A retrospective cohort analysis on the contribution of fetal magnetic resonance imaging to the diagnosis and management of sonographically detected fetal abnormalities

Yıl 2019, Cilt: 33 Sayı: 1, 33 - 43, 26.04.2019

Semir Köse Fatma Ceren Sarıoğlu , Dilay Gökdeniz Handan Güleryüz , Sabahattin Altunyurt

https://doi.org/10.5505/deutfd.2019.68552

Öz

INTRODUCTION: To evaluate the main indications of the fetal magnetic resonance imaging (fMRI) for the sonographically detected fetal abnormalities and to assess the contribution of this modality to the management of these cases.
METHODS: This retrospective cohort analysis were based on the assesment of the fMRI recordings obtained from the archive of the Dokuz Eylul University Radiodiagnostics Department from between January 2007 and January 2018. The clinical indications, the main findings of the ultrasound examination and the decision of the ethical comitte were also gathered as the integral parameters of the study. 
RESULTS: A sample of 146 fMRI recordings were consisting of 127 (87%) cases of central or peripheral nervous system (CP-NS) abnormalities and 19 (13%) abnormality cases originated from other systems. The biggest 5 sub-groups in the CP-NS abnormalities category were ventriculomegaly (n: 34;26.7%), developmental disorders of the corpus callosum (n: 28; 22.0%), abnormalities of the posterior fossa (n: 14; 11.0%), open neural tube defects (n: 14; 11.0%) and the malformation of the cortical development (n: 7; %5.5). The median gestational age at the time of the sonographic diagnosis was 23 (18-35) weeks in the CP-NS group and 22 (18-28) weeks in the other systems group (p: 0.04). None of the fetal MRI cases was related to a fetal cardiac abnormality. 
DISCUSSION AND CONCLUSION: Confirmation of the diagnosis, archiving for medicolegal and academic purposes and seeking for additional findings seems to be the main reasons when resorting to the fMRI. The nervous system abnormalities were the predominant indication category and abnormalities originated from other sytems were very limited in number. 

Anahtar Kelimeler

Fetal abnormalities, fetal magnetic resonance imaging, fetal ultrasonography, prenatal diagnosis

Manyetik rezonans görüntülemenin fetal anomalilerin tanı ve yönetimine katkısının retrospektif bir kohortta analizi

Öz

GİRİŞ ve AMAÇ: Prenatal ultrasonografi ile saptanan fetal anomalilerin incelenmesinde manyetik rezonans görüntülemeye (MRG) hangi endikasyonlarla başvurulduğunun ve fetal MRG ile elde edilen bilgilerin olguların yönetimine katkısının değerlendirilmesi amaçlanmıştır. 
YÖNTEM ve GEREÇLER: Retrospektif kohort analiz için Radyoloji Anabilim Dalı arşivinden 1 Ocak 2007- 1 Ocak 2018 tarihleri arasında çekilmiş, dahil edilme ve dışlanma kriterlerini karşılayan 146 fetal MRG kaydı elde edildi. Bu olguların Perinatoloji Bilim Dalı’ndan istem endikasyonlarına, ultrasonografi bulgularına, Perinatoloji Etik Kurul kararlarına ve obstetrik sonuçlarına ulaşıldı. 
BULGULAR: Kesitteki toplam 146 fetal MRG kaydına ait örneklem içinde 127 (%87) olgu santral sinir sistemi (SSS) anomalilerine ait iken 19 (%13) olgu ise diğer organ sistemlerine ait anomalilerden oluşmakta idi. SSS anomalileri içinde en yüksek frekansa sahip 5 alt-grup ventrikülomegali (n: 34, % 26.7), korpus kallozum gelişim bozuklukları (n: 28, %22.0), posterior fossa anomalileri (n: 14, %11.0), açık nöral tüp defektleri (n: 14, %11.0) ve kortikal gelişim malformasyonları (n: 7, %5.5) idi. Ultrasonografik tanı anında medyan gebelik yaşı SSS olgularında 23 (18-35) hafta iken diğer sistemler grubunda ise 22 (18-28) hafta idi (p: 0.04). Fetal MRG anında medyan gebelik yaşı SSS olgularında 23 (18-37) hafta ve diğer sistemler grubunda 23 (18-28) hafta idi (p: 0.051). Fetal kardiyak malformasyonlara yönelik istenmiş fetal MRG kaydına rastlanmadı. 
TARTIŞMA ve SONUÇ: Prenatal sonografi ile saptanmış fetal anomalilerin yönetiminde MRG sonografik tanıyı doğrulama, arşivleme ve ek anomaliler araştırma gerekçeleri ile isteniyor görünmektedir. Santral sinir sistemi dışındaki fetal organ sistemlerinde MRG’ye başvuru oldukça kısıtlıdır. Fetal MRG’nin geleceği ultrasonografide cihaz, yazılım ve kullanıcı tecrübelerinin gelişimini, fetal anomalilere yaklaşımda bilimsel-etik bilgi birikiminin evrimini ve MRG teknolojisindeki yenilikleri içeren dinamik bir süreçte şekillenecektir. 

Anahtar Kelimeler

Fetal anomaliler, fetal manyetik rezonans görüntüleme, fetal ultrasonografi, prenatal tanı

Kaynakça

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