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Ercolani G, Capuani S, Antonelli A, Camilli A, Ciulla S, Petrillo R, Satta S, Grimm R, Giancotti A, Ricci P, Catalano C, Manganaro L. IntraVoxel Incoherent Motion (IVIM) MRI of fetal lung and kidney: Can the perfusion fraction be a marker of normal pulmonary and renal maturation? Eur J Radiol 2021; 139:109726. [PMID: 33895624 DOI: 10.1016/j.ejrad.2021.109726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the use of IntraVoxel Incoherent Motion (IVIM) MRI in the study of microstructural tissue changes occurring in fetal lung and kidney during gestation. METHODS 34 normal pregnancies were enrolled. Patients were divided into two groups based on gestational age (GA): group A (21-29 weeks) and group B (30-39 weeks). MR examinations were performed at 1.5T, with a standard fetal MR protocol including a Diffusion-Weighted Echo-Planar Imaging sequence with 10 different b-values (0, 10, 30, 50, 75, 100, 200, 400, 700, 1000s/mm2). For each fetus, two bilateral ROIs were manually placed in lung and renal parenchyma. Mean values of perfusion fraction f, pseudo-diffusion coefficient D* and diffusion coefficient D were obtained. The correlation between IVIM parameters and GA was investigated. RESULTS In renal ROIs a positive correlation between fkidney and GA (p < 0.005) was found; similarly flung showed a statistically significant correlation with GA (p < 0.001). F mean values were significantly higher in group B compared to group A in both renal (p = 0.0002) and lung (p = 0.018) ROIs. No correlation was found in D and D* as a function of GA. CONCLUSIONS The IVIM perfusion fraction f may be considered as a potential marker of pulmonary and renal maturation in relation to hemodynamic changes described in intrauterine life. Our results highlight that IVIM model is useful as an additional prenatal diagnostic tool to study lung and renal development.
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Affiliation(s)
- Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Silvia Capuani
- CNR ISC, Physics Department, "Sapienza" University of Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Arianna Camilli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Roberta Petrillo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | | | - Antonella Giancotti
- Department of Gynecological-Obstetrical and Urological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy.
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Paruszewska-Achtel M, Dombek M, Badura M, Elminowska-Wenda G, Dąbrowska M, Grzonkowska M, Baumgart M, Szpinda-Barczyńska A, Szpinda M. Morphometric study of the diaphragmatic surface of the liver in the human fetus. PLoS One 2020; 15:e0227872. [PMID: 31978157 PMCID: PMC6980541 DOI: 10.1371/journal.pone.0227872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/01/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to examine age-specific reference intervals and growth dynamics of the best fit for liver dimensions on the diaphragmatic surface of the fetal liver. The research material consisted of 69 human fetuses of both sexes (32♂, 37♀) aged 18–30 weeks. Using methods of anatomical dissection, digital image analysis and statistics, a total of 10 measurements and 2 calculations were performed. No statistical significant differences between sexes were found (p>0.05). The parameters studied displayed growth models that followed natural logarithmic functions. The mean value of the transverse–to–vertical diameter ratio of the liver throughout the analyzed period was 0.71±0.11. The isthmic ratio decreased significantly from 0.81±0.12 in the 18–19th week to 0.62±0.06 in the 26–27th week, and then increased to 0.68±0.11 in the 28–30th week of fetal life (p<0.01). The morphometric parameters of the diaphragmatic surface of the liver present age-specific reference data. No sex differences are found. The transverse–to–vertical diameter ratio supports a proportionate growth of the fetal liver. Quantitative anatomy of the growing liver may be of relevance in both the ultrasound monitoring of the fetal development and the early detection of liver anomalies.
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Affiliation(s)
- Monika Paruszewska-Achtel
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Małgorzata Dombek
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Mateusz Badura
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Gabriela Elminowska-Wenda
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Maria Dąbrowska
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Magdalena Grzonkowska
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Mariusz Baumgart
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | - Michał Szpinda
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
- * E-mail:
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Ravelli A, Napolitano M, Rustico M, Riccipetitoni G, Di Leo G, Righini A, Sardanelli F. Prenatal MRI of neck masses with special focus on the evaluation of foetal airway. Radiol Med 2019; 124:917-925. [PMID: 31175537 DOI: 10.1007/s11547-019-01049-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal magnetic resonance imaging is the best tool to visualize foetal airway. OBJECTIVE To evaluate the performance of MRI in the assessment of foetal airway status in the presence of a neck mass. MATERIALS AND METHODS Two paediatric radiologists with 12- and 2-year experience in foetal imaging retrospectively analysed 23 foetal MRI examinations, performed between 2001 and 2016, after a second-level ultrasound suspicious for presence of a neck mass. Postnatal imaging, postoperative report, histology, autopsy, and clinical outcomes were the reference standard to calculate sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of prenatal MRI in detecting airway patency. We used the Cohen к statistics to estimate the interobserver agreement. We also assessed MRI performance in the diagnosis of the mass nature. RESULTS We obtained data about postnatal airway status in 19 of 23 patients; prenatal MRI demonstrated a sensitivity of 9/9 [100%, 95% confidence interval (CI) 66-100%], specificity 8/10 (80%, 44-98%), accuracy 17/19 (89%, 67-99%), PPV 9/11 (82%, 48-98%), and NPV 8/8 (100%, 63-100%); the interobserver agreement was perfect. Prenatal MRI correctly identified 21 of 23 masses (к = 0.858); the interobserver agreement was almost perfect (к = 0.851). CONCLUSION Prenatal MRI demonstrated high accuracy in assessing foetal airway status and diagnosing mass nature, allowing proper delivery planning.
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Affiliation(s)
- Anna Ravelli
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy.
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Mariangela Rustico
- Department of Obstetrics and Gynecology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Andrea Righini
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
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Cannie MM, De Keyzer F, Van Laere S, Leus A, de Mey J, Fourneau C, De Ridder F, Van Cauteren T, Willekens I, Jani JC. Potential Heating Effect in the Gravid Uterus by Using 3-T MR Imaging Protocols: Experimental Study in Miniature Pigs. Radiology 2016; 279:754-61. [DOI: 10.1148/radiol.2015151258] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mieke M Cannie
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Frederik De Keyzer
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Sigrid Van Laere
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Astrid Leus
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Johan de Mey
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Catherine Fourneau
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Filip De Ridder
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Toon Van Cauteren
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Inneke Willekens
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Jacques C Jani
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
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Manganaro L, Scialpi M, Piscioli F, Pusiol T, Roncati L. MRI prenatal diagnosis of genitourinary abnormalities in a case of inconclusive ultrasonography. J OBSTET GYNAECOL 2016; 36:762-763. [PMID: 27159155 DOI: 10.3109/01443615.2016.1157154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lucia Manganaro
- a Department of Radiologic, Oncologic and Pathologic Sciences , La Sapienza University , Rome , Italy
| | - Michele Scialpi
- b Department of Surgical and Biomedical Sciences, Second Division of Radiology , University of Perugia , Perugia , Italy
| | - Francesco Piscioli
- c Provincial Health Care Services, Institute of Pathology , Santa Maria Del Carmine Hospital , Rovereto , Italy , and
| | - Teresa Pusiol
- c Provincial Health Care Services, Institute of Pathology , Santa Maria Del Carmine Hospital , Rovereto , Italy , and
| | - Luca Roncati
- d Department of Diagnostic and Clinical Medicine and of Public Health , University of Modena and Reggio Emilia , Modena , Italy
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Gómez Huertas M, Culiañez Casas M, Molina García F, Carrillo Badillo M, Pastor Pons E. Complementary role of magnetic resonance imaging in the study of the fetal urinary system. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.03.005] [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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7
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Gómez Huertas M, Culiañez Casas M, Molina García F, Carrillo Badillo M, Pastor Pons E. Papel complementario de la resonancia magnética en el estudio del sistema urinario fetal. RADIOLOGIA 2016; 58:101-10. [DOI: 10.1016/j.rx.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 12/11/2022]
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Abstract
Fetal magnetic resonance imaging (MRI) is currently offered in a limited number of centers but is predominantly used for suspected fetal central nervous system abnormalities. This article concentrates on the role of the different imaging sequences and their value to clinical practice. It also discusses the future of fetal MRI.
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Affiliation(s)
- Elspeth Whitby
- Academic Unit of Reproductive and Developmental Medicine, Sheffield, UK.
| | - Peter Wright
- Medical Imaging and Medical Physics, Radiology, Royal Hallamshire Hospital, Sheffield, UK
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Dokumcu Z, Uygun O, Turhan T, Yalaz M, Ozcan C, Erdener A. Two-stage approach in the management of thoracic neuroenteric cyst with spinal extension: thoracoscopic excision following dorsal laminectomy. Childs Nerv Syst 2015; 31:185-9. [PMID: 25236467 DOI: 10.1007/s00381-014-2553-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neuroenteric cysts (NC) are rare pathologies and localized generally in posterior mediastinum or abdomen where they may extend to spinal canal through a vertebral defect. Isolated spinal lesions require dorsal/ventral laminectomy and thoracic ones thoracotomy or thoracoscopy. Posterolateral approach via thoracotomy is generally performed for lesions with both thoracic and spinal components. Minimal invasive excision of a thoracic NC with spinal extension in an infant is presented herein. CASE REPORT A term female newborn with an antenatal (26th week) diagnosis of congenital diaphragmatic hernia (CDH) was admitted. On physical examination, she was normal except mild dyspnea and CDH were excluded on radiogram. Left parenchymal opacity necessitated thorax tomography that revealed lobulated cystic lesion (6 × 3.5 × 4.5 cm) in posterior mediastinum. MRI showed intraspinal extension of the lesion through a hemivertebrae (6th). Two-stage procedure was planned for suspected neuroenteric cyst. First, intraspinal component was excised with dorsal laminectomy and the connection was closed. Then, the thoracic component was excised thoracoscopically. Histopathological evaluation confirmed the diagnosis. Total parenteral nutrition and high dose somatostatin analog was needed due to transient left chylothorax on postoperative course. She was well and symptom-free in postoperative period. CONCLUSION Neuroenteric cysts may lead to misdiagnoses in antenatal period. MRI is critical to show spinal and vertebral pathologies in suspected cases. Thoracoscopy may safely be performed for thoracic lesions with spinal extension in two-stage approach following closure of the connection and excision of the spinal component.
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Affiliation(s)
- Zafer Dokumcu
- Department of Pediatric Surgery, Division of Pediatric Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkey,
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Bazeed MF, Al-Dumairy MA, Maher MA, Ghanem MAEF. MRI as complementary tool added to ultrasound in the diagnosis of fetal renal abnormalities – any added value? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Early second-trimester diagnosis of body stalk anomaly by fetal magnetic resonance imaging. Jpn J Radiol 2013; 31:289-92. [PMID: 23385378 DOI: 10.1007/s11604-013-0182-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
We report a case of body stalk anomaly detected prenatally by fetal magnetic resonance imaging (MRI) at 14 weeks' gestation. A 29-year-old woman was followed during her first pregnancy. At 11-12 weeks' gestation, our sonographic images showed multiple fetal deformities. An abdominal wall defect was suspected. The exteriorized abdominal contents and the lower limb appeared within the extraembryonic celom with an intact amniotic membrane. Fetal MRI at 14 weeks' gestation confirmed a large anterior wall defect with herniation of the liver and bowel. In addition, abnormally rotated lower limb and scoliosis could be demonstrated. The fetus was prenatally diagnosed with body stalk anomaly, expected to be lethal in nature. The parents decided to terminate the pregnancy at 15 weeks' gestation. Prenatal diagnosis of body stalk anomaly is usually based on sonographic findings. As far as we are aware, this is the first case report of body stalk anomaly satisfactorily diagnosed by fetal MRI in the early second trimester. Fetal MRI scans should provide ground for a precise antenatal diagnosis of body stalk anomaly from early gestation.
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Weichert J, Hartge DR. Obstetrical sonography in obese women: a review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:209-216. [PMID: 21480286 DOI: 10.1002/jcu.20767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 09/22/2010] [Indexed: 05/30/2023]
Abstract
Obstetric sonographic imaging in pregnant women is adversely affected by obesity with a negative impact on the detection rate of congenital anomalies. This review aims to analyze relevant data regarding this issue and to discuss clinical and technical problems associated with sonographic examination of obese pregnant women.
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Affiliation(s)
- Jan Weichert
- Division of Prenatal Medicine, University of Schleswig-Holstein, Campus Luebeck, Germany
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Giday SA, Buscaglia JM, Althaus J, Donatelli G, Krishnamurty DM, Dray X, Ruben D, Liang D, Wroblewski R, Magno P, Shin EJ, Kalloo AN. Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos). Gastrointest Endosc 2009; 70:377-81. [PMID: 19523622 DOI: 10.1016/j.gie.2009.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 03/11/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite advances in the development of fetal surgery, morbidity and mortality are substantial. A natural orifice transluminal endoscopic surgery (NOTES)-guided approach to the gravid uterus may offer a less-invasive technique. OBJECTIVE To assess the feasibility of NOTES for diagnostic and therapeutic intrauterine fetal interventions. SETTING Survival and nonsurvival experiments on pregnant sheep. DESIGN AND INTERVENTION Nonsurvival experiments performed in 2 pregnant sheep (80-110 days' gestation). A third ewe underwent NOTES and survived for 4 weeks. Transgastric (nonsurvival ewes) and transvaginal (1 nonsurvival and the survived ewe) peritoneoscopy was performed after standard needle-knife entry into the peritoneal cavity. Endoscopic access to the gravid uterus was assessed. EUS-guided, transuterine injection of saline solution into the fetal cardiac ventricle and vessels was attempted in all. MAIN OUTCOME MEASUREMENTS Feasibility of NOTES- and EUS-guided intervention in a pregnant animal model, visibility of fetal parts via EUS compared with transabdominal US. RESULTS Entry into the peritoneal cavity was achieved in each ewe. Access to and complete visualization of the gravid uterus were successful once within the abdominal cavity. Visualization of the fetal parts and the placental cotyledons by EUS was achieved in all animals. EUS-guided amniocenteses and transuterine intracardiac and intravascular injection of saline were successful. There were no complications or preterm delivery after the procedures. LIMITATIONS Animal model. CONCLUSIONS NOTES is technically feasible in the pregnant ewe. Intraperitoneal EUS via a NOTES approach provides excellent access and visualization of the intrauterine cavity and fetal parts.
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Affiliation(s)
- Samuel A Giday
- Medicine/Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Barseghyan K, Jackson HA, Chmait R, De Filippo RE, Miller DA. Complementary roles of sonography and magnetic resonance imaging in the assessment of fetal urinary tract anomalies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1563-1569. [PMID: 18946095 DOI: 10.7863/jum.2008.27.11.1563] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of our study was to determine whether fetal magnetic resonance imaging (MRI) provides additional information that might affect the obstetric management of pregnancies complicated by sonographically diagnosed fetal urinary tract anomalies. METHODS Fetal MRI and sonography were used to study 39 women with suspected fetal urinary tract anomalies in the second and third trimesters of pregnancy. RESULTS In 24 of 39 cases (61%), fetal MRI confirmed the sonographic diagnosis. In 14 cases (36%), fetal MRI modified the initial sonographic diagnosis and counseling but did not change obstetric management. In 1 case (3%), the addition of fetal MRI resulted in a substantial change in the management of the pregnancy. CONCLUSIONS During the second and third trimesters of pregnancy, fetal MRI showed fetal urinary tract anomalies in excellent anatomic detail. Fetal MRI is a useful complementary tool in the assessment of sonographically diagnosed fetal urinary tract anomalies. In a small percentage of cases, it can have a substantial impact on obstetric management.
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Affiliation(s)
- Karine Barseghyan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-9300 USA.
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Manganaro L, Perrone A, Sassi S, Fierro F, Savelli S, Di Maurizio M, Tomei A, Francioso A, La Barbera L, Giancotti A, Ballesio L. Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience. Prenat Diagn 2008; 28:745-8. [DOI: 10.1002/pd.2041] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Levine D, Feldman HA, Tannus JFK, Estroff JA, Magnino M, Robson CD, Poussaint TY, Barnewolt CE, Mehta TS, Robertson RL. Frequency and cause of disagreements in diagnoses for fetuses referred for ventriculomegaly. Radiology 2008; 247:516-27. [PMID: 18430880 DOI: 10.1148/radiol.2472071067] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess the frequency and cause of disagreements in diagnoses at ultrasonography (US) and magnetic resonance (MR) imaging for fetuses referred for ventriculomegaly (VM). MATERIALS AND METHODS One hundred ninety-five women, aged 18-44 years, with 200 fetal referrals for VM, were recruited in a prospective IRB-approved, HIPAA-compliant study. Written informed consent was obtained. US scans were prospectively interpreted by three obstetric radiologists and MR examinations were read by one obstetric radiologist and three pediatric neuroradiologists. Final diagnosis was reached by consensus (198 US, 198 MR, and 196 US-MR comparisons). Gestational age, ventricular size, types of disagreements, and reasons for disagreements were recorded. Interreader agreement was assessed with kappa statistics. Ventricular diameter, gestational age, and confidence scores were analyzed by using mixed-model analysis of variance, accounting for correlation within reader and fetus. RESULTS There was prospective agreement on 118 (60%) of 198 US and 104 (53%) of 198 MR readings. Consensus was more likely when the final diagnosis was isolated VM (83 of 104, 80% at US; 82 of 109, 75% at MR) than when the final diagnosis included other anomalies as well (14 of 63, 22% at US; seven of 68, 10% at MR; P < .001). There was disagreement on 19 (10%) of 196 and 31 (16%) of 196 fetuses about the presence of VM at US and MR, respectively, and on 29 (15%) of 198 and 39 (20%) of 198 fetuses regarding the presence of major findings at US and MR, respectively. Reasons for discrepancies in reporting major findings included errors of observation, lack of real-time US scanning, lack of neuroradiology experience, as well as modality differences in helping depict abnormalities. CONCLUSION Of radiologists who read high-risk obstetric US and fetal MR images for VM, there is considerable variability in central nervous system diagnosis.
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Affiliation(s)
- Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Sarno AP, Wilson RD. Fetal cardiocentesis: a review of indications, risks, applications and technique. Fetal Diagn Ther 2008; 23:237-44. [PMID: 18417985 DOI: 10.1159/000116748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 01/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To review the indications, applications and technique of fetal cardiocentesis. METHODS Review of published case reports and case series of fetal cardiocentesis utilizing the PubMed search engine of the National Library of Medicine. RESULTS Case reports and case series demonstrate that fetal cardiocentesis may be an alternative method by which to facilitate prenatal diagnosis, intravascular therapy, multifetal and selective fetal reduction and in utero therapy of congenital heart disease. However, procedure-associated risk is higher than with cordocentesis and may limit use of this procedure. CONCLUSIONS Fetal cardiocentesis may be a reasonable option to obtain fetal intravascular access and facilitate therapeutic interventions when cordocentesis fails or is not feasible. However, expected benefit must clearly outweigh the procedure-associated risk.
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Affiliation(s)
- Albert P Sarno
- Maternal-Fetal Medicine Section, Perinatal Center, St. Luke's Hospital and Health Network, Bethlehem, Pa 18015, USA.
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18
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Balassy C, Kasprian G, Brugger PC, Csapo B, Weber M, Hörmann M, Bankier A, Bammer R, Herold CJ, Prayer D. Diffusion-weighted MR imaging of the normal fetal lung. Eur Radiol 2007; 18:700-6. [DOI: 10.1007/s00330-007-0784-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/30/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
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Abstract
PURPOSE Fast MRI has provided detailed and reproducible fetal anatomy. This study was performed to evaluate the usefulness of fetal MRI for prenatal diagnosis. MATERIALS AND METHODS Fifty-six fetuses with congenital abnormalities on ultrasonography were evaluated by fetal MRI from 2001 to 2004 in Severance Hospital. Final diagnosis was made by postnatal pathology, postnatal MRI, and other modalities (such as ultrasound, retrograde pyelogram). A 1.5-Tesla superconductive MR imaging unit was used to obtain half-Fourier acquisition single-shot turbo spin images. RESULTS Of the 56 fetuses, intracranial abnormalities were found in 26 fetuses, intraabdominal abnormalities in 17 fetuses, intrathoracic in 6 fetuses, head and neck in 5 fetuses, and other sites in 2 fetuses. There were six cases in which the diagnoses of fetal MRI and ultrasonography differed. In such cases, fetal MRI provided more exact diagnosis than ultrasonography (5 vs. 0). Three fetuses with intracranial abnormalities on ultrasonography were diagnosed as normal by fetal MRI and in postnatal diagnosis. CONCLUSION Although ultrasonography is known as a screening modality of choice in the evaluation of fetus because of the cost-effectiveness and safety, the sonographic findings are occasionally inconclusive or insufficient for choosing the proper management. Thus, in this study, we suggest that fetal MRI is more useful than ultrasonography for the evaluation of intracranial abnormalities in some instances. For prenatal counseling and postnatal treatment planning, fetal MRI can be informative when prenatal ultrasonography is inadequate and doubtful.
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Affiliation(s)
- Yong-Seok Sohn
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Myung-Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Won Park
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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20
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Guo WY, Ono S, Oi S, Shen SH, Wong TT, Chung HW, Hung JH. Dynamic motion analysis of fetuses with central nervous system disorders by cine magnetic resonance imaging using fast imaging employing steady-state acquisition and parallel imaging: a preliminary result. J Neurosurg 2006; 105:94-100. [PMID: 16922069 DOI: 10.3171/ped.2006.105.2.94] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors present a novel cine magnetic resonance (MR) imaging, two-dimensional (2D) fast imaging employing steady-state acquisition (FIESTA) technique with parallel imaging. It achieves temporal resolution at less than half a second as well as high spatial resolution cine imaging free of motion artifacts for evaluating the dynamic motion of fetuses in utero. The information obtained is used to predict postnatal outcome. METHODS Twenty-five fetuses with anomalies were studied. Ultrasonography demonstrated severe abnormalities in five of the fetuses; the other 20 fetuses constituted a control group. The cine fetal MR imaging demonstrated fetal head, neck, trunk, extremity, and finger as well as swallowing motions. Imaging findings were evaluated and compared in fetuses with major central nervous system (CNS) anomalies in five cases and minor CNS, non-CNS, or no anomalies in 20 cases. Normal motility was observed in the latter group. For fetuses in the former group, those with abnormal motility failed to survive after delivery, whereas those with normal motility survived with functioning preserved. The power deposition of radiofrequency, presented as specific absorption rate (SAR), was calculated. The SAR of FIESTA was approximately 13 times lower than that of conventional MR imaging of fetuses obtained using single-shot fast spin echo sequences. CONCLUSIONS The following conclusions are drawn: 1) Fetal motion is no longer a limitation for prenatal imaging after the implementation of parallel imaging with 2D FIESTA, 2) Cine MR imaging illustrates fetal motion in utero with high clinical reliability, 3) For cases involving major CNS anomalies, cine MR imaging provides information on extremity motility in fetuses and serves as a prognostic indicator of postnatal outcome, and 4) The cine MR used to observe fetal activity is technically 2D and conceptually three-dimensional. It provides four-dimensional information for making proper and timely obstetrical and/or postnatal management decisions.
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Affiliation(s)
- Wan-Yuo Guo
- Department of Radiology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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21
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Zizka J, Elias P, Hodik K, Tintera J, Juttnerova V, Belobradek Z, Klzo L. Liver, meconium, haemorrhage: the value of T1-weighted images in fetal MRI. Pediatr Radiol 2006; 36:792-801. [PMID: 16799788 DOI: 10.1007/s00247-006-0239-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 11/20/2005] [Accepted: 12/04/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrafast T2-weighted (T2-W) MRI sequences are currently considered a routine technique for fetal MR imaging. Limited experience exists with fetal T1-weighted (T1-W) imaging techniques. OBJECTIVE To determine MRI patterns of some fetal abdominal or haemorrhagic disorders with particular respect to the diagnostic value of T1-W images. MATERIALS AND METHODS In addition to standard T2-W single-shot sequences, T1-W single-shot and/or multislice sequences were employed in 25 MR examinations performed in 23 fetuses between 20 and 36 weeks of gestation for more detailed assessment of liver, meconium-filled digestive tract, haemorrhage, or further characterization of a fetal abdominal mass. Diagnostic value and presence of motion artefacts on T1-W images was recorded in each case. RESULTS T1-W images enabled superior delineation of fetal liver and large intestine. They provided additional diagnostic information in 9 (39%) of 23 fetuses. One false-positive and one false-negative MRI diagnosis of malrotation anomaly were encountered. Use of single-shot T1-W sequences reduced the occurrence of motion artefacts in 64%. CONCLUSION Our results suggest that the specific signal properties of methaemoglobin, meconium and liver are sufficiently important for T1-W sequences to become a routine part of fetal MRI protocols when dealing with digestive tract anomalies, diaphragmatic and abdominal wall defects, intraabdominal masses, and fetal haemorrhage.
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Affiliation(s)
- Jan Zizka
- Department of Radiology, Charles University Hospital, Sokolska 581, 50005, Hradec Kralove, Czech Republic.
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Kazmi SS, Nejat F, Tajik P, Roozbeh H. The prenatal ultrasonographic detection of myelomeningocele in patients referred to Children's Hospital Medical Center: a cross sectional study. Reprod Health 2006; 3:6. [PMID: 16846520 PMCID: PMC1540421 DOI: 10.1186/1742-4755-3-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 07/18/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To find out about the prenatal diagnosis rate of myelomeningocele (MMC) by ultrasound scan in patients referred to the Children's Hospital Medical Center in Tehran, Iran from July 2004 to July 2005. METHODS We included 140 children born with MMC and who were referred for management, surgery and treatment of complications associated with it. The ultrasound reports were examined. Data on sex, age, location of MMC, time of prenatal ultrasound and the trimester in which the diagnosis was made along with the results of the diagnosis (MMC, hydrocephalus, or both), were collected. RESULTS Among the studied patients, 136 (97.1%) cases had prenatal ultrasound, amongst those, 58 (42.6%) sonographic evaluations were diagnostic for hydrocephalus and/or MMC. The prenatal ultrasound was positive for MMC in 16 (11.8%), hydrocephalus in 25 (18.4%) and both MMC and hydrocephalus in 17 (12.5%) cases. Among all cases with prenatal diagnosis of MMC, 3.4% were detected in the first, 31% in the second and 65.5% in the third trimester. Thoracic/thoracolumbar lesions were found prenatally in 40% of cases, which is significantly higher than the detection rate of other locations including cervical/cervicothoracic and lumbar/lumbosacral/sacral regions diagnosed only in 0% and 21% of cases respectively. CONCLUSION There is a large difference between the detection rate of our population (24.3%) compared to others (68%). Pregnant women should have an ultrasound at 20-22 week for detection of congenital anomalies including MMC.
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Affiliation(s)
- Syed Shuja Kazmi
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Tajik
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Roozbeh
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Büsing KA, Kilian AK, Schaible T, Neff KW. [Fetal magnetic resonance imaging. Diagnostics in cases of congenital cystadenomatoid malformation of the lung (CCAM)]. Radiologe 2006; 46:133-8. [PMID: 16369825 DOI: 10.1007/s00117-005-1311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite advancing therapeutic strategies, congenital cystadenomatoid malformation of the fetal lung is still a potentially life-threatening anomaly. Antenatally, the development of hydrops as well as the natural history of the malformation is of particular therapeutic and prognostic importance. Postnatally, respiratory distress due to pulmonary hypoplasia counts as a crucial limiting factor. Owing to its feasibility and practicability, as well as a high sensitivity, antenatal ultrasound is still the screening method of choice for the detection of fetal thoracic malformations. However, particularly in cases of indistinguishable sonographic findings, fetal MRI is the modality of choice for proving the diagnosis and preliminary appraisal of intensive care therapy and extracorporal membrane oxygenation postnatally. Furthermore, fetal MRI often facilitates assessment and planning of intrauterine surgical procedures. These two features frequently require a close transfer to an expert neonatal centre.
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Affiliation(s)
- K A Büsing
- Institut für Klinische Radiologie, Universitätsklinikum Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg, Mannheim.
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25
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Cannie M, Jani J, Dymarkowski S, Deprest J. Fetal magnetic resonance imaging: luxury or necessity? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:471-6. [PMID: 16619388 DOI: 10.1002/uog.2776] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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26
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Abstract
Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies.
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Affiliation(s)
- Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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27
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Kunisaki SM, Fauza DO, Nemes LP, Barnewolt CE, Estroff JA, Kozakewich HP, Jennings RW. Bronchial atresia: the hidden pathology within a spectrum of prenatally diagnosed lung masses. J Pediatr Surg 2006; 41:61-5; discussion 61-5. [PMID: 16410109 DOI: 10.1016/j.jpedsurg.2005.10.082] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study was aimed at determining whether different congenital lung masses represent diverse manifestations of a single developmental abnormality associated with fetal airway obstruction. METHODS We conducted a 3-year retrospective review of patients who underwent surgical resection of a prenatally diagnosed lung mass. Prenatal imaging was used to define mass position and its effect on adjacent organs. Lung specimens were examined through careful full-specimen microdissections, as well as by plain and contrast roentgenograms. RESULTS Twenty-five patients underwent lung resection during this study period. Based on the final pathology reports, 56% were congenital cystic adenomatoid malformations, 12% were congenital lobar emphysemas, 8% were bronchopulmonary sequestrations, and 24% had features of both cystic adenomatoid malformation and bronchopulmonary sequestrations. No bronchogenic cysts were present in this series. Overall, bronchial atresia was identified in 77% of the examined specimens (n = 22) and was associated with all types of lung malformations. CONCLUSIONS Bronchial atresia is a common, unrecognized component of prenatally diagnosed congenital cystic adenomatoid malformations, bronchopulmonary sequestrations, congenital lobar emphysemas, and lesions of mixed pathology. Most congenital lung masses may be part of a spectrum of anomalies linked to obstruction of the developing fetal airway as an underlying component in their pathogenesis.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
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Hayashi S, Sago H, Kashima K, Kitano Y, Kuroda T, Honna T, Nosaka S, Nakamura T, Ito Y, Kitagawa M, Natori M. Prenatal diagnosis of fetal hydrometrocolpos secondary to a cloacal anomaly by magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:577-9. [PMID: 16184505 DOI: 10.1002/uog.2584] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Fetal female urogenital anomalies are often difficult to evaluate by ultrasonography, especially in late gestation. We report a case of fetal hydrometrocolpos detected at 35 weeks of gestation. Ultrasonography revealed a large retrovesical septate hypoechogenic mass in the fetal abdomen, however the sonographic findings were inconclusive. Magnetic resonance imaging (MRI) confirmed that the abdominal mass was fluid-filled with a mid-plane septum in the midline posterior to the bladder, and showed a connection to the dilated uterus that was duplicated. These findings were consistent with a diagnosis of hydrometrocolpos with septate vagina and uterus didelphys. The neonate showed abdominal distension, ambiguous genitalia and anal atresia with a single perineal opening. Hydrometrocolpos was secondary to a urethral type of cloacal anomaly. Aspiration of the mass and a colostomy were performed on the first postnatal day, followed by anorectoplasty at 19 months of age. MRI is a useful complementary tool for assessing fetal urogenital anomalies when ultrasonography is inconclusive.
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Affiliation(s)
- S Hayashi
- Division of Fetal Medicine, National Center for Child Health and Development, Tokyo, Japan
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Abstract
Fetal surgery is a newly evolving multidisciplinary medical field, being performed in specialized centers. It deals with the treatment of selected fetuses with congenital anomalies that cause high morbidity and mortality. The aim of the surgical treatment is to avoid the development of progressive and eventually irreversible damage at birth. Examples of entities treated are obstructive uropathy leading to renal insufficiency, lung hypoplasia in severe congenital diaphragmatic hernia, severe congenital cystic adenomatoid malformation of the lung, and sacrococcygeal teratoma. This review describes principles of fetal surgery, physiopathologic processes of some of the anomalies treated in this way, and diagnostic and therapeutic approaches. Recently published results are presented and discussed.
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Affiliation(s)
- S Hosie
- Kinderchirurgische Universitätsklinik, Klinikum Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg.
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Abstract
Fetal magnetic resonance imaging (MRI) can be used as a problem-solving tool when ultrasonic findings are equivocal. The role of fetal MRI has increased as obstetricians become aware of its potential and in utero therapy for anomalies becomes increasingly sophisticated. In this pictorial essay, we present a wide range of anomalies diagnosed or confirmed using MRI and discuss findings that help in the differential diagnosis.
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Affiliation(s)
- Kumaresan Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
PURPOSE OF REVIEW Current magnetic resonance imaging systems allow the visualization of normal and diseased kidney, with exquisite resolution of renal structures. Dynamic contrast magnetic resonance imaging has the potential, unique among all noninvasive modalities, to differentiate diseases that affect different portions of the vascular-nephron system. This article reviews the most important recently published studies in selected topics chosen because of their clinical relevance or potential for technical developments. RECENT FINDINGS Magnetic resonance imaging is used increasingly to evaluate renal masses, the prenatal genitourinary system, urinary obstruction and infection, renal vasculature, and the kidneys of transplant donors and recipients. Dynamic contrast magnetic resonance renography based on gadolinium chelated to diethylenetriamine pentaacetic acid, a safe (non-nephrotoxic) paramagnetic agent, emerges as the functional renal imaging modality of choice. Both perfusion and filtration rates can be assessed in individual kidney. SUMMARY Magnetic resonance imaging has the potential to provide a complete anatomic, physiologic, kidney-specific evaluation. With future advances in automated image analysis methods we can expect functional renal magnetic resonance imaging to play an influential role in management of renal disease.
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Affiliation(s)
- Henry Rusinek
- Department of Radiology, New York University Medical Center, Bellevue C&D building room D120, 550 First Avenue, New York, NY 10016, USA.
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Abstract
Fetal tumors are a diverse group of neoplasms, which are unique in their histologic characteristics, anatomic distribution, and pathophysiology. The biologic behavior of tumors in the fetus may differ dramatically compared with that of the same tumor detected later in life. Teratomas are the dominant histologic type and constitute the majority of both extracranial and intracranial neoplasms. Although often histologically mature, they may prove lethal because of their location and metabolic demands on the fetus. Large solid tumors may lead to cardiovascular compromise and hydrops fetalis. Extracranial teratomas are most commonly located in the sacrococcygeal area, followed by the head and neck, chest, and retroperitoneum. Fetuses with intracranial tumors have a poor prognosis regardless of histologic type. There are, however, two notable exceptions: lipomas and choroid plexus papillomas, both of which have a more favorable outcome. Neuroblastoma is the most common fetal malignancy. It may be either solid or cystic and is more often located on the right side. It typically has favorable biologic markers and stage at presentation. The prognosis for prenatally diagnosed cases is excellent. Other fetal neoplasms include soft-tissue tumors (both benign and malignant), leukemia, mesenchymal hamartoma of the kidney, and liver tumors (hemangioendothelioma, mesenchymal hamartoma, and hepatoblastoma).
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th and Alaska Ave NW, Washington, DC 20306-6000, USA.
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Aslan H, Ozseker B, Gul A. Prenatal sonographic and magnetic resonance imaging diagnosis of cystic neuroblastoma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:693-694. [PMID: 15386600 DOI: 10.1002/uog.1733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Abstract
This article presents a general overview of fetal sonography and an approach to the sonographic evaluation of the fetal central nervous system. Annotated images of anomalies of the fetal head, brain, spine, face, and neck are shown. Sonographic technique,including the choice of transducers and imaging windows is presented. The complementary relationship of fetal neurosonography and fetal MR imaging is covered, and the strengths and weaknesses of each modality are discussed.
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Affiliation(s)
- Carol E Barnewolt
- Department of Radiology, Advanced Fetal Care Center, Children's Hospital Boston, MA 02115, USA.
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