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Ana K, Iris ŽI, Nina P, Marina R, Tomislav Ć, Snježana S, Andrea B, Milan R, Ivica K. Linking integrity of visual pathways trajectories to visual behavior deficit in very preterm infants. Infant Behav Dev 2022; 67:101697. [DOI: 10.1016/j.infbeh.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
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2
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Mckinnon K, Kendall GS, Tann CJ, Dyet L, Sokolska M, Baruteau KP, Marlow N, Robertson NJ, Peebles D, Srinivasan L. Biometric assessments of the posterior fossa by fetal MRI: A systematic review. Prenat Diagn 2020; 41:258-270. [PMID: 33251640 DOI: 10.1002/pd.5874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Posterior fossa abnormalities (PFAs) are commonly identified within routine screening and are a frequent indication for fetal magnetic resonance imaging (MRI). Although biometric measurements of the posterior fossa (PF) are established on fetal ultrasound and MRI, qualitative visual assessments are predominantly used to differentiate PFAs. OBJECTIVES This systematic review aimed to assess 2-dimensional (2D) biometric measurements currently in use for assessing the PF on fetal MRI to delineate different PFAs. METHODS The protocol was registered (PROSPERO ID CRD42019142162). Eligible studies included T2-weighted MRI PF measurements in fetuses with and without PFAs, including measurements of the PF, or other brain areas relevant to PFAs. RESULTS 59 studies were included - 6859 fetuses had 62 2D PF and related measurements. These included linear, area and angular measurements, representing measures of PF size, cerebellum/vermis, brainstem, and supratentorial measurements. 11 measurements were used in 10 or more studies and at least 1200 fetuses. These dimensions were used to characterise normal for gestational age, diagnose a range of pathologies, and predict outcome. CONCLUSION A selection of validated 2D biometric measurements of the PF on fetal MRI may be useful for identification of PFA in different clinical settings. Consistent use of these measures, both clinically and for research, is recommended.
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Affiliation(s)
- Katie Mckinnon
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Giles S Kendall
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Cally J Tann
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Leigh Dyet
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Institute for Women's Health, University College London, London, UK.,Medical Physics Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kelly Pegoretti Baruteau
- Institute for Women's Health, University College London, London, UK.,Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Nicola J Robertson
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Donald Peebles
- Institute for Women's Health, University College London, London, UK.,Obstetric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Latha Srinivasan
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
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Rao U, de Vries B, Ross GP, Gordon A. Fetal biometry for guiding the medical management of women with gestational diabetes mellitus for improving maternal and perinatal health. Cochrane Database Syst Rev 2019; 9:CD012544. [PMID: 31476798 PMCID: PMC6718273 DOI: 10.1002/14651858.cd012544.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common medical condition that complicates pregnancy and causes adverse maternal and fetal outcomes. At present, most treatment strategies focus on normalisation of maternal blood glucose values with use of diet, lifestyle modification, exercise, oral anti-hyperglycaemics and insulin. This has been shown to reduce the incidence of adverse outcomes, such as birth trauma and macrosomia. However, this involves intensive monitoring and treatment of all women with GDM. We propose that using medical imaging to identify pregnancies displaying signs of being affected by GDM could help to target management, allowing low-risk women to be spared excessive intervention, and facilitating better resource allocation. OBJECTIVES We wanted to address the following question: in women with gestational diabetes, does the use of fetal imaging plus maternal blood glucose concentration to indicate the need for medical management compared with glucose concentration alone reduce the risk of adverse perinatal outcomes? SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 January 2019), ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (both on 29 January 2019), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials, including those published in abstract form only. Studies using a cluster-randomised design and quasi-randomised controlled trials were both eligible for inclusion, but we didn't identify any. Cross-over trials were not eligible for inclusion in our review.We included women carrying singleton pregnancies who were diagnosed with GDM, as defined by the trials' authors. The intervention of interest was the use of fetal biometry on imaging methods in addition to maternal glycaemic values for indicating the use of medical therapy for GDM. The control group was the use of maternal glycaemic values alone for indicating the use of such therapy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors extracted data and checked them for accuracy. MAIN RESULTS Three randomised controlled trials met the inclusion criteria for our systematic review - the studies randomised a total of 524 women.We assessed the three included studies as being at a low to moderate risk of bias; the nature of the intervention made it difficult to achieve blinding of participants and personnel and none of the trial reports contained information about methods of allocation concealment (and were therefore assessed as being at an unclear risk of selection bias).In all studies, the intervention was the use of fetal biometry on ultrasound to identify fetuses displaying signs of fetal macrosomia, and the use of this information to indicate the use of medical anti-hyperglycaemic treatments. Those pregnancies were subject to more stringent blood glucose targets than those without signs of fetal macrosomia.Maternal outcomesThe use of fetal biometry in addition to maternal blood glucose concentration (compared with maternal blood glucose concentration alone) may make little or no difference to the incidence of caesarean delivery (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.59 to 1.10; 2 trials, 428 women; low-certainty evidence). We are unclear about the results for hypertensive disorders of pregnancy (RR 0.80, 95% CI 0.34 to 1.89; 2 trials, 325 women) due to very low-certainty evidence. The included trials did not report on development of type 2 diabetes in the mother or maternal hypoglycaemia.Fetal and neonatal outcomesThe use of fetal biometry may make little or no difference to the incidence of neonatal hypoglycaemia (RR 0.90, 95% CI 0.57 to 1.42; 3 trials, 524 women; low-certainty evidence). Very low-certainty evidence means that we are unclear about the results for large-for-gestational age (RR 0.81, 95% CI 0.38 to 1.74; 3 trials, 524 women); shoulder dystocia (RR 0.33, 95% CI 0.01 to 7.98; 1 trial, 96 women); a composite measure of perinatal morbidity or mortality (RR 1.00, 95% CI 0.21 to 4.71; 1 study, 96 women); or perinatal mortality (RR 0.33, 95% CI 0.01 to 7.98; 1 trial, 96 women). AUTHORS' CONCLUSIONS This review is based on evidence from three trials involving 524 women. The trials did not report some important outcomes of interest to this review, and the majority of our secondary outcomes were also unreported. The available evidence ranged from low- to very low-certainty, with downgrading decisions based on limitations in study design, imprecision and inconsistency.There is insufficient evidence to evaluate the use of fetal biometry (in addition to maternal blood glucose concentration values) to assist in guiding the medical management of GDM, on either maternal or perinatal health outcomes, or the associated costs.More research is required, ideally larger randomised studies which report the maternal and infant short- and long-term outcomes listed in this review, as well as those outcomes relating to financial and resource implications.
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Affiliation(s)
- Ujvala Rao
- Royal Prince Alfred HospitalDepartment of Women and BabiesMissenden RdSydneyNSWAustralia2050
| | - Bradley de Vries
- Royal Prince Alfred HospitalDepartment of High Risk ObstetricsSydneyAustralia
| | - Glynis P Ross
- Royal Prince Alfred HospitalDepartment of EndocrinologyMissenden RoadSydneyNSWAustralia2050
| | - Adrienne Gordon
- Royal Prince Alfred HospitalNeonatologyMissenden RoadCamperdownSydneyNSWAustralia2050
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4
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Matthew J, Malamateniou C, Knight CL, Baruteau KP, Fletcher T, Davidson A, McCabe L, Pasupathy D, Rutherford M. A comparison of ultrasound with magnetic resonance imaging in the assessment of fetal biometry and weight in the second trimester of pregnancy: An observer agreement and variability study. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:229-244. [PMID: 30479638 DOI: 10.1177/1742271x17753738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
Abstract
Objective To compare the intra and interobserver variability of ultrasound and magnetic resonance imaging in the assessment of common fetal biometry and estimated fetal weight in the second trimester. Methods Retrospective measurements on preselected image planes were performed independently by two pairs of observers for contemporaneous ultrasound and magnetic resonance imaging studies of the same fetus. Four common fetal measurements (biparietal diameter, head circumference, abdominal circumference and femur length) and an estimated fetal weight were analysed for 44 'low risk' cases. Comparisons included, intra-class correlation coefficients, systematic error in the mean differences and the random error. Results The ultrasound inter- and intraobserver agreements for ultrasound were good, except intraobserver abdominal circumference (intra-class correlation coefficient = 0.880, poor), significant increases in error was seen with larger abdominal circumference sizes. Magnetic resonance imaging produced good/excellent intraobserver agreement with higher intra-class correlation coefficients than ultrasound. Good interobserver agreement was found for both modalities except for the biparietal diameter (magnetic resonance imaging intra-class correlation coefficient = 0.942, moderate). Systematic errors between modalities were seen for the biparietal diameter, femur length and estimated fetal weight (mean percentage error = +2.5%, -5.4% and -8.7%, respectively, p < 0.05). Random error was above 5% for ultrasound intraobserver abdominal circumference, femur length and estimated fetal weight and magnetic resonance imaging interobserver biparietal diameter, abdominal circumference, femur length and estimated fetal weight (magnetic resonance imaging estimated fetal weight error >10%). Conclusion Ultrasound remains the modality of choice when estimating fetal weight, however with increasing application of fetal magnetic resonance imaging a method of assessing fetal weight is desirable. Both methods are subject to random error and operator dependence. Assessment of calliper placement variations may be an objective method detecting larger than expected errors in fetal measurements.
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Affiliation(s)
- Jacqueline Matthew
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Hospital Foundation Trust, London, UK
| | - Christina Malamateniou
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Department of Family Care and Mental Health, Faculty of Education and Health, University of Greenwich, London, UK
| | - Caroline L Knight
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Department of Women and Children's Health, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Kelly P Baruteau
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tara Fletcher
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Radiology Department, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Alice Davidson
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Laura McCabe
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Dharmintra Pasupathy
- Department of Family Care and Mental Health, Faculty of Education and Health, University of Greenwich, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
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Rao U, de Vries B, Ross GP, Gordon A. Fetal biometry for guiding the medical management of women with gestational diabetes mellitus for improving maternal and perinatal health. Hippokratia 2017. [DOI: 10.1002/14651858.cd012544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ujvala Rao
- Royal Prince Alfred Hospital; Department of Women and Babies; Missenden Rd Camperdown NSW Australia 2050
| | - Bradley de Vries
- Royal Prince Alfred Hospital; Department of High Risk Obstetrics, RPA Women and Babies; Sydney Australia
| | - Glynis P Ross
- Royal Prince Alfred Hospital; Department of Endocrinology; Missenden Rd Camperdown NSW Australia 2050
| | - Adrienne Gordon
- Royal Prince Alfred Hospital; Neonatology; Missenden Road Camperdown Sydney NSW Australia 2050
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6
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Xi Y, Brown E, Bailey A, Twickler DM. MR imaging of the fetal cerebellar vermis: Biometric predictors of adverse neurologic outcome. J Magn Reson Imaging 2016; 44:1284-1292. [DOI: 10.1002/jmri.25270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yin Xi
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Emily Brown
- University of Texas Southwestern Medical Center; Dallas Texas USA
| | - April Bailey
- University of Texas Southwestern Medical Center; Dallas Texas USA
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7
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Euser AG, Meyers ML, Zaretsky MV, Crombleholme TM. Comparison of congenital pulmonary airway malformation volume ratios calculated by ultrasound and magnetic resonance imaging. J Matern Fetal Neonatal Med 2015; 29:3172-7. [DOI: 10.3109/14767058.2015.1118038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anna G. Euser
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA,
| | - Mariana L. Meyers
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Radiology, University of Colorado Denver, Aurora, CO, USA, and
| | - Michael V. Zaretsky
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA,
| | - Timothy M. Crombleholme
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Surgery, Children’s Hospital of Colorado, Aurora, CO, USA
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8
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Ergaz U, Goldstein I, Divon M, Weiner Z. A Preliminary Study of Three-dimensional Sonographic Measurements of the Fetus. Rambam Maimonides Med J 2015; 6:e0019. [PMID: 25973271 PMCID: PMC4422458 DOI: 10.5041/rmmj.10203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study was aimed at establishing an ideal method for performing three-dimensional measurements of the fetus in order to improve the estimation of fetal weight. METHODS The study consisted of two phases. Phase I was a prospective cross-sectional study performed between 28 and 40 weeks' gestation. The study population (n=110) comprised low-risk singleton pregnancies who underwent a routine third-trimester sonographic estimation of fetal weight. The purpose of this phase was to establish normal values for the fetal abdominal and head volumes throughout the third trimester. Phase II was a prospective study that included patients admitted for an elective cesarean section or for induction of labor between 38 and 41 weeks' gestation (n=91). This phase of the study compared the actual birth weight to two- (2D) and three-dimensional (3D) measurements of the fetus. Conventional 2D ultrasound fetal biometry was performed measuring the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur diaphysis length (FL). Volume estimates were computed utilizing Virtual Organ Computer-aided AnaLysis (VOCAL), and the correlation between measured volumes and actual neonatal weight was calculated. RESULTS Overall, this longitudinal study consisted of 110 patients between 28 and 41 weeks' gestation. Normal values were computed for the fetal abdomen and head volume throughout the third trimester. Ultrasound examination was performed within three days prior to delivery on 91 patients. A good correlation was found between birth weight and abdominal volume (r=0.77) and between birth weight and head volume (r=0.5). Correlation between bidimensional measurements and actual fetal weights was found to be comparable with previously published correlations. CONCLUSION Volume measurements of the fetus may improve the accuracy of estimating fetal size. Additional studies using different volume measurement of the fetus are necessary.
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Affiliation(s)
- Udi Ergaz
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Israel Goldstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Michael Divon
- Department of Obstetrics and Gynecology, Lenox Hill hospital, New York, NY, USA
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
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9
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Gholipour A, Estroff JA, Barnewolt CE, Robertson RL, Grant PE, Gagoski B, Warfield SK, Afacan O, Connolly SA, Neil JJ, Wolfberg A, Mulkern RV. Fetal MRI: A Technical Update with Educational Aspirations. CONCEPTS IN MAGNETIC RESONANCE. PART A, BRIDGING EDUCATION AND RESEARCH 2014; 43:237-266. [PMID: 26225129 PMCID: PMC4515352 DOI: 10.1002/cmr.a.21321] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Fetal magnetic resonance imaging (MRI) examinations have become well-established procedures at many institutions and can serve as useful adjuncts to ultrasound (US) exams when diagnostic doubts remain after US. Due to fetal motion, however, fetal MRI exams are challenging and require the MR scanner to be used in a somewhat different mode than that employed for more routine clinical studies. Herein we review the techniques most commonly used, and those that are available, for fetal MRI with an emphasis on the physics of the techniques and how to deploy them to improve success rates for fetal MRI exams. By far the most common technique employed is single-shot T2-weighted imaging due to its excellent tissue contrast and relative immunity to fetal motion. Despite the significant challenges involved, however, many of the other techniques commonly employed in conventional neuro- and body MRI such as T1 and T2*-weighted imaging, diffusion and perfusion weighted imaging, as well as spectroscopic methods remain of interest for fetal MR applications. An effort to understand the strengths and limitations of these basic methods within the context of fetal MRI is made in order to optimize their use and facilitate implementation of technical improvements for the further development of fetal MR imaging, both in acquisition and post-processing strategies.
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Affiliation(s)
- Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judith A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard L Robertson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Borjan Gagoski
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey J Neil
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Wolfberg
- Boston Maternal Fetal Medicine, Boston, Massachusetts, USA
| | - Robert V Mulkern
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
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10
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Abstract
Fetal magnetic resonance imaging (MRI) is used with increasing frequency as a complementary imaging modality to ultrasound (US) in prenatal diagnosis. Fetal MRI displays the fetal, uterine, and extrauterine anatomy in ways that allow confirmation of normal anatomy and the diagnosis of pathological entities that were formerly very difficult to detect prenatally. Comparison of US views with standard orthogonal plane MR images reinforces the understanding of fetal anatomy as visualized with US. Technological advances in US equipment have allowed the recent description of subtle fetal anatomical structures. Similarly, knowledge of the MRI appearances of pathological conditions has opened opportunities for the sonographic diagnosis of entities such as brainstem malformations and alterations in the normal transient laminar pattern that occur during development of the fetal cerebrum. Fetal MRI can confirm suspicious US findings and thus add confidence in a particular prenatal diagnosis before performing invasive and interventional procedures. Specific MRI sequences can be used to add information about the chemical composition of fetal structures, such as fat, blood, and meconium. Dynamic MRI sequences have increased understanding of gestational age-dependent behavior, and assist the sonographer in assessment of fetal structural anomalies that cause abnormal movement and behavior. The technological ability of US to demonstrate very small structures complements the lower resolution of fetal MR images, whereas the ability of MR to visualize the whole fetus improves the limited views necessitated by US. Therefore, both US and fetal MRI have complementary strengths and weaknesses that can be used to full advantage in prenatal diagnosis.
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Hellinger JC, Medina LS, Epelman M. Pediatric Advanced Imaging and Informatics: State of the Art. Semin Ultrasound CT MR 2010; 31:171-93. [DOI: 10.1053/j.sult.2010.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Abstract
PURPOSE OF REVIEW Fetal magnetic resonance imaging (MRI) is a relatively new clinical application but is becoming increasingly used in fetal medicine in combination with the established technique of antenatal ultrasound. A review of the literature to date provides information for clinicians to help assess which patients they should be referring for fetal MRI and what additional information to ultrasound they can obtain. RECENT FINDINGS This review covers recent articles on practical aspects of imaging, MR findings in common disorders and comparisons with ultrasound. It includes information on current applications for fetal MRI, new sequence acquisitions and postprocessing techniques. Fetal motion is the single most important barrier to improving image data. SUMMARY Fetal MR has become an established tool for assessing the fetal brain. It provides complementary information to ultrasound. However, further optimization of this technique is still required to ensure it is exploited to the full in fetal medicine.
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13
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Kim K, Habas PA, Rousseau F, Glenn OA, Barkovich AJ, Studholme C. Intersection based motion correction of multislice MRI for 3-D in utero fetal brain image formation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:146-58. [PMID: 19744911 PMCID: PMC3328314 DOI: 10.1109/tmi.2009.2030679] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In recent years, postprocessing of fast multislice magnetic resonance imaging (MRI) to correct fetal motion has provided the first true 3-D MR images of the developing human brain in utero. Early approaches have used reconstruction based algorithms, employing a two-step iterative process, where slices from the acquired data are realigned to an approximate 3-D reconstruction of the fetal brain, which is then refined further using the improved slice alignment. This two step slice-to-volume process, although powerful, is computationally expensive in needing a 3-D reconstruction, and is limited in its ability to recover subvoxel alignment. Here, we describe an alternative approach which we term slice intersection motion correction (SIMC), that seeks to directly co-align multiple slice stacks by considering the matching structure along all intersecting slice pairs in all orthogonally planned slices that are acquired in clinical imaging studies. A collective update scheme for all slices is then derived, to simultaneously drive slices into a consistent match along their lines of intersection. We then describe a 3-D reconstruction algorithm that, using the final motion corrected slice locations, suppresses through-plane partial volume effects to provide a single high isotropic resolution 3-D image. The method is tested on simulated data with known motions and is applied to retrospectively reconstruct 3-D images from a range of clinically acquired imaging studies. The quantitative evaluation of the registration accuracy for the simulated data sets demonstrated a significant improvement over previous approaches. An initial application of the technique to studying clinical pathology is included, where the proposed method recovered up to 15 mm of translation and 30 degrees of rotation for individual slices, and produced full 3-D reconstructions containing clinically useful additional information not visible in the original 2-D slices.
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Affiliation(s)
- Kio Kim
- Department of Radiology and Biomedical Imaging, University of California San Francisco CA, 94143 USA. (Website: http://radiology.ucsf.edu/bicg)
| | - Piotr A. Habas
- Department of Radiology and Biomedical Imaging, University of California San Francisco CA, 94143 USA. (Website: http://radiology.ucsf.edu/bicg)
| | | | - Orit A. Glenn
- Department of Radiology and Biomedical Imaging, University of California San Francisco CA, 94143 USA. (Website: http://radiology.ucsf.edu/bicg)
| | - Anthony J. Barkovich
- Department of Radiology and Biomedical Imaging, University of California San Francisco CA, 94143 USA. (Website: http://radiology.ucsf.edu/bicg)
| | - Colin Studholme
- Department of Radiology and Biomedical Imaging, University of California San Francisco CA, 94143 USA (Website: http://radiology.ucsf.edu/bicg)
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14
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Abstract
Fetal magnetic resonance imaging (MRI) may add important diagnostic information to prenatal sonography and has the power to confirm or change decisions at critical points in clinical care. Recent studies have shown MRI to be a critical clinical adjunct in the evaluation of the developing central nervous system (CNS), especially at early gestational ages, and MRI has been used in three significant ways: (1) for the quantification of brain growth and structural abnormalities using biometry, (2) for the qualitative evaluation of CNS microstructure, and (3) for the qualitative assessment of dynamic fetal movements in utero.
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16
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Abstract
MRI is a useful supplement to USG for the assessment of fetal brain malformations. Superior soft tissue contrast and the ability to depict sulcation and myelination are the strengths of MRI. Subtle or inconclusive USG abnormalities can be confirmed or ruled out by MRI. In some cases, additional findings detected with MRI often help in arriving at a definitive diagnosis, which is necessary for parental counseling and for guiding management. Fast T2W sequences form the basis of fetal MRI. There have been no reports of deleterious effects of MRI on the fetus. A few case examples are presented to illustrate the advantages of MRI.
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Affiliation(s)
- Ganesh Rao B
- Ragavs Diagnostic and Research Centre, Sadguru Complex, 27 Cross, 4 Block, West, Jayanagar, Bangalore- 560 011, India
| | - BS Ramamurthy
- Srinivasa Ultrasound Scanning Centre, 48/2, Shankar Mutt Road, Shankarpuram, Bangalore - 560 004, India
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