Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies

Introduction

Our aim was to investigate the accuracy of postmortem fetal magnetic resonance imaging (MRI) compared with fetal autopsy in second trimester pregnancies terminated due to fetal anomalies. A secondary aim was to compare the MRI evaluations of two senior radiologists.

Material and methods

This was a prospective study including 34 fetuses from pregnancies terminated in the second trimester due to fetal anomalies. All women accepted a postmortem MRI and an autopsy of the fetus. Two senior radiologists performed independent evaluations of the MRI images. A senior pathologist performed the fetal autopsies. The degree of concordance between the MRI evaluations and the autopsy reports was estimated as well as the consensus between the radiologists.

Results

Thirty‐four fetuses were evaluated. Sixteen cases were associated with the central nervous system (CNS), five were musculoskeletal, one cardiovascular, one was associated with the urinary tract, and 11 cases had miscellaneous anomalies such as chromosomal aberrations, infections and syndromes. In the 16 cases related to the CNS, both radiologists reported all or some, including the most clinically significant anomalies in 15 (94%; CI 70%‐100%) cases. In the 18 non‐CNS cases, both radiologists reported all or some, including the most clinically significant anomalies in six (33%; CI 5%‐85%) cases. In 21 cases (62%; CI 44%‐78%), both radiologists held opinions that were consistent with the autopsy reports. The degree of agreement between the radiologists was high, with a Cohen's Kappa of 0.87.

Conclusions

Postmortem fetal MRI can replace autopsy for second trimester fetuses with CNS anomalies. For non‐CNS anomalies, the concordance is lower but postmortem MRI can still be of value when autopsy is not an option.

Ultrasmall iron oxide particle contrast agent and MRI can be used to monitor the effect of anti-rejection treatment

BACKGROUND

The purpose of the study was to investigate the feasibility of monitoring anti-rejection treatment using a blood pool contrast agent and magnetic resonance (MR) imaging.

METHODS

Allogeneic heterotopic heart transplantations in rats were performed. In one group (treated group), a mild acute rejection was developed and subsequently treated and MR imaging was performed before and after anti-rejection treatment. In the other group (nontreated group), a mild acute rejection was developed and allowed to progress without treatment and MR examinations were performed before and after the advance of the acute rejection. After injecting ultrasmall superparamagnetic contrast agent, the relative change of signal intensity (SI) over time was measured. The SI difference between both radiological investigations for every animal was calculated; hence, every animal served as its own control.

RESULTS

In both treated and nontreated groups, a significant difference over time was found between the two MR examinations seen as a decrease in the treated group and an increase in the nontreatment group.

CONCLUSION

It is concluded that the effect of anti-rejection treatment can be detected using a blood pool agent and MR imaging, as a change in SI corresponding to changes in the vascular permeability.

Bridging the research gap: aboriginal and academic collaboration in FASD prevention. The Healthy Communities, Mothers and Children Project

OBJECTIVES

The objective was to assist with the prevention of Fetal Alcohol Spectrum Disorder through a participatory research approach involving local women and health care workers. Our interest was in understanding how well communities could develop culturally appropriate methods of helping women to reduce their alcohol consumption during pregnancy.

STUDY DESIGN

Four geographically distant Aboriginal communities were presented with a task of adapting a standard Brief Alcohol Intervention, and in particular to develop a culturally appropriate means of using the Intervention with women in the community.

METHODS

Academic and Aboriginal community researchers worked together in partnership, using a participatory action research approach to address alcohol use during pregnancy.

RESULTS

The outcome of the project was the design of four differing models of culturally appropriate community interventions designed to support vulnerable women in their childbearing years. The intervention models developed by the four communities have five core characteristics: (1) identification of women at risk; (2) assessment of the woman's drinking/ drug use; (3) provision of information to the women; (4) delivery method facilitates the decision to adopt healthier behaviors; and (5) means to monitor changes.

CONCLUSION

This project was considered successful in many respects: (1) each community developed a culturally-relevant prevention tool; (2) community involvement in the design lead to better understanding of its usefulness; (3) considerable knowledge exchange between academic and community partners took place; and (4) most importantly, it was found that community members can be active members in developing and implementing solutions to important public health issues.

Macrophage uptake of ultra-small iron oxide particles for magnetic resonance imaging in experimental acute cardiac transplant rejection

PURPOSE

To discriminate between acutely rejecting and non-rejecting transplanted hearts using a blood pool contrast agent and T2* magnetic resonance imaging (MRI) in a clinical 1.5T scanner.

MATERIAL AND METHODS

Allogeneic and syngeneic heterotopic heart transplantations were performed in rats. One allogeneic and one syngeneic group each received either the ultra-small iron oxide particle (USPIO), at two different doses, or no contrast agent at all. MRI was performed on postoperative day 6. Immediately after the MR scanning, contrast agent was injected and a further MRI was done 24 h later. Change in T2* was calculated.

RESULTS

No significant difference in change in T2* could be seen between rejecting and non-rejecting grafts in either of the doses, or in the control groups. There was a difference between the allogeneic group that received the higher contrast agent dose and the allogeneic group that did not receive any contrast agent at all.

CONCLUSION

In our rat model, measurements of T2* after myocardial macrophage uptake of AMI-227 in a clinical 1.5T scanner were not useful for the diagnosis of acute rejection.

Acute cardiac transplant rejection: detection and grading with MR imaging with a blood pool contrast agent--experimental study in the rat

PURPOSE

To investigate the possibility of detecting cardiac transplant rejection and determining its degree of severity with magnetic resonance (MR) imaging with a blood pool contrast agent.

MATERIALS AND METHODS

Rat allogeneic (PVG to Wistar/Kyoto, n = 9) and syngeneic (Wistar/Kyoto to Wistar/Kyoto, n = 6) heterotopic heart transplantations were performed. On the 2nd and 6th postoperative days, an ultrasmall superparamagnetic iron oxide, or USPIO, contrast agent was injected intravenously at a dose of 2 mg of iron per kilogram of body weight. The injection was followed by three-dimensional T1-weighted MR imaging of the heart grafts with an imaging time of approximately 2 minutes for each image for 44 minutes. The signal intensity (SI) was measured in the myocardium over time, and the relative enhancement was calculated. After the 6th day, the rats were sacrificed, and the morphology of the transplanted hearts was assessed histologically. The CIs for the difference of the means on day 2 and day 6 were calculated by using a bootstrap technique, and the correlation between the relative SI change and the histologically determined degree of rejection were calculated with the Spearman rank order correlation coefficient.

RESULTS

On day 6, a statistically significant difference between the groups was found at 4 minutes after injection of the contrast agent and increased with increasing time after injection. The mean percentage change in SI at the last time point for the allogeneic group on day 2 was -8.7% (SD, 8.5) and for the syngeneic group was -6.6% (SD, 6.0). On day 6, the allogeneic group had a relative SI change of 17.7% (SD, 8.7), whereas the syngeneic group had a change of -7.4% (SD, 2.6). There was a significant difference between only the two groups on day 6 (P <.001). Furthermore, in the allogeneic group the histologically determined degree of rejection correlated positively with the relative SI enhancement (r = 0.89, P <.005).

CONCLUSION

Acutely rejecting heart transplants can be distinguished from nonrejecting ones in an animal model with MR imaging and a blood pool contrast agent. In addition, the relative SI enhancement reflects the histologically determined degree of rejection.

The effect of transmission bandwidth on the quality of ophthalmological still and video images

We have examined the minimum realtime transmission speed for video-angiography with the Rodenstock scanning laser ophthalmoscope (SLO) with respect to spatial and contrast resolution. An SLO fluorescein video-angiography sequence was recorded using high-quality media and relayed to a remote site at transmission speeds ranging from T3 (4.5 Mbit/s) to 0.125 T (197 kbit/s). Images were compared with each other subjectively by an ophthalmologist and objectively with image processing software. When compared qualitatively there was little difference between the T3 and T1 images. The T1 images scored well on clarity and contrast, while 0.5 T was satisfactory but inferior to T1. Transmission speeds below 0.5 T were inadequate. The digital analysis showed a slight difference between T3 and T1. We calculated that there was up to a 92% loss of resolution at 0.25 T and up to a 98% loss at 0.125 T. Based on our quantitative and qualitative analysis, a T3 line provided the highest bandwidth and best resolution, as expected. However, 0.5 T gave satisfactory results for realtime consultations and appears to be the minimum speed required for ophthalmic purposes, producing few motion artefacts and good resolution.