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Micheletti T, Castro PT, Araujo Júnior E, Castellano MA, Andrade CF, Werner H. Fetal cervical sarcoma: Comparison between virtual and real fetal bronchoscopy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39180358 DOI: 10.1002/jcu.23806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/10/2024] [Indexed: 08/26/2024]
Abstract
Fetal cervical tumors are a life-threatening condition if proper diagnosis and perinatal care are inadequate. The most common causes of fetal cervical masses are teratomas and lymphangiomas. Less common tumors may obstruct the fetal airway due to cervical compression. In this case report, a fetus with a cervical sarcoma was evaluated by ultrasound and MRI. The prenatal imaging characteristics of the tumor were described, virtual navigation of the fetal airway was performed and compared with fetal bronchoscopy to evaluate the consistency of the tumor. Neonatal outcome was also described.
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Affiliation(s)
- Talita Micheletti
- Celso Rigo Maternal Fetal Institute, Santa Casa of Porto Alegre, Porto Alegre, Brazil
| | - Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, Brazil
| | - Marco Aurélio Castellano
- Diagnostic Imaging Center, Santo Antônio Children's Hospital/Santa Casa of Porto Alegre, Porto Alegre, Brazil
| | - Cristiano Feijó Andrade
- Pediatric Thoracic Surgery Service, Santo Antônio Children's Hospital/Santa Casa of Porto Alegre, Porto Alegre, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
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Varela MF, Pinzon-Guzman C, Riddle S, Parikh R, McKinney D, Rutter M, Lim FY, Peiro JL. EXIT-to-airway: Fundamentals, prenatal work-up, and technical aspects. Semin Pediatr Surg 2021; 30:151066. [PMID: 34172204 DOI: 10.1016/j.sempedsurg.2021.151066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ex-utero intrapartum treatment (EXIT) is a delivery strategy developed to manage a variety of prenatally diagnosed conditions in the transition to newborn life. This procedure allows control and provides time for intervention in otherwise life-threatening malformations, such as congenital upper airway obstructions. EXIT-to-airway has changed the outcome of fetuses with these anomalies. The main purpose of this intervention is to improve the safety of establishing a reliable airway at birth. Maximal but controlled uterine relaxation to maintain feto-maternal perfusion and thus gas exchange, while keeping the fetal and maternal well-being are the paradigms of any type of EXIT. The most important aspect of fetal airway management is to consolidate a highly trained, well-coordinated, multidisciplinary team that is prepared for every contingency. A comprehensive prenatal assessment, including ultrasound, fetal echocardiogram, fetal MRI, and genetic testing is imperative for patient selection. Extensive preoperative planning, ad-hoc team meetings, and surgical simulations for challenging cases are critical strategies to achieve the best outcomes. This article outlines the prenatal work-up, decision making, technical aspects, and principles for a successful EXIT-to-airway procedure.
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Affiliation(s)
- Maria Florencia Varela
- The Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, USA
| | - Carolina Pinzon-Guzman
- The Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, USA; Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Stefanie Riddle
- Division of Neonatology, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA.; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rupi Parikh
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David McKinney
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Rutter
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jose L Peiro
- The Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, USA; Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Bao Y, Wan W, Li Q, Hu Q, Pang Y, Wang J, Tang D, Xia L, Sun Z. MR Virtual Endoscopy of the Fetal Limb Anomalies Using Three-Dimensional Fast Imaging Employing Steady-State Acquisition Sequence. Fetal Diagn Ther 2021; 48:333-341. [PMID: 33895744 DOI: 10.1159/000514327] [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: 02/24/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To retrospectively investigate the feasibility of magnetic resonance virtual endoscopy (MRVE) to visualize the normal limbs and limb deformities Methods: MR sequences included two-dimensional (2D) single fast spin-echo sequence and 2D and 3D steady-state procession fast imaging sequences. MRVE reconstruction was retrospectively performed by 2 radiologists in 32 fetuses in 30 pregnant women. The correlation between the radiologists for the virtual endoscopy threshold of MRVE was determined. Image quality and limb segment visibility were independently rated. Area under the receiver operating characteristics curve (AUC) of 2D MRI and MRVE was calculated. RESULTS The mean virtual endoscopy threshold required for the visualization of the limb was 991.93 ± 12.13 and 991.83 ± 12.26 for 2 radiologists, respectively. The correlation between the radiologists for virtual endoscopy threshold was excellent (r = 0.933). The weighted kappa statistic was 0.96 for the evaluation of image quality of limb segments, indicating excellent interobserver agreement. Compared to that of 2D MRI alone, a higher AUC of 2D MRI with MRVE was achieved in detection of both upper and lower limb deformities (0.91 vs. 0.69 and 0.83 vs. 0.71, respectively). CONCLUSION MRVE may display normal and abnormal fetal limb orientation and structures from multiple perspectives and provide incremental information for obstetrics.
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Affiliation(s)
- Yuwei Bao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Wan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiongjie Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Pang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyan Sun
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Werner H, Castro P, Daltro P, Lopes J, Ribeiro G, Araujo Júnior E. Prenatal diagnosis of Apert syndrome using ultrasound, magnetic resonance imaging, and three-dimensional virtual/physical models: three case series and literature review. Childs Nerv Syst 2018; 34:1563-1571. [PMID: 29441430 DOI: 10.1007/s00381-018-3740-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This aimed to describe the prenatal diagnosis of three cases of Apert syndrome using two-dimensional (2D) and three-dimensional (3D) ultrasound, magnetic resonance imaging (MRI), and 3D virtual/physical models. METHODS We retrospectively analyzed three cases of Apert syndrome at our service. The prenatal diagnostic methods used were 2D ultrasound, 3D ultrasound in conventional and HDlive rendering modes, T2-weighted MRI sequences, and 3D virtual/physical models from MRI or 3D ultrasound scan data. All imaging methods were performed by one observer. All prenatal diagnoses were confirmed by autopsy in cases of termination of pregnancy or genetic assessment during the postnatal period. RESULTS Mean ± standard deviation of maternal and gestational age at the time of diagnosis was 36.5 ± 3.5 years and 32 ± 4.2 weeks, respectively. Main 2D/3D ultrasound and MRI findings were craniosynostosis, hypertelorism, low ear implantation, increased kidneys dimensions, and syndactyly of hands and feet. 3D virtual/physical models allowed 3D view of fetal head and extremity abnormalities. Termination of pregnancy occurred in two cases. CONCLUSION Prenatal 3D ultrasound and MRI enabled the identification of all Apert syndrome phenotypes. 3D virtual/physical models provided both the parents and the medical team a better understanding of fetal abnormalities.
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Affiliation(s)
- Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Pedro Castro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Pedro Daltro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Jorge Lopes
- Department of Arts and Design, Pontifícia Universidade Católica (PUC Rio), Rio de Janeiro, RJ, Brazil
| | - Gerson Ribeiro
- Department of Arts and Design, Pontifícia Universidade Católica (PUC Rio), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
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Tonni G, Ruano R, Sà R, Peixoto Filho FM, Lopes J, Werner H. 3D Virtual Broncoscopy before FETO Procedure in a Fetus with Severe, Isolated Left Congenital Diaphragmatic Hernia. Fetal Pediatr Pathol 2018; 37:134-139. [PMID: 29608113 DOI: 10.1080/15513815.2018.1445148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) is a life-threatening event in severe forms and fetuses affected may benefit from in utero treatment by fetoscopic endotracheal occlusion (FETO). MATERIALS AND METHODS Application of 3D virtual bronchoscopy in a case of severe, isolated, left CDH before performing FETO procedure at 27 week's gestation is reported. RESULTS The 3D virtual imaging of the fetal trachea was technically useful in planning the real FETO procedure. FETO successfully promoted fetal lung growth by decreasing the herniation of abdominal organs into the thorax and decreasing the risk of pulmonary hypoplasia. Ultrasound calculation of lung to head ratio (LHR) and fetal-MRI were used to assess lung development following FETO procedure. CONCLUSION 3D virtual fetal reality enabled the fetal surgeon to review and navigate on demand inside the upper airway, reducing the risk of unexpected intervention complications.
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Affiliation(s)
- Gabriele Tonni
- a AUSL Reggio Emilia, Obstetrics & Gynceology , Guastalla , Italy
| | - Rodrigo Ruano
- b Maternal-Fetal medicine, Mayo Clinic, Obstetrics and Gynecology , Rochester , USA
| | - Renato Sà
- c Universidade Federal Fluminense Niteroi, Obstetrics and Gynecology , Rio de Janeiro , Brazil
| | | | - Jorge Lopes
- e Pontificia Universidade Catolica do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Heron Werner
- f Clínica de Diagnóstico por Imagem (CDPI), Radiology , Rio de Janeiro , Brazil
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Tonni G, Granese R, Martins Santana EF, Parise Filho JP, Bottura I, Borges Peixoto A, Giacobbe A, Azzerboni A, Araujo Júnior E. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med 2017; 45:149-165. [PMID: 27508950 DOI: 10.1515/jpm-2016-0074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/19/2016] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. METHODS PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. RESULTS A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%. CONCLUSION Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good prognosis.
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Werner H, Mocarzel C, Sá RA, Tonni G, Novoa Y Novoa VA, Avvad-Portari E, Bonasoni P, Araujo Júnior E. Antenatal Diagnosis of a Large Immature Abdominal Wall Teratoma by 2D-3D Ultrasound Using HDlive and Magnetic Resonance Imaging. Fetal Pediatr Pathol 2016; 35:434-441. [PMID: 27560103 DOI: 10.1080/15513815.2016.1214199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We describe the first case of prenatally detected teratoma of the fetal abdomen wall using ultrasound and fetal magnetic resonance imaging (MRI). A heterogeneous mass, partly solid and cystic, originating from the anterior abdominal wall of the fetus close to an omphalocele sac was detected by means of 2D/3D ultrasound and MRI. Amniodrainage was performed and due to sign of impending fetal risk, an emergency Cesarean section was performed. A bulky, crumbly and bleeding tumoral mass was confirmed at delivery. Ligation of the supplying artery to the tumor was complicated by uncontrollable hemorrhage and early neonatal death. Pathology identified the tumor as an immature teratoma of the anterior fetal abdominal wall. 2D/3D ultrasound, especially using HDlive application and MRI demonstrated accurate detection and characterization of this congenital tumor.
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Affiliation(s)
- Heron Werner
- a Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Carolina Mocarzel
- b Obstetrics, Hospital Federal Servidores do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Renato Augusto Sá
- c Obstetrics & Gynecology , Clínica Perinatal Laranjeiras , Rio de Janeiro , Brazil
| | - Gabriele Tonni
- d Obstetrics & Gynaecology , Guastalla Civil Hospital , Reggio Emilia , Italy
| | | | | | - Paola Bonasoni
- g Pathology , Arcispedale S. Maria Nuova , Reggio Emilia , Italy
| | - Edward Araujo Júnior
- e Obstetrics, Paulista School of Medicine - Federal University of São Paulo , Sao Paulo , Brazil
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