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Danzer E, Peña-Trujillo V, Gallo-Bernal S, Gee MS, Victoria T. Neonatal Anthropometric Measurements: A Comparison of Neonates With 3-T Fetal MRI Exposure, With 1.5-T Fetal MRI Exposure, and Without In-Utero MRI Exposure. AJR Am J Roentgenol 2024. [PMID: 39230404 DOI: 10.2214/ajr.24.31647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Background: Fetal MRI is increasingly performed at 3 T. Nonetheless, safety concerns persist regarding potential increased risk of intrauterine growth restriction from in-utero 3-T MRI exposure. Objective: To compare neonatal anthropometric measurements between newborns who underwent 3-T fetal MRI, newborns who underwent 1.5-T fetal MRI, and newborns without in utero MRI exposure. Methods: This single-center retrospective study included gravid patients who underwent fetal ultrasound and possible 1.5-T or 3-T fetal MRI within 10 days from January 2017 to January 2022. For each included patient who also underwent 3-T fetal MRI, one matched patient who also underwent 1.5-T MRI and two matched patients without in-utero MRI exposure, were randomly selected. Matching was based on gestational age per the fetal ultrasound. Neonatal anthropometric characteristics were compared among groups. Results: The final sample included 416 patients (mean age, 32±5 years), 104 in the 3-T MRI group, 104 in the 1.5-T MRI group, and 208 in the MRI-unexposed group. Mean gestational age at the time of fetal ultrasound used for matching was 27 weeks 2 days in the 3-T group, 25 weeks 2 days in the 1.5-T group, and 26 weeks 0 days in the MRI-unexposed group (p=.07). The distribution of indications for fetal MRI was not significantly different between the 3-T and 1.5-T groups (p=.62). Mean gestational age at delivery was 37 weeks 5 days in the 3-T group, 38 weeks 0 day in the 1.5-T group, and 38 weeks 2 days in the unexposed group (p=.51). No significant difference (p=.09) was observed among groups in mean neonatal weight (3-T: 3120±753 g; 1.5-T: 3104±704 g; unexposed: 2967±614 g); neonatal weight percentile (3-T: 45±27; 1.5-T: 42±26; MRI: 41±24); neonatal head circumference (3-T: 34±3 cm; 1.5-T: 34±3 cm; unexposed: 34±2 cm), or neonatal head circumference percentile (3-T: 48±29; 1.5-T: 42±23; unexposed: 43±30). Conclusion: There were no significant differences in neonatal anthropometric measurements among newborns who underwent in-utero 3-T MRI, newborns who underwent in-utero 1.5-T MRI, and newborns without in-utero MRI exposure. Clinical Impact: The results support the safety of 3-T MRI with respect to growth of the developing fetus.
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Affiliation(s)
- Enrico Danzer
- Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Valeria Peña-Trujillo
- Department of Pediatric Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sebastian Gallo-Bernal
- Department of Pediatric Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, NYC Health + Hospitals, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA
| | - Michael S Gee
- Department of Pediatric Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Teresa Victoria
- Department of Pediatric Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, Boston, Massachusetts, USA
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Haj Yahya R, Roman A, Grant S, Whitehead CL. Antenatal screening for fetal structural anomalies - Routine or targeted practice? Best Pract Res Clin Obstet Gynaecol 2024; 96:102521. [PMID: 38997900 DOI: 10.1016/j.bpobgyn.2024.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 07/14/2024]
Abstract
Antenatal screening with ultrasound identifies fetal structural anomalies in 3-6% of pregnancies. Identification of anomalies during pregnancy provides an opportunity for counselling, targeted imaging, genetic testing, fetal intervention and delivery planning. Ultrasound is the primary modality for imaging the fetus in pregnancy, but magnetic resonance imaging (MRI) is evolving as an adjunctive tool providing additional structural and functional information. Screening should start from the first trimester when more than 50% of severe defects can be detected. The mid-trimester ultrasound balances the benefits of increased fetal growth and development to improve detection rates, whilst still providing timely management options. A routine third trimester ultrasound may detect acquired anomalies or those missed earlier in pregnancy but may not be available in all settings. Targeted imaging by fetal medicine experts improves detection in high-risk pregnancies or when an anomaly has been detected, allowing accurate phenotyping, access to advanced genetic testing and expert counselling.
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Affiliation(s)
- Rani Haj Yahya
- Department of Fetal Medicine, The Royal Women's Hospital, Parkville, Australia; Perinatal Research Group, Dept. Obstetrics, Gynaecology, Newborn, University of Melbourne, Parkville, Australia.
| | - Alina Roman
- Department of Fetal Medicine, The Royal Women's Hospital, Parkville, Australia.
| | - Steven Grant
- Department of Fetal Medicine, The Royal Women's Hospital, Parkville, Australia.
| | - Clare L Whitehead
- Department of Fetal Medicine, The Royal Women's Hospital, Parkville, Australia; Perinatal Research Group, Dept. Obstetrics, Gynaecology, Newborn, University of Melbourne, Parkville, Australia.
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George E, Jaimes C, Xu D, Kasprian G, Glenn OA. How to Perform Fetal MR Imaging. Magn Reson Imaging Clin N Am 2024; 32:443-457. [PMID: 38944433 DOI: 10.1016/j.mric.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
This article provides the readers with practical guidance on how to perform fetal MR imaging, including technical considerations such as scanner field strength and use of appropriate radiofrequency receive coils, and summarizes the role, strengths, and limitations of the various MR imaging sequences. The authors review the various factors to consider in scan preparation, including study indication, timing, maternal preparation, and the creation of an institutional fetal imaging protocol. Additional factors that go into scan optimization during acquisition including prioritizing maternal comfort and ways to troubleshoot various artifacts that maybe encountered in fetal imaging are discussed.
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Affiliation(s)
- Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Camilo Jaimes
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, 1700 4th Street BH303B, San Francisco, CA 94143, USA
| | - Gregor Kasprian
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Medical University of Vienna, Währinger Gürtel 18-21, Vienna 1090, Austria
| | - Orit A Glenn
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
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Shrot S, Hadi E, Barash Y, Hoffmann C. Effect of magnet strength on fetal brain biometry - a single-center retrospective MRI-based cohort study. Neuroradiology 2023; 65:1517-1525. [PMID: 37436475 DOI: 10.1007/s00234-023-03193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Abnormal fetal brain measurements might affect clinical management and parental counseling. The effect of between-field-strength differences was not evaluated in quantitative fetal brain imaging until now. Our study aimed to compare fetal brain biometry measurements in 3.0 T with 1.5 T scanners. METHODS A retrospective cohort of 1150 low-risk fetuses scanned between 2012 and 2021, with apparently normal brain anatomy, were retrospectively evaluated for biometric measurements. The cohort included 1.5 T (442 fetuses) and 3.0 T scans (708 fetuses) of populations with comparable characteristics in the same tertiary medical center. Manually measured biometry included bi-parietal, fronto-occipital and trans-cerebellar diameters, length of the corpus-callosum, vermis height, and width. Measurements were then converted to centiles based on previously reported biometric reference charts. The 1.5 T centiles were compared with the 3.0 T centiles. RESULTS No significant differences between centiles of bi-parietal diameter, trans-cerebellar diameter, or length of the corpus callosum between 1.5 T and 3.0 T scanners were found. Small absolute differences were found in the vermis height, with higher centiles in the 3.0 T, compared to the 1.5 T scanner (54.6th-centile, vs. 39.0th-centile, p < 0.001); less significant differences were found in vermis width centiles (46.9th-centile vs. 37.5th-centile, p = 0.03). Fronto-occipital diameter was higher in 1.5 T than in the 3.0 T scanner (66.0th-centile vs. 61.8th-centile, p = 0.02). CONCLUSIONS The increasing use of 3.0 T MRI for fetal imaging poses a potential bias when using 1.5 T-based charts. We elucidate those biometric measurements are comparable, with relatively small between-field-strength differences, when using manual biometric measurements. Small inter-magnet differences can be related to higher spatial resolution with 3 T scanners and may be substantial when evaluating small brain structures, such as the vermis.
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Affiliation(s)
- Shai Shrot
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 2 Sheba Rd, 52621, Ramat Gan, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Hadi
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Ramat Gan, Israel
| | - Yiftach Barash
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 2 Sheba Rd, 52621, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Hoffmann
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 2 Sheba Rd, 52621, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Effects of 1.5-T versus 3-T magnetic resonance imaging in fetuses: is there a difference in postnatal neurodevelopmental outcome? Evaluation in a fetal population with left-sided congenital diaphragmatic hernia. Pediatr Radiol 2023; 53:1085-1091. [PMID: 36823375 DOI: 10.1007/s00247-023-05629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The utilization of 3-T magnetic field strength in obstetric imaging is increasingly common. It is important to ensure that magnetic resonance (MR) imaging with higher magnetic field strength is safe for the fetus. Comparison of neurodevelopmental outcome in neonates undergoing prenatal MR imaging with 1.5-T versus 3-T is of interest but has not yet been examined. OBJECTIVE We hypothesized no clinically meaningful difference in neurodevelopmental outcome between fetuses undergoing 1.5-T versus 3-T fetal MR imaging. As imaging a normal fetus for research purposes is illegal in Pennsylvania, this study was conducted in a population of fetuses with left congenital diaphragmatic hernia (left-CDH). MATERIALS AND METHODS A retrospective review of neurodevelopmental outcome of fetuses with left-CDH scanned at 1.5-T (n=75) versus 3-T (n=25) magnetic field strength between July of 2012 and December of 2019 was performed. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant Development, 3rd Edition (BSID-III). RESULTS There were no statistical differences in median age of assessment (1.5-T: 18 [12, 25] versus 3-T: 21 [11, 26], P=0.79), in mean BSID-III cognitive (1.5-T: 91 ± 14 versus 3-T: 90 ± 16, P=0.82), language (1.5-T: 92 ± 20 versus 3-T: 91 ± 20, P=0.91), and motor composite (1.5-T: 89 ± 15 versus 3-T: 87 ± 18, P=0.59) scores, subscales scores (for all, P>0.50), or in risk of abnormal neuromuscular exam (P=0.29) between neonates with left-CDH undergoing a 1.5-T versus 3-T MR imaging during fetal life. Additionally, the distribution of patients with average, mildly delayed, and severely delayed BSID-III scores was similar between the two groups (for all, P>0.50). The overall distribution of the composite scores in this CDH population was similar to the general population independent of exposure to 1.5-T or 3-T fetal MR imaging. Two 3-T patients (8%) and five 1.5-T patients (7%) scored within the significant delayed range for all BSID-III domains. Subjects with lower observed-to-expected fetal lung volume (O/E FLV) and postnatal need for ECMO had lower cognitive, language, motor, and subscales scores (for all, P<0.03) regardless of being imaged at 1.5-T versus 3-T. CONCLUSION This preliminary study suggests that, compared to 1.5-T MR imaging, fetal exposure to 3-T MR imaging does not increase the risk of neurodevelopmental impairment in fetuses with left-CDH. Additional MR imaging studies in larger CDH cohorts and other fetal populations are needed to replicate and extend the present findings.
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Prayer D, Malinger G, De Catte L, De Keersmaecker B, Gonçalves LF, Kasprian G, Laifer-Narin S, Lee W, Millischer AE, Platt L, Prayer F, Pugash D, Salomon LJ, Sanz Cortes M, Stuhr F, Timor-Tritsch IE, Tutschek B, Twickler D, Raine-Fenning N. ISUOG Practice Guidelines (updated): performance of fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:278-287. [PMID: 36722431 PMCID: PMC10107509 DOI: 10.1002/uog.26129] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 05/03/2023]
Affiliation(s)
- D Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L De Catte
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L F Gonçalves
- Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - S Laifer-Narin
- Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - A-E Millischer
- Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - F Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - D Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada
| | - L J Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Paris, France
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - F Stuhr
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU Grossmann School of Medicine, New York, NY, USA
| | - B Tutschek
- Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Prenatal Zurich, Zürich, Switzerland
| | - D Twickler
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Raine-Fenning
- Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK; Nurture Fertility, The Fertility Partnership, Nottingham, UK
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Caro-Domínguez P, García-Díaz L, Rebollo Polo M. Survey about the current use of fetal MRI in Spain. RADIOLOGIA 2022. [DOI: 10.1016/j.rxeng.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Colleran GC, Kyncl M, Garel C, Cassart M. Fetal magnetic resonance imaging at 3 Tesla - the European experience. Pediatr Radiol 2022; 52:959-970. [PMID: 35147713 DOI: 10.1007/s00247-021-05267-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/22/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Fetal Imaging Taskforce was established in 2018 by the European Society of Paediatric Radiology. The first survey on European practice of fetal imaging published in 2020 revealed that 30% of fetal magnetic resonance imaging (MRI) is performed at 3 tesla (T). The purpose of this second survey was to identify the impact of 3-T fetal MRI with an emphasis on image quality, diagnostic yield, and technical challenges and artifacts at higher field strengths. OBJECTIVE To describe the prenatal imaging practice at 3-T MRI units in various centres in Europe and to prepare recommendations on behalf of the Fetal Imaging Taskforce. MATERIALS AND METHODS A survey was sent to all members performing 3-T fetal MRI. Questions included practitioner experience, magnet brand, protocols, counselling, artifacts and benefits of imaging at higher field strengths. RESULTS Twenty-seven centres replied and reported improved spatial resolution and improved signal-to-noise ratio when performing fetal MRI at 3 T. Shading and banding artifacts and susceptibility to motion artifacts were common problems identified by practitioners at the higher field strength. For all neurological indications, practitioners reported a benefit of imaging at 3 T, most marked for posterior fossa evaluation and parenchymal lesions. CONCLUSION The use of 3-T magnets in fetal MRI has improved the availability and quality of advanced imaging sequences and allowed for better anatomical evaluation. There remain significant challenges to minimize the impact of artifacts on image quality. This paper includes guidelines for clinical practice and imaging at 3 T.
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Affiliation(s)
- Gabrielle C Colleran
- Department of Radiology, National Maternity Hospital, Holles Street, Dublin 2, Ireland. .,Department of Radiology, Children's Health Ireland, Dublin, Ireland. .,Discipline of Paediatrics, Trinity College Dublin and Women's and Children's Health, UCD School of Medicine, University College Dublin, Dublin, Ireland.
| | - Martin Kyncl
- Department of Radiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Catherine Garel
- Department of Radiology, Hôpital d'Enfants Armand-Trousseau, AP-HP, Paris, France
| | - Marie Cassart
- Department of Radiology and Fetal Medicine, Iris South Hospitals and CHU St Pierre, Brussels, Belgium
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Segev M, Djurabayev B, Katorza E, Yaniv G, Hoffmann C, Shrot S. 3.0 Tesla normative diffusivity in 3rd trimester fetal brain. Neuroradiology 2021; 64:1249-1254. [PMID: 34820712 DOI: 10.1007/s00234-021-02863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Apparent diffusion coefficient (ADC) values in the developing fetus provide valuable information on the diagnosis and prognosis of prenatal brain pathologies. Normative ADC data has been previously established in 1.5 T MR scanners but lacking in 3.0 T scanners. Our objective was to measure ADC values in various brain areas in a cohort of normal singleton fetuses scanned in a 3.0 T MR scanner. METHODS DWI (diffusion-weighted imaging) was performed in 47 singleton fetuses with normal or questionably abnormal results on sonography followed by normal structural MR imaging. ADC values were measured in cerebral lobes (frontal, parietal, temporal lobes), basal ganglia, and pons. Regression analysis was used to examine gestational age-related changes in regional ADC. RESULTS Median gestational age was 30.1 weeks (range, 26-34 weeks). There was a significant effect of region on ADC values, whereby ADC values were highest in cerebral lobes (parietal > frontal > temporal lobes), compared with basal ganglia. The lowest values were found in the pons. On regression analysis, there was a decrease in ADC values in basal ganglia and pons with increasing gestational age. ADC values in frontal, parietal, and temporal lobes were stable in our cohort. CONCLUSION Regional brain ADC values in 3.0 T scanners are comparable with previously reported values in 1.5 T scanners, with similar changes over gestational age. Using 3.0 T scanners is increasing worldwide. For fetal imaging, establishing normal ADC values is critical as DWI enables a sensitive and quantitative technique to evaluate normal and abnormal brain development.
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Affiliation(s)
- Maria Segev
- Department of Diagnostic Imaging, Sheba Medical Center, 2 Sheba Rd, Ramat-Gan 52621, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Bella Djurabayev
- Department of Diagnostic Imaging, Sheba Medical Center, 2 Sheba Rd, Ramat-Gan 52621, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Antenatal Diagnostic Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Gal Yaniv
- Department of Diagnostic Imaging, Sheba Medical Center, 2 Sheba Rd, Ramat-Gan 52621, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chen Hoffmann
- Department of Diagnostic Imaging, Sheba Medical Center, 2 Sheba Rd, Ramat-Gan 52621, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Shrot
- Department of Diagnostic Imaging, Sheba Medical Center, 2 Sheba Rd, Ramat-Gan 52621, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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11
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Aboughalia H, Noda S, Chapman T, Revzin MV, Deutsch GH, Browd SR, Katz DS, Moshiri M. Multimodality Imaging Evaluation of Fetal Spine Anomalies with Postnatal Correlation. Radiographics 2021; 41:2176-2192. [PMID: 34723699 DOI: 10.1148/rg.2021210066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Congenital anomalies of the spine are associated with substantial morbidity in the perinatal period and may affect the rest of the patient's life. Accurate early diagnosis of spinal abnormalities during fetal imaging allows prenatal, perinatal, and postnatal treatment planning, which can substantially affect functional outcomes. The most common and clinically relevant congenital anomalies of the spine fall into three broad categories: spinal dysraphism, segmentation and fusion anomalies of the vertebral column, and sacrococcygeal teratomas. Spinal dysraphism is further categorized into one of two subtypes: open spinal dysraphism and closed spinal dysraphism. The latter category is further subdivided into those with and without subcutaneous masses. Open spinal dysraphism is an emergency and must be closed at birth because of the risk of infection. In utero closure is also offered at some fetal centers. Sacrococcygeal teratomas are the most common fetal pelvic masses and the prognosis is variable. Finally, vertebral body anomalies are categorized into formation (butterfly and hemivertebrae) and segmentation (block vertebrae) anomalies. Although appropriate evaluation of the fetal spine begins with US, which is the initial screening modality of choice, MRI is increasingly important as a problem-solving tool, especially given the recent advances in fetal MRI, its availability, and the complexity of fetal interventions. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hassan Aboughalia
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Sakura Noda
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Teresa Chapman
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Margarita V Revzin
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Gail H Deutsch
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Samuel R Browd
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (H.A., S.N., T.C., M.M.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (S.N., T.C.), Laboratory Medicine and Pathology (G.H.D.), and Neurological Surgery (S.R.B.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
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12
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Utilization of 3-T fetal magnetic resonance imaging in clinical practice: a single-institution experience. Pediatr Radiol 2021; 51:1798-1808. [PMID: 34009407 DOI: 10.1007/s00247-021-05087-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/03/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the safety and efficacy of fetal magnetic resonance imaging (MRI) at 3 tesla (T) continues to evolve, understanding its potential benefits and limitations is becoming increasingly important. OBJECTIVE We aim to compare the image quality of fetal MRI between 1.5 T and 3 T in routine clinical practice. MATERIALS AND METHODS Fetal MRIs performed at 3 T between Jan. 1, 2019, and Dec. 31, 2019, at our institution were retrospectively reviewed by four fellowship-trained subspecialty radiologists. Imaging quality by system, sequence and artifacts were compared with matched controls at 1.5 T and rated using a modified Likert scale. RESULTS Thirty-three fetal MRIs at 3 T were reviewed, and a control group of studies for the same clinical indication and equivalent gestational age were selected for comparison. Two of the four radiologists preferred 3-T image quality of the brain with slight agreement among the four reviewers (k=0.19, P=0.01). Three of the four radiologists had no preference for 1.5 T vs. 3 T in the majority of cases in evaluating the chest and abdomen. In the overall assessment, 3 T was preferred in less than half of cases by all four radiologists (k=0.07, P=0.26). In the evaluation of standing wave, moire fringe and magnetic susceptibility artifacts, 3 T was not preferred in the majority of studies by all four radiologists. Total exam time was significantly longer in the 3-T fetal MRIs (75.0±15.1 min) compared to the 1.5-T fetal MRIs (55.5±13.3 min, P<0.001). CONCLUSION While 3 T is a feasible alternative to 1.5 T for fetal MRI, the increased artifacts and longer exam times observed at 3 T without clear improvement in overall image quality make 1.5 T preferable for fetal MRI in routine clinical practice.
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13
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Jabehdar Maralani P, Kapadia A, Liu G, Moretti F, Ghandehari H, Clarke SE, Wiebe S, Garel J, Ertl-Wagner B, Hurrell C, Schieda N. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J 2021; 73:56-67. [PMID: 34000852 DOI: 10.1177/08465371211015657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.
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Affiliation(s)
| | - Anish Kapadia
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Grace Liu
- Department of Obstetrics and Gynecology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Hournaz Ghandehari
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juliette Garel
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Casey Hurrell
- Research and Policy Development - Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, 12365University of Ottawa, Ottawa, Ontario, Canada
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14
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Caro-Domínguez P, García-Díaz L, Rebollo Polo M. Survey about the current use of fetal MRI in Spain. RADIOLOGIA 2021; 65:S0033-8338(21)00045-X. [PMID: 33712322 DOI: 10.1016/j.rx.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
In June 2019 in Seville, at the first course in fetal MRI, endorsed by the Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Pediatric Radiology (SERPE), the Spanish fetal MRI group was founded. To establish this group, a questionnaire was designed for radiologists dedicated to prenatal imaging in Spain and disseminated to the SERAM's members. The questions were related to the type of hospital, to MRI studies (magnetic field, gestational age, use of sedation, number of studies per year, proportion of fetal neuroimaging studies), and to teaching and research about fetal MRI. A total of 41 responses were received from radiologists in 25 provinces (88% working in public hospitals). Very few radiologists in Spain perform prenatal ultrasonography (7%) or prenatal CT. MRI is done in the second trimester (34%) or in the third trimester (44%). In 95% of centers, fetal brain MRI studies predominate. In 41% of the centers, studies can be done on 3 T MRI scanners. Maternal sedation is used in 17% of centers. The number of fetal MRI studies per year varies widely, being much higher in Barcelona and Madrid than in the rest of Spain.
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Affiliation(s)
- P Caro-Domínguez
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - L García-Díaz
- Departamento de Medicina Materno-Fetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - M Rebollo Polo
- Departamento de Radiología, Hospital Universitario Materno-infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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15
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European overview of current practice of fetal imaging by pediatric radiologists: a new task force is launched. Pediatr Radiol 2020; 50:1794-1798. [PMID: 32556810 DOI: 10.1007/s00247-020-04710-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/09/2020] [Accepted: 05/10/2020] [Indexed: 02/03/2023]
Abstract
A new task force dedicated to prenatal imaging was created in 2018 by the European Society of Pediatric Radiology. In order to establish a network of European prenatal imaging practice, we sent a questionnaire to radiologists practicing prenatal imaging in Europe. The questions were related to the type of institution, the local legislation for termination of pregnancy, the type of imaging modality and the following items regarding magnetic resonance imaging (MRI): magnetic field, gestational age at which it is performed, use of maternal sedation, number of examinations per year, proportion of cerebral versus body indications and proportion of repeated examinations. We collected responses from 20 European countries, 52 cities and 67 institutions (82% public). In most countries, the upper gestational age limit for termination of pregnancy is 24 weeks of gestation. In some countries, it is earlier and in other countries, there is no limit. Very few radiologists practice fetal ultrasonography and computed tomography. In some countries, fetal MRI is mainly performed before 24 weeks of pregnancy, while in others, it is mainly performed in the third trimester. Neurological indications are by far predominant and 30% of the institutions have access to a 3-tesla (T) unit for fetal MRI. Maternal sedation is rarely used. The number of scans per year is highly variable with an average of 140, which is not necessarily correlated to the size of the population.
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16
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Lum M, Tsiouris AJ. MRI safety considerations during pregnancy. Clin Imaging 2020; 62:69-75. [PMID: 32109683 DOI: 10.1016/j.clinimag.2020.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability to provide detailed cross-sectional anatomy without ionizing radiation. Despite the favorable radiation profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA) administration have been raised. Currently there are no studies that have shown any attributable harms of MRI during any trimester of pregnancy although prospective and longitudinal studies are lacking. GBCA administration may be associated with a slightly higher rate of neonatal death, although this is based on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy in the context of current society guidelines will help the radiologist serve as a valuable resource to patients and referring providers.
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Affiliation(s)
- Mark Lum
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America.
| | - A John Tsiouris
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America
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