Fetal Manyetik Rezonans Görüntülemenin Ultrasonografi ile Tespit Edilen Fetal Anomalilerin Değerlendirilmesindeki Katkısı

Öz

Fetal manyetik rezonans görüntüleme (MRG), prenatal ultrasona ek olarak kullanılan bir fetal tanı yöntemidir. Bu çalışmanın amacı kliniğimizdeki fetal MRG’lerin endikasyonlarını, tanısal doğruluğunu, ultrasonda tespit edilemeyen anomalilerin görülmesi sıklığını incelemekti. Bu çalışma, kliniğimizde Ekim 2014 – Aralık 2017 tarihleri arasında değerlendirilen olguların dahil edildiği bir retrospektif kohort çalışmasıydı. Çalışma süresince 50 olgu fetal MRG ile değerlendirilmiştir. Fetal MRG’lerin %90’I (n=45) fetal santral sinir sistemi anomalisi nedeniyle çekilmişti. Olguların %56’sında fetal MRI ultrasonografi ile tespit edilen anomalileri doğrulamış ve herhangi bir ek tanı sağlamamıştır. Olguların %24’ünde ise fetal MRG, ultrasonografide görülmeyen anomaliler tespit etmiş ve hastaların yönetiminde değişikliğe sebep olmuştur. Fetal MRG kliniğimizde olguların %24’ünde ultrason ile görülemeyen anomalileri tespit etmiş ve hasta yönetiminde değişikliğe yol açmıştır.

Anahtar Kelimeler

• fetal MRG,fetal beyin anomalileri,nörosonografi,prenatal ultrasonografi

Assessment of the Additional Value of Fetal Magnetic Resonance Imaging to Prenatal Ultrasound in a Single Institution

Öz

Fetal magnetic resonance imaging (MRI) is a useful addition to prenatal ultrasonography especially for advanced evaluation of fetal brain abnormalities. The aim of this study is to investigate the indications, diagnostic accuracy and added diagnostic value of fetal MRI. This study is a retrospective cohort conducted at our institution between October 2014 and December 2017. Total number of fetal MRIs during study period was 50. Ninety percent (n=45) of the fetal MRIs were performed with an indication of fetal central nervous system anomaly. In 56% of cases fetal MRI confirmed the ultrasonographic diagnosis without any additional anomaly; in 24% of the cases fetal MRI provided additional diagnosis to the prenatal ultrasound and altered the management of the patients. In our institution, fetal MRI has provided additional diagnosis that is not seen in ultrasound in almost a quarter of the patients with suspected brain abnormalities.

Anahtar Kelimeler

• Fetal MRI,fetal brain anomalies,neurosonography,prenatal ultrasound

Kaynakça

1. 1. Prayer D, Malinger G, Brugger PC, Cassady C, De Catte L, De Keersmaecker B, et al. ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging. Ultrasound Obstet Gynecol. 2017;49(5):671-80.
2. 2. Hedrick HL, Flake AW, Crombleholme TM, Howell LJ, Johnson MP, Wilson RD, et al. History of fetal diagnosis and therapy: Children's Hospital of Philadelphia experience. Fetal Diagn Ther. 2003;18(2):65-82.
3. 3. Jokhi RP, Whitby EH. Magnetic resonance imaging of the fetus. Dev Med Child Neurol. 2011;53(1):18-28.
4. 4. Malinger G, Lev D, Lerman-Sagie T. Is fetal magnetic resonance imaging superior to neurosonography for detection of brain anomalies? Ultrasound Obstet Gynecol. 2002;20(4):317-21.
5. 5. Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2011;37(1):116-26.
6. 6. Griffiths PD, Bradburn M, Campbell MJ, Cooper CL, Graham R, Jarvis D, et al. Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): a multicentre, prospective cohort study. Lancet. 2017;389(10068):538-46.
7. 7. Griffiths PD, Brackley K, Bradburn M, Connolly DJA, Gawne-Cain ML, Griffiths DI, et al. Anatomical subgroup analysis of the MERIDIAN cohort: failed commissuration. Ultrasound Obstet Gynecol. 2017;50(6):753-60.
8. 8. Griffiths PD, Brackley K, Bradburn M, Connolly DJA, Gawne-Cain ML, Kilby MD, et al. Anatomical subgroup analysis of the MERIDIAN cohort: posterior fossa abnormalities. Ultrasound Obstet Gynecol. 2017;50(6):745-52.

9. 9. Griffiths PD, Brackley K, Bradburn M, Connolly DJA, Gawne-Cain ML, Griffiths DI, et al. Anatomical subgroup analysis of the MERIDIAN cohort: ventriculomegaly. Ultrasound Obstet Gynecol. 2017;50(6):736-44.
10. 10. Reeves MJ, Brandreth M, Whitby EH, Hart AR, Paley MN, Griffiths PD, et al. Neonatal cochlear function: measurement after exposure to acoustic noise during in utero MR imaging. Radiology. 2010;257(3):802-9.
11. 11. Kok RD, de Vries MM, Heerschap A, van den Berg PP. Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: a follow-up study. Magn Reson Imaging. 2004;22(6):851-4.
12. 12. Girard NJ, Chaumoitre K. The brain in the belly: what and how of fetal neuroimaging? J Magn Reson Imaging. 2012;36(4):788-804.
13. 13. Frick N, Fazelnia C, Kanzian K, Hitzl W, Fischer T, Forstner R, et al. The reliability of fetal MRI in the assessment of brain malformations. Fetal Diagn Ther. 2015;37(2):93-101.
14. 14. Verburg B, Fink AM, Reidy K, Palma-Dias R. The Contribution of MRI after Fetal Anomalies Have Been Diagnosed by Ultrasound: Correlation with Postnatal Outcomes. Fetal Diagn Ther. 2015;38(3):186-94.
15. 15. van Doorn M, Oude Rengerink K, Newsum EA, Reneman L, Majoie CB, Pajkrt E. Added value of fetal MRI in fetuses with suspected brain abnormalities on neurosonography: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2016;29(18):2949-61.
16. 16. Rossi AC, Prefumo F. Additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies: a systematic review of the literature. Ultrasound Obstet Gynecol. 2014;44(4):388-93.
17. 17. Malinger G, Paladini D, Pilu G, Timor-Tritsch IE. Fetal cerebral magnetic resonance imaging, neurosonography and the brave new world of fetal medicine. Ultrasound Obstet Gynecol. 2017;50(6):679-80.
18. 18. Pharoah PO, Adi Y. Consequences of in-utero death in a twin pregnancy. Lancet. 2000;355(9215):1597-602.
19. 19. Robinson A, Teoh M, Edwards A, Fahey M, Goergen S. Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling. Prenat Diagn. 2017;37(6):611-27.
20. 20. Jelin AC, Norton ME, Bartha AI, Fick AL, Glenn OA. Intracranial magnetic resonance imaging findings in the surviving fetus after spontaneous monochorionic cotwin demise. Am J Obstet Gynecol. 2008;199(4):398 e1-5.