has been the more commonly accepted course of action, but conservative, nonsurgical approaches are now being considered. This report describes the latest recommendations from different fields and organizations for the diagnosis and treatment of appendicitis during pregnancy.
Collapse
Affiliation(s)
- Shahram Lotfipour
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Max Jason
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Vincent J Liu
- Taipei Medical University, College of Medicine, Taipei, Taiwan
| | - Mohammad Helmy
- University of California, Irvine, Department of Radiological Sciences, Orange, California
| | | | - C Eric McCoy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Bharath Chakravarthy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| |
Collapse
|
68
|
Shrot S, Johnson CT, Golden WC, Baschat AA, Bullard JE, Tekes A, Poretti A, Dunn E, Huisman TA. Persistent Extreme Hyperextension of the Fetal Neck: Clinical and Neuroimaging Findings. J Neuroimaging 2018; 28:278-282. [DOI: 10.1111/jon.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shai Shrot
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of Diagnostic ImagingSheba Medical Center Ramat‐Gan Israel
| | - Clark T. Johnson
- Department of Gynecology & ObstetricsJohns Hopkins University School of Medicine Baltimore MD
| | - W. Christopher Golden
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Ahmet A. Baschat
- Center for Fetal TherapyDepartment of ObstetricsGynecology, and Reproductive SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Janine E. Bullard
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Aylin Tekes
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Andrea Poretti
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of NeurogeneticsKennedy Krieger Institute Baltimore MD
| | - Emily Dunn
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Thierry A.G.M. Huisman
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| |
Collapse
|
69
|
Aarabi M, Sniezek O, Jiang H, Saller DN, Bellissimo D, Yatsenko SA, Rajkovic A. Importance of complete phenotyping in prenatal whole exome sequencing. Hum Genet 2018; 137:175-181. [PMID: 29392406 DOI: 10.1007/s00439-017-1860-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/16/2017] [Indexed: 12/16/2022]
Abstract
Whole exome sequencing (WES) is an emerging technique in prenatal diagnosis. In this retrospective study, we examined diagnostic utility and limitations of WES in prenatal cases with structural birth defects. DNA from 20 trios (fetal and parental), with normal karyotype and microarray findings, underwent WES and variant interpretation at a reference laboratory. The WES results were later re-evaluated in our academic center utilizing prenatal and postnatal phenotyping. Initial analysis using only prenatal ultrasound findings revealed no pathogenic or likely pathogenic variants in 20 pregnancies with structural birth defects. Re-analysis of WES variants and combination of prenatal and postnatal phenotyping yielded pathogenic variants in at least 20% of cases including PORCN gene in a fetus with split-hand/foot malformation, as well as variants of uncertain significance in NEB and NOTCH1 in fetuses with postnatal muscle weakness and Adams-Oliver syndrome, respectively. Furthermore, Sanger sequencing in a patient with holoprosencephaly, elucidated by postnatal MRI, revealed a pathogenic 47-base pairs deletion in ZIC2 which was missed by prenatal WES. This study suggests that incomplete prenatal phenotyping and lack of prenatal ultrasound-genotype databases are the limiting factors for current interpretation of WES data in prenatal diagnosis. Development of prenatal phenotype-genotype databases would significantly help WES interpretation in this setting. Patients who underwent prenatal clinical WES may benefit from the re-analysis based on detailed postnatal findings.
Collapse
Affiliation(s)
- Mahmoud Aarabi
- Medical Genetics and Genomics Laboratories, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Olivia Sniezek
- Westminster College, New Wilmington, PA, USA.,Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Huaiyang Jiang
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Devereux N Saller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel Bellissimo
- Medical Genetics and Genomics Laboratories, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Svetlana A Yatsenko
- Medical Genetics and Genomics Laboratories, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aleksandar Rajkovic
- Medical Genetics and Genomics Laboratories, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA. .,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
70
|
Liu TJ, Shen F, Zhang C, Huang PT, Zhu YJ. Real-time ultrasound-MRI fusion image virtual navigation for locating intraspinal tumour in a pregnant woman. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:436-439. [PMID: 29380148 DOI: 10.1007/s00586-017-5442-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard fluoroscopic guidance (C-arm fluoroscopy) has been routinely used for intraoperative localization of spinal level for surgical removal of intraspinal tumour, while it is not suitable for selected patients, e.g. pregnant women, who need to avoid radiation exposure. Fusion imaging of real-time ultrasound (US) and magnetic resonance imaging (MRI) is a radiation-free technique which has been reported to have good localization accuracy in managing several conditions. CLINICAL PRESENTATION A 37-year-old pregnant patient, presented with a progressively aggravating lower back pain for 20 days and was incapable of lying supine with lower extremities swelling for 1 week, was referred to our hospital in her 18th week of gestation. Lumbar MRI identified an L1 level intraspinal lesion, and surgery was planned. To avoid the ionizing radiation generated by fluoroscopy, volume navigation technique (VNT) based fusion imaging of US and MRI was used to localize the intraspinal lesion, which was removed entirely via minimally invasive interlaminar approach. Pathological examination confirmed the diagnosis of ependymoma of the conus medullaris. Her symptoms were largely relieved after the operation, and a healthy baby was delivered at the 40th week of pregnancy. CONCLUSION We presented the first case of using VNT based fusion imaging of real-time US/MRI to guide the surgical resection of an intraspinal tumour. Future study with larger patient number is needed to validate this technique as an alternative to fluoroscopy in patients who need to avoid radiation exposure.
Collapse
Affiliation(s)
- Tian-Jian Liu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Fang Shen
- Department of Orthopaedic Surgery's Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Chao Zhang
- Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pin-Tong Huang
- Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China.
| |
Collapse
|
71
|
Jakab A, Tuura RL, Kottke R, Ochsenbein-Kölble N, Natalucci G, Nguyen TD, Kellenberger C, Scheer I. Microvascular perfusion of the placenta, developing fetal liver, and lungs assessed with intravoxel incoherent motion imaging. J Magn Reson Imaging 2017; 48:214-225. [PMID: 29281153 DOI: 10.1002/jmri.25933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In utero intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) provides a novel method for examining microvascular perfusion fraction and diffusion in the developing human fetus. PURPOSE To characterize gestational changes in the microvascular perfusion fraction of the placenta, fetal liver, and lungs using IVIM-MRI. STUDY TYPE Retrospective, cross-sectional study. SUBJECTS Fifty-five datasets from 33 singleton pregnancies were acquired (17-36 gestational weeks). FIELD STRENGTH/SEQUENCE In utero diffusion-weighted echo-planar imaging at 1.5T and 3.0T with b-factors ranging from 0 to 900 s/mm2 in 16 steps. ASSESSMENT Using the IVIM principle, microvascular perfusion fraction (f), pseudodiffusion (D*), and diffusion coefficients (d) were estimated for the placenta, liver, and lungs with a biexponential model. A free-form nonlinear deformation algorithm was used to correct for the frame-by-frame motion of the fetal organs and the placenta. The IVIM parameters were then compared to a Doppler ultrasound-based assessment of the umbilical artery resistance index. STATISTICAL TESTS Pearson product-moment correlation coefficient (PMCC) to reveal outlier corrected correlations between Doppler and IVIM parameters. Gestational age-related changes were assessed using linear regression analysis (LR). RESULTS Placental f (0.29 ± 0.08) indicates high blood volume in the microvascular compartment, moderately increased during gestation (LR, R = 0.338), and correlated negatively with the umbilical artery resistance index (PMCC, R = -0.457). The f of the liver decreased sharply during gestation (LR, R = -0.436). Lung maturation was characterized by increasing perfusion fraction (LR, R = 0.547), and we found no gestational changes in d and D* values (LR, R = -0.013 and R = 0.051, respectively). The Doppler measurements of the umbilical artery and middle cerebral artery did not correlate with the IVIM parameters of the lungs and liver. DATA CONCLUSION Gestational age-associated changes of the placental, liver, and lung IVIM parameters likely reflect changes in placental and fetal circulation, and characterize the trajectory of microstructural and functional maturation of the fetal vasculature. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017.
Collapse
Affiliation(s)
- András Jakab
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland.,Computational Imaging Research Lab (CIR), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Ruth L Tuura
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
| | | | - Giancarlo Natalucci
- Department of Neonatology, University Hospital and University of Zurich, Switzerland
| | - Thi Dao Nguyen
- Department of Neonatology, University Hospital and University of Zurich, Switzerland
| | | | - Ianina Scheer
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
| |
Collapse
|
72
|
Moshe Y, Bentur OS, Lishner M, Avivi I. The management of hodgkin lymphomas in pregnancies. Eur J Haematol 2017; 99:385-391. [DOI: 10.1111/ejh.12956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Yakir Moshe
- Department of Hematology and Bone Marrow Transplantation; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Ohad Shimshon Bentur
- Department of Hematology and Bone Marrow Transplantation; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Michael Lishner
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Medicine A; Meir Medical Center; Kfar Saba Israel
| | - Irit Avivi
- Department of Hematology and Bone Marrow Transplantation; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
73
|
Peccatori FA, Codacci-Pisanelli G, Del Grande M, Scarfone G, Zugni F, Petralia G. Whole body MRI for systemic staging of breast cancer in pregnant women. Breast 2017; 35:177-181. [PMID: 28756339 DOI: 10.1016/j.breast.2017.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/16/2022] Open
Abstract
When breast cancer is diagnosed during pregnancy, treatment should be as close; as possible to what is used in non-pregnant patients. This requires accurate local and systemic staging: ultrasound (US) is used for local staging and allows adequate evaluation of the liver and pelvis, but chest and bones cannot be explored and imaging techniques involving exposure to ionizing radiation would be needed. However, since imaging techniques involving ionizing radiation and the use of radionuclides should be limited, whole body magnetic resonance imaging (WB-MRI) without administration of contrast agent represents a very interesting alternative, but limited data is available. In this paper we describe the obstetrical and oncological outcome of 14 patients in whom breast cancer was diagnosed during the second or third trimester of pregnancy and that were staged using WB-MRI. Median age of the patient at diagnosis was 35 years (range 20-36), median gestational age at MRI was 30 weeks (range 13-32) and median age at delivery was 38 weeks (range 32-38). At birth, one new-born presented respiratory distress syndrome and one jaundice. We conclude that diffusion-weighted MRI is feasible accurate and safe for the mother and for the foetus. It may represent the staging technique of choice in pregnant women diagnosed with breast cancer after the first trimester of pregnancy.
Collapse
Affiliation(s)
- Fedro A Peccatori
- Fertility and Procreation Unit, Department of Gynaecological Oncology, European Institute of Oncology (IEO), Milan, Italy
| | | | - Maria Del Grande
- Fertility and Procreation Unit, Department of Gynaecological Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Giovanna Scarfone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Zugni
- Post-graduation School in Radiodiagnostics, University of Milan, Italy
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology (IEO), Milan, Italy
| |
Collapse
|
74
|
Lester RM, Johnson K, Khalil RE, Khan R, Gorgey AS. MRI analysis and clinical significance of lower extremity muscle cross-sectional area after spinal cord injury. Neural Regen Res 2017; 12:714-722. [PMID: 28616021 PMCID: PMC5461602 DOI: 10.4103/1673-5374.206634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 12/11/2022] Open
Abstract
Shortly after spinal cord injury (SCI), the musculoskeletal system undergoes detrimental changes in size and composition, predominantly below the level of injury. The loss of muscle size and strength, along with increased immobility, predisposes persons with SCI to rapid and severe loss in bone mineral density and other health related consequences. Previous studies have highlighted the significance of measuring thigh muscle cross-sectional area, however, measuring the size and composition of muscles of the lower leg may provide insights on how to decrease the risk of various comorbidities. The purpose of the current review was to summarize the methodological approach to manually trace and measure the muscles of the lower leg in individuals with SCI, using magnetic resonance imaging. We also intend to highlight the significance of analyzing lower leg muscle cross-sectional area and its relationship to musculoskeletal and vascular systems in persons with SCI.
Collapse
Affiliation(s)
- Robert M. Lester
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Administration Medical Center (VAMC), Richmond, VA, USA
| | - Kori Johnson
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Administration Medical Center (VAMC), Richmond, VA, USA
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Administration Medical Center (VAMC), Richmond, VA, USA
| | - Rehan Khan
- Radiology Service, Hunter Holmes McGuire Veterans Administration Medical Center (VAMC), Richmond, VA, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Administration Medical Center (VAMC), Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
75
|
Fraum TJ, Ludwig DR, Bashir MR, Fowler KJ. Gadolinium-based contrast agents: A comprehensive risk assessment. J Magn Reson Imaging 2017; 46:338-353. [PMID: 28083913 DOI: 10.1002/jmri.25625] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have been used in magnetic resonance imaging (MRI) since the 1980s and are now administered in up to 35% of all MRI examinations. While GBCAs were initially felt to carry minimal risk, the subsequent identification of GBCAs as the key etiologic factor in the development of nephrogenic systemic fibrosis (NSF) has raised concerns about the broader health impacts of gadolinium exposure. Clinicians, radiologists, and patients should be aware of the most up-to-date data pertaining to the risks of GBCA administration. Specific issues covered in this review article include immediate adverse reactions; pregnancy and lactation; and gadolinium deposition and toxicity, with a special focus on NSF. Practice recommendations based on the presented data, as well as current professional society guidelines, are provided for each section. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:338-353.
Collapse
Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| |
Collapse
|
76
|
Gentillon H, Stefańczyk L, Strzelecki M, Respondek-Liberska M. Texture analysis of the developing human brain using customization of a knowledge-based system. F1000Res 2017. [DOI: 10.12688/f1000research.10401.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pattern recognition software originally designed for geospatial and other technical applications could be trained by physicians and used as texture-analysis tools for evidence-based practice, in order to improve diagnostic imaging examination during pregnancy.Methods: Various machine-learning techniques and customized datasets were assessed for training of an integrable knowledge-based system (KBS), to determine a hypothetical methodology for texture classification of closely-related anatomical structures in fetal brain magnetic resonance (MR) images. Samples were manually categorized according to the magnetic field of the MRI scanner (i.e. 1.5-tesla (1.5T), 3-tesla (3T)), rotational planes (i.e. coronal, sagittal and axial), and signal weighting (i.e. spin-lattice, spin-spin, relaxation, proton density). In the machine-learning sessions, the operator manually selected relevant regions of interest (ROI) in 1.5/3T MR images. Semi-automatic procedures in MaZda/B11 were performed to determine optimal parameter sets for ROI classification. Four classes were defined: ventricles, thalamus, grey matter, and white matter. Various textures analysis methods were tested. The KBS performed automatic data pre-processing and semi-automatic classification of ROIs.Results: After testing 3456 ROIs, statistical binary classification revealed that combination of reduction techniques with linear discriminant algorithms (LDA) or nonlinear discriminant algorithms (NDA) yielded the best scoring in terms of sensitivity (both 100%, 95% CI: 99.79-100), specificity (both 100%, 95% CI: 99.79-100) and Fisher coefficient (≈E+4, ≈E+5, respectively). Conclusions: LDA and NDA in MaZda can be useful data mining tools for screening a population of interest subjected to a clinical test.
Collapse
|
77
|
Weisstanner C, Gruber GM, Brugger PC, Mitter C, Diogo MC, Kasprian G, Prayer D. Fetal MRI at 3T-ready for routine use? Br J Radiol 2017; 90:20160362. [PMID: 27768394 PMCID: PMC5605013 DOI: 10.1259/bjr.20160362] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fetal MR now plays an important role in the clinical work-up of pregnant females. It is performed mainly at 1.5 T. However, the desire to obtain a more precise fetal depiction or the fact that some institutions have access only to a 3.0 T scanner has resulted in a growing interest in performing fetal MR at 3.0 T. The aim of this article was to provide a reference for the use of 3.0 T MRI as a prenatal diagnostic method.
Collapse
Affiliation(s)
- Christian Weisstanner
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
- 2 Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Gerlinde M Gruber
- 3 Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Peter C Brugger
- 3 Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Christan Mitter
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Mariana C Diogo
- 4 Neuroradiology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gregor Kasprian
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
78
|
Gentillon H, Stefańczyk L, Strzelecki M, Respondek-Liberska M. Parameter set for computer-assisted texture analysis of fetal brain. BMC Res Notes 2016; 9:496. [PMID: 27887658 PMCID: PMC5124296 DOI: 10.1186/s13104-016-2300-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Magnetic resonance data were collected from a diverse population of gravid women to objectively compare the quality of 1.5-tesla (1.5 T) versus 3-T magnetic resonance imaging of the developing human brain. MaZda and B11 computational-visual cognition tools were used to process 2D images. We proposed a wavelet-based parameter and two novel histogram-based parameters for Fisher texture analysis in three-dimensional space. RESULTS Wavenhl, focus index, and dispersion index revealed better quality for 3 T. Though both 1.5 and 3 T images were 16-bit DICOM encoded, nearly 16 and 12 usable bits were measured in 3 and 1.5 T images, respectively. The four-bit padding observed in 1.5 T K-space encoding mimics noise by adding illusionistic details, which are not really part of the image. In contrast, zero-bit padding in 3 T provides space for storing more details and increases the likelihood of noise but as well as edges, which in turn are very crucial for differentiation of closely related anatomical structures. CONCLUSIONS Both encoding modes are possible with both units, but higher 3 T resolution is the main difference. It contributes to higher perceived and available dynamic range. Apart from surprisingly larger Fisher coefficient, no significant difference was observed when testing was conducted with down-converted 8-bit BMP images.
Collapse
Affiliation(s)
- Hugues Gentillon
- Department of Radiology and Diagnostic Imaging, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
- Institute of Electronics, The Faculty of Electrical, Electronic, Computer and Control Engineering, Technical University of Lodz, Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Michał Strzelecki
- Institute of Electronics, The Faculty of Electrical, Electronic, Computer and Control Engineering, Technical University of Lodz, Lodz, Poland
| | - Maria Respondek-Liberska
- Diagnosis and Prevention of Congenital Malformations, Instytut Centrum Zdrowia Matki Polki, Lodz, Poland
| |
Collapse
|
79
|
Odelia A, Erel J, Chava P, Yair H, Nadav S, Michael L, Irit A. Continuing dilemmas in the management of lymphoma during pregnancy: review of a 10-point case-based questionnaire. Int J Clin Oncol 2016; 22:190-199. [DOI: 10.1007/s10147-016-1036-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/27/2016] [Indexed: 01/18/2023]
|
80
|
Paydas S. Management of hemopoietic neoplasias during pregnancy. Crit Rev Oncol Hematol 2016; 104:52-64. [DOI: 10.1016/j.critrevonc.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/12/2016] [Accepted: 05/10/2016] [Indexed: 11/30/2022] Open
|
81
|
Abstract
The diagnosis and management of hematologic malignancy during pregnancy is a significant challenge. This is due to both medical and ethical considerations regarding when and how to treat this special sub-group of patients. Recurring uncertainties remain around appropriate imaging techniques, timing and dosage of chemotherapy, and timing of delivery. In this article we examine and summarize current literature in this field to assist physicians in their understanding and management of this patient group. Special attention has been given to diagnostic and staging procedures, risks associated with chemotherapy at different stages of gestation, and chemotherapy-dose adaption during pregnancy. In addition, recommended guidelines for management of lymphoma, leukemia, and planning delivery are discussed. A multidisciplinary team approach is critical for patient care, as is shared decision making with the patient and family.
Collapse
|
82
|
Tsai LL, Grant AK, Mortele KJ, Kung JW, Smith MP. A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Radiographics 2016; 35:1722-37. [PMID: 26466181 DOI: 10.1148/rg.2015150108] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Magnetic resonance (MR) imaging can provide critical diagnostic and anatomic information while avoiding the use of ionizing radiation, but it has a unique set of safety risks associated with its reliance on large static and changing magnetic fields, high-powered radiofrequency coil systems, and exogenous contrast agents. It is crucial for radiologists to understand these risks and how to mitigate them to protect themselves, their colleagues, and their patients from avoidable harm and to comply with safety regulations at MR imaging sites. Basic knowledge of MR imaging physics and hardware is necessary for radiologists to understand the origin of safety regulations and to avoid common misconceptions that could compromise safety. Each of the components of the MR imaging unit can be a factor in injuries to patients and personnel. Safety risks include translational force and torque, projectile injury, excessive specific absorption rate, burns, peripheral neurostimulation, interactions with active implants and devices, and acoustic injury. Standards for MR imaging device safety terminology were first issued in 2005 and are required by the U.S. Food and Drug Administration, with devices labeled as "MR safe," "MR unsafe," or "MR conditional." MR imaging contrast agent safety is also discussed. Additional technical and safety policies relate to pediatric, unconscious, incapacitated, or pregnant patients and pregnant imaging personnel. Division of the MR imaging environment into four distinct, clearly labeled zones--with progressive restriction of entry and increased supervision for higher zones--is a mandatory and key aspect in avoidance of MR imaging-related accidents. All MR imaging facilities should have a documented plan to handle emergencies within zone IV, including cardiac arrest or code, magnet quench, and fires. Policies from the authors' own practice are provided for additional reference. Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Leo L Tsai
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Aaron K Grant
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Koenraad J Mortele
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Justin W Kung
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Martin P Smith
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| |
Collapse
|
83
|
Wataganara T, Ebrashy A, Aliyu LD, Moreira de Sa RA, Pooh R, Kurjak A, Sen C, Adra A, Stanojevic M. Fetal magnetic resonance imaging and ultrasound. J Perinat Med 2016; 44:533-42. [PMID: 27092644 DOI: 10.1515/jpm-2015-0226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has been increasingly adopted in obstetrics practice in the past three decades. MRI aids prenatal ultrasound and improves diagnostic accuracy for selected maternal and fetal conditions. However, it should be considered only when high-quality ultrasound cannot provide certain information that affects the counseling, prenatal intervention, pregnancy course, and delivery plan. Major indications of fetal MRI include, but are not restricted to, morbidly adherent placenta, selected cases of fetal brain anomalies, thoracic lesions (especially in severe congenital diaphragmatic hernia), and soft tissue tumors at head and neck regions of the fetus. For fetal anatomy assessment, a 1.5-Tesla machine with a fast T2-weighted single-shot technique is recommended for image requisition of common fetal abnormalities. Individual judgment needs to be applied when considering usage of a 3-Tesla machine. Gadolinium MRI contrast is not recommended during pregnancy. MRI should be avoided in the first half of pregnancy due to small fetal structures and motion artifacts. Assessment of fetal cerebral cortex can be achieved with MRI in the third trimester. MRI is a viable research tool for noninvasive interrogation of the fetus and the placenta.
Collapse
|
84
|
Riknagel D, Dinesen B, Zimmermann H, Farlie R, Schmidt S, Toft E, Struijk JJ. Digital auscultation of the uterine artery: a measure of uteroplacental perfusion. Physiol Meas 2016; 37:1163-71. [PMID: 27328380 DOI: 10.1088/0967-3334/37/7/1163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This observational study investigated digital auscultation for the purpose of assessing the clinical feasibility of monitoring vascular sounds in pregnancy. The study was performed at the Regional Hospital Viborg, Denmark, and included 29 pregnant women, 10 non-pregnant women and 10 male participants. Digital auscultation was performed with an electronic stethoscope bilaterally near the uterine arteries and correlated to the clinical diagnosis of preeclampsia (PE), intrauterine growth restriction (IUGR) or normal pregnancy in the group of pregnant participants. In the group of non-pregnant participants, digital auscultation was performed as control measurements in the same anatomical positions. The auscultations displayed pulse waveforms comprising systolic and diastolic periods in 20 of the 29 pregnant participants. However, in the non-pregnant and male participants, the pulse waveforms were absent. The pulsatile patterns are thus likely to originate from the arteries in relation to the pregnant uterus. In the participants displaying pulse waveforms, the presence of a dicrotic notch appeared with a sensitivity of 89% and a specificity of 100% in the discrimination of normal pregnancies (n = 11) from pregnancies with PE or IUGR (n = 9), (p < 0.001). This preliminary study shows the potential of identifying vascular complications during pregnancy such as preeclampsia and intrauterine growth restriction. The morphology of the derived pulse contour should be investigated and could be further developed to identify pathophysiology.
Collapse
Affiliation(s)
- Diana Riknagel
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, C1-223, Aalborg, 9220, Denmark. Viewcare A/S, Herlev, Denmark
| | | | | | | | | | | | | |
Collapse
|
85
|
Murbach M, Neufeld E, Samaras T, Córcoles J, Robb FJ, Kainz W, Kuster N. Pregnant women models analyzed for RF exposure and temperature increase in 3T RF shimmed birdcages. Magn Reson Med 2016; 77:2048-2056. [PMID: 27174499 DOI: 10.1002/mrm.26268] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE MRI is increasingly used to scan pregnant patients. We investigated the effect of 3 Tesla (T) two-port radiofrequency (RF) shimming in anatomical pregnant women models. THEORY AND METHODS RF shimming improves B1+ uniformity, but may at the same time significantly alter the induced current distribution and result in large changes in both the level and location of the absorbed RF energy. In this study, we evaluated the electrothermal exposure of pregnant women in the third, seventh, and ninth month of gestation at various imaging landmarks in RF body coils, including modes with RF shimming. RESULTS Although RF shimmed configurations may lower the local RF exposure for the mother, they can increase the thermal load on the fetus. In worst-case configurations, whole-body exposure and local peak temperatures-up to 40.8°C-are equal in fetus and mother. CONCLUSIONS Two-port RF shimming can significantly increase the fetal exposure in pregnant women, requiring further research to derive a very robust safety management. For the time being, restriction to the CP mode, which reduces fetal SAR exposure compared with linear-horizontal polarization modes, may be advisable. Results from this study do not support scanning pregnant patients above the normal operating mode. Magn Reson Med 77:2048-2056, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
| | | | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Juan Córcoles
- Department of Electronic and Communication Technology, Universidad Autónoma de Madrid (UAM), Escuela Politécnica Superior, Madrid, Spain
| | | | - Wolfgang Kainz
- US Food and Drug Administration (FDA), Center for Devices and Radiological Health (CDRH), Silver Spring, Maryland, USA
| | - Niels Kuster
- IT'IS Foundation, Zurich, Switzerland.,Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| |
Collapse
|
86
|
Zagouri F, Dimitrakakis C, Marinopoulos S, Tsigginou A, Dimopoulos MA. Cancer in pregnancy: disentangling treatment modalities. ESMO Open 2016; 1:e000016. [PMID: 27843602 PMCID: PMC5070264 DOI: 10.1136/esmoopen-2015-000016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/25/2023] Open
Abstract
Pregnancy-associated cancer constitutes an uncommon and difficult to manage clinical situation. It is defined as the cancer diagnosed from the first day of childbearing to 1 year post partum. Coexistence of cancer with pregnancy adds complexity to treatment recommendations, as both the mother and the fetus may be affected. The optimal therapeutic management of pregnant women with cancer diagnosis should take into account, apart from medical factors, a host of other parameters (ethical, psychological, religious, legal, etc). Unfortunately, this situation becomes more complex as more women delay childbearing, and consequently the incidence of cancer during pregnancy is constantly increasing. This manuscript summarises the general principles in managing pregnant patients with cancer and gives detailed instructions in the management of pregnant patients with breast cancer, ovarian cancer, melanoma, lymphoma, lung cancer, soft-tissue sarcoma and cervical cancer. Of note, management of pregnant women with cancer diagnosis should be performed in specialised centres with experience and all cases should be discussed in multidisciplinary meetings composed of multiple specialists (medical oncologists, obstetricians, surgeons, radiologists and paediatricians).
Collapse
Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Constantine Dimitrakakis
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Spyridon Marinopoulos
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Alexandra Tsigginou
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Meletios-Athanassios Dimopoulos
- Department of Clinical Therapeutics , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| |
Collapse
|
87
|
Girardi G. MRI-based methods to detect placental and fetal brain abnormalities in utero. J Reprod Immunol 2016; 114:86-91. [DOI: 10.1016/j.jri.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/21/2015] [Accepted: 05/29/2015] [Indexed: 11/29/2022]
|
88
|
Mahmoud HK, Samra MA, Fathy GM. Hematologic malignancies during pregnancy: A review. J Adv Res 2016; 7:589-96. [PMID: 27408762 PMCID: PMC4921778 DOI: 10.1016/j.jare.2016.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/20/2022] Open
Abstract
Malignancy is the second most common cause of mortality in the reproductive period and it complicates up to one out of every 1000 pregnancies. When cancer is diagnosed during pregnancy, the management approach must take into consideration both the mother and her fetus. Hematologic cancers diagnosed in pregnancy are not common, resulting in paucity of randomized controlled trials. Diagnosis of such malignancies may be missed or delayed, as their symptoms are similar to those encountered during normal pregnancy. Also, many imaging studies may be hazardous during pregnancy. Management of these malignancies during pregnancy induces many treatment-related risks for mother and baby and should consider patient's preferences for pregnancy continuation. In this article, hematologic malignancies diagnosed in pregnant patients including acute leukemias, chronic myeloid leukemia, lymphomas, multiple myeloma and myeloproliferative neoplasms, will be reviewed, including diagnostic and management strategies and their impact on the pregnant patient and the developing fetus.
Collapse
Affiliation(s)
- Hossam K Mahmoud
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Mohamed A Samra
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Gamal M Fathy
- Department of Hematology and BMT, Nasser Institute for Research and Treatment, Ministry of Health, Egypt
| |
Collapse
|
89
|
Effects of Gestational Magnetic Resonance Imaging on Methylation Status of Leptin Promoter in the Placenta and Cord Blood. PLoS One 2016; 11:e0147371. [PMID: 26789724 PMCID: PMC4720398 DOI: 10.1371/journal.pone.0147371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 01/04/2016] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades, magnetic resonance imaging (MRI) has been widely used for diagnosis in gestational women. Though it has several advantages, animal and human studies on the safety of MRI for the fetus remain inconclusive. Epigenetic modifications, which are crucial for cellular functioning, are prone to being affected by environmental changes. Therefore, we hypothesized that MRI during gestation may cause epigenetic modification alterations. Here, we investigated DNA methylation patterns of leptin promoter in the placenta and cord blood of women exposed to MRI during gestation. Results showed that average methylation levels of leptin in the placenta and cord blood were not affected by MRI. We also found that the methylation levels in the placenta and cord blood were not affected by different magnetic fields (1.5T and 3.0T MRI). However, if pregnant women were exposed to MRI at 15 to 20 weeks of gestation, the methylation level of leptin in cord blood was visibly lower than that of pregnant women exposed to MRI after 20-weeks of gestation (P = 0.037). mRNA expression level of leptin in cord blood was also altered, though mRNA expression of leptin in the placenta was not significantly affected. Therefore, we concluded that gestational MRI may not have major effects on the methylation level of leptin in cord blood and the placenta except for MRI applied before 20 weeks of gestation.
Collapse
|
90
|
Clinical characteristics and outcome of cancer diagnosed during pregnancy. Obstet Gynecol Sci 2016; 59:1-8. [PMID: 26866029 PMCID: PMC4742470 DOI: 10.5468/ogs.2016.59.1.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/27/2022] Open
Abstract
Objective The aim of this study is to describe the clinical characteristics and outcome of cancer diagnosed during pregnancy. Methods This is a retrospective cohort study of women who were diagnosed with cancer during pregnancy at a tertiary academic hospital between 1995 and 2013. Maternal characteristics, gestational age at diagnosis, and type, stage, symptoms and signs of cancer for each patient were retrieved from the medical records. The cancer treatment, pregnancy management and the subsequent perinatal and maternal outcomes for each cancer were assessed. Results A total of 87 women were diagnosed with cancer during pregnancy (172.6 cases per 100,000 deliveries). The most common cancer was breast cancer (n=20), followed by gastrointestinal (n=17), hematologic (n=13), thyroid (n=11), central nervous system (n=7), cervical (n=7), ovarian (n=5), lung (n=3), and other cancers (n=4). Eighteen (20.7%) patients terminated their pregnancies. In the 69 (79.3%) patients who maintained their pregnancies, one patient miscarried and 34 patients delivered preterm. Of the preterm babies, 24 (70.6%) were admitted to the neonatal intensive care unit and 3 (8.8%) of those expired. The maternal mortality rate was 31.0%, with highest rate seen with lung cancers (66.7%), followed by gastrointestinal (50.0%), central nervous system (50.0%), hematologic (30.8%), breast (25.0%), ovarian (20.0%) cervical (14.3%), and thyroid cancers (0%). Conclusion The clinical characteristics and outcome of cancer during pregnancy were highly variable depending on the type of cancer. However, timely diagnosis and appropriate management of cancer during pregnancy may improve both maternal and neonatal outcome.
Collapse
|
91
|
Egloff A, Bulas D. Magnetic Resonance Imaging Evaluation of Fetal Neural Tube Defects. Semin Ultrasound CT MR 2015; 36:487-500. [DOI: 10.1053/j.sult.2015.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
92
|
Lishner M, Avivi I, Apperley JF, Dierickx D, Evens AM, Fumagalli M, Nulman I, Oduncu FS, Peccatori FA, Robinson S, Van Calsteren K, Vandenbroucke T, Van den Heuvel F, Amant F. Hematologic Malignancies in Pregnancy: Management Guidelines From an International Consensus Meeting. J Clin Oncol 2015; 34:501-8. [PMID: 26628463 DOI: 10.1200/jco.2015.62.4445] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The incidence of hematologic malignancies during pregnancy is 0.02%. However, this figure is increasing, as women delay conception until a later age. Systemic symptoms attributed to the development of a hematologic cancer may overlap with physiologic changes of pregnancy. A favorable prognosis is contingent upon early diagnosis and treatment. Therefore, a high index of suspicion is required by health care providers. Although timely, accurate diagnosis followed by appropriate staging is essential and should not be delayed due to pregnancy, management guidelines are lacking due to insufficient evidence-based research. Consequently, treatment is delayed, posing significant risks to maternal and fetal health, and potential pregnancy termination. This report provides guidelines for clinical management of hematologic cancers during the perinatal period, which were developed by a multidisciplinary team including an experienced hematologist/oncologist, a high-risk obstetrics specialist, a neonatologist, and experienced nurses, social workers, and psychologists. METHODS These guidelines were developed by experts in the field during the first International Consensus Meeting of Prenatal Hematologic Malignancies, which took place in Leuven, Belgium, on May 23, 2014. RESULTS AND CONCLUSION This consensus summary equips health care professionals with novel diagnostic and treatment methodologies that aim for optimal treatment of the mother, while protecting fetal and pediatric health.
Collapse
Affiliation(s)
- Michael Lishner
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium.
| | - Irit Avivi
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Jane F Apperley
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Daan Dierickx
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Andrew M Evens
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Monica Fumagalli
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Irena Nulman
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Fuat S Oduncu
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Fedro Alessandro Peccatori
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Susan Robinson
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Tineke Vandenbroucke
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van den Heuvel
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Frederic Amant
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
93
|
Xu F, Liu Y, Wei Y, Zhao Y, Yuan H, Guo X. Differences in lumbar dural sac dimension in supine and lateral positions in late pregnancy: a magnetic resonance imaging study. Int J Obstet Anesth 2015; 26:19-23. [PMID: 26597406 DOI: 10.1016/j.ijoa.2015.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was designed to quantitatively investigate differences in lumbar dural sac dimensions between the lateral and supine positions in late pregnancy. METHODS Ten healthy volunteers with singleton pregnancies at 28-39weeks of gestation were included. Magnetic resonance imaging was performed in random order while subjects were in the left lateral and supine positions. Lumbosacral axial scans were obtained at the L1-2, L2-3, L3-4, L4-5 and L5-S1 intervertebral disc levels. The axial section area, anteroposterior maximum diameter and transversal maximum diameter of the dural sac were measured and differences between these parameters in the lateral and supine positions were compared. RESULTS The axial section areas of the dural sac at L1-2 (P<0.001), L2-3 (P=0.001), L3-4 (P<0.001) and L4-5 (P=0.005) and the transversal maximum diameter of the dural sac at L1-2 (P<0.001), L2-3 (P<0.001), L3-4 (P<0.001) and L4-5 (P=0.001) were greater in the lateral position compared with the supine position. The anteroposterior maximum diameter of the dural sac at L4-5 was greater in the lateral position compared with the supine position (P=0.019) but there were no significant differences at other levels. The magnitude of the differences in axial section area and transverse maximal diameter were similar among the levels studied. CONCLUSIONS The axial section area and the transversal maximum diameter of the dural sac in the lumbar area are reduced in the supine compared with the lateral position in late pregnancy.
Collapse
Affiliation(s)
- Fei Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Ying Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
94
|
Bouyssi-Kobar M, du Plessis AJ, Robertson RL, Limperopoulos C. Fetal magnetic resonance imaging: exposure times and functional outcomes at preschool age. Pediatr Radiol 2015; 45:1823-30. [PMID: 26155983 DOI: 10.1007/s00247-015-3408-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/20/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) has been routinely used as a noninvasive diagnostic tool for more than a decade; however, there is a paucity of follow-up studies examining the effects of prenatal exposure to 1.5-T MRI on developmental outcome. OBJECTIVE The objective of this study was to assess the safety of 1.5-T fetal MRI by evaluating functional outcomes of preschool children who were exposed in utero. MATERIALS AND METHODS In the context of a prospective observational study, healthy pregnant women underwent a 1.5-T MRI study using single-shot fast spin echo (SSFSE) sequences during the second or third trimester of pregnancy. The study was approved by the institutional review board at our institution, and written informed consent was obtained from all study participants. MRI scanning times were recorded, and prenatal/postnatal clinical data were collected prospectively. Functional outcomes were assessed using the Vineland Adaptive Behavior Scale (VABS), a widely used, norm-referenced and psychometrically sound functional assessment. RESULTS We studied 72 healthy pregnant women, who underwent fetal MRI at a mean gestational age of 30.5 ± 3.1 weeks. The cohort of fetuses was composed of 43% females, and 18 fetuses were scanned during the second trimester. All fetuses were born at term with appropriate birth weights (3.54 ± 0.5 kg) for gestational age. Mean age at follow-up testing was 24.5 ± 6.7 months. All children had age-appropriate scores in the communication, daily living, socialization and motor skills subdomains of the VABS (z-scores, P > 0.05). Furthermore, all children passed their newborn otoacoustic emission test and had normal hearing at preschool age. MRI study duration and exposure time to radio frequency waves and SSFSE sequences were not associated with adverse functional outcomes or hearing impairment. CONCLUSION Prenatal exposure to 1.5-T MRI during the second or third trimester of pregnancy in a cohort of healthy fetuses is not associated with disturbances in functional outcomes or hearing impairment at preschool age.
Collapse
Affiliation(s)
- Marine Bouyssi-Kobar
- Institute for Biomedical Sciences, George Washington University, Washington, DC, USA.,Advanced Pediatric Brain Imaging Research Laboratory, Departments of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adré J du Plessis
- Fetal and Transitional Medicine, Children's National Health System, Washington, DC, USA
| | - Richard L Robertson
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Catherine Limperopoulos
- Advanced Pediatric Brain Imaging Research Laboratory, Departments of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA. .,Fetal and Transitional Medicine, Children's National Health System, Washington, DC, USA.
| |
Collapse
|
95
|
[New aspects from legislation, guidelines and safety standards for MRI]. Radiologe 2015. [PMID: 26220129 DOI: 10.1007/s00117-015-2859-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many aspects of magnetic resonance (MR) operation are not directly regulated by law but in standards, guidelines and the operating instructions of the MR scanner. The mandatory contents of the operating instructions are regulated in a central standard of the International Electrotechnical Commission (IEC) 60601-2-33. In this standard, the application of static magnetic fields in MRI up to 8 Tesla (T) in the clinical routine (first level controlled mode) has recently been approved. Furthermore, the equally necessary CE certification of ultra-high field scanners (7-8 T) in Europe is expected for future devices. The existing installations will not be automatically certified but will retain their experimental status. The current extension of IEC 60601-2-33 introduces a new add-on option, the so-called fixed parameter option (FPO). This option might also be switched on in addition to the established operating modes and defines a fixed device constellation and certain parameters of the energy output of MR scanners designed to simplify the testing of patients with implants in the future.The employment of pregnant workers in an MRI environment is still not generally regulated in Europe. In parts of Germany and Austria pregnant and lactating employees were prohibited from working in the MR control zone (0.5 mT) in 2014. This is based on the mostly unresolved question of the applicability of limits for employees (exposure of extremities to static magnetic fields up to 8 T allowed) or the thresholds for the general population (maximum 400 mT). According to the European Society of Urogenital Radiology (ESUR), the discarding of breast milk after i.v. administration of gadolinium-based contrast agents in the case of a breastfeeding woman is only recommended when using contrast agents in the nephrogenic systemic fibrosis (NSF) high-risk category.
Collapse
|
96
|
Hendy P, Chadwick G, Hart A. Republished curriculum based clinical review: IBD: reproductive health, pregnancy and lactation. Postgrad Med J 2015; 91:230-5. [DOI: 10.1136/postgradmedj-2014-100430rep] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
97
|
Tocchio S, Kline-Fath B, Kanal E, Schmithorst VJ, Panigrahy A. MRI evaluation and safety in the developing brain. Semin Perinatol 2015; 39:73-104. [PMID: 25743582 PMCID: PMC4380813 DOI: 10.1053/j.semperi.2015.01.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Magnetic resonance imaging (MRI) evaluation of the developing brain has dramatically increased over the last decade. Faster acquisitions and the development of advanced MRI sequences, such as magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), perfusion imaging, functional MR imaging (fMRI), and susceptibility-weighted imaging (SWI), as well as the use of higher magnetic field strengths has made MRI an invaluable tool for detailed evaluation of the developing brain. This article will provide an overview of the use and challenges associated with 1.5-T and 3-T static magnetic fields for evaluation of the developing brain. This review will also summarize the advantages, clinical challenges, and safety concerns specifically related to MRI in the fetus and newborn, including the implications of increased magnetic field strength, logistics related to transporting and monitoring of neonates during scanning, and sedation considerations, and a discussion of current technologies such as MRI conditional neonatal incubators and dedicated small-foot print neonatal intensive care unit (NICU) scanners.
Collapse
Affiliation(s)
- Shannon Tocchio
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth Kline-Fath
- Department of Radiology Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Emanuel Kanal
- Director, Magnetic Resonance Services; Professor of Neuroradiology; Department of Radiology, University of Pittsburgh Medical Center (UPMC)
| | - Vincent J. Schmithorst
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- Pediatric Imaging Research Center, Department of Radiology Children׳s Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.
| |
Collapse
|
98
|
Eyre TA, Lau IJ, Mackillop L, Collins GP. Management and controversies of classical Hodgkin lymphoma in pregnancy. Br J Haematol 2015; 169:613-30. [DOI: 10.1111/bjh.13327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Toby A. Eyre
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| | - I-Jun Lau
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| | - Lucy Mackillop
- Department of Obstetrics & Gynaecology; John Radcliffe Hospital; Oxford University Hospitals NHS Trust; Oxford UK
| | - Graham P. Collins
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| |
Collapse
|
99
|
Hendy P, Chadwick G, Hart A. IBD: reproductive health, pregnancy and lactation. Frontline Gastroenterol 2015; 6:38-43. [PMID: 28839793 PMCID: PMC5369556 DOI: 10.1136/flgastro-2014-100430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/26/2014] [Accepted: 04/01/2014] [Indexed: 02/04/2023] Open
Abstract
The peak incidence of inflammatory bowel diseases (IBD) occurs during the child-bearing years, and so questions about fertility, pregnancy and breast feeding are often asked by patients. It is known that patients with IBD receive twice as much information about pregnancy-related issues from gastroenterologists as from any other source (including the internet). Therefore, the role of the gastroenterologist in correctly educating patients to avoid misconceptions is paramount, and this should be done proactively prior to planning pregnancy so that the patient's health and medications can be optimised. A clear understanding of medication safety during pregnancy and lactation will improve clinical management.
Collapse
Affiliation(s)
- Philip Hendy
- Gastroenterology SPRs, St Mark's Hospital, Harrow, UK
| | | | - Ailsa Hart
- Gastroenterology, St Mark's Hospital, Harrow, UK
| |
Collapse
|
100
|
Broekman BFP, Wang C, Li Y, Rifkin-Graboi A, Saw SM, Chong YS, Kwek K, Gluckman PD, Fortier MV, Meaney MJ, Qiu A. Gestational age and neonatal brain microstructure in term born infants: a birth cohort study. PLoS One 2014; 9:e115229. [PMID: 25535959 PMCID: PMC4275243 DOI: 10.1371/journal.pone.0115229] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 11/20/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Understanding healthy brain development in utero is crucial in order to detect abnormal developmental trajectories due to developmental disorders. However, in most studies neuroimaging was done after a significant postnatal period, and in those studies that performed neuroimaging on fetuses, the quality of data has been affected due to complications of scanning during pregnancy. To understand healthy brain development between 37-41 weeks of gestational age, our study assessed the in utero growth of the brain in healthy term born babies with DTI scanning soon after birth. METHODS A cohort of 93 infants recruited from maternity hospitals in Singapore underwent diffusion tensor imaging between 5 to 17 days after birth. We did a cross-sectional examination of white matter microstructure of the brain among healthy term infants as a function of gestational age via voxel-based analysis on fractional anisotropy. RESULTS Greater gestational age at birth in term infants was associated with larger fractional anisotropy values in early developing brain regions, when corrected for age at scan. Specifically, it was associated with a cluster located at the corpus callosum (corrected p<0.001), as well as another cluster spanning areas of the anterior corona radiata, anterior limb of internal capsule, and external capsule (corrected p<0.001). CONCLUSIONS Our findings show variation in brain maturation associated with gestational age amongst 'term' infants, with increased brain maturation when born with a relatively higher gestational age in comparison to those infants born with a relatively younger gestational age. Future studies should explore if these differences in brain maturation between 37 and 41 weeks of gestational age will persist over time due to development outside the womb.
Collapse
Affiliation(s)
- Birit F. P. Broekman
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
| | - Changqing Wang
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yue Li
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Anne Rifkin-Graboi
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kenneth Kwek
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Marielle V. Fortier
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Departments of Psychiatry and Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Anqi Qiu
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Clinical Imaging Research Centre, National University of Singapore, Singapore, Singapore
| | | |
Collapse
|