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Fievet A, Morel B, Sembély-Taveau C, Thoreau B, Perrotin F, Sirinelli D. [Fetal MRI practices in a university prenatal center]. ACTA ACUST UNITED AC 2017; 45:276-282. [PMID: 28343908 DOI: 10.1016/j.gofs.2017.02.007] [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: 10/20/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Fetal MRI is a third intention examination to prenatal diagnosis. If its diagnostic value is well known in many pathologies, its place in the management of pregnancies remains unclear. METHODS We collected retrospectively demographical, radiological (fetal MRI indications, fetal anatomical region and diagnostic information provided by fetal MRI) and obstetrical data of pregnant patients in university prenatal center during a 5 years' period. RESULTS Among 2439 patients of the prenatal center, 196 (8%) patients with fetal MRI were included. The main anatomical regions studied were the brain (n=132, 67%), the thorax (n=31, 16%) and the abdomen (n=25, 13%). No cardiac fetal MRI was performed. Ninety-five percent of fetal MRI was consecutively of an ultrasound sign. Fetal brain MRI was abnormal in 65% of cases, the thoracic and abdominopelvic MRI in 81.5%. The ultrasound diagnosis was unchanged in 42%, completed in 50% and redirected in 8% of cases. A termination of pregnancy was deemed admissible in 31% of patients with MRI versus 21% in patients without MRI (P=0.001). CONCLUSION Fetal MRI requires selective indications and provides additional diagnostic information with important implications for the future of the pregnancy, particularly in case of severe and incurable pathologies. Our results could be useful as a reference basis for the comparison with others prenatal center practices.
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Affiliation(s)
- A Fievet
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - B Morel
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - C Sembély-Taveau
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - B Thoreau
- Médecine interne, hôpital Bretonneau, CHRU de Tours, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - F Perrotin
- Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France; Pôle de gynécologie-obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe-de-Gouges, hôpital Bretonneau, CHRU de Tours, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - D Sirinelli
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
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Patenaude Y, Pugash D, Lim K, Morin L. Utilisation de l'imagerie par résonance magnétique en obstétrique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S418-S425. [PMID: 28063554 DOI: 10.1016/j.jogc.2016.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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[Segmental approach to congenital heart diseases: Principles and applications to prenatal imaging]. ACTA ACUST UNITED AC 2016; 44:428-34. [PMID: 27451065 DOI: 10.1016/j.gyobfe.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 11/21/2022]
Abstract
This pictorial essay will initially present the origin, definitions, objectives and main principles of the segmental approach to congenital heart diseases. Then, through ultrasound scans iconography we will consider its practical applications to prenatal screening. Eventually, through both ultrasound and MRI cases, we will discuss its potential use in fetal diagnostic evaluation.
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Patenaude Y, Pugash D, Lim K, Morin L, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Naud K, Ouellet A, Salem S. The Use of Magnetic Resonance Imaging in the Obstetric Patient. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:349-63. [DOI: 10.1016/s1701-2163(15)30612-5] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Patenaude Y, Pugash D, Lim K, Morin L, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Naud K, Ouellet A, Salem S. Archivée: Utilisation de l’imagerie par résonance magnétique en obstétrique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dray G, Olivier C, Teissier N, Vuillard E, Michel J, Farnoux C, Sibony O, Oury JF. [Epignathus teratoma: diagnostic and neonatal management; a case report]. ACTA ACUST UNITED AC 2013; 42:596-601. [PMID: 23684541 DOI: 10.1016/j.jgyn.2012.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 12/03/2012] [Accepted: 12/11/2012] [Indexed: 10/26/2022]
Abstract
Epignathus teratoma is a rare tumor whose prognosis essentially depends on its resectability and on neonatal care. When it is undiagnosed prenatally, mortality is close to 100 % at birth, because of obstruction of the upper airways. We present a case of epignathus teratoma detected during obstetrical ultrasound screening. Diagnosis enabled planning for a safe delivery in a suitable multidisciplinary unit and use of the EXIT procedure.
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Affiliation(s)
- G Dray
- Service de gynécologie-obstétrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
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Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012; 32:897-911. [PMID: 22403117 DOI: 10.1148/rg.323115120] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of computed tomography (CT) and magnetic resonance (MR) imaging has increased tremendously in the past 2 decades. Hence, pregnant and breast-feeding women, although generally healthier than the population at large, are also more likely to require contrast material-enhanced imaging. When a contrast-enhanced CT or MR imaging study is being considered for a pregnant or lactating patient, the potential risks to the fetus related to exposure to radiation, high magnetic fields, or contrast agents must be considered and weighed carefully against the risks of potential misdiagnosis due to withholding contrast agents and imaging studies. Fetal radiation doses up to 1 mGy are considered acceptable; with larger doses, the risk of carcinogenesis approximately doubles, although it remains low in absolute terms. No damage to a developing human fetus caused by MR imaging exposure has been documented. However, caution is advised, and risks and benefits must always be considered before evaluating a pregnant patient with MR imaging. The use of iodinated contrast agents is generally safe during pregnancy; nevertheless, these agents should be used with caution due to the risk of fetal hypothyroidism and should be administered only when the clinical situation clearly requires doing so. The use of gadolinium-based contrast agents during pregnancy remains controversial due to lack of human clinical data and potential toxicity. Use of all contrast agents is considered safe during lactation. It is hoped that this knowledge will help radiologists develop a consensus with their clinical colleagues regarding case management of pregnant and lactating patients.
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Affiliation(s)
- Emilie Tremblay
- Department of Radiology, Hôtel-Dieu de Montréal, Centre Hospitalier de l'Université de Montréal, 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8
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Ballouhey Q, Sartor A, Baunin C, Danjoux M, Léobon B, Galinier P, Vayssiere C. [Unusual fetal teratoma presenting as a posterior mediastinal cyst]. ACTA ACUST UNITED AC 2012; 41:338-40. [PMID: 22296937 DOI: 10.1016/j.gyobfe.2011.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 07/11/2011] [Indexed: 10/14/2022]
Abstract
Mediastinal cysts are uncommon prenatal findings. As isolated and non-compressing entities, they don't compromise the course of gestation. Massive lesions can compress vital structures, resulting in fetal demise. Thus, close follow-up with sonographic monitoring is recommended until birth. Non-hydroptic fetuses can be managed expectantly. Definitive etiology is known after surgical resection only. We present the first case of posterior mediastinal teratoma associated with severe vertebral abnormalities. After CT scan and fetal MRI, medical termination of pregnancy was decided. Histological examination revealed an immature teratoma. With this unique case report, we discuss the optimal prenatal management of mediastinal cysts.
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Affiliation(s)
- Q Ballouhey
- Service de chirurgie pédiatrique, hôpital des Enfants, 330 avenue de Grande-Bretagne, Toulouse cedex 9, France.
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Ben Regaya L, Abbes Z, Fatnassi R, Fekih M, Memmi A, Bouguizene S, Chaieb A, Bibi M, Ghannouchi S, Khairi H. Les masses cervicomédiastinales : problèmes du diagnostic prénatal et de la prise en charge néonatale. À propos de deux observations. IMAGERIE DE LA FEMME 2010. [DOI: 10.1016/j.femme.2010.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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10
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Harou K, L'Hermite M. [Asphyxiating thoracic dysplasia (Jeune syndrome): about two cases]. J Gynecol Obstet Hum Reprod 2010; 39:163-167. [PMID: 19853385 DOI: 10.1016/j.jgyn.2008.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 12/09/2008] [Accepted: 12/18/2008] [Indexed: 05/28/2023]
Abstract
Asphyxiating thoracic dysplasia (Jeune syndrome) is an osteochondrodysplasia with autosomal recessive inheritance, characterised by a nanism with rhizomelic predominance, associated with a narrow thorax. It induces an alteration of the respiratory function that conditions the prognosis, which is worsened in case of associated visceral lesions (probably related to mutations of genes implicated in ciliary development, as recently described). We report the observation of two severe cases of Jeune syndrome to emphasize the advancement of imaging, especially echography, and molecular biology in establishing prenatal diagnosis as well as prognosis of this syndrome.
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Affiliation(s)
- K Harou
- Service de gynécologie obstétrique, CHU Brugmann, université libre de Bruxelles, Bruxelles, Belgique.
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Diguet A, Marpeau L. Pour une échographie obstétricale tardive de 34 semaines d’aménorrhée. ACTA ACUST UNITED AC 2008; 36:680-2. [DOI: 10.1016/j.gyobfe.2008.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Quarello E. [Fetal MRI: indications, limits and dangers]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2008; 36:120-121. [PMID: 18191602 DOI: 10.1016/j.gyobfe.2007.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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