评估胎儿磁共振成像(MRI)在检测患有轻度或中度孤立性脑室增宽(VM)的胎儿中相关异常中的作用,并对胎儿进行多平面超声评估。
这是一个多中心,回顾性,队列研究涉及意大利的15个转诊胎儿医学中心,英国和西班牙。纳入标准是受孤立的轻度影响的胎儿(心室心房直径,10.0-11.9mm)或中等(心室心房直径,12.0-14.9mm)超声上的VM,定义为具有正常核型的VM,并且在超声上没有其他额外的中枢神经系统(CNS)或CNS外异常,根据国际妇产科超声学会胎儿神经声像图指南的建议,使用多平面方法对胎儿大脑进行详细评估。其次是胎儿MRI。该研究的主要结果是报告仅在产前MRI上检测到的额外CNS异常的发生率,而在超声检查中漏诊。而次要目的是估计仅在出生后发现并在产前成像(超声和MRI)中遗漏的其他异常的发生率。根据MRI的胎龄进行亚组分析(<24vs≥24周),还进行了VM的侧向性(单侧与双侧)和扩张的严重程度(轻度与中度VM).
分析中包括550例超声产前诊断为孤立的轻度或中度VM的胎儿。在5.4%(95%CI,3.8-7.6%)的病例中,在产前MRI上检测到其他结构异常,在超声检查中漏诊。当考虑异常类型时,26.7%的胎儿在MRI上发现了幕上颅内出血,而在20.0%和13.3%的病例中检测到多微陀螺和无脑畸形,分别。6.7%的病例在MRI上发现call体发育不全,而在3.3%中检测到发育不全。仅在MRI上检测到相关异常的胎儿更可能患有中度VM而不是轻度VM(60.0%vs17.7%;P<0.001),而两组患者双侧VM的比例差异无统计学意义(P=0.2)。Logistic回归分析显示,较低的产妇体重指数(调整比值比(aOR),0.85(95%CI,0.7-0.99);P=0.030),中等VM的存在(AOR,5.8(95%CI,2.6-13.4);P<0.001)和MRI≥24周的胎龄(aOR,4.1(95%CI,1.1-15.3);P=0.038)与在MRI上检测到相关异常的概率独立相关。在3.8%的病例中,仅在出生时就发现了相关的异常,并在产前成像中漏诊。
在接受神经超声检查的孤立的轻度或中度VM的胎儿中,超声检查漏出且仅在胎儿MRI上检测到的相关胎儿异常的发生率低于先前报道的发生率。这些异常中的大部分难以在超声上检测到。这项研究的发现支持MRI评估在每个胎儿中进行产前诊断为VM的实践,尽管在神经超声检查中隔离VM时,父母可以放心相关异常的低风险。版权所有©2020ISUOG。由JohnWiley&SonsLtd.发布.
To assess the role of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses presenting with mild or moderate isolated ventriculomegaly (VM) undergoing multiplanar ultrasound evaluation of the fetal brain.
This was a multicenter, retrospective, cohort
study involving 15 referral fetal medicine centers in Italy, the UK and Spain. Inclusion criteria were fetuses affected by isolated mild (ventricular atrial diameter, 10.0-11.9 mm) or moderate (ventricular atrial diameter, 12.0-14.9 mm) VM on ultrasound, defined as VM with normal karyotype and no other additional central nervous system (CNS) or extra-CNS anomalies on ultrasound, undergoing detailed assessment of the fetal brain using a multiplanar approach as suggested by the International Society of Ultrasound in Obstetrics and Gynecology guidelines for the fetal neurosonogram, followed by fetal MRI. The primary outcome of the
study was to report the incidence of additional CNS anomalies detected exclusively on prenatal MRI and missed on ultrasound, while the secondary aim was to estimate the incidence of additional anomalies detected exclusively after birth and missed on prenatal imaging (ultrasound and MRI). Subgroup analysis according to gestational age at MRI (< 24 vs ≥ 24 weeks), laterality of VM (unilateral vs bilateral) and severity of dilatation (mild vs moderate VM) were also performed.
Five hundred and fifty-six fetuses with a prenatal diagnosis of isolated mild or moderate VM on ultrasound were included in the analysis. Additional structural anomalies were detected on prenatal MRI and missed on ultrasound in 5.4% (95% CI, 3.8-7.6%) of cases. When considering the type of anomaly, supratentorial intracranial hemorrhage was detected on MRI in 26.7% of fetuses, while polymicrogyria and lissencephaly were detected in 20.0% and 13.3% of cases, respectively. Hypoplasia of the corpus callosum was detected on MRI in 6.7% of cases, while dysgenesis was detected in 3.3%. Fetuses with an associated anomaly detected only on MRI were more likely to have moderate than mild VM (60.0% vs 17.7%; P < 0.001), while there was no significant difference in the proportion of cases with bilateral VM between the two groups (P = 0.2). Logistic regression analysis showed that lower maternal body mass index (adjusted odds ratio (aOR), 0.85 (95% CI, 0.7-0.99); P = 0.030), the presence of moderate VM (aOR, 5.8 (95% CI, 2.6-13.4); P < 0.001) and gestational age at MRI ≥ 24 weeks (aOR, 4.1 (95% CI, 1.1-15.3); P = 0.038) were associated independently with the probability of detecting an associated anomaly on MRI. Associated anomalies were detected exclusively at birth and missed on prenatal imaging in 3.8% of cases.
The incidence of an associated fetal anomaly missed on ultrasound and detected only on fetal MRI in fetuses with isolated mild or moderate VM undergoing neurosonography is lower than that reported previously. The large majority of these anomalies are difficult to detect on ultrasound. The findings from this
study support the practice of MRI assessment in every fetus with a prenatal diagnosis of VM, although parents can be reassured of the low risk of an associated anomaly when VM is isolated on neurosonography. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.