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Hung SC, Dahmoush H, Lee HJ, Chen HC, Guimaraes CV. Prenatal Imaging of Supratentorial Fetal Brain Malformation. Magn Reson Imaging Clin N Am 2024; 32:395-412. [PMID: 38944430 DOI: 10.1016/j.mric.2024.03.002] [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 review article provides a comprehensive overview of fetal MR imaging in supratentorial cerebral malformations. It emphasizes the importance of fetal MR imaging as an adjunct diagnostic tool used alongside ultrasound, improving the detection and characterization of prenatal brain abnormalities. This article reviews a spectrum of cerebral malformations, their MR imaging features, and the clinical implications of these findings. Additionally, it outlines the growing importance of fetal MR imaging in the context of perinatal care.
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Affiliation(s)
- Sheng-Che Hung
- Division of Neuroradiology, Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA; Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Hisham Dahmoush
- Division of Pediatric Neuroradiology, Department of Radiology, Stanford School of Medicine, Stanford, CA, USA
| | - Han-Jui Lee
- Division of Neuroradiology, Department of Radiology, Taipei Veterans General Hospital, Taiwan; National Yang Ming Chiao Tung University, Taiwan
| | - Hung-Chieh Chen
- National Yang Ming Chiao Tung University, Taiwan; Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Carolina V Guimaraes
- Division of Pediatric Radiology, Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
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2
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Mappa I, Di Mascio D, Carbone L, Lu JLA, Sorrenti S, Patelli C, D’Amico A, Matarrelli B, Giuliani GA, Neola D, Di Girolamo R, Sarno L, Khalil A, Rizzo G, Maruotti GM, D’Antonio F. Sonographic Cortical Development and Anomalies in the Fetus: A Systematic Review and Meta-Analysis. Biomedicines 2024; 12:1397. [PMID: 39061971 PMCID: PMC11273757 DOI: 10.3390/biomedicines12071397] [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: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this systematic review is to report the normal cortical development of different fetal cerebral fissures on ultrasound, describe associated anomalies in fetuses with cortical malformations, and evaluate the quality of published charts of cortical fissures. The inclusion criteria were studies reporting development, anomalies, and reference charts of fetal cortical structures on ultrasound. The outcomes observed were the timing of the appearance of different cortical fissures according to different gestational age windows, associated central nervous system (CNS) and extra-CNS anomalies detected at ultrasound in fetuses with cortical malformation, and rate of fetuses with isolated anomaly. Furthermore, we performed a critical evaluation of the published reference charts for cortical development on ultrasound. Random-effect meta-analyses of proportions were used to combine the data. Twenty-seven studies (6875 fetuses) were included. Sylvian fissure was visualized on ultrasound in 97.69% (95% CI 92.0-100) of cases at 18-19, 98.17% (95% CI 94.8-99.8) at 20-21, 98.94% (95% CI 97.0-99.9) at 22-23, and in all cases from 24 weeks of gestation. Parieto-occipital fissure was visualized in 81.56% (95% CI 48.4-99.3) of cases at 18-19, 96.59% (95% CI 83.2-99.8) at 20-21, 96.85% (95% CI 88.8-100) at 22-23, and in all cases from 24 weeks of gestation, while the corresponding figures for calcarine fissure were 37.27% (95% CI 0.5-89.6), 80.42% (95% CI 50.2-98.2), 89.18% (95% CI 74.0-98.2), and 96.02% (95% CI 96.9-100). Malformations of cortical development were diagnosed as an isolated finding at ultrasound in 6.21% (95% CI 2.9-10.9) of cases, while they were associated with additional CNS anomalies in 93.79% (95% CI 89.1-97.2) of cases. These findings highlight the need for large studies specifically looking at the timing of the appearance of the different brain sulci. Standardized algorithms for prenatal assessment of fetuses at high risk of malformations of cortical development are also warranted.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy (C.P.); (G.R.)
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00161 Roma, Italy
| | - Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy (C.P.); (G.R.)
| | - Sara Sorrenti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00161 Roma, Italy
| | - Chiara Patelli
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy (C.P.); (G.R.)
| | - Alice D’Amico
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00161 Roma, Italy
| | - Barbara Matarrelli
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, 66100 Chieti, Italy
| | - Giulia Andrea Giuliani
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, 66100 Chieti, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy (G.M.M.)
| | - Raffaella Di Girolamo
- Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy (G.M.M.)
| | - Laura Sarno
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Asma Khalil
- Fetal Medicine Unit, St George’s University Hospital, London SW17 0QT, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
- Twins Trust Centre for Research and Clinical Excellence, St George’s University Hospital, St George’s University of London, London SW17 0RE, UK
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy (C.P.); (G.R.)
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy (G.M.M.)
| | - Francesco D’Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, 66100 Chieti, Italy
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Wang X, Zhang S, Wang J, Zhang S, Feng L, Wu Q. Follow-up outcome analysis of 324 cases of early-onset and late-onset mild fetal ventriculomegaly: a retrospective cohort study. Eur J Med Res 2024; 29:128. [PMID: 38365795 PMCID: PMC10870476 DOI: 10.1186/s40001-024-01709-7] [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: 12/11/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Mild fetal ventriculomegaly (VM) is a nonspecific finding common to several pathologies with varying prognosis and is, therefore, a challenge in fetal consultation. We aimed to perform a constant, detailed analysis of prenatal findings and postnatal outcomes in fetuses with early-onset and late-onset mild ventriculomegaly, and provide a new evidence basis and new perspective for prenatal counseling. METHODS This is a retrospective cohort study of women with a diagnosis of mild fetal VM between January 2018 and October 2020. The population was divided into two groups according to the gestational ages (GAs) at initial diagnosis: the early-onset group (diagnosed at/before 24+6 weeks) and the late-onset group (diagnosed after 24+6 weeks). Clinical data and pregnancy outcomes were obtained from hospital records. The children's neurodevelopment status was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3) and telephone interviews. RESULTS Our study cohort comprised 324 fetuses, out of which 94 (29%) were classified as early-onset group and 230 (71%) late-onset group. Early-onset group was more likely to have concurrent additional abnormalities, whereas in the late-onset group, isolated enlargement was more common (P = 0.01). Unilateral enlargement was more common in the late-onset group (P = 0.05), and symmetrical enlargement in the early-onset group (P < 0.01). In addition, early-onset mild VM cases were more likely to have intrauterine progression (P = 0.03), and many had a higher proportion of complex multisystem abnormalities. Compared with the late-onset group, the early-onset group was more often associated with congenital brain structure malformations. Approximately 11% of fetuses with mild VM had postnatal neurodevelopmental delay/disorders, and the risk was higher in the early-onset group (19.4% vs. 7.4%). Regression analysis showed that the GA at first diagnosis, non-isolated, and intrauterine progression significantly correlated with neurodevelopmental abnormalities. CONCLUSIONS Early-onset and late-onset mild VM had significantly different ultrasound features and outcomes. Early-onset mild VM may have more complex potential abnormalities and are more likely to predict poor prognosis than the late-onset.
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Affiliation(s)
- Xuemei Wang
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
- Ultrasound Department, The Second Affiliated Hospital of Shandong First Medical University, 271000, Taian, Shandong, People's Republic of China
| | - Shanlong Zhang
- Ultrasound Department, The Second Affiliated Hospital of Shandong First Medical University, 271000, Taian, Shandong, People's Republic of China
| | - Jingjing Wang
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
| | - Simin Zhang
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
| | - Li Feng
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China
| | - Qingqing Wu
- Ultrasound Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
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Tarui T, Gimovsky AC, Madan N. Fetal neuroimaging applications for diagnosis and counseling of brain anomalies: Current practice and future diagnostic strategies. Semin Fetal Neonatal Med 2024; 29:101525. [PMID: 38632010 PMCID: PMC11156536 DOI: 10.1016/j.siny.2024.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Advances in fetal brain neuroimaging, especially fetal neurosonography and brain magnetic resonance imaging (MRI), allow safe and accurate anatomical assessments of fetal brain structures that serve as a foundation for prenatal diagnosis and counseling regarding fetal brain anomalies. Fetal neurosonography strategically assesses fetal brain anomalies suspected by screening ultrasound. Fetal brain MRI has unique technological features that overcome the anatomical limits of smaller fetal brain size and the unpredictable variable of intrauterine motion artifact. Recent studies of fetal brain MRI provide evidence of improved diagnostic and prognostic accuracy, beginning with prenatal diagnosis. Despite technological advances over the last several decades, the combined use of different qualitative structural biomarkers has limitations in providing an accurate prognosis. Quantitative analyses of fetal brain MRIs offer measurable imaging biomarkers that will more accurately associate with clinical outcomes. First-trimester ultrasound opens new opportunities for risk assessment and fetal brain anomaly diagnosis at the earliest time in pregnancy. This review includes a case vignette to illustrate how fetal brain MRI results interpreted by the fetal neurologist can improve diagnostic perspectives. The strength and limitations of conventional ultrasound and fetal brain MRI will be compared with recent research advances in quantitative methods to better correlate fetal neuroimaging biomarkers of neuropathology to predict functional childhood deficits. Discussion of these fetal sonogram and brain MRI advances will highlight the need for further interdisciplinary collaboration using complementary skills to continue improving clinical decision-making following precision medicine principles.
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Affiliation(s)
- Tomo Tarui
- Pediatric Neurology, Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Alexis C Gimovsky
- Maternal Fetal Medicine, Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel Madan
- Neuroradiology, Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Rodríguez MA, Echevarría M, Perdomo L, Gómez-Chiari M, García S, Prats P, Serra B, Albaiges G. Prevalence of corpus callosum pathology in an unselected population. Should assessment of the corpus callosum be included in the routine 20 weeks scan? Prenat Diagn 2024. [PMID: 38161311 DOI: 10.1002/pd.6510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To determine the prevalence of abnormalities of the corpus callosum (AbnCC) in a non-selected population, to propose a systematic screening protocol for AbnCC in all populations through direct assessment, and to describe the follow-up and prognosis of all AbnCC cases diagnosed in our clinical setting. METHODS This was a retrospective review of the prevalence of AbnCC over 11 years. We included a sagittal assessment of the corpus callosum (CC) in the second-trimester scan. AbnCC was classified into complete agenesis of CC (ACC) and dysgenesis of CC (DCC; including small, partial agenesis, thick and with lipoma). RESULTS Of the 38,586 second-trimester scans performed during our screening, 43 cases of AbnCC were detected (prevalence of 0.8/1000). Of the AbnCC cases, 10 cases were identified as ACC (29.40%) and 24 as DCC (70.59%). Follow-up investigations showed that in the 43 cases with AbnCC, 76.5% had other associated ultrasound abnormalities, 26.5% had genetic abnormalities, 11.8% had other MRI abnormalities, and 25% of the children had neurodevelopmental delays (8.8% of the total), which were severe in only one case. CONCLUSIONS AbnCC is found in approximately 0.8/1000 of cases in an unselected population. The findings suggest that systematic and direct assessment of the CC as part of screening ultrasound in the second trimester of gestation should be recommended as a routine practice.
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Affiliation(s)
- Mª Angeles Rodríguez
- Fetal Medicine Unit, Department of Obstetrics, Gynecology, and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain
| | - Mónica Echevarría
- Fetal Medicine Unit, Department of Obstetrics, Gynecology, and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain
| | - Laura Perdomo
- Fetal Medicine Unit, Department of Obstetrics, Gynecology, and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Marta Gómez-Chiari
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Sandra García
- Epidemiological Unit, Department of Obstetrics, Gynecology, and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain
| | - Pilar Prats
- Fetal Medicine Unit, Department of Obstetrics, Gynecology, and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Bernat Serra
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Quirón Dexeus, Barcelona, Spain
| | - Gerard Albaiges
- Fetal Medicine Unit, Department of Obstetrics, Gynecology, and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain
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6
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Zhang Y. Prenatal ultrasound for the diagnosis of the agenesis of corpus callosum: a meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2228454. [PMID: 37365011 DOI: 10.1080/14767058.2023.2228454] [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: 05/26/2022] [Revised: 04/20/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Prenatal ultrasound has been regularly used as the screening tool for agenesis of corpus callosum (ACC) of the fetuses, which were mainly suspected on the basis of indirect signs rather than the visualization of the CC. However, the diagnostic accuracy of prenatal ultrasound for ACC, compared to the gold standard of postmortem diagnosis or postnatal images, is still unknown. This meta-analysis was performed to comprehensively evaluate the efficacy of prenatal ultrasound for the diagnosis of ACC. METHODS Studies evaluating the diagnostic accuracy of prenatal ultrasound for ACC compared to postmortem diagnosis or postnatal images were retrieved by searching PubMed, Embase, and Web of Science databases. Pooled sensitivity and specificity were calculated with a random-effects model. The diagnostic accuracy was measured by summarized area under the receiver operating characteristic (AUC) curve. RESULTS Twelve studies involving 544 fetuses with suspected anomalies of central nervous system were included, and 143 of them were with validated diagnosis of ACC. Pooled results showed that prenatal ultrasound has satisfying diagnostic efficacy for ACC, with the pooled sensitivity, specificity, positive and negative likelihood ratios of 0.72 (95% confidence interval [CI]: 0.39-0.91), 0.98 (95% CI: 0.79-1.00), 43.73 (95% CI: 3.42-558.74, and 0.29 (95% CI: 0.11-0.74), respectively. The pooled AUC was 0.94 (95% CI: 0.92-0.96), suggesting good diagnostic performance of prenatal ultrasound. Subgroup analysis according to the prenatal ultrasound procedures showed a better diagnostic efficacy of neurosonography than that of regular ultrasound screening (sensitivity: 0.84 versus 0.57, specificity: 0.98 versus 0.89, and AUC: 0.97 versus 0.78). CONCLUSIONS Prenatal ultrasound, particularly for the neurosonography, confers satisfying efficacy for the diagnosis of ACC.
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Affiliation(s)
- Yan Zhang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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7
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Tsai P, Shinar S. Agenesis of the corpus callosum: What to tell expecting parents? Prenat Diagn 2023; 43:1527-1535. [PMID: 37794643 DOI: 10.1002/pd.6447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
Agenesis of the corpus callosum (ACC) is one of the most common brain malformations, with an incidence estimated to range from 0.5 to 70 in 10,000 among the general population. Prenatal diagnosis is made via ultrasound; however, fetal MRI is useful to confirm or exclude the presence of associated cerebral abnormalities-mostly cortical malformations-that may affect postnatal prognosis. When no additional central nervous system (CNS) or extra CNS anomalies are identified and no genetic cause is found, an isolated ACC is diagnosed. Overall, in cases of ACC, an underlying genetic cause can be identified in up to 12.5% with chromosomal microarray (CMA) and up to 47% with whole exome sequencing (WES). In cases where ACC is the only anomaly detected, the yield of WES is 30%. Postnatal outcomes are variable and depend on whether the condition is isolated or not. In truly isolated ACC, outcomes range from normal in 65% of cases through mild to severe neurodevelopmental impairments in 35% of cases. An interdisciplinary team of medical experts is key in guiding parents toward informed decision-making in pregnancies complicated by ACC. Considering current and expected advancements in genetic testing and imaging technologies in upcoming years, we herein summarize current recommendations for the management and prenatal counseling of expecting parents of fetuses with ACC. Our review pertains primarily to expecting parents of fetuses with complete ACC.
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Affiliation(s)
- Pascale Tsai
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, Hamilton, Ontario, Canada
| | - Shiri Shinar
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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8
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D'Antonio F, Di Mascio D, Rizzo G. Reply: Neurosonography and magnetic resonance imaging for cytomegalovirus infection - integration of imaging modalities is key. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:306-307. [PMID: 37523513 DOI: 10.1002/uog.26300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- F D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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9
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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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10
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Mappa I, De Vito M, Flacco ME, di Mascio D, D'Antonio F, Rizzo G. Prenatal predictors of adverse perinatal outcome in congenital cytomegalovirus infection: a retrospective multicenter study. J Perinat Med 2023; 51:102-110. [PMID: 35993868 DOI: 10.1515/jpm-2022-0286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/07/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To identify predictors of adverse perinatal outcome in congenital cytomegalovirus (CMV) infection. METHODS In a multicenter study fetuses with congenital CMV infection diagnosed by PCR on amniotic fluid and normal prenatal imaging at the time of diagnosis were included. Primary outcome was the occurrence of structural anomalies at follow-up ultrasound or prenatal magnetic resonance imaging (MRI). Secondary outcomes were the occurrence of anomalies detected exclusively postnatally and the rate of symptomatic infection. RESULTS One hundred and four fetuses with congenital CMV were included in the study. Anomalies were detected at follow-up ultrasound or MRI in 18.3% (19/104) cases. Additional anomalies were found after birth in 11.9% (10/84) of cases and 15.5% (13/85) of newborns showed clinical symptoms related to CMV infection. There was no difference in either maternal age (p=0.3), trimester (p=0.4) of infection and prenatal therapy (p=0.4) between fetuses with or whiteout anomalies at follow-up. Conversely, median viral load in the amniotic fluid was higher in fetuses with additional anomalies at follow-up (p=0.02) compared to those without. At multivariate logistic regression analysis, high viral load in the amniotic fluid, defined as ≥100,000 copies/mL was the only independent predictor for the occurrence of anomalies detected exclusively at follow-up ultrasound assessment or MRI, with an OR of 3.12. CONCLUSIONS Viral load in the amniotic fluid is a strong predictor of adverse perinatal outcome in congenital CMV infection. The results of this study emphasize the importance of adequate follow up even in case of negative neurosonography to better predict postnatal adverse outcomes of infected newborns, especially in amniotic fluid high viral load.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Marika De Vito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | | | - Daniele di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco D'Antonio
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chiety, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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11
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Di Mascio D, Rizzo G, Khalil A, D'Antonio F. Role of fetal magnetic resonance imaging in fetuses with congenital cytomegalovirus infection: multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:67-73. [PMID: 36056700 DOI: 10.1002/uog.26054] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the role of fetal brain magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses with congenital cytomegalovirus (CMV) infection and normal neurosonography. METHODS This was a multicenter, retrospective cohort study of patients examined between 2012 and 2021 in 11 referral fetal medicine centers in Italy. Inclusion criteria were fetuses with congenital CMV infection diagnosed by polymerase chain reaction analysis of amniotic fluid, pregnancies that underwent detailed multiplanar ultrasound assessment of the fetal brain as recommended by the International Society of Ultrasound in Obstetrics and Gynecology, maternal age ≥ 18 years, normal fetal karyotype and MRI performed within 3 weeks after the last ultrasound examination. The primary outcome was the rate of central nervous system (CNS) anomalies detected exclusively on MRI and confirmed after birth or autopsy in fetuses with a prenatal diagnosis of congenital CMV infection and normal neurosonography at diagnosis. Additional CNS anomalies were classified into anomalies of the ventricular and the periventricular zone, intracranial calcifications in the basal ganglia or germinal matrix, destructive encephalopathy in the white matter, malformations of cortical development, midline anomalies, posterior fossa anomalies and complex brain anomalies. We evaluated the relationship between the incidence of structural CNS malformations diagnosed exclusively on fetal MRI and a number of maternal and gestational characteristics. Univariate and multivariate logistic regression analyses were used to identify and adjust for potential independent predictors of the MRI diagnosis of fetal anomalies. RESULTS The analysis included 95 fetuses with a prenatal diagnosis of congenital CMV infection and normal neurosonography referred for prenatal MRI. The rate of structural anomalies detected exclusively at fetal MRI was 10.5% (10/95). When considering the type of anomaly, malformations of cortical development were detected on MRI in 40.0% (4/10) of fetuses, destructive encephalopathy in 20.0% (2/10), intracranial calcifications in the germinal matrix in 10.0% (1/10) and complex CNS anomalies in 30.0% (3/10). On multivariate logistic regression analysis, only CMV viral load in the amniotic fluid, expressed as a continuous variable (odds ratio (OR), 1.16 (95% CI, 1.02-1.21); P = 0.02) or categorical variable (> 100 000 copies/mL) (OR, 12.0 (95% CI, 1.2-124.7); P = 0.04), was independently associated with the likelihood of detecting fetal anomalies on MRI. Associated anomalies were detected exclusively at birth and missed by both prenatal neurosonography and fetal MRI in 3.8% (3/80) of fetuses with congenital CMV infection. CONCLUSIONS Fetal brain MRI can detect additional anomalies in a significant proportion of fetuses with congenital CMV infection and negative neurosonography. Viral load in the amniotic fluid was an independent predictor of the risk of associated anomalies in these fetuses. The findings of this study support a longitudinal evaluation using fetal MRI in congenital CMV infection, even in cases with negative neurosonography at diagnosis. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - F D'Antonio
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
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12
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Scelsa B. Fetal Neurology: From Prenatal Counseling to Postnatal Follow-Up. Diagnostics (Basel) 2022; 12:diagnostics12123083. [PMID: 36553090 PMCID: PMC9776544 DOI: 10.3390/diagnostics12123083] [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: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Brain abnormalities detected in fetal life are being increasingly recognized. Child neurologists are often involved in fetal consultations, and specific fetal neurology training has been implemented in many countries. Pediatric neurologists are asked to examine the data available and to contribute to the definition of the long-term outcomes. Ventriculomegaly, posterior fossa malformations, and agenesis/dysgenesis of corpus callosum are among the most common reasons for antenatal neurological consultations. Fetuses with central nervous system and extra-CNS anomalies should ideally be managed in secondary/tertiary hospitals where obstetricians who are experts in fetal medicine and pediatric specialists are available. Obstetricians play a critical role in screening, performing detailed neurosonography, and referring to other specialists for additional investigations. Clinical geneticists are frequently asked to propose diagnostic tests and counsel complex fetal malformations whose phenotypes may differ from those during postnatal life. Advances in fetal MRI and genetic investigations can support the specialists involved in counseling. Nevertheless, data interpretation can be challenging, and it requires a high level of expertise in a multidisciplinary setting. Postnatally, child neurologists should be part of an integrated multidisciplinary follow-up, together with neonatologists and pediatricians. The neurodevelopmental outcomes should be assessed at least up to school age. Children should be evaluated with formal tests of their gross motor, cognitive, language, fine motor/visuo-perceptual skills, and their behavior. In this perspective, fetal neurology can be regarded as the beginning of a long journey which continues with a prolonged, structured follow-up, support to the families, and transition to adult life. A review of the most common conditions is presented, along with the long-term outcomes and a proposal of the neurodevelopmental follow-up of children with CNS malformation which are diagnosed in uterus.
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Affiliation(s)
- Barbara Scelsa
- Department of Pediatric Neurology and Psychiatry, V. Buzzi Children's Hospital, ASST-FBF-Sacco, via Castelvetro 32, 20154 Milan, Italy
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13
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Lanna M, Scelsa B, Cutillo G, Amendolara M, Doneda C, Balestriero M, Faiola S, Casati D, Spaccini L, Cetin I. Long-term outcome of consecutive case series of congenital isolated agenesis of corpus callosum. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:494-498. [PMID: 35274783 DOI: 10.1002/uog.24898] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the long-term outcome of children with prenatally diagnosed isolated complete agenesis of the corpus callosum (cACC). METHODS In this single-center case series, we reviewed retrospectively the charts of fetuses referred to our fetal therapy unit from January 2004 to July 2020 for a suspected anomaly of the corpus callosum (CC). Cases with prenatally diagnosed isolated cACC were included. Fetal karyotype and comparative genomic hybridization microarray of amniotic fluid, in addition to fetal magnetic resonance imaging, were offered to all pregnant women with a diagnosis of fetal CC malformation. The surviving children were enrolled in the neurodevelopmental follow-up program at our institution, which included postnatal magnetic resonance imaging, serial neurological examinations and neurodevelopmental evaluations with standardized tests according to age. Families living in remote areas or far from our institution were offered a structured ad-hoc phone interview. RESULTS A total of 128 pregnancies with fetal CC malformation were identified (mean gestational age at diagnosis, 24.5 (range, 21-34) weeks), of which 53 cases were diagnosed prenatally with apparently isolated cACC. Of these, 12 cases underwent termination of pregnancy, one resulted in intrauterine demise at 24 weeks of gestation and 13 cases were lost to follow-up. Of the remaining 27 children, one was excluded due to an associated chromosomal anomaly (8p21.3q11.21 mosaic duplication) diagnosed after birth, which could have been detected prenatally if the parents had consented to amniocentesis. In the 26 children included in the analysis, neurodevelopmental follow-up was available for a median of 3 (range, 1-16) years. Three (11.5%) infants had severe neurodevelopmental impairment, two of which were diagnosed postnatally with a genetic syndrome (Mowat-Wilson syndrome and Vici syndrome) that would not have been diagnosed prenatally. Seven (26.9%) children had mild neurodevelopmental impairment and 16 (61.5%) had normal neurodevelopmental outcome. The Full-Scale Intelligence Quotients of the three children with severe neurodevelopmental impairment were 50, 64 and 63, respectively, while that of the remaining children was in the normal range (median, 101; range, 89-119). CONCLUSIONS In 88% of the children with cACC included in this study, neurodevelopment was not severely impaired. However, long-term follow-up is recommended in all cases of congenital isolated cACC to recognize subtle neurodevelopmental disorders as early as possible. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Lanna
- Fetal Therapy Unit 'U. Nicolini', Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - B Scelsa
- Department of Pediatric Neurology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - G Cutillo
- Department of Pediatric Neurology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - M Amendolara
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - C Doneda
- Department of Radiology and Neuroradiology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - M Balestriero
- Department of Pediatric Neurology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - S Faiola
- Fetal Therapy Unit 'U. Nicolini', Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - D Casati
- Fetal Therapy Unit 'U. Nicolini', Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - L Spaccini
- Clinical Genetic Service, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - I Cetin
- Department of Women, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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14
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Welp A, Gembicki M, Dracopoulos C, Scharf JL, Rody A, Weichert J. Applicability of a semiautomated volumetric approach (5D CNS+™) for detailed antenatal reconstruction of abnormal fetal CNS anatomy. BMC Med Imaging 2022; 22:154. [PMID: 36056307 PMCID: PMC9438215 DOI: 10.1186/s12880-022-00888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy and reliability of a semiautomated volumetric approach (5D CNS+™) when examining fetuses with an apparent abnormal anatomy of the central nervous system (CNS). METHODS Stored 3D volumes extracted from a cohort of > 1.400 consecutive 2nd and 3rd trimester pregnancies (range 15-36 gestational weeks) were analyzed using the semiautomatic software tool 5D CNS+™, enabling detailed reconstruction of nine diagnostic planes of the fetal brain. All 3D data sets were examined and judged for plane accuracy, the need for manual adjustment, and fetal CNS anomalies affecting successful plane reconstruction. RESULTS Based on our data of 91 fetuses with structural cerebral anomalies, we were able to reveal details of a wide range of CNS anomalies with application of the 5D CNS+™ technique. The corresponding anatomical features and consecutive changes of neighboring structures could be clearly demonstrated. Thus, a profound assessment of the entire altered CNS anatomy could be achieved in nearly all cases. The comparison with matched controls showed a significant difference in volume acquisition (p < 0.001) and in need for manual adjustment (p < 0.001) but not in the drop-out rates (p = 0.677) of both groups. CONCLUSION 5D CNS+™ is applicable in the majority of cases with brain lesions and constitutes a reliable tool even if the integrity of the fetal CNS is compromised by structural anomalies. Using volume data that were acquired in identical cutting sections needed for conventional biometry allows for detailed anatomic surveys grossly independent of the examiner's experience.
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Affiliation(s)
- Amrei Welp
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Michael Gembicki
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Christoph Dracopoulos
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jann Lennard Scharf
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Achim Rody
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jan Weichert
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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15
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Moradi B, Taherian R, Tahmasebpour AR, Sanei Taheri M, Kazemi MA, Pak N, Shirazi M, Radmanesh A, Oztekin O, Arab-Ahmadi M. Fetal corpus callosum abnormalities: Ultrasound and magnetic resonance imaging role. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:989-1003. [PMID: 35488776 DOI: 10.1002/jcu.23212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
The corpus callosum (CC) is the major interhemispheric commissure and its abnormalities include agenesis, hypoplasia, and hyperplasia. The CC anomalies are typically related to other central nervous system (CNS) or extra-CNS malformations. The antenatal diagnosis of complete CC agenesis is easy after mid-trimester by ultrasound (US) even in the axial plane. The non-visualization of cavum septum pellucidum and colpocephaly are critical signs in the axial view. More subtle findings (i.e., hypoplasia and partial agenesis) might also be recognized antenatally. In this review, the focus was given on the prenatal diagnosis of CC abnormalities in US and magnetic resonance imaging.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Taherian
- Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Morteza Sanei Taheri
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Radmanesh
- Department of Radiology, School of Medicine, New York University, New York, New York, USA
| | - Ozgur Oztekin
- Radiology Department, Izmir Education and Research Hospital, Izmir, Turkey
| | - Mehran Arab-Ahmadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
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16
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Vasciaveo L, Rizzo G, Khalil A, Alameddine S, Di Girolamo R, Candia M, De Lucia G, Mappa I, Liberati M, Nappi L, D'Antonio F. Assessment of pericallosal artery at 11-14 weeks of gestation: Cohort study and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND 2022; 50:984-988. [PMID: 35315936 DOI: 10.1002/jcu.23191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To report the rate of visualization of the pericallosal artery (PCA) in the first trimester of pregnancy (11-14 weeks). METHODS Prospective observational study of consecutive fetuses undergoing first trimester risk assessment for chromosomal anomalies. The presence of PCA was assessed in a midsagittal view of fetal brain using high-definition power Color Doppler. A normal course of the PCA was defined as the visualization of an artery emerging from the anterior cerebral artery running parallel the corpus callosum (CC). The reference standard was the visualization of CC and PCA between the 20 and 22 weeks of gestation. We also performed a systematic review and meta-analysis of the published literature. Multivariate logistic regression and random-effect meta-analyses of proportion were used to analyze the data. RESULTS Cohort study: Five-hundred women were included. PCA was identified trans-abdominally or transvaginally at 11-14 weeks of gestation in 98.8% (95% CI 97.4-99.6: 494/500); of the four cases of PCA not identified one had a diagnosis of complete agenesis of the corpus callosum during the anomaly scan which was confirmed at birth. Systematic review of the published literature: Six studies (1093 fetuses, including the present series) were included. The PCA was detected at the 11-14 weeks scan and confirmed to co-exist with a normal CC at time of the anomaly scan in 96.9% (95% CI 93.8-99.0); 20.6% (95% CI 5.7-41.7) of fetuses with no clear identification of the PCA at the 11-14 weeks scan had a normal appearance of the CC at the time of anomaly scan. CONCLUSION Prenatal ultrasonography has a high diagnostic accuracy in detecting PCA in the first trimester. Visualization of the PCA at the time of 11-14 scan is highly specific for the presence of a normal CC later in pregnancy.
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Affiliation(s)
- Lorenzo Vasciaveo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata Università Roma Tor Vergata Roma, Rome, Italy
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Sara Alameddine
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Raffaella Di Girolamo
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Mariangela Candia
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Graziana De Lucia
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata Università Roma Tor Vergata Roma, Rome, Italy
| | - Marco Liberati
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Luigi Nappi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Francesco D'Antonio
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
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17
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Rizzo G, Mappa I, D'Antonio F, Di Mascio D. The combined use of ultrasound with magnetic resonance in the study of fetal brain: From the diagnosis towards the prognosis and beyond! JOURNAL OF CLINICAL ULTRASOUND 2022; 50:500-501. [PMID: 35521925 DOI: 10.1002/jcu.23157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata Università Roma Tor Vergata Roma, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata Università Roma Tor Vergata Roma, Rome, Italy
| | - Francesco D'Antonio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Di Mascio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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18
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Moradi B, Parooie F, Kazemi MA, Hashemi H, Miratashi Yazdi SN. Fetal brain imaging: A comparison between fetal ultrasonography and intra uterine magnetic resonance imaging (a systematic review and meta-analysis). JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:491-499. [PMID: 35266167 DOI: 10.1002/jcu.23158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study was to compare ultrasound (US) and intra uterine MRI (IUMRI) of the brain in the diagnosis of fetal brain abnormalities. METHODS The present systematic review is done based on guidelines for preferred reporting items for systematic reviews and meta-analysis. All major articles comparing fetal US with IUMRI in fetuses with suspected brain abnormalities were qualified. Articles published before 2010 were excluded from the study. An I2 > 20% was considered as a sign of significant change. The statistical analysis was done using STATA -15 and Meta-Disk 1.4 applications. RESULTS Five articles were considered for meta-analysis. The sensitivity of US and IUMRI in diagnosing fetal abnormalities were 86% and 95%, respectively. The corresponding rates for specificity were 77% and 80%. IUMRI and US were concordant in 72.5% (95% CI: 68%-77%) of diagnoses. However, IUMRI added information in 21.7% of cases, while US added value was only 1.48. CONCLUSION Our results approved the good diagnostic performance of both US and IUMRI in confirming fetal brain normal development and emphasized that US is an appropriate screening technique in pregnancy. In cases of detected abnormalities in US, IUMRI is suggested as it was the most accurate imaging method and added information about the diagnosis in 22.2% of cases.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Women's Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex(IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Parooie
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Ali Kazemi
- Department of Radiology, Women's Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Nooshin Miratashi Yazdi
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex(IKHC), Tehran University of Medical Sciences, Tehran, Iran
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19
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Di Mascio D, Buca D, Rizzo G, Khalil A, Timor-Tritsch IE, Odibo A, Mappa I, Flacco ME, Giancotti A, Liberati M, D'Antonio F. Methodological quality of fetal brain structure charts for screening examination and targeted neurosonography: a systematic review. Fetal Diagn Ther 2022; 49:145-158. [DOI: 10.1159/000521421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Introduction: The methodological quality of fetal brain charts has not been critically appraised yet.
Material and methods: MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to December 31, 2020. The primary outcome was to evaluate the methodology of the studies assessing the growth of fetal brain structures throughout gestation. A list of 28 methodological quality criteria divided into three domains according to “study design”, “statistical and reporting methods”, and “specific relevant neurosonography aspects” was developed in order to assess the methodological appropriateness of the included studies. The overall quality score was defined as the sum of low risk of bias marks, with the range of possible scores being 0–28. This quality assessment was applied to each individual study reporting reference ranges for fetal brain structures.
Results: Sixty studies were included in the systematic review. The overall mean quality score of the studies included in this review was 51.3%. When focusing on each of the assessed domains, the mean quality score was 53.7% for “study design”, 54.2% for “statistical and reporting methods” and 38.6% for “specific relevant neurosonography aspects”. The sample size calculation, the correlation with a postnatal imaging evaluation and the whole fetal brain assessment were the items at the highest risk of bias for each domain assessed, respectively. The subgroup analysis according to different anatomical location showed the lowest quality score for ventricular and periventricular structures and the highest for cortical structures.
Conclusions: Most previously published studies reporting fetal brain charts suffers from poor methodology and are at high risk of biases, mostly when focusing on neurosonography issues. Further prospective longitudinal studies aiming at constructing specific growth charts for fetal brain structures should follow rigorous methodology to minimize the risk of biases, guarantee higher levels of reproducibility and improve the standard of care.
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20
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Di Mascio D, Khalil A, Rizzo G, Kasprian G, Caulo M, Manganaro L, Odibo AO, Flacco ME, Giancotti A, Buca D, Liberati M, Timor-Tritsch IE, D'Antonio F. Reference ranges for fetal brain structures using magnetic resonance imaging: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:296-303. [PMID: 34405927 DOI: 10.1002/uog.23762] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the methodology of studies reporting reference ranges for fetal brain structures on magnetic resonance imaging (MRI). METHODS MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to 31 December 2020 to identify studies investigating biometry and growth of the fetal brain and reporting reference ranges for brain structures using MRI. The primary aim was to evaluate the methodology of these studies. A list of 26 quality criteria divided into three domains, including 'study design', 'statistical and reporting methods' and 'specific aspects relevant to MRI', was developed and applied to evaluate the methodological appropriateness of each of the included studies. The overall quality score of a study, ranging between 0 and 26, was defined as the sum of scores awarded for each quality criterion and expressed as a percentage (the lower the percentage, the higher the risk of bias). RESULTS Fifteen studies were included in this systematic review. The overall mean quality score of the studies evaluated was 48.7%. When focusing on each domain, the mean quality score was 42.0% for 'study design', 59.4% for 'statistical and reporting methods' and 33.3% for 'specific aspects relevant to MRI'. For the 'study design' domain, sample size calculation and consecutive enrolment of women were the items found to be at the highest risk of bias. For the 'statistical and reporting methods' domain, the presence of regression equations for mean and SD for each measurement, the number of measurements taken for each variable and the presence of postnatal assessment information were the items found to be at the highest risk of bias. For the 'specific aspects relevant to MRI' domain, whole fetal brain assessment was not performed in any of the included studies and was therefore considered to be the item at the highest risk of bias. CONCLUSIONS Most of the previously published studies reporting fetal brain reference ranges on MRI are highly heterogeneous and have low-to-moderate quality in terms of methodology, which is similar to the findings reported for ultrasound studies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - G Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - M Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. D'Annunzio' University, Chieti, Italy
| | - L Manganaro
- Department of Radiology, Sapienza University of Rome, Rome, Italy
| | - A O Odibo
- Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - M E Flacco
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - D Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - M Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - I E Timor-Tritsch
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, NY, USA
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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21
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Goncalves LF, Lindblade CL, Cornejo P, Patel MC, McLaughlin ES, Bardo DME. Contribution of fetal magnetic resonance imaging in fetuses with congenital heart disease. Pediatr Radiol 2022; 52:513-526. [PMID: 34842935 DOI: 10.1007/s00247-021-05234-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing evidence supports an association among congenital heart disease (CHD), structural brain lesions on neuroimaging, and increased risk of neurodevelopmental delay and other structural anomalies. Fetal MRI has been found to be effective in demonstrating fetal structural and developmental abnormalities. OBJECTIVE To determine the contribution of fetal MRI to identifying cardiovascular and non-cardiovascular anomalies in fetuses with CHD compared to prenatal US and fetal echocardiography. MATERIALS AND METHODS We performed a retrospective study of fetuses with CHD identified by fetal echocardiography. Exams were performed on 1.5-tesla (T) or 3-T magnets using a balanced turbo field echo sequence triggered by an external electrocardiogram simulator with a fixed heart rate of 140 beats per minute (bpm). Fetal echocardiography was performed by pediatric cardiologists and detailed obstetrical US by maternal-fetal medicine specialists prior to referral to MRI. We compared the sensitivity of fetal MRI and fetal echocardiography for the diagnosis of cardiovascular anomalies, as well as the sensitivity of fetal MRI and referral US for the diagnosis of non-cardiac anomalies. We performed statistical analysis using the McNemar test. RESULTS We identified 121 anomalies in 31 fetuses. Of these, 73 (60.3%) were cardiovascular and 48 (39.7%) involved other organ systems. Fetal echocardiography was more sensitive for diagnosing cardiovascular anomalies compared to fetal MRI, but the difference was not statistically significant (85.9%, 95% confidence interval [CI] 77.8-94.0% vs. 77.5%, 95% CI 67.7-87.2%, respectively; McNemar test 2.29; P=0.13). The sensitivity of fetal MRI was higher for diagnosing extracardiac anomalies when compared to referral US (84.1%, 95% CI 73.3-94.9% vs. 31.8%, 95% CI 18.1-45.6%, respectively; McNemar test 12.9; P<0.001). The additional information provided by fetal MRI changed prognosis, counseling or management for 10/31 fetuses (32.2%), all in the group of 19 fetuses with anomalies in other organs and systems besides CHD. CONCLUSION Fetal MRI performed in a population of fetuses with CHD provided additional information that altered prognosis, counseling or management in approximately one-third of the fetuses, mainly by identifying previously unknown anomalies in other organs and systems.
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Affiliation(s)
- Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
- University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, Creighton University, Phoenix, AZ, USA.
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA.
| | - Christopher L Lindblade
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Mittun C Patel
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ericka Scheller McLaughlin
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dianna M E Bardo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
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22
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D'Antonio F, Di Mascio D, Rizzo G. Should we expand indications for targeted fetal neurosonography? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:274-276. [PMID: 35104926 DOI: 10.1002/uog.24840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/18/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Affiliation(s)
- F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - G Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, University of Rome, Tor Vergata, Rome, Italy
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Di Mascio D, Khalil A, Pilu G, Rizzo G, Caulo M, Liberati M, Giancotti A, Lees C, Volpe P, Buca D, Oronzi L, D'Amico A, Tinari S, Stampalija T, Fantasia I, Pasquini L, Masini G, Brunelli R, D'Ambrosio V, Muzii L, Manganaro L, Antonelli A, Ercolani G, Ciulla S, Saccone G, Maruotti GM, Carbone L, Zullo F, Olivieri C, Ghi T, Frusca T, Dall'Asta A, Visentin S, Cosmi E, Forlani F, Galindo A, Villalain C, Herraiz I, Sileo FG, Mendez Quintero O, Salsi G, Bracalente G, Morales-Roselló J, Loscalzo G, Pellegrino M, De Santis M, Lanzone A, Parazzini C, Lanna M, Ormitti F, Toni F, Murru F, Di Maurizio M, Trincia E, Garcia R, Bennike Bjørn Petersen O, Neerup L, Sandager P, Prefumo F, Pinelli L, Mappa I, Acuti Martellucci C, Flacco ME, Manzoli L, Giangiordano I, Nappi L, Scambia G, Berghella V, D'Antonio F. Role of prenatal magnetic resonance imaging in fetuses with isolated severe ventriculomegaly at neurosonography: A multicenter study. Eur J Obstet Gynecol Reprod Biol 2021; 267:105-110. [PMID: 34773875 DOI: 10.1016/j.ejogrb.2021.10.014] [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: 05/22/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to report the rate of additional anomalies detected exclusively at prenatal magnetic resonance imaging (MRI) in fetuses with isolated severe ventriculomegaly undergoing neurosonography. METHOD Multicenter, retrospective, cohort study involving 20 referral fetal medicine centers in Italy, United Kingdom, Spain and Denmark. Inclusion criteria were fetuses affected by isolated severe ventriculomegaly (≥15 mm), defined as ventriculomegaly with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on ultrasound. In all cases, a multiplanar assessment of fetal brain as suggested by ISUOG guidelines on fetal neurosonography had been performed. The primary outcome was the rate of additional CNS anomalies detected exclusively at fetal MRI within two weeks from neurosonography. Subgroup analyses according to gestational age at MRI (<vs ≥ 24 weeks of gestation) and the laterality of ventriculomegaly (unilateral vs bilateral) were also performed. Univariate and multivariate logistic regression analysis was used to analyze the data. RESULTS 187 fetuses with a prenatal diagnosis of isolated severe ventriculomegaly on neurosonography were included in the analysis. Additional structural anomalies were detected exclusively at prenatal MRI in 18.1% of cases. When considering the type of anomaly, malformations of cortical development were detected on MRI in 32.4% cases, while midline or acquired (hypoxemic/hemorrhagic) lesions were detected in 26.5% and 14.7% of cases, respectively. There was no difference in the rate of additional anomalies when stratifying the analysis according to either gestational age at MRI or laterality of the lesion. At multivariate logistic regression analysis, the presence of additional anomalies only found at MRI was significantly higher in bilateral compared versus unilateral ventriculomegaly (OR: 4.37, 95% CI 1.21-15.76; p = 0.04), while neither maternal body mass index, age, severity of ventricular dilatation, interval between ultrasound and MRI, nor gestational age at MRI were associated with the likelihood of detecting associated anomalies at MRI. CONCLUSION The rate of associated anomalies detected exclusively at prenatal MRI in fetuses with isolated severe ventriculomegaly is lower than previously reported, but higher compared to isolated mild and moderate ventriculomegaly. Fetal MRI should be considered as a part of the prenatal assessment of fetuses presenting with isolated severe ventriculomegaly at neurosonography.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
| | - Gianluigi Pilu
- Unit of Obstetrics, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy; Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. D'Annunzio" University of Chieti, Italy
| | - Marco Liberati
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Christoph Lees
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Danilo Buca
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Ludovica Oronzi
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Alice D'Amico
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Tinari
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Lucia Pasquini
- Fetal Medicine Unit, Department for Women and Children Health, AOU Careggi, Florence, Italy
| | - Giulia Masini
- Fetal Medicine Unit, Department for Women and Children Health, AOU Careggi, Florence, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Amanda Antonelli
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Giada Ercolani
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Sandra Ciulla
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Italy
| | | | - Tullio Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Italy
| | - Andrea Dall'Asta
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Italy
| | - Silvia Visentin
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Erich Cosmi
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Francesco Forlani
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Filomena Giulia Sileo
- Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom; Department of Biochemical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Ginevra Salsi
- Unit of Obstetrics, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Gabriella Bracalente
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Osp. Cà Foncello Treviso, Italy
| | - José Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría Obstetricia y Ginecología, Universidad de Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría Obstetricia y Ginecología, Universidad de Valencia, Spain
| | - Marcella Pellegrino
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco De Santis
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Università di Milano, Italy
| | - Mariano Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Children's Hospital, V. Buzzi Università di Milano, Italy
| | - Francesca Ormitti
- Department of Radiology - Azienda Ospedaliera Universitaria di Parma, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche UOC Neuroradiologia, Bologna, Italy
| | - Flora Murru
- Unit of Paediatric Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Italy
| | | | - Elena Trincia
- UOC Neuroradiologia, Osp. Cà Foncello Treviso, Italy
| | - Raquel Garcia
- Complejo Hospitalario Universitario Insular - Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Olav Bennike Bjørn Petersen
- Center for Fetal Medicine and Ultrasound, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lisa Neerup
- Center for Fetal Medicine and Ultrasound, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Puk Sandager
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Lorenzo Pinelli
- Neuroradiology Unit, Pediatric Neuroradiology Section, ASST Spedali Civili, Brescia, Italy
| | - Ilenia Mappa
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | - Ilaria Giangiordano
- Department of Child and Adolescent Neuropsychiatry, Local Health Unit of Avezzano-Sulmona-L'Aquila, Sulmona, Italy
| | - Luigi Nappi
- Fetal Medicine Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giovanni Scambia
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA
| | - Francesco D'Antonio
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy.
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Role of prenatal magnetic resonance imaging in fetuses with isolated anomalies of corpus callosum: multinational study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:26-33. [PMID: 33596324 DOI: 10.1002/uog.23612] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the performance of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses diagnosed with isolated corpus callosal (CC) anomaly on multiplanar ultrasound evaluation of the fetal brain (neurosonography). METHODS This was a multicenter, retrospective cohort study involving 14 fetal medicine centers in Italy, UK, Portugal, Canada, Austria and Spain. Inclusion criteria were fetuses with an apparently isolated CC anomaly, defined as an anomaly of the CC and no other additional central nervous system (CNS) or extra-CNS abnormality detected on expert ultrasound, including multiplanar neurosonography; normal karyotype; maternal age ≥ 18 years; and gestational age at diagnosis ≥ 18 weeks. The primary outcome was the rate of additional CNS abnormalities detected exclusively on fetal MRI within 2 weeks following neurosonography. The secondary outcomes were the rate of additional abnormalities according to the type of CC abnormality (complete (cACC) or partial (pACC) agenesis of the CC) and the rate of additional anomalies detected only on postnatal imaging or at postmortem examination. RESULTS A total of 269 fetuses with a sonographic prenatal diagnosis of apparently isolated CC anomalies (207 with cACC and 62 with pACC) were included in the analysis. Additional structural anomalies of the CNS were detected exclusively on prenatal MRI in 11.2% (30/269) of cases, with malformations of cortical development representing the most common type of anomaly. When stratifying the analysis according to the type of CC anomaly, the rate of associated anomalies detected exclusively on MRI was 11.6% (24/207) in cACC cases and 9.7% (6/62) in pACC cases. On multivariate logistic regression analysis, only maternal body mass index was associated independently with the likelihood of detecting associated anomalies on MRI (odds ratio, 1.07 (95% CI, 1.01-1.14); P = 0.03). Associated anomalies were detected exclusively after delivery and were missed on both types of prenatal imaging in 3.9% (8/205) of fetuses with prenatal diagnosis of isolated anomaly of the CC. CONCLUSION In fetuses with isolated anomaly of the CC diagnosed on antenatal neurosonography, MRI can identify a small proportion of additional anomalies, mainly malformations of cortical development, which are not detected on ultrasound. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Di Mascio D, Buca D, D'Antonio F. Moving beyond the diatribe on ultrasound vs MRI. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:175-176. [PMID: 33387403 DOI: 10.1002/uog.23560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023]
Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - D Buca
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - F D'Antonio
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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