PDF(Pubmed)
Abstract：
BACKGROUND: Fetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.
METHODS: We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.
RESULTS: MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001).
CONCLUSIONS: There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.
METHODS: We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.
RESULTS: MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001).
CONCLUSIONS: There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.
摘要：
背景：胎儿手术治疗开放性脊柱裂（OSB）需要使用影像学进行全面的术前评估，以选择合适的患者，并评估术后疗效和并发症。我们探索了胎儿磁共振成像（MRI）的患者进入和进行，以对符合胎儿手术资格的OSB患者进行产前评估。我们将影像采集和报告与国际妇产科超声学会MRI性能指南进行了比较。
方法：我们调查了英国和爱尔兰的OSB在转诊胎儿医学单位（FMU）时使用胎儿MRI的情况，和两个NHS英格兰专家在伦敦大学学院医院委托的胎儿手术中心（FSC），和比利时鲁汶大学医院。为了研究MRI采集协议，我们回顾性分析了胎儿OSB手术前后的胎儿MRI图像。
结果：胎儿OSB的MRI可由适当的专家监督，执行,并报告扫描。从请求开始安排胎儿MRI预约的平均时间为4±3天(范围，0-10),可用的平均扫描时间为37±16分钟(范围，20-80分钟),15±11分钟(范围，0-30分钟）根据需要重复序列的额外时间。特定的MRI采集协议，MRI报告模板仅有32%和18%的单位可用，分别。所有中心术前均在三个正交平面中获得满意的T2加权（T2W）脑成像，术后6周，96%的FSC和78%的转诊FMU。然而,对于T2W脊柱图像采集，参考FMU不太能够提供三个正交平面的手术前手术(98%FSC与50%FMU,p<0.001)，手术后6周(100%FSCvs.48%FMU,p<0.001)。其他标准成像建议，如T1加权(T1W)，与手术前和手术后的FMU相比,FSCs中一个或两个正交平面的梯度回波(GE)或超声平面胎儿脑和脊柱成像更有可能(p<0.001).
结论：可以及时获得有监督的MRI来评估OSB胎儿手术。然而,在足够的正交平面中提供胎儿大脑和脊柱的图像，这是确定资格和确定胎儿手术后脑疝的逆转所必需的，不太经常被收购。我们的证据表明，需要对OSB的胎儿MRI进行具体指导。我们提出了MRI采集和报告的示例指导。
方法：我们调查了英国和爱尔兰的OSB在转诊胎儿医学单位（FMU）时使用胎儿MRI的情况，和两个NHS英格兰专家在伦敦大学学院医院委托的胎儿手术中心（FSC），和比利时鲁汶大学医院。为了研究MRI采集协议，我们回顾性分析了胎儿OSB手术前后的胎儿MRI图像。
结果：胎儿OSB的MRI可由适当的专家监督，执行,并报告扫描。从请求开始安排胎儿MRI预约的平均时间为4±3天(范围，0-10),可用的平均扫描时间为37±16分钟(范围，20-80分钟),15±11分钟(范围，0-30分钟）根据需要重复序列的额外时间。特定的MRI采集协议，MRI报告模板仅有32%和18%的单位可用，分别。所有中心术前均在三个正交平面中获得满意的T2加权（T2W）脑成像，术后6周，96%的FSC和78%的转诊FMU。然而,对于T2W脊柱图像采集，参考FMU不太能够提供三个正交平面的手术前手术(98%FSC与50%FMU,p<0.001)，手术后6周(100%FSCvs.48%FMU,p<0.001)。其他标准成像建议，如T1加权(T1W)，与手术前和手术后的FMU相比,FSCs中一个或两个正交平面的梯度回波(GE)或超声平面胎儿脑和脊柱成像更有可能(p<0.001).
结论：可以及时获得有监督的MRI来评估OSB胎儿手术。然而,在足够的正交平面中提供胎儿大脑和脊柱的图像，这是确定资格和确定胎儿手术后脑疝的逆转所必需的，不太经常被收购。我们的证据表明，需要对OSB的胎儿MRI进行具体指导。我们提出了MRI采集和报告的示例指导。
