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Prayer F, Watzenböck ML, Heidinger BH, Rainer J, Schmidbauer V, Prosch H, Ulm B, Rubesova E, Prayer D, Kasprian G. Fetal MRI radiomics: non-invasive and reproducible quantification of human lung maturity. Eur Radiol 2023; 33:4205-4213. [PMID: 36604329 PMCID: PMC10182107 DOI: 10.1007/s00330-022-09367-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To assess the reproducibility of radiomics features extracted from the developing lung in repeated in-vivo fetal MRI acquisitions. METHODS In-vivo MRI (1.5 Tesla) scans of 30 fetuses, each including two axial and one coronal T2-weighted sequences of the whole lung with all other acquisition parameters kept constant, were retrospectively identified. Manual segmentation of the lungs was performed using ITK-Snap. One hundred radiomics features were extracted from fetal lung MRI data using Pyradiomics, resulting in 90 datasets. Intra-class correlation coefficients (ICC) of radiomics features were calculated between baseline and repeat axial acquisitions and between baseline axial and coronal acquisitions. RESULTS MRI data of 30 fetuses (12 [40%] females, 18 [60%] males) at a median gestational age of 24 + 5 gestational weeks plus days (GW) (interquartile range [IQR] 3 + 3 GW, range 21 + 1 to 32 + 6 GW) were included. Median ICC of radiomics features between baseline and repeat axial MR acquisitions was 0.92 (IQR 0.13, range 0.33 to 1), with 60 features exhibiting excellent (ICC > 0.9), 27 good (> 0.75-0.9), twelve moderate (0.5-0.75), and one poor (ICC < 0.5) reproducibility. Median ICC of radiomics features between baseline axial and coronal MR acquisitions was 0.79 (IQR 0.15, range 0.2 to 1), with 20 features exhibiting excellent, 47 good, 29 moderate, and four poor reproducibility. CONCLUSION Standardized in-vivo fetal MRI allows reproducible extraction of lung radiomics features. In the future, radiomics analysis may improve diagnostic and prognostic yield of fetal MRI in normal and pathologic lung development. KEY POINTS • Non-invasive fetal MRI acquired using a standardized protocol allows reproducible extraction of radiomics features from the developing lung for objective tissue characterization. • Alteration of imaging plane between fetal MRI acquisitions has a negative impact on lung radiomics feature reproducibility. • Fetal MRI radiomics features reflecting the microstructure and shape of the fetal lung could complement observed-to-expected lung volume in the prediction of postnatal outcome and optimal treatment of fetuses with abnormal lung development in the future.
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Affiliation(s)
- Florian Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Martin L Watzenböck
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Benedikt H Heidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Julian Rainer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Victor Schmidbauer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Barbara Ulm
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Vienna, Austria
| | - Erika Rubesova
- Department of Pediatric Radiology, Lucile Packard Children's Hospital at Stanford, Stanford University, 725 Welch Road, Stanford, CA, 94305, USA
| | - Daniela Prayer
- Imaging Bellaria, Bellariastrasse 3, 1010, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Eshiba SM, Zahran MH, Elnekeidy AM, Abdeldayem TM, Hassan HHM. Added value of fetal MRI as a complementary method to antenatal ultrasound in the assessment of non-CNS fetal congenital anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Birth defects and congenital anomalies are different words used to describe developmental abnormalities that occur at birth. Congenital anomalies diagnosis during pregnancy is a difficult topic to which ultrasonography has made significant contributions. The availability of a generally safe, independent technique in the evaluation of prenatal anomalies would be a welcomed clinical and scientific alternative. Ultrasound (US) is the predominant modality for evaluating disorders related to fetus and pregnancy. In most situations, this examination by a professional operator offers sufficient information about fetal morphology, surroundings, and well-being. The abnormalities revealed by ultrasound can be subtle or inconclusive at times. MRI has been demonstrated to be useful in such circumstances in various studies. So the effective use of fetal MRI in the evaluation of non-CNS abnormalities of the body is a reason for adopting fetal MRI as an adjunct to US in obstetric imaging. This study aimed to examine the role of fetal MRI as a complementary method to the antenatal US in assessing non-CNS anomalies and how it changed or modified the diagnosis of anomalies.
Results
By analyzing the data of 30 pregnant females with fetal non-CNS congenital anomalies, the diagnostic accuracy of prenatal ultrasound alone in the detection of congenital anomalies was 76%, with a sensitivity of about 76%. And diagnostic accuracy of MRI alone was 96.6%, with a sensitivity of approximately 96.6%. Moreover, the diagnostic accuracy of combined prenatal US and prenatal MRI in the detection of congenital anomalies was 100%, with sensitivity about 100% and PPV about 100%.
Conclusion
Fetal MRI raises confidence in non-CNS malformation assessment. Compared to US, MRI overcomes many of the obstacles faced by the antenatal US. MRI is superior to the US in refining, changing, or adding more diagnostic information about the disease.
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Amodeo I, Borzani I, Raffaeli G, Persico N, Amelio GS, Gulden S, Colnaghi M, Villamor E, Mosca F, Cavallaro G. The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia. Eur J Pediatr 2022; 181:3243-3257. [PMID: 35794403 PMCID: PMC9395465 DOI: 10.1007/s00431-022-04540-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022]
Abstract
UNLABELLED In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity. CONCLUSION Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment. WHAT IS KNOWN • MRI plays a key role in evaluating the fetal lung in patients with CDH. • Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling. WHAT IS NEW • Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction. • Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.
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Affiliation(s)
- Ilaria Amodeo
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Irene Borzani
- grid.414818.00000 0004 1757 8749Pediatric Radiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Persico
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy ,grid.414818.00000 0004 1757 8749Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Simeone Amelio
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Silvia Gulden
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Mariarosa Colnaghi
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Eduardo Villamor
- grid.412966.e0000 0004 0480 1382Department of Pediatrics, School for Oncology and Reproduction (GROW), Maastricht University Medical Center, University of Maastricht, MUMC+), Maastricht, the Netherlands
| | - Fabio Mosca
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy.
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Aboughalia H, Pathak P, Basavalingu D, Chapman T, Revzin MV, Sienas LE, Deutsch GH, Katz DS, Moshiri M. Imaging Review of Obstetric Sequelae of Maternal Diabetes Mellitus. Radiographics 2021; 42:302-319. [PMID: 34855544 DOI: 10.1148/rg.210164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetes mellitus, whether preexisting or gestational, poses significant risk to both the mother and the developing fetus. A myriad of potential fetal complications in the setting of diabetic pregnancies include, among others, congenital anomalies, delayed fetal lung maturity, macrosomia, and increased perinatal morbidity and mortality. Congenital anomalies most commonly involve the nervous, cardiovascular, genitourinary, and musculoskeletal systems. Delayed fetal lung maturity, probably secondary to hyperglycemia suppressing surfactant secretion, is a major determinant of perinatal morbidity and mortality. Besides the potential complications encountered during cesarean delivery in macrosomic fetuses, vaginal delivery is also associated with increased risks of shoulder dystocia, clavicular and humeral fractures, and brachial plexus palsy. Maternal complications are related to the increased risk of hypertensive diseases of pregnancy and associated preeclampsia and hemolysis, elevated liver function, and low platelets (HELLP) syndrome, as well as complications encountered at the time of delivery secondary to fetal macrosomia and cesarean delivery. Additional conditions encountered in the setting of maternal diabetes include polyhydramnios, placental thickening, and two-vessel umbilical cord, each of which is associated with adverse fetal and maternal outcomes including fetal growth restriction, preterm labor, placental abruption, and premature rupture of membranes. Imaging plays a vital role in the evaluation of the mother and the fetus and can provide invaluable information that can be used by maternal fetal medicine to manage this patient population effectively. The authors review the pathophysiologic alterations induced by diabetes in pregnancy, discuss the imaging spectrum of diabetic embryopathy, and provide a detailed review of potential associated maternal complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hassan Aboughalia
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Priya Pathak
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Deepashri Basavalingu
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Teresa Chapman
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Margarita V Revzin
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Laura E Sienas
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Gail H Deutsch
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
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Moradi B, Ghorbani Z, Shirazi M, Gity M, Kazemi MA, Sharifian H, Rahimi Sharbaf F. Comparison of fetal lung maturation in fetuses with intrauterine growth restriction with control group, using lung volume, lung/liver and lung/muscle signal intensity and apparent diffusion coefficient ratios on different magnetic resonance imaging sequences. J Matern Fetal Neonatal Med 2021; 35:8936-8944. [PMID: 34847801 DOI: 10.1080/14767058.2021.2008349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare lung volume, lung apparent diffusion coefficient (ADC) and signal intensity ratio (SIR) on different magnetic resonance imaging (MRI) sequences between intrauterine growth restriction (IUGR) fetuses and the control group. MATERIALS AND METHODS 49 IUGR and 58 non-IUGR fetuses were imaged using 3 Tesla MRI units. Total lung volume (TLV), lung/liver SIR (LLSIR) and lung/muscle SIR (LMSIR) in T1 and T2-weighted sequences and lung/liver ADC ratio (LLADCR) and lung/muscle ADC ratio (LMADCR) were assessed. RESULTS LLSIR and LMSIR were significantly higher in the T1-weighted sequence (p-value: .03) and LLADCR and LMADCR were significantly lower on diffusion-weighted imaging (DWI) in IUGR fetuses compared to the control group (p-value: .01). There was no significant difference in SIRs in the T2-weighted sequence between the two groups. Although TLV was increased with gestational age in both groups, it was significantly lower in the IUGR group (mean: 82 ± 22.7 ml vs. 110.8 ± 18 ml, p-value: <.001). CONCLUSION The T1-weighted sequence and DWI seem to be better than the T2-weighted sequence for assessing the faint difference of lung maturity between groups. However, SIR differences were not as meaningful as TLV differences and this could be related to the complex maturation process in IUGR fetuses as the effect of higher endogenous corticosteroids.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Ghorbani
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Gity
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sharifian
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahimi Sharbaf
- Maternal, Fetal and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Sakuma J, Nakata M, Takano M, Nagasaki S, Hayata E, Maemura T, Ohtsu M, Morita M. Prenatal evaluation of functional pulmonary hypoplasia via fetal magnetic resonance imaging. J Obstet Gynaecol Res 2021; 47:3100-3106. [PMID: 34109704 DOI: 10.1111/jog.14833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to retrospectively examine the use of lung-to-liver signal intensity ratio (LLSIR) on T2-weighted images to predict functional pulmonary hypoplasia. METHODS The subjects of this study were pregnant women who underwent magnetic resonance imaging (MRI). Patients who required nitric oxide inhalation and those who died from respiratory disorders were classified as having functional pulmonary hypoplasia (FPH). All other cases were presented as the control group. We retrospectively analyzed MRI and perinatal data. LLSIR was defined as the ratio of lung signal intensity to liver signal intensity. We examined the relationship between LLSIR and gestational age, compared the LLSIRs in the two groups, and calculated the best cut-off value of the LLSIR to predict FPH. RESULTS One hundred and ninety-one patients were eligible for this study, and 12 cases were classified as having FPH. In the control group, LLSIR increased with age (r = 0.383, p < 0.001). We used the observed/expected LLSIR (o/e LLSIR), which was the ratio of obtained LLSIR to expected LLSIR calculated by the regression line to correct the effect of gestational age. In the FHP group, o/e LLSIR was significantly lower than in the control group (p < 0.001). A receiver operating characteristic curve analysis showed that cases with o/e LLSIR above 0.85 were less likely to cause FPH. CONCLUSIONS Low o/e LLSIR might reflect the histological characteristics of hypoplastic lung structures. O/e LLSIR seems to be a useful MRI parameter for screening FPH.
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Affiliation(s)
- Junya Sakuma
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
| | - Sumito Nagasaki
- Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
| | - Toshimitsu Maemura
- Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
| | - Motoharu Ohtsu
- Department of Radiology, Toho University Omori medical center, Tokyo, Japan
| | - Mineto Morita
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori medical center, Tokyo, Japan
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Ercolani G, Capuani S, Antonelli A, Camilli A, Ciulla S, Petrillo R, Satta S, Grimm R, Giancotti A, Ricci P, Catalano C, Manganaro L. IntraVoxel Incoherent Motion (IVIM) MRI of fetal lung and kidney: Can the perfusion fraction be a marker of normal pulmonary and renal maturation? Eur J Radiol 2021; 139:109726. [PMID: 33895624 DOI: 10.1016/j.ejrad.2021.109726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the use of IntraVoxel Incoherent Motion (IVIM) MRI in the study of microstructural tissue changes occurring in fetal lung and kidney during gestation. METHODS 34 normal pregnancies were enrolled. Patients were divided into two groups based on gestational age (GA): group A (21-29 weeks) and group B (30-39 weeks). MR examinations were performed at 1.5T, with a standard fetal MR protocol including a Diffusion-Weighted Echo-Planar Imaging sequence with 10 different b-values (0, 10, 30, 50, 75, 100, 200, 400, 700, 1000s/mm2). For each fetus, two bilateral ROIs were manually placed in lung and renal parenchyma. Mean values of perfusion fraction f, pseudo-diffusion coefficient D* and diffusion coefficient D were obtained. The correlation between IVIM parameters and GA was investigated. RESULTS In renal ROIs a positive correlation between fkidney and GA (p < 0.005) was found; similarly flung showed a statistically significant correlation with GA (p < 0.001). F mean values were significantly higher in group B compared to group A in both renal (p = 0.0002) and lung (p = 0.018) ROIs. No correlation was found in D and D* as a function of GA. CONCLUSIONS The IVIM perfusion fraction f may be considered as a potential marker of pulmonary and renal maturation in relation to hemodynamic changes described in intrauterine life. Our results highlight that IVIM model is useful as an additional prenatal diagnostic tool to study lung and renal development.
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Affiliation(s)
- Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Silvia Capuani
- CNR ISC, Physics Department, "Sapienza" University of Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Arianna Camilli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Roberta Petrillo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | | | - Antonella Giancotti
- Department of Gynecological-Obstetrical and Urological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy.
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Gupta S, Mohi JK, Gambhir P, Mohi MK. Prenatal diagnosis of congenital anomalies of genito-urinary system on fetal magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00278-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
The aim of this study is to elucidate the spectrum of commonly encountered anomalies affecting fetal genito-urinary system (GUS) on fetal MRI and examine its utility in providing better morphological information resulting in improved diagnostic accuracy and in detecting additional malformations. The study also aims to highlight the promising role of fetal MRI in the detection and characterization of renal fusion anomalies like the horseshoe kidney or developmental abnormalities such as renal agenesis/ectopia.
Results
The mean age of study participants was 29 years ± 3 years. The gestation age of pregnant mothers ranged from 18 weeks and 1 day to 39 weeks and 0 day. Amniotic fluid was reduced or absent in 41% (N = 13) and normal in 59% (N = 18) of participating mothers. Overall, urinary obstruction was the commonest anomaly encountered (29%) followed by the multicystic dysplastic kidney (MCDK) (22%). Bilateral renal disease was seen in all mothers having features of anhydramnios {B/L MCDK (N = 3), autosomal recessive polycystic kidney disease (ARPKD) (N = 2), posterior urethral valves (PUV) (N = 2), B/L renal agenesis (N = 3), and megacystis (N = 1)}. Fusion anomalies (horseshoe kidney) and rotation anomaly (malrotation) were detected in one case each. Additional extrarenal findings were seen on fetal MRI in 35% (N = 11) cases.
Conclusions
Fetal MRI improves diagnostic accuracy in anomalies affecting the fetal kidney and genito-urinary systems by better morphological delineation. It has the ability to detect additional extra-renal malformations and perform a more accurate assessment of associated pulmonary hypoplasia. The diffusion-weighted sequence is particularly useful in confirming the diagnosis of renal agenesis/ectopia.
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Dütemeyer V, Cordier AG, Cannie MM, Bevilacqua E, Huynh V, Houfflin-Debarge V, Verpillat P, Olivier C, Benachi A, Jani JC. Prenatal prediction of postnatal survival in fetuses with congenital diaphragmatic hernia using MRI: lung volume measurement, signal intensity ratio, and effect of experience. J Matern Fetal Neonatal Med 2020; 35:1036-1044. [PMID: 32212880 DOI: 10.1080/14767058.2020.1740982] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To evaluate various signal intensity ratios in isolated congenital diaphragmatic hernia (CDH) and to compare their potential in predicting survival with that of the observed-to-expected (O/E) ratio of total fetal lung volume (TFLV) using magnetic resonance imaging (MRI) measurements. Our second objective was to evaluate the impact of operator's experience in comparing the prediction of postnatal survival by O/E-TFLV.Methods: In 75 conservatively managed CDH fetuses and in 50 who underwent fetoscopic endoluminal tracheal occlusion (FETO), the fetal lung-to-amniotic fluid, lung-to-liver, lung-to-muscle, lung-to-spinal fluid signal intensity ratios, respectively LAFSIR, LLSIR, LMSIR, and LSFSIR, were measured, as was O/E-TFLV. Receiver operating characteristic (ROC) curves were constructed and used to compare the various signal intensity ratios with O/E-TFLV in the prediction of postnatal survival. In 72 MRI lung volumes assessed by the referring radiologists in Paris and Lille and secondarily by our expert radiologist in Brussels (M.M.C.) using the same MRI examinations, ROC curves were constructed and used to compare the value of O/E-TFLV determined by the two centers in the prediction of postnatal survival.Results: In the total cohort of CDH fetuses, O/E-TFLV and LLSIR were predictive of postnatal survival whereas in the conservatively managed group O/E-TFLV, LLSIR, and LMSIR predicted postnatal survival. O/E-TFLV predicted postnatal survival far better than the signal intensity ratios: area under the ROC curve for prediction by O/E-TFLV in the total cohort was 0.866 (p < .001; standard error = 0.031). The area under the ROC curve for prediction of postnatal survival using O/E-TFLV by MRI evaluated at the referral centers was 0.640 (p = 102; standard error = 0.085), and with O/E-TFLV reevaluated by M.M.C., it was 0.872 (p < .001; standard error = 0.061). Pairwise comparison showed a significant difference between the areas under the ROC curves (difference = 0.187, p = .012; standard error = 0.075).Conclusion: In fetuses with CDH with/without FETO, LLSIR was significantly correlated with the prediction of postnatal survival. However, measurement of O/E-TFLV was far better in predicting postnatal outcome. Operator experience in measurement of lung volumes using MRI seem to play a role in the predictive value of the technique.
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Affiliation(s)
- Vivien Dütemeyer
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anne-Gael Cordier
- Department of Gynecology and Obstetrics, Bicêtre Hospital, Paris Sud University, Le Kremlin Bicêtre, France.,Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium.,Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Van Huynh
- Department of Paediatric Radiology, Bicêtre Hospital, Paris Sud University, Le Kremlin Bicêtre, France
| | | | | | - Camille Olivier
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Benachi
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France.,Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, Paris Sud University, Clamart, France
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
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Magnetic Resonance Imaging in Pregnancy with Intrauterine Growth Restriction: A Pilot Study. DISEASE MARKERS 2019; 2019:4373490. [PMID: 31827633 PMCID: PMC6881754 DOI: 10.1155/2019/4373490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
Abstract
Objective Intrauterine growth restriction (IUGR) is a major cause of late stillbirth, though not all compromised babies remain small or are considered growth restricted as pregnancy progresses. Fetal Magnetic Resonance Imaging (f-MRI) represents a second-line tool to study pregnancies with IUGR fetuses. The aim of our study was to evaluate the usefulness of f-MRI on predicting fetal growth and the offspring's perinatal respiratory outcome. Design All f-MRI performed between 2014 and 2016 in Siena were analysed. Pregnancies with IUGR (Study group (SG)) were recruited together with a control population (Control group (CG)), coupled for gestational age (GA) at the time of f-MRI (mean GA 31 wks). Neonatal information was collected. The f-MRI protocol consisted of T2w images. Six regions of interest (ROI) were placed as follows: 2 on the lung, 2 on the liver, and 2 on the amniotic fluid. The signal intensities (SI) of each ROI were measured. The SI lung to liver ratio (SI lung/liver) and SI lung to amniotic fluid ratio (SI lung/amniotic fluid) were obtained for each fetus. Each ratio was compared between SG and CG. Therefore, SG was divided into two subgroups: adequate and small for gestational age (AGA and SGA) newborns. All measurements were related to offspring's perinatal respiratory outcome. Results SI lung/liver was linearly related with GA at the time of f-MRI and with EFW. SI lung/amniotic fluid was significantly higher in SG than in CG (p = 0,014). In contrast, among SG, lower values of SI lung/amniotic fluid were found in the SGA compared to AGA (p = 0,036). The days of oxygen supply were higher in the SGA subgroup than in the AGA subgroup (p = 0,028). Conclusions SI lung/liver increases with fetal lung maturation and appears to be useful to estimate intrauterine fetal growth. SI lung/amniotic fluid seems to be a reliable predictive index to distinguish the IUGR fetuses that can recover their growth from those that were born SGA. f-MRI represents a promising frontier to predict IUGR fetus outcome, thus contributing to ameliorate the perinatal management.
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Fazecas TM, Araujo Júnior E, Werner H, Daltro P, Peixoto AB, Lima GM, Barbosa AD. Applicability of Magnetic Resonance Imaging in the Assessment of Fetal Urinary Tract Malformations. Can Assoc Radiol J 2019; 70:83-95. [PMID: 30691568 DOI: 10.1016/j.carj.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/09/2018] [Accepted: 10/20/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To assess the applicability of magnetic resonance imaging (MRI) to complement ultrasound in the diagnosis of fetal urinary tract anomalies. METHODS This was a retrospective cohort study that included 41 women between 19 weeks and 37 weeks and 6 days of gestation carrying fetuses with malformations of the urinary tract which were initially diagnosed by ultrasound and then referred for MRI. In all cases, the diagnosis was confirmed after birth either through imaging or autopsy. A surface coil was positioned over the abdomen and T2-weighted sequences were obtained in the axial, coronal, and sagittal planes; T1 in at least one plane; and three-dimensional (3-D) TRUFI in fetuses with dilatation of the urinary tract. RESULTS Mean gestational age at the time of MRI examination was 28.21 weeks. The rapid T2 sequences allowed all the anomalies of the fetal urinary tract to be assessed, whereas 3-D TRUFI sequencing proved very useful in evaluating anomalies involving dilatation of the urinary tract. The signs of pulmonary hypoplasia characterized by hypointense signal in the T2-weighted sequences were identified in 13 of the 41 fetuses. CONCLUSION MRI confirmed and added information to the ultrasound regarding fetal urinary tract anomalies, as well as information related to the other associated malformations, their progress in the prenatal period, and possible postnatal prognosis.
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Affiliation(s)
- Tatiana Mendonça Fazecas
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil; Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Pedro Daltro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Glaucia Macedo Lima
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Adauto Dutra Barbosa
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil
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Yokoi A, Ohfuji S, Yoshimoto S, Sugioka Y, Akasaka Y, Funakoshi T. A new approach to risk stratification using fetal MRI to predict outcomes in congenital diaphragmatic hernia: the preliminary retrospective single institutional study. Transl Pediatr 2018; 7:356-361. [PMID: 30460187 PMCID: PMC6212392 DOI: 10.21037/tp.2018.09.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a condition with a wide range of severity. Prenatal diagnosis is essential to optimize postnatal management, especially for severe cases. The lung to head ratio (LHR) and liver herniation estimated by prenatal ultrasound has been used as prenatal predictors in CDH. However, reliability of these factors remains to be proven and prediction of outcome from prenatal imaging is still challenging. We propose our new stratification system using lung to liver signal intensity ratio (LLSIR) in fetal MRI, which has been shown to be related to pulmonary maturation. METHODS Retrospective chart review was conducted on 25 infants with CDH treated from 2009 through 2016 in our hospital. We stratified patients according to fetal T2-weighted MRI as Grade I, detectable ipsilateral lung at the apex; Grade II, undetectable ipsilateral lung at the apex and contralateral LLSR ≥2.0; Grade III, undetectable ipsilateral lung at the apex and contralateral LLSR <2.0. To evaluate this stratification system, we analyzed survival, severity [inhaled nitric oxide (iNO) usage with or without extracorporeal membrane oxygenation (ECMO)], and requirement of patch closure. RESULTS All 15 patients survived in Grade I, while 2 out of 6 died in Grade II, and 3 out of 4 died in Grade III (P=0.003). Four were severe in Grade I, and all in Grade II and III who survived (P=0.007). One needed patch in Grade I, and all in Grade II and III (OR: 414,238,332; 95% CI, 0-∞). Liver herniation was noted in five patients, and significantly associated with survival (P=0.04), however, neither with severity (P=1.00) nor with the requirement of patch closure (P=0.52). CONCLUSIONS The risk stratification algorithm using contralateral LLSIR in fetal MRI could be useful and more reliable than liver herniation to predict survival, severity, and need of patch closure. Further investigation is warranted.
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Affiliation(s)
- Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Seiji Yoshimoto
- Department of Neonatology, Perinatal Medical Center, Kobe Children's Hospital, Kobe, Japan
| | - Yusuke Sugioka
- Department of Radiology, Kobe Children's Hospital, Kobe, Japan
| | | | - Toru Funakoshi
- Department of Obstetrics, Perinatal Medical Center, Kobe Children's Hospital, Kobe, Japan
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Magnetic resonance assessment of fetal lung maturity: comparison between signal intensity and volume measurement. Jpn J Radiol 2018; 36:444-449. [PMID: 29767297 DOI: 10.1007/s11604-018-0745-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE We evaluated the associations between gestational age (GA) and lung-to-liver signal intensity ratio (LLSIR) and fetal lung volume (FLV) using magnetic resonance imaging (MRI). Moreover, we evaluated the reproducibility of these measurements. MATERIALS AND METHODS LLSIR and FLV were measured using single-shot fast spin-echo MRI in 88 consecutive fetuses. The Spearman test was used to assess the relationships between (1) LLSIR and GA, and (2) FLV and GA in 81 fetuses without lung abnormalities. Intra- and inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). RESULTS Overall, GA and LLSIR were significantly correlated (r = 0.62, p < 0.001). However, GA and LLSIR were only significantly correlated during the third trimester (before third trimester: r = 0.39, p = 0.08; during third trimester: r = 0.46, p < 0.001). Overall, GA and FLV were significantly correlated (r = 0.72, p < 0.001). FLV was significantly correlated with GA before (r = 0.86, p < 0.001) and during the third trimester (r = 0.47, p < 0.001). All ICCs were above 0.90. CONCLUSIONS LLSIR and FLV are useful for the assessment of fetal lung maturity and are highly reproducible. Before the third trimester, FLV is more suitable than LLSIR for the evaluation of fetal lung maturity.
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14
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Abstract
In congenital diaphragmatic hernia (CDH), herniation of the abdominal organs into the fetal chest causes pulmonary hypoplasia and pulmonary hypertension, the main causes of neonatal mortality. As antenatal ultrasound screening improves, the risk of postnatal death can now be better predicted, allowing for the identification of fetuses that might most benefit from a prenatal intervention. Fetoscopic tracheal occlusion is being evaluated in a large international randomized controlled trial. We present the antenatal imaging approaches that can help identify fetuses that might benefit from antenatal therapy, and review the evolution of fetal surgery for CDH to date.
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Affiliation(s)
- Titilayo Oluyomi-Obi
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of Calgary, 1403 29 Street NW, Calgary, Alberta.
| | - Tim Van Mieghem
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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15
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Prognostic usefulness of derived T2-weighted fetal magnetic resonance imaging measurements in congenital diaphragmatic hernia. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Determination of fetal lung maturity using magnetic resonance imaging signal intensity measurements. Ultrasound Q 2015; 30:61-7. [PMID: 24901781 DOI: 10.1097/ruq.0000000000000054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to determine if magnetic resonance signal intensity measurements can be used to predict gestational age and hence fetal lung maturity. METHODS This institutional review board-approved study was a retrospective review of 394 fetal magnetic resonance imaging cases from a single institution for the years 2001 to 2011. For each case, T1- and T2-weighted sequences were selected for data collection. A single reviewer obtained 10 regions of interest (when possible) from each scan (fetal lung, fetal liver, fetal muscle, fetal spleen, and maternal urine, for both T1- and T2-weighted sequences). The medical record was searched for relevant information including best estimate of gestational age, Apgar scores, karyotype, and fetal diagnosis. A variety of organ-to-organ ratios and direct organ signal intensity measurements were assessed for correlation with gestational age. RESULTS Three hundred thirty-five cases met inclusion criteria with gestational ages ranging from 17 to 39 weeks (mean, 28.6 weeks). A significant relationship between magnetic resonance signal intensity ratios and gestational age was demonstrated on the T2 lung-to-liver, T2 lung-to-spleen, T2 lung-to-muscle, T1 lung-to-liver, and T1 lung-to-spleen ratios (P < 0.05). T2 lung-to-liver and T2 lung-to-muscle demonstrated the strongest relationship with gestational age (best correlation r = 0.483, P < 0.001). T1 lung-to-liver and T1 lung-to-spleen demonstrated inverse relationships with gestational age (r = -0.174 [P = 0.03] and r = -0.236 [P = 0.02], respectively). CONCLUSIONS A significant correlation between multiple signal intensity ratios and gestational age is demonstrated. However, the large variances preclude a clinically useful relationship.
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Oka Y, Rahman M, Sasakura C, Waseda T, Watanabe Y, Fujii R, Makinoda S. Prenatal diagnosis of fetal respiratory function: evaluation of fetal lung maturity using lung-to-liver signal intensity ratio at magnetic resonance imaging. Prenat Diagn 2014; 34:1289-94. [PMID: 25081823 PMCID: PMC4305273 DOI: 10.1002/pd.4469] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 11/20/2022]
Abstract
Objective The purpose of this retrospective study is to determine the fetal lung-to-liver signal intensity ratio (LLSIR) on T2-weighted images for the prediction of neonatal respiratory outcome. Methods One hundred ten fetuses who underwent magnetic resonance imaging (MRI) examination for various indications after 22 weeks of gestation participated in this study. LLSIR was measured as the ratio of signal intensities of the fetal lung and liver on T2-weighted images at MRI. We examined the changes of the ratio with advancing gestation and the relations between LLSIR and the presence of the severe respiratory disorder (SRD) after birth. The best cut-off value of the LLSIR to predict respiratory outcome after birth was calculated using receiver operating characteristic (ROC) curve analysis. Results Lung-to-liver signal intensity ratio correlated significantly with advancing gestational age (R = 0.35, p < 0.001). The non-SRD group had higher LLSIR compared with the SRD group (2.15 ± 0.30 vs. 1.53 ± 0.40, p < 0.001). ROC curve analysis showed that fetuses with an LLSIR < 2.00 were more likely to develop SRD [sensitivity: 100%, 95% confidence interval (CI): 52–100%; specificity: 73%, 95% CI 54–88%]. Conclusion The fetal LLSIR on T2-weighted images is an accurate marker to diagnose the fetal lung maturity. © 2014 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Yasuko Oka
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Japan
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18
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Sebastià C, Gomez O, Salvador R, Buñesch L, Garcia R, Nicolau C. Prognostic usefulness of derived T2-weighted fetal magnetic resonance imaging measurements in congenital diaphragmatic hernia. RADIOLOGIA 2014; 57:239-47. [PMID: 25011437 DOI: 10.1016/j.rx.2014.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 02/17/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the usefulness of various parameters based on T2-weighted fetal magnetic resonance (MR) imaging measurements of the uninvolved lung for the neonatal prognosis of congenital diaphragmatic hernia (CDH). MATERIAL AND METHODS We used ultrasonography and MR imaging to study 28 fetuses with CDH. We retrospectively analyzed a) on fetal ultrasonography, the observed-to-expected lung to head ratio (O/E LHR) and the position of the liver, and b) on fetal MR imaging, the lung-liver signal ratio (LLSR) and the lungcerebrospinal fluid ratio (L/CSF SR). To determine the prognostic value of these parameters, we compared them with the following postnatal parameters: survival, pulmonary hypertension, need for oxygen supplementation, and need for extracorporeal membrane oxygenation. RESULTS We found significant differences between O/E LHR and the need for postnatal extracorporeal membrane oxygenation (P=.033) and postnatal survival (P=.01). We also found significant differences in LLSR between fetuses that survived more than 45 days and those that died within 45 days (1.91 vs. 2.56; P=.039). CONCLUSIONS In fetuses with CDH, the LLSR correlates with postnatal survival and can potentially be used as a prognostic parameter in CDH.
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Affiliation(s)
- C Sebastià
- Departamento de Radiología (CDI), Hospital Clínic , Barcelona, España.
| | - O Gomez
- Departamento de Ginecología y Obstetricia (ICGON), Hospital Clínic, Barcelona, España
| | - R Salvador
- Departamento de Radiología (CDI), Hospital Clínic , Barcelona, España
| | - L Buñesch
- Departamento de Radiología (CDI), Hospital Clínic , Barcelona, España
| | - R Garcia
- Departamento de Ginecología y Obstetricia (ICGON), Hospital Clínic, Barcelona, España
| | - C Nicolau
- Departamento de Radiología (CDI), Hospital Clínic , Barcelona, España
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Fetal Lung Maturity Assessment With MRI Fetal Lung-to-Liver Signal-Intensity Ratio. AJR Am J Roentgenol 2013; 201:1386-90. [DOI: 10.2214/ajr.12.9679] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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[Fetal magnetic resonance imaging of thoracic and abdominal malformations]. Radiologe 2013; 53:123-9. [PMID: 23354851 DOI: 10.1007/s00117-012-2400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE Diagnosis and differential diagnosis of fetal thoracic and abdominal malformations. STANDARD RADIOLOGICAL METHODS Ultrasound and magnetic resonance imaging (MRI). METHODICAL INNOVATIONS In cases of suspected pathologies based on fetal ultrasound MRI can be used for more detailed examinations and can be of assistance in the differential diagnostic process. PERFORMANCE Improved imaging of anatomical structures and of the composition of different tissues by the use of different MRI sequences. ACHIEVEMENTS Fetal MRI has become a part of clinical routine in thoracic and abdominal malformations and is the basis for scientific research in this field. PRACTICAL RECOMMENDATIONS In cases of thoracic or abdominal malformations fetal MRI provides important information additional to ultrasound to improve diagnostic accuracy, prognostic evaluation and surgical planning.
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Trompoukis P, Papantoniou N, Chlapoutaki C, Mesogitis S, Antsaklis A. Fetal MRI: is it really helpful? J Matern Fetal Neonatal Med 2012; 25:2363-8. [PMID: 22708680 DOI: 10.3109/14767058.2012.696161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study is to emphasize on the diagnostic effectiveness of fetal MRI that led to increased utilization in fetal medicine as well as its value in prognosis and decision making in the modern obstetric practice. METHODS One hundred five (n = 105) pregnant women were referred for a fetal MRI examination after a high detailed ultrasound examination revealed a fetal abnormality. Fetal MRI was performed using 1, 5 Tesla units, with T1, T2-weighted and diffusion-weighted images. The findings were analyzed in comparison to the previous ultrasound findings, according to the fetal organ affected and the value of the MRI for therapeutic decision making was addressed. A statistical analysis was performed. RESULTS The fetal MRI provides a more accurate diagnosis compared to ultrasound examination, and when the ultrasound detects fetal anomalies, the MRI can efficiently either confirm or reject the finding, proving its high value for prenatal diagnosis and perinatal and management. The sensitivity, specificity and positive predictive value of fetal MRI as a screening tool approaches 100%. CONCLUSIONS Despite the fact that ultrasound is the method of choice for fetal screening, MRI can add up significantly to the diagnosis and management of congenital abnormalities and the indications for MRI continue to increase as new sequences and shorter acquisition times evolve.
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Affiliation(s)
- P Trompoukis
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece.
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22
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Schmid M, Marschalek J, Springer S, Klein K, Kasprian G, Prayer D. Maternal smoking and fetal lung signals--an in utero MRI investigation. Prenat Diagn 2012; 32:272-6. [PMID: 22430727 DOI: 10.1002/pd.3823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate whether fetal lung signals and fetal lung signal progression over gestation observed on magnetic resonance imaging are different in mothers who reported smoking during pregnancy compared with nonsmoking controls. METHOD Cross-sectional retrospective study of 100 consecutive singleton pregnancies that underwent magnetic resonance imaging. Fetal lung-liver signal intensity ratios of 18 fetuses of mothers who reported smoking during pregnancy were compared with 82 fetuses of nonsmoking controls. RESULTS Average gestational age at magnetic resonance imaging was 26.4 ± 5.2 weeks (Range 18.4-38.2 weeks). Cases reported smoking between 2 and 15 cigarettes per day. The mean number of cigarettes per day for cases was 9.2 ± 3.4. Mean fetal lung-liver signal intensity ratios did not differ significantly between the two groups (p = 0.8). They showed a linear increase with gestational age (r(2) = 0.3). Multiple regression analysis of lung-liver signal intensity ratios using gestational age and smoking status as predictors revealed a significant influence of gestational age (p < 0.0001) but not maternal smoking status (p = 0.8) on fetal lung-liver signal intensity ratios. CONCLUSIONS Fetuses of mothers who reported smoking during pregnancy show similar lung signals and lung signal progression over gestation on magnetic resonance imaging as nonsmoking controls.
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Affiliation(s)
- Maximilian Schmid
- Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
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23
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Kline-Fath BM. Current advances in prenatal imaging of congenital diaphragmatic [corrected] hernia. Pediatr Radiol 2012; 42 Suppl 1:S74-90. [PMID: 21739292 DOI: 10.1007/s00247-011-2183-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 03/22/2011] [Accepted: 03/31/2011] [Indexed: 11/29/2022]
Abstract
Congenital diaphragmatic hernia, despite advances in therapy, remains a complex condition with significant morbidity and mortality. The etiology of the disorder is still incompletely understood, though the pulmonary hypoplasia and pulmonary hypertension that develop secondarily must be overcome to improve survival. Prenatal US and fetal MRI have helped in the development of a greater understanding of this disease. Also with these modalities, measurement techniques have been developed in an attempt to provide prognosticators for the development of pulmonary hypoplasia and pulmonary hypertension. There is a broad range of approaches for performing these measurements, and variability among imaging centers is noted. Despite inconsistent approaches, these techniques have become the foundation for counseling and prenatal and postnatal therapy. It is hoped that with further research with prenatal US and fetal MRI and the development of innovative medical and surgical therapies that the morbidity and mortality of children with congenital diaphragmatic hernias can be significantly reduced.
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Affiliation(s)
- Beth M Kline-Fath
- Department of Radiology, Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Kul S, Korkmaz HAA, Cansu A, Dinc H, Ahmetoglu A, Guven S, Imamoglu M. Contribution of MRI to ultrasound in the diagnosis of fetal anomalies. J Magn Reson Imaging 2011; 35:882-90. [DOI: 10.1002/jmri.23502] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/19/2011] [Indexed: 11/10/2022] Open
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Rangasami R, Chandrasekharan A, Joseph S, Nanda A, Johnson T, Reddy S. Magnetic resonance signal intensity measurements in the diagnosis of fetal central nervous system anomalies. J Matern Fetal Neonatal Med 2011; 25:679-86. [DOI: 10.3109/14767058.2011.594116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Schmid M, Kasprian G, Kuessel L, Messerschmidt A, Brugger PC, Prayer D. Effect of antenatal corticosteroid treatment on the fetal lung: a magnetic resonance imaging study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:94-98. [PMID: 21308834 DOI: 10.1002/uog.8948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To investigate the effect of antenatal corticosteroid treatment on the fetal lung using magnetic resonance imaging. METHODS Prospective evaluation of 30 consecutive singleton pregnancies that received antenatal corticosteroid treatment (12 mg betamethasone i.m. on admission and 24 h later) because of threatened preterm birth. Fetal lungs were assessed using T2-weighted single-shot fast spin-echo images of a whole-body 1.5-T superconducting unit twice: less than 24 h and more than 48 h after the first course of betamethasone. Lung volumes and lung-liver signal-intensity ratios were compared between the two time points. RESULTS Nine patients had to be excluded from the analysis because they did not complete the study protocol as required. Ten female and 11 male fetuses with a gestational age between 23.4 and 32.6 weeks were included in the final analysis. The mean gestational age of included fetuses was 27.5 ± 2.8 weeks. Using a linear regression model, a significant influence of gestational age on ln fetal lung volume (r(2)=0.414; P<0.0001) and lung-liver signal-intensity ratios (r(2)=0.271, P<0.0001) was found. Between the two evaluated time points, a significant increase in lung-liver signal-intensity ratios (2.34 ± 0.72 vs. 3.22 ± 1.12, P<0.0001), but not in mean lung volumes (46.6 ± 20.7 cm(3) vs. 48.8 ± 16.0 cm(3) , P=0.292), was observed. CONCLUSION We demonstrate a significant increase in lung-liver signal-intensity ratios after antenatal corticosteroid treatment for induction of lung maturation which most likely reflects changing properties of the fetal lung parenchyma. This could potentially be useful in non-invasively assessing the effect of antenatal corticosteroid treatment on the lungs of fetuses at risk for preterm birth.
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Affiliation(s)
- M Schmid
- Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
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Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung. J Perinatol 2011; 31:269-73. [PMID: 21052047 DOI: 10.1038/jp.2010.119] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prognostic prediction in prenatally diagnosed congenital diaphragmatic hernia (CDH) is needed. The aim of the study was to evaluate magnetic resonance imaging (MRI) signal intensity of the fetal lung as a predictor of prognosis in CDH. STUDY DESIGN The subjects consisted of 12 fetuses with prenatally diagnosed CDH, who were treated soon after the birth in our institution. They all underwent MRI at 29 to 37 weeks of gestation. The ratio of the lung signal intensity to the spinal fluid signal intensity (L/SF) was calculated using region-of-interest analysis of T2-weighted images. The relationship between L/SF and clinical data was then examined. RESULT L/SF were significantly larger in survivors compared with deaths (0.815 vs 0.614, P<0.05). In survivors, L/SF significantly correlated with duration of tracheal intubation (rs=-0.938, P<0.01). CONCLUSION L/SF is a unique factor to predict the survival prognosis and likely to quantify the degree of pulmonary hypoplasia in CDH.
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Cannie M, Jani J, De Keyzer F, Roebben I, Breysem L, Deprest J. T2 quantifications of fetal lungs at MRI-normal ranges. Prenat Diagn 2011; 31:705-11. [DOI: 10.1002/pd.2746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 11/09/2022]
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Diagnosis of Congenital Diaphragmatic Hernia. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/174_2010_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Balassy C, Kasprian G, Brugger PC, Weber M, Csapo B, Herold C, Prayer D. Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging. Eur Radiol 2009; 20:829-37. [DOI: 10.1007/s00330-009-1633-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Revised: 08/07/2009] [Accepted: 08/26/2009] [Indexed: 11/29/2022]
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Nishie A, Tajima T, Asayama Y, Ishigami K, Hirakawa M, Nakayama T, Ushijima Y, Kakihara D, Okamoto D, Yoshiura T, Masumoto K, Taguchi T, Tsukimori K, Tokunaga S, Irie H, Yoshimitsu K, Honda H. MR prediction of postnatal outcomes in left-sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume. J Magn Reson Imaging 2009; 30:112-20. [DOI: 10.1002/jmri.21829] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Paciente asintomático y alteración pulmonar. Rev Clin Esp 2009; 209:192-3. [DOI: 10.1016/s0014-2565(09)71314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kasprian G, Brugger PC, Weber M, Krssák M, Krampl E, Herold C, Prayer D. In utero tractography of fetal white matter development. Neuroimage 2008; 43:213-24. [PMID: 18694838 DOI: 10.1016/j.neuroimage.2008.07.026] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 07/02/2008] [Accepted: 07/06/2008] [Indexed: 11/26/2022] Open
Abstract
Diffusion tensor imaging (DTI) and tractography are noninvasive tools that enable the study of three-dimensional diffusion characteristics and their molecular, cellular, and microstructural correlates in the human brain. To date, these techniques have mainly been limited to postnatal MR studies of premature infants and newborns. The primary aim of this cross-sectional study was to assess the potential of in utero DTI and tractography to visualize the main projection and commissural pathways in 40 living, non-sedated human fetuses between 18 and 37 gestational weeks (GW) of age, with no structural brain pathologies. During a mean time of 1 min and 49 s, an axial, single-shot, echo planar DT sequence, with 32 diffusion gradient encoding directions and a reconstructed voxel size of 1.44 mm/1.45 mm/4.5 mm, was acquired. Most (90%) of the fetuses were imaged in the cephalic presentation. In 40% of examined fetuses, DTI measurements were robust enough to successfully calculate and visualize bilateral, craniocaudally oriented (mainly sensorimotor), and callosal trajectories in utero. Furthermore, fiber lengths, ADC, FA, and eigenvalues (lambda(1), lambda(2) and lambda(3)) were determined at different anatomically defined areas. FA values and the axial eigenvalue (lambda(1)) showed a characteristic distribution, with the highest values for the splenium, followed by the genu, the right, and the left posterior limb of the internal capsule. The right-sided sensorimotor trajectories were found to be significantly longer than on the left side (p=0.007), reflecting higher right-sided lambda(1) values (14 cases vs. 9 cases). Based on the good correlation of these initial in utero tractography results with prior documented postmortem and ex utero DTI data, this new imaging technique promises new insights into the normal and pathological development of the unborn child.
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Affiliation(s)
- Gregor Kasprian
- Department of Radiology, Medical University of Vienna, Vienna, Austria.
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Matsushita M, Ishii K, Tamura M, Takahashi Y, Kamura T, Takakuwa K, Tanaka K. Perinatal magnetic resonance fetal lung volumetry and fetal lung-to-liver signal intensity ratio for predicting short outcome in isolated congenital diaphragmatic hernia and cystic adenomatoid malformation of the lung. J Obstet Gynaecol Res 2008; 34:162-7. [DOI: 10.1111/j.1447-0756.2008.00754.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MR imaging appearance of laryngeal atresia (congenital high airway obstruction syndrome): unique course in a fetus. Pediatr Radiol 2008; 38:344-7. [PMID: 18071686 DOI: 10.1007/s00247-007-0693-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Revised: 10/13/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
Congenital high airway obstruction syndrome (CHAOS) is a rare life-threatening syndrome. Most cases are diagnosed prenatally by US. We report a fetus with this syndrome that showed a unique course revealed on MRI. Ultrasonography at 22 weeks demonstrated that the fetus had ascites and bilaterally enlarged hyperechoic lungs. Congenital infection, congenital cystic adenomatoid malformation or CHAOS was suspected. Subsequent MRI performed at 24 weeks demonstrated bilaterally enlarged high-signal lungs, dilated bronchi, massive ascites, subcutaneous oedema and polyhydramnios. MRI confirmed the diagnosis of CHAOS. A second MRI at 35 weeks showed that the bilateral lung enlargement, ascites, oedema and polyhydramnios had resolved, but that the appearance of the airway was unchanged. The infant was delivered by caesarean section at 38 weeks of gestation and immediate tracheostomy was performed. This spontaneous regression was explained by a tracheo-oesophageal fistula that may have decreased the intrathoracic pressure.
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Cannie M, Jani J, De Keyzer F, Van Kerkhove F, Meersschaert J, Lewi L, Deprest J, Dymarkowski S. Magnetic resonance imaging of the fetal lung: a pictorial essay. Eur Radiol 2008; 18:1364-74. [DOI: 10.1007/s00330-008-0877-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 11/17/2007] [Accepted: 12/11/2007] [Indexed: 11/28/2022]
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Balassy C, Kasprian G, Brugger PC, Csapo B, Weber M, Hörmann M, Bankier A, Bammer R, Herold CJ, Prayer D. Diffusion-weighted MR imaging of the normal fetal lung. Eur Radiol 2007; 18:700-6. [DOI: 10.1007/s00330-007-0784-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/30/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
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Prayer D, Brugger PC. Investigation of normal organ development with fetal MRI. Eur Radiol 2007; 17:2458-71. [PMID: 17342486 DOI: 10.1007/s00330-007-0604-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 12/15/2006] [Accepted: 01/22/2007] [Indexed: 01/28/2023]
Abstract
The understanding of the presentation of normal organ development on fetal MRI forms the basis for recognition of pathological states. During the second and third trimesters, maturational processes include changes in size, shape and signal intensities of organs. Visualization of these developmental processes requires tailored MR protocols. Further prerequisites for recognition of normal maturational states are unequivocal intrauterine orientation with respect to left and right body halves, fetal proportions, and knowledge about the MR presentation of extrafetal/intrauterine organs. Emphasis is laid on the demonstration of normal MR appearance of organs that are frequently involved in malformation syndromes. In addition, examples of time-dependent contrast enhancement of intrauterine structures are given.
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Affiliation(s)
- Daniela Prayer
- Department of Radiology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
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Balassy C, Kasprian G, Brugger PC, Weber M, Csapo B, Mittermayer C, Hörmann M, Prayer D. MRI investigation of normal fetal lung maturation using signal intensities on different imaging sequences. Eur Radiol 2006; 17:835-42. [PMID: 17180330 DOI: 10.1007/s00330-006-0409-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 05/24/2006] [Accepted: 07/20/2006] [Indexed: 11/29/2022]
Abstract
To purpose of this paper is to study the relation between normal lung maturation signal and changes in intensity ratios (SIR) and to determine which magnetic resonance imaging sequence provides the strongest correlation of normal lung SIs with gestational age. 126 normal singleton pregnancies (20-37 weeks) were examined with a 1.5 Tesla unit. Mean SIs for lungs, liver, and gastric fluid were assessed on six different sequences, and SIRs of lung/liver (LLSIR) and lung/gastric fluid (LGSIR) were correlated with gestational age for each sequence. To evaluate the feasibility of SIRs in the prediction of the state of the lung maturity, accuracy of the predicted SIRs (D*) was measured by calculating relative residuals (D*-D)/D for each sequence. LLSIRs showed significant changes in every sequence (p<0.05), while LGSIRs only on two sequences. Significant differences were shown for the mean of absolute residuals for both LLSIRs (p<0.001) and for LGSIRs (p=0.003). Relative residuals of LLSIRs were significantly smaller on T1-weighted sequence, whereas they were significantly higher for LGSIRs on FLAIR sequence. Fetal liver seems to be adequate reference for the investigation of lung maturation. T1-weighted sequence was the most accurate for the measurement of the lung SIs; thus, we propose to determine LLSIR on T1-weighted sequence when evaluating lung development.
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Affiliation(s)
- Csilla Balassy
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Abstract
Magnetic resonance imaging (MRI) is an important diagnostic component for central nervous system and thoracic diseases during fetal development. Although ultrasound remains the method of choice for observing the fetus during pregnancy, fetal MRI is being increasingly used as an additional technique for the accurate diagnosis of abdominal diseases. Recent publications confirm the value of MRI in the diagnosis of fetal gastrointestinal tract and urogenital system diseases. The following report provides an overview of MRI-examination techniques for the most frequent diseases of the abdomen.
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Affiliation(s)
- M Hörmann
- Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien.
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Kasprian G, Balassy C, Brugger PC, Prayer D. MRI of normal and pathological fetal lung development. Eur J Radiol 2006; 57:261-70. [PMID: 16413987 DOI: 10.1016/j.ejrad.2005.11.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 10/25/2022]
Abstract
Normal fetal lung development is a complex process influenced by mechanical and many biochemical factors. In addition to ultrasound, fetal magnetic resonance imaging (MRI) constitutes a new method to investigate this process in vivo during the second and third trimester. The techniques of MRI volumetry, assessment of signal intensities, and MRI spectroscopy of the fetal lung have been used to analyze this process and have already been applied clinically to identify abnormal fetal lung growth. Particularly in conditions such as oligohydramnios and congenital diaphragmatic hernia (CDH), pulmonary hypoplasia may be the cause of neonatal death. A precise diagnosis and quantification of compromised fetal lung development may improve post- and perinatal management. The main events in fetal lung development are reviewed and MR volumetric data from 106 normal fetuses, as well as different examples of pathological lung growth, are provided.
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Affiliation(s)
- Gregor Kasprian
- University Clinic of Radiodiagnostics, Medical University of Vienna, Allgemeines Krankenhaus, AKH, Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Kasprian G, Brugger PC, Helmer H, Langer M, Balassy C, Prayer D. Fetale Lungenentwicklung in der MRT. Radiologe 2006; 46:120-7. [PMID: 16365775 DOI: 10.1007/s00117-005-1321-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A well-organized interplay between many molecular factors as well as mechanical forces influence fetal lung development. At the end of this complex process a sufficiently sized and structurally mature organ should ensure the postnatal survival of the newborn. Besides prenatal ultrasonography, magnetic resonance imaging (MRI) can now be used to investigate normal and pathological human lung growth in utero. Oligohydramnios, due to premature rupture of membranes (PROM), is an important risk factor for compromised fetal lung growth. In these situations MR volumetry can be used to measure the size of the fetal lung quite accurately. Together with the evaluation of lung signal intensities on T2-weighted sequences, fetuses with pulmonary hypoplasia can be readily detected.
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Affiliation(s)
- G Kasprian
- Klinik für Radiodiagnostik, Medizinische Universität Wien.
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Hörmann M, Brugger PC, Balassy C, Witzani L, Prayer D. Fetal MRI of the urinary system. Eur J Radiol 2006; 57:303-11. [PMID: 16386865 DOI: 10.1016/j.ejrad.2005.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 11/26/2022]
Abstract
The assessment of the urinary system is typically performed by ultrasound. Nevertheless, an ultrasound may be inconclusive in fetuses with renal diseases that result in anhydramnios or oligohydramnios. In such cases, and in other cases in which ultrasound is limited, further investigation with MR should be considered. In the following article, we will provide an overview of the most commonly encountered disorders of the urinary system and their appearance on fetal MR imaging. Fetal MR imaging can accurately diagnose a wide variety of urinary tract disorders and must be seen as a valuable complementary tool to ultrasound in the assessment of the urinary system, particularly in cases of inconclusive ultrasound findings.
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Affiliation(s)
- Marcus Hörmann
- Department of Radiodiagnostics, Medical University of Vienna, Währingergürtel 18-20, A-1090 Vienna, Austria.
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Prayer D, Brugger PC, Kasprian G, Witzani L, Helmer H, Dietrich W, Eppel W, Langer M. MRI of fetal acquired brain lesions. Eur J Radiol 2006; 57:233-49. [PMID: 16413156 DOI: 10.1016/j.ejrad.2005.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 12/27/2022]
Abstract
Acquired fetal brain damage is suspected in cases of destruction of previously normally formed tissue, the primary cause of which is hypoxia. Fetal brain damage may occur as a consequence of acute or chronic maternal diseases, with acute diseases causing impairment of oxygen delivery to the fetal brain, and chronic diseases interfering with normal, placental development. Infections, metabolic diseases, feto-fetal transfusion syndrome, toxic agents, mechanical traumatic events, iatrogenic accidents, and space-occupying lesions may also qualify as pathologic conditions that initiate intrauterine brain damage. MR manifestations of acute fetal brain injury (such as hemorrhage or acute ischemic lesions) can easily be recognized, as they are hardly different from postnatal lesions. The availability of diffusion-weighted sequences enhances the sensitivity in recognizing acute ischemic lesions. Recent hemorrhages are usually readily depicted on T2 (*) sequences, where they display hypointense signals. Chronic fetal brain injury may be characterized by nonspecific changes that must be attributable to the presence of an acquired cerebral pathology. The workup in suspected acquired fetal brain injury also includes the assessment of extra-CNS organs that may be affected by an underlying pathology. Finally, the placenta, as the organ that mediates oxygen delivery from the maternal circulation to the fetus, must be examined on MR images.
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Affiliation(s)
- Daniela Prayer
- Department of Radiodiagnostics, Medical University of Vienna, Austria.
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Wedegärtner U, Schröder HJ, Adam G. Fetal MRI in experimental tracheal occlusion. Eur J Radiol 2006; 57:271-7. [PMID: 16406439 DOI: 10.1016/j.ejrad.2005.11.026] [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: 11/11/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 11/21/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is associated with a high mortality, which is mainly due to pulmonary hypoplasia and secondary pulmonary hypertension. In severely affected fetuses, tracheal occlusion (TO) is performed prenatally to reverse pulmonary hypoplasia, because TO leads to accelerated lung growth. Prenatal imaging is important to identify fetuses with pulmonary hypoplasia, to diagnose high-risk fetuses who would benefit from TO, and to monitor the effect of TO after surgery. In fetal imaging, ultrasound (US) is the method of choice, because it is widely available, less expensive, and less time-consuming to perform than magnetic resonance imaging (MRI). However, there are some limitations for US in the evaluation of CDH fetuses. In those cases, MRI is helpful because of a better tissue contrast between liver and lung, which enables evaluation of liver herniation for the diagnosis of a high-risk fetus. MRI provides the ability to determine absolute lung volumes to detect lung hypoplasia. In fetal sheep with normal and hyperplastic lungs after TO, lung growth was assessed on the basis of cross-sectional US measurements, after initial lung volume determination by MRI. To monitor fetal lung growth after prenatal TO, both MRI and US seem to be useful methods.
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Affiliation(s)
- Ulrike Wedegärtner
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
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Current awareness in prenatal diagnosis. Prenat Diagn 2005. [DOI: 10.1002/pd.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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