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01-06-2019 | Neuro

Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage

Authors: Giana Izzo, Giacomo Talenti, Giorgia Falanga, Marco Moscatelli, Giorgio Conte, Elisa Scola, Chiara Doneda, Cecilia Parazzini, Mariangela Rustico, Fabio Triulzi, Andrea Righini

Published in: European Radiology | Issue 6/2019

Abstract

Background and purpose

Fetal postmortem MR Imaging (pmMRI) has been recently used as an adjuvant tool to conventional brain autopsy after termination of pregnancy (TOP). Our purpose was to compare the diagnostic performance of intrauterine MRI (iuMRI) and pmMRI in the detection of brain anomalies in fetuses at early gestational age (GA).

Material and methods

We retrospectively collected 53 fetuses who had undergone iuMRI and pmMRI for suspected brain anomalies. Two pediatric neuroradiologists reviewed iuMRI and pmMRI examinations separately and then together. We used Cohen’s K to assess the agreement between pmMRI and iuMRI. Using the combined evaluation iuMRI+pMRI as the reference standard, we calculated the “correctness ratio.” We used Somers’ D to assess the cograduation between postmortem image quality and time elapsed after fetus expulsion.

Results

Our data showed high agreement between iuMRI and pmMRI considering all the categories together, for both observers (K1 0.84; K2 0.86). The correctness ratio of iuMRI and pmMRI was 79% and 45% respectively. The major disagreements between iuMRI and pmMRI were related to postmortem changes as the collapse of liquoral structures and distorting phenomena. We also found a significant cograduation between the time elapsed from expulsion and pmMRI contrast resolution and distortive phenomena (both p < 0.001).

Conclusions

Our study demonstrates an overall high concordance between iuMRI and pmMRI in detecting fetal brain abnormalities at early GA. Nevertheless, for the correct interpretation of pmMRI, the revision of fetal examination seems to be crucial, in particular when time elapsed from expulsion is longer than 24 h.

Key Points

• IuMRI and pmMRI showed overall high concordance in detecting fetal brain abnormalities at early GA.

• PmMRI corroborated the antemortem diagnosis and it could be a valid alternative to conventional brain autopsy, only when the latter cannot be performed.

• Some caution should be taken in interpreting pmMR images when performed after 24 h from fetal death.

Glenn OA (2006) Fetal central nervous system MR imaging. Neuroimaging Clin N Am 16(1):1–17CrossRefPubMed

Jarvis D, Mooney C, Cohen J et al (2017) A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities in utero. Eur Radiol 27(6):2367–2380CrossRef

Huisman TA, Wisser J, Stallmach T, Krestin GP, Huch R, Kubik-Huch RA (2002) MR conventional brain autopsy in fetuses. Fetal Diagn Ther 17:58–64CrossRefPubMed

Griffiths PD, Paley MN, Whitby EH (2005) Post-mortem MRI as an adjunct to fetal or neonatal conventional brain autopsy. Lancet 365:1271–1273CrossRefPubMed

Addison S, Arthurs OJ, Thayyil S (2014) Post-mortem MRI as an alternative to non forensic conventional brain autopsy in fetuses and children: from research into clinical practice. Br J Radiol. https://doi.org/10.1259/bjr.20130621

Brookes JS, Hagmann C (2006) MRI in fetal necroscopy. J Magn Reson Imaging 24:1221–1228CrossRefPubMed

Pfefferbaum A, Sullivan EV, Adalsteinsson E, Garrick T, Harper C (2004) Postmortem MR imaging of formalin-fixed human brain. Neuroimage 21:1585–1595CrossRefPubMed

Thayyil S, Sebire NJ, Chitty LS et al (2011) Post mortem magnetic resonance imaging in the fetuses, infant and child : a comparative study with conventional conventional brain autopsy (MaRIAS protocol). BMC Pediatr. https://doi.org/10.1186/1471-2431-11-120

Lequin MH, Huisman TA (2012) Postmortem MR imaging in the fetal and neonatal period. Magn Reson Imaging Clin N Am 20:129–143

10.

Whitby EH, Paley MN, Cohen M, Griffiths PD (2005) Postmortem MR imaging of the fetus: an adjunct or a replacement for conventional conventional brain autopsy? Semin Fetal Neonatal Med 10:475–483

11.

Breeze AC, Cross JJ, Hackett GA et al (2006) Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 28:918–924

12.

Scola E, Conte G, Palumbo G et al (2018) High resolution post-mortem MRI of non fixed in situ foetal brain in the second trimester of gestation : normal foetal brain development. Eur Radiol 28(1):363–371CrossRef

13.

Whitby EH, Variend S, Rutter S et al (2004) Corroboration of in utero MRI using post-mortem MRI and conventional brain autopsy in foetuses with CNS abnormalities. Clin Radiol 59:1114–1120CrossRef

14.

Griffiths PD, Bradburn M, Campbell MJ et al (2017) Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): a multicentre, prospective cohort study. Lancet 389(10068):538–546CrossRef

15.

Arthurs OJ, Thayyil S, Pauliah SS et al (2015) Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children. Clin Radiol 70:872–800CrossRef

16.

Griffiths PD, Varient D, Evans M et al (2003) Postmortem MR imaging of the fetal and stillborn central nervous system. AJNR Am J Neuroradiol 24:22–27

17.

Whitby EH, Paley MN, Cohen M, Griffiths PD (2006) Post-mortem fetal MRI: what do we learn from it? Eur J Radiol 57:250–255CrossRefPubMed

18.

Thayyil S, Sebire N, Chitty LS et al (2013) Post-mortem MRI versus conventional conventional brain autopsy in fetuses and children: a prospective validation study. Lancet 382:223–233CrossRef

19.

Sebire NJ, Miller S, Jacques TS et al (2013) Post-mortem apparent resolution of fetal ventriculomegaly : evidence from magnetic resonance imaging. Prenat Diagn 33:360–364

20.

Garel C, Fallet-Bianco C, Guibaud L (2011) The fetal cerebellum: development and common malformations. J Child Neurol 26(12):1483–1492CrossRefPubMed

21.

Conte G, Parazzini C, Falanga G et al (2016) Diagnostic value of prenatal MR imaging in the detection of brain malformations in fetuses before the 26th week of gestational age. AJNR 37(5):946–951CrossRefPubMed

22.

Thayyil S, De Vita E, Sebire NJ et al (2012) Post-mortem cerebral magnetic resonance imaging T1 and T2 in fetuses, newborns and infants. Eur J Radiol 81:232–238CrossRef

23.

Montaldo P, Addison S, Oliveira V et al (2016) Quantification of maceration changes using post mortem MRI in fetuses. BMC Med Imaging. https://doi.org/10.1186/s12880-016-0137-9

24.

Verhoye M, Votino C, Cannie MM et al (2013) Post-mortem high-field magnetic resonance imaging: effect of various factors. J Matern Fetal Neonatal Med 26(11):1060–1065CrossRefPubMed

25.

Kostovic I, Judas M, Rados M, Hrabac P (2002) Laminar organization of the human fetal cerebrum revealed by histochemical markers and magnetic resonance imaging. Cereb Cortex 12:536–544CrossRefPubMed

26.

Zhang Z, Liu S, Lin X et al (2011) Development of fetal brain of 20 weeks gestational age: assessment with post-mortem magnetic resonance imaging. Eur J Radiol 80(3):e432–e439CrossRefPubMed

27.

Widjaja E, Geibprasert S, Blaser S, Rayner T, Shannon P (2009) Abnormal fetal cerebral lamination in cobbleston complex seen on post-mortem MRI and DTI. Pediatr Radiol 38:860–864CrossRef

28.

Widjaja E, Geibprasert S, Mahmoodabadi SZ, Brown NE, Shannon P (2010) Corroboration of normal and abnormal fetal cerebral lamination on post mortem MR imaging with postmortem examination. AJNR 31:1987–1993CrossRefPubMed

29.

Sebire NJ (2006) Towards the minimally invasive conventional brain autopsy? Ultrasound Obstet Gynecol 28:865–867

30.

Breeze AC, Jessop FA, Set PA et al (2011) Minimally-invasive fetal autopsy using magnetic resonance imaging and percutaneus organ biopsies: clinical value and comparison to conventional autopsy. Ultrasound Obstet Gynecol 37:317–323

Title: Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage
Authors: Giana Izzo
Giacomo Talenti
Giorgia Falanga
Marco Moscatelli
Giorgio Conte
Elisa Scola
Chiara Doneda
Cecilia Parazzini
Mariangela Rustico
Fabio Triulzi
Andrea Righini
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5878-0

At a glance: The STEP trials

Springer Medicine

Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage

Abstract

Background and purpose

Material and methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Material and methods

Results

Conclusions

Key Points

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