1
|
Gat I, Bar Yosef O, Hoffmann C, Lebovitz O, Shashar D, Gilboa Y, Yagel I, Achiron R, Katorza E. Prenatal Brain Imaging in Isolated vs. Complicated Club Foot: A Cohort Study. Ultraschall Med 2016; 37:591-597. [PMID: 26359688 DOI: 10.1055/s-0035-1553359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose: Talipes equinovarus (TEV) is a common birth defect. Differentiation between isolated and complex TEV is fundamental due to its effect on prognosis. Association between TEV and poor neurological outcome is more prominent in complex cases and highlights the significance of brain evaluation. The aim of the current study was to evaluate the contribution of fetal brain MRI to sonographic evaluation. Materials and Methods: In this retrospective study we evaluated charts of all pregnant patients referred for fetal brain MRI due to fetal TEV between 1/1/2011 and 12/31/14 in a single tertiary referral center. Isolated and complex TEV were differentiated according to associated anomalies. Brain US and MRI results were compared. Results: 28 pregnant patients were included with an average gestation and parity of 2.5 and 1.5, respectively. Both isolated and complicated TEV groups included 14 fetuses after initial TEV diagnosis on anatomical survey. Brain sonography and MRI were normal among 12/14 patients with isolated TEV while two patients were later diagnosed with mild ventriculomegaly. US brain evaluation has revealed pathologic findings in 4 (28.6 %) cases in the complicated TEV group, while MRI demonstrated abnormal findings in 8 (57.1 %) fetuses with notable severity diversity. In 6 cases, MRI diagnosed additional pathologies which were not demonstrated by US. Conclusion: Brain fetal MRI is an efficient tool during antenatal evaluation of complicated TEV with a high percentage of additional findings not demonstrated songraphically while its efficacy in isolated cases is in doubt. The current study expands the relevance of fetal brain MRI in cases of non-CNS anomalies.
Collapse
Affiliation(s)
- I Gat
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Bar Yosef
- Pediatric Neurology Unit, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - C Hoffmann
- Department of Radiology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Lebovitz
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Shashar
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Gilboa
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - I Yagel
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Achiron
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - E Katorza
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
2
|
Valsky DV, Lipschuetz M, Cohen SM, Daum H, Messing B, Yagel I, Yagel S. Persistence of levator ani sonographic defect detected by three-dimensional transperineal sonography in primiparous women. Ultrasound Obstet Gynecol 2015; 46:724-729. [PMID: 25760927 DOI: 10.1002/uog.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Correlation of the sonographic appearance of levator ani muscle (LAM) injury soon after delivery with that at long-term follow-up has not been described fully. We aimed to compare results of three-dimensional (3D) transperineal sonographic (TPS) evaluation of the LAM from the period immediately postpartum with long-term follow-up, to determine whether sonographic findings persist over time. METHODS Primiparous women (n = 210) who had been examined by 3D-TPS in a previous study to determine LAM trauma 24-72 hours after delivery were invited to participate in a follow-up examination 3-21 months postpartum. We included in this study only women who were not pregnant when approached and who had not given birth in the interim. LAM trauma was diagnosed with 3D-TPS when we observed discontinuity and distortion of the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Initial and follow-up 3D-TPS results were compared using Cohen's kappa test for inter-rater agreement. RESULTS Among the 87 women included in this study we found strong correlation between earlier and later sonographic appearance of LAM: 17/21 women with a sonographic finding of LAM injury in the period immediately postpartum were positive in the follow-up examination, and only 2/66 women negative for LAM damage at the first examination were found to have sonographic evidence of LAM defect at follow-up (Cohen's kappa, 0.805 (95% CI, 0.656-0.954), P < 0.001). CONCLUSIONS Our findings suggest that 3D-TPS of the LAM is a reliable examination. A sonographic finding of LAM defect identified in the period immediately postpartum persists months or years after delivery; therefore, this test may be performed following delivery, or may be delayed without impacting the result. It is likely that this sonographic defect represents real anatomical disruption and is not an imaging artifact.
Collapse
Affiliation(s)
- D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - M Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - H Daum
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - B Messing
- Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - I Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| |
Collapse
|
3
|
Lipschuetz M, Valsky DV, Shick-Naveh L, Daum H, Messing B, Yagel I, Yagel S, Cohen SM. Sonographic finding of postpartum levator ani muscle injury correlates with pelvic floor clinical examination. Ultrasound Obstet Gynecol 2014; 44:700-703. [PMID: 24510840 DOI: 10.1002/uog.13325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 12/19/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Correlation of the sonographic finding of levator ani muscle (LAM) injuries with clinical examination in primiparous women following vaginal delivery has not been fully described. We aimed to examine the correlation of three-dimensional transperineal ultrasound (3D-TPS) finding of LAM defects with results of clinical examination of the pelvic floor, at intermediate follow-up. METHODS Subjects were primiparae 3-21 months following vaginal delivery, who had not become pregnant or delivered in the interim. On 3D-TPS, LAM trauma was diagnosed when discontinuity and distortion were visible in the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Clinical examination was performed by a physiotherapist who was blinded to the ultrasound results, and included palpation of the medial and lateral parts of the LAM mass, evaluation of tissue quality and whether there was any palpable gap. Muscle strength was evaluated using the modified Oxford scale. RESULTS Eighty-seven women were included, 19 (21.8%) of whom were found to have a sonographic LAM injury. Oxford score palpation parameter of asymmetric muscle mass or texture was significantly correlated with the finding of a LAM defect: of 68 women with normal 3D-TPS, 22 (32.4%) were found to have asymmetry of muscle mass or tissue quality on clinical examination vs 12 (63.2%) of 19 women with sonographic evidence of LAM injury (P = 0.016). Muscle strength and endurance parameters did not significantly correlate with the 3D-TPS findings. CONCLUSION Our findings suggest that persistent 3D-TPS LAM injury after primary vaginal delivery has clinical expression in changes in mass and texture of the LAM, as assessed by palpation.
Collapse
Affiliation(s)
- M Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | | | | | | | | | | | | | | |
Collapse
|