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Rubesova E, Moeremans M. MR Imaging of the Fetal Gastrointestinal Anomalies. Magn Reson Imaging Clin N Am 2024; 32:489-496. [PMID: 38944436 DOI: 10.1016/j.mric.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Fetal MR imaging has been shown to be a useful tool for the diagnosis of fetal gastro-intestinal pathologies. To recognize the various pathologies, it is, however, essential to know the normal MR imaging appearance of the fetal bowel at various gestational ages. By providing additional information to ultrasound in case of a fetal gastrointestinal anomaly, MR imaging helps to improve planning for the delivery, postnatal management, and improves parental counseling.
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Affiliation(s)
- Erika Rubesova
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304, USA.
| | - Marine Moeremans
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304, USA
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Mangione R, Voirin-Mathieu E, Yvert M, Fries N, Mousty E, Castaigne V, Muller F, Dreux S. Fetal intestinal loop dilatation: Follow-up and outcome of a series of 133 consecutive cases (the DILDIG study). Prenat Diagn 2023; 43:328-338. [PMID: 36604769 DOI: 10.1002/pd.6300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To define the prognostic markers of fetal dilated bowel loops. METHODS National non-interventional study of 133 consecutive prenatal observations of dilated loops including ultrasound examinations, complementary laboratory tests, magnetic resonance imaging (MRI), outcomes, and postnatal diagnosis. RESULTS One hundred twenty seven cases were classified according to outcome: Group 1, very severe (n = 43), Group 2, children needing specific care (n = 39), and Group 3, healthy children (n = 45). Prenatal ultrasound scan suggested duodenal obstruction in 30 cases, small bowel obstruction in 81, colonic obstruction in 11, and diffuse dilatation in 5. Diameter of dilated loops did not significantly differ between the groups. A poor prognosis was significantly associated with duodenal obstruction, genetic anomalies (53% vs. 21.8%), including aneuploidies or CFTR gene mutations and abnormal amniotic fluid biochemistry (86.4% vs. 38.7%). A good prognosis was associated with regression of dilatation and normal MRI. CONCLUSION In this study, postnatal outcomes for fetuses with intestinal dilatation were best predicted by assessing the level of obstruction with prenatal ultrasound and MRI, determining the presence of associated malformations, amniotic fluid biochemical and genetic testing, and monitoring for regression of bowel dilatation. These results should help inform future guidelines on the prenatal and neonatal management of congenital intestinal obstruction.
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Affiliation(s)
- Raphaële Mangione
- Collège Français d'Echographie Fœtale, CFEF, Paris, France.,Fédération Française des Centres Pluridisciplinaires de Diagnostic Prénatal, Paris, France.,Imagerie de la Femme, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Marianne Yvert
- Collège Français d'Echographie Fœtale, CFEF, Paris, France.,Fédération Française des Centres Pluridisciplinaires de Diagnostic Prénatal, Paris, France.,Diagnostic Prénatal, Maison de Santé Protestante Bagatelle, Talence, France
| | - Nicolas Fries
- Collège Français d'Echographie Fœtale, CFEF, Paris, France
| | - Eve Mousty
- Fédération Française des Centres Pluridisciplinaires de Diagnostic Prénatal, Paris, France.,Gynécologie Obstétrique, CPDPN, CHU Nimes, Nimes, France
| | - Vanina Castaigne
- Fédération Française des Centres Pluridisciplinaires de Diagnostic Prénatal, Paris, France.,Gynécologie Obstétrique, Hôpital Intercommunal de Créteil, Créteil, France
| | - Françoise Muller
- Fédération Française des Centres Pluridisciplinaires de Diagnostic Prénatal, Paris, France.,Biochimie Foetale, Hôpital Robert Debré, DMU BioGeM, AP-HP, Paris, France
| | - Sophie Dreux
- Fédération Française des Centres Pluridisciplinaires de Diagnostic Prénatal, Paris, France.,Biochimie Foetale, Hôpital Robert Debré, DMU BioGeM, AP-HP, Paris, France
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Huang L, Huang D, Wang H, Zhang X, Yu H, Yang P. Antenatal predictors of intestinal pathologies in fetal bowel dilatation. J Paediatr Child Health 2020; 56:1097-1100. [PMID: 32073210 DOI: 10.1111/jpc.14825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
AIM Fetal bowel dilatation (FBD) in the late trimester of pregnancy can be related with varies of prognosis. Our aims were to obtain antenatal factors that might have relevance for the distinct prognosis with FBD. METHODS Seven features of 68 pregnancies presented with FBD were assessed. The best cut-off value to predict intestinal outcomes was selected using receiver-operating characteristics curves, and the effective variables were included into a logistic regression model. RESULTS The best cut-off valves to predict intestinal pathologies were 14.5 mm of fetus dilated loop and 37.7 weeks of gestational age at delivery, respectively. The congenital gastrointestinal tract anomalies included 24 cases (92.3%) of intestine atresia, 1 case (3.85%) of small intestine volvulus and 1 case (3.85%) of midgut malrotation. CONCLUSION Fetal dilated loops and gestational age at delivery are both an independent risk factor for predicting intestinal pathologies of newborns, which should arouse high attention.
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Affiliation(s)
- Lan Huang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiangxiang Zhang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongkui Yu
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Pan Yang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Kuan K, Reznik SE. Educational Case: Intrauterine Fetal Demise and Intestinal Atresia: An Autopsy Investigation. Acad Pathol 2020; 7:2374289520909498. [PMID: 32232125 PMCID: PMC7092656 DOI: 10.1177/2374289520909498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/19/2020] [Accepted: 02/01/2020] [Indexed: 12/26/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Kevin Kuan
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra E Reznik
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
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Kong CKY, Zi Xean K, Li FX, Chandran S. Umbilical cord anomalies: antenatal ultrasound findings and postnatal correlation. BMJ Case Rep 2018; 2018:bcr-2018-226651. [PMID: 30366896 DOI: 10.1136/bcr-2018-226651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Umbilical cord anomalies are rare. The differential diagnosis for a cystic structure around the umbilical cord and its insertion include pseudocyst, omphalomesenteric duct cyst, haemangioma, omphalocele or anterior abdominal wall defects. Although cord anomalies can be detected through antenatal ultrasound scans (US), very often a definitive diagnosis cannot be made. This may affect the management of the infant at birth. In cases where antenatal US was not diagnostic, current evidence supports the use of MRI to help in making an accurate diagnosis. We report two cases of umbilical cord anomalies. The first case was diagnosed in antenatal US as an omphalocele, but was found to be an allantoic cyst with hamartoma on postnatal diagnosis. The second case was not detected on antenatal US, and was diagnosed postnatally as a small omphalocele with vitellointestinal duct remnants.
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Affiliation(s)
| | - Khoo Zi Xean
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Fay Xiangzhen Li
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Yong Loo Lian School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
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