Congenital Thoracic Abnormalities: Contribution of Prenatal Magnetic Resonance İmaging to Ultrasound Diagnosis

Year 2021, Volume: 11 Issue: 1, 67 - 76, 22.03.2021

Gülseren Dinç , Deniz Öztürk

https://doi.org/10.31832/smj.798874

Abstract

Objective: We aimed to evaluate the contribution of prenatal magnetic resonance (MR) imaging to ultrasound (US) in the diagnosis of congenital thoracic abnormalities.
Materials and Methods: Thirty-three out of 984 pregnant women, with fetal thoracic anomalies detected at US and subsequently underwent fetal MR imaging were analyzed retrospectively. In the present methodological study, prenatal MR imaging and US findings are compared with postnatal imaging, autopsy, surgical pathologic examination, physical examination or clinical follow-up. Diagnostic sensitivities were calculated for US, MR imaging and combinations of both methods by comparing US and MR results with postnatal definite diagnoses.
Results: The sensitivities of US and MR imaging in detecting thoracic anomalies were 53.3% and 66.7%, respectively. Both US and MRI findings were consistent in prenatal imaging in a total 27 (82%) of cases. Both US and MR imaging made correct diagnosis in 48% of cases. MR imaging confirmed the suspected US diagnosis in 3%. Prenatal MR imaging positively contributed to US with revealing additional findings such as pulmonary hypoplasia and mediastinal shift in 30% cases. Main contribution (90%) of MR imaging to US was in congenital diaphragmatic hernia (CDH) cases. In all cases with CDH, MRI showed reduction in T2 signal consistent with pulmonary hypoplasia. MR imaging completely altered the diagnosis in 9% of cases. Total contribution rate of prenatal MR imaging to US was 42%. Sixty-seven percent of prenatally detected congenital cystic adenomatoid malformation (CCAM) and congenital lobar fluid overload (CLFO) cases exhibited spontaneous resolution before birth.
Conclusion: MR imaging as a complementary to US can be used successfully in the prenatal diagnosis of congenital thoracic pathologies. It can provide additional findings, confirm the suspected diagnosis or completely alter the prenatal US diagnosis. The most additional contribution of MRI to US was provided in cases of CDH.

Keywords

prenatal diagnosis, magnetic resonance imaging, ultrasound, thorax abnormalities

Supporting Institution

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Project Number

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Congenital Thoracic Abnormalities: Contribution of Prenatal Magnetic Resonance İmaging to Ultrasound Diagnosis

Abstract

Amaç: Çalışmada konjenital torasik anomalikleri olan fetüslerde prenatal manyetik rezonans görüntüleme (MRG)’nin prenatal ultrason (US)'na olan katkısını ortaya koymayı amaçladık.
Gereç ve Yöntemler: Prenatal dönemde ultrason (US) de fetal torasik anomaliler tespit edilen ve ardından fetal Amaç: Çalışmada konjenital torasik anomalikleri olan fetüslerde prenatal manyetik rezonans görüntüleme (MRG)’nin prenatal ultrason (US)'na olan katkısını ortaya koymayı amaçladık.
Gereç ve Yöntemler: Prenatal dönemde ultrason (US) de fetal torasik anomaliler tespit edilen ve ardından fetal MRG yapılan 984 gebenin 33'ü retrospektif olarak analiz edildi. Metadolojik çalışmada, prenatal MR görüntüleme ve US bulguları doğum sonrası görüntüleme, otopsi, cerrahi patolojik inceleme, fizik muayene veya klinik takip ile karşılaştırıldı. US, MRG ve her iki yöntemin kombinasyonları için tanısal duyarlılıklar, US ve MR sonuçları, doğum sonrası kesin tanılarla karşılaştırılarak hesaplandı.
Sonuçlar: US ve MRG'nin torasik anomalileri saptamadaki duyarlılıkları sırasıyla % 53.3 ve % 66.7 bulundu. Prenatal görüntülemede olguların %82’sinde hem MR hem de US bulguları birbiriyle uyumluydu. Olguların %48’inde hem MR hem de US doğru tanıyı koydu. MRG, %3 olguda şüpheli US tanısını doğruladı. Prenatal MRG, %30 vakada primer tanıya ek olarak pulmoner hipoplazi ve mediastinal şift gibi ek bulguları ortaya çıkararak US’ye ilave katkıda bulunmuştur. MRG’nin US'ye en fazla katkısı (% 90) konjenital diyafram hernilerinde (KDH) oldu. KDH’li olguların tümünde pulmoner hipoplazi ile uyumlu olarak T2 ağırlıklı MRG’de sinyal azalması saptandı. MRG, %9 olguda US tanısını tamamen değiştirdi. Prenatal MRG’nin US’ye toplam katkı oranı %42 idi. Doğum öncesi kistik adenomatoid malformasyon (CCAM) veya doğumsal lober sıvı yüklenmesi (CLFO) tanısı konan fetüslerin %67’sinde doğum sonrasında spontan rezolüsyon saptandı.
Sonuç: US'ye tamamlayıcı yöntem olarak MRG görüntüleme doğumsal toraks patolojilerinin prenatal tanısında başarıyla kullanılabilir. MRG prenatal dönemde US’ye ek bulgular sağlayabilir, şüpheli tanıyı doğrulayabilir veya tanıyı tamamen değiştirebilir. Çalışmada MRG’nin US’ye en fazla (%90) katkı sağladığı patoloji konjenital diyafram hernileri bulundu.

Keywords

prenatal tanı, manyetik rezonans görüntüleme,, ultrason, fetüs

Project Number

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References

• 1. Pacharn P, Kline-Fath B, Calvo-Garcia M, Linam LE, Rubio EI, Salisbury S, Brody AS. Congenital lung lesions: prenatal MRI and postnatal findings. Pediatr Radiol. 2013 Sep;43(9):1136-43.
• 2. The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Practice Guidelines: ultrasound assessment of fetal biometry and growth Ultrasound Obstet Gynecol 2019;53: 715–723.
• 3. Daltro P, Werner H, Gasparetto TD, Domingues RC, Rodrigues L, Marchiori E, Gasparetto EL. Congenital chest malformations: a multimodality approach with emphasis on fetal MR imaging. Radiographics 2010; 30:385-95
• 4. Hibbeln JF, Shors SM, Byrd SE. MR imaging: is there a role in obstetrics? Clin Obstet Gynecol 2012; 55:352-66.
• 5. Torrents-Barrena J, Piella G, Masoller N, Gratacós E, Eixarch E, Ceresa M, Gonzalez Ballester MA. Segmentation and classification in MRI and US fetal imaging: Recent trends and future prospects. Med Image Anal 2019; 51:61-88.
• 6. Kul S, Korkmaz HA, Cansu A, Dinc H, Ahmetoglu A, Guven S, Imamoglu M. Contribution of MR imaging to ultrasound in the diagnosis of fetal anomalies. J Magn Reson Imaging 2012; 35:882-90
• 7. Breysem L, Bosmans H, Dymarkowski S, Schoubroeck DV, Witters I, Deprest J, Demaerel P, Vanbeckevoort D, Vanhole C, Casaer P, Smet M. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. Eur Radiol 2003; 13(7):1538-48.
• 8. Matsuoka S, Takeuchi K, Yamanaka Y, Kaji Y, Sugimura K, Maruo T. Comparison of magnetic resonance imaging and ultrasonography in the prenatal diagnosis of congenital thoracic abnormalities. Fetal Diagn Ther 2003; 18(6):447-53.
• 9. Johnston JH, Kline-Fath BM, Bitters C, Calvo-Garcia MA, Lim FY. Congenital overinflation: prenatal MR imaging and US findings and outcomes. Prenat Diagn 2016; 36(6):568-75.
• 10.Khatib N, Beloosesky R, Ginsberg Y, Lea B, Michal G, Weiner Z, Bronshtein M. Early sonographic manifestation of fetal congenital lobar emphysema. J Clin Ultrasound 2019; 47:225-227
• 11 Martin C, Darnell A, Escofet C, Duran C, Pérez V. Fetal MR in the evaluation of pulmonary and digestive system pathology. Insights Imaging 2012; 3(3):277-93.
• 12. Alamo L, Gudinchet F, Reinberg O, Vial Y, Francini K, Osterheld MC, Meuli R. Prenatal diagnosis of congenital lung malformations. Pediatr Radiol 2012; 42(3):273-83
• 13. Hubbard AM, Adzick NS, Crombleholme TM, Coleman BG, Howell LJ, Haselgrove JC, Mahboubi S. Congenital chest lesions: diagnosis and characterization with prenatal MR imaging. Radiology 1999; 212:43-8
• 14. Alamo L, Gudinchet F, Meuli R. Imaging findings in fetal diaphragmatic abnormalities. Pediatr Radiol 2015; 45 (13) :1887-900.
• 15. Mehollin-Ray AR, Cassady CI, Cass DL, Olutoye OO. Fetal MR imaging of congenital diaphragmatic hernia. Radiographics 2012; 32 (4):1067-84.
• 16.Aksoy Ozcan U, Altun E, Abbasoglu L. Space occupying lesions in the fetal chest evaluated by MRI. Iran J Radiol 2012;9(3):122-9.
• 17. Levine D, Barnewolt CE, Mehta TS, Trop I, Estroff J, Wong G. Fetal thoracic abnormalities: MR imaging. Radiology 2003 Aug;228(2):379-88.
• 18.Kuwashima S, Nishimura G, Iimura F, Kohno T, Watanabe H, Kohno A, Fujioka M. Low-intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia. Pediatr Radiol 2001;31(9):669-72.
• 19.Deprest J, Brady P, Nicolaides K, Benachi A, Berg C, Vermeesch J, Gardener G, Gratacos E. Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial. Semin Fetal Neonatal Med 2014;19(6):338-48.
• 20.Liu YP, Chen CP, Shih SL, Chen YF, Yang FS, Chen SC. Fetal cystic lung lesions: evaluation with magnetic resonance imaging. Pediatr Pulmonol 2010;45(6):592-600.
• 21.Labege JM, Flageole H, Pugash D, Khalife S, Blair G, Filiatrault D, Russo P, Lees G, Wilson RD. Outcome of the prenatally diagnosed congenital cystic adenomatoid lung malformation: A Canadian experience. Fetal Diagn Ther 2001;16 (3):178-86.
• 22.Ankers D, Sajjad N, Green P, McPartland JL. Antenatal management of pulmonary hyperplasia (congenital cystic adenomatoid malformation). BMJ Case Rep 2010;21; 1-5.
• 23. Mashiach R, Hod M, Friedman S, Schoenfeld A, Ovadia J, Merlob P. Antenatal ultrasound diagnosis of congenital cystic adenomatoid malformation of the lung: spontaneous resolution in utero. J Clin Ultrasound 1993; 21:453-7.
• 24. Daventport M, Warne SA, Cacciaguerra S, Patel S, Greenough A, Nicoliaides K. Current outcome of antenatally diagnostic cystic lung disease. J Pediatr Surg 2004; 39 (4):549-556.
• 25.Tsai PS, Chen CP, Lin DC, Liu YP. Prenatal diagnosis of congenital lobar fluid overload. Taiwan J Obstet Gynecol 2017;56 (4): 425-431.
• 26. Oliver ER, DeBari SE, Horii SC, Pogoriler JE, Victoria T, Khalek N, Howell LJ, Adzick NS, Coleman BG. Congenital Lobar Overinflation: A Rare Enigmatic Lung Lesion on Prenatal Ultrasound and Magnetic Resonance Imaging. J Ultrasound Med 2019; 38 (5):1229-1239.
• 27.Ierullo AM, Ganapathy R, Crowley S, Craxford L, Bhide A, Thilaganathan B. Neonatal outcome of antenatally diagnosed congenital cystic adenomatoid malformations. Ultrasound Obstet Gynecol 2005;26(2):150-3.