Araştırma Makalesi
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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
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. 

Kaynakça

  • Levine D. Obstetric MRI. J Magn Reson Imaging 2006;24:1-15.
  • Weston MJ. Magnetic resonance imaging in fetal medicine: a pictorial review of current and developing indications. Postgrad Med J 2010;86:42-51.
  • Chung R, Kasprian G, Brugger PC, Prayer D. The current state and future of fetal imaging. Clin Perinatol 2009;36:685-99.
  • 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;38:186-94.
  • Smith FW, Adam AH, Phillips WD. NMR imaging in pregnancy. Lancet 1983;1:61-2.
  • Levine D, Barnes PD, Sher S, et al. Fetal fast MR imaging: reproducibility, technical quality, and conspicuity of anatomy. Radiology 1998;206:549-54.
  • 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;44:388-93.
  • Saleem SN. Fetal MRI: An approach to practice: A review. J Adv Res 2014;5:507-23.
  • Bahado-Singh RO, Goncalves LF. Techniques, terminology, and indications for MRI in pregnancy. Semin Perinatol 2013;37:334-9.
  • International Society of Ultrasound in Obstetrics & Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the 'basic examination' and the 'fetal neurosonogram'. Ultrasound Obstet Gynecol 2007;29:109-16.
  • Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Clinical Standards Committee. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011;37:116-26.
  • Prayer D, Malinger G, Brugger PC, et al. ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 2017;49:671-680.
  • Bekker MN, van Vugt JM. The role of magnetic resonance imaging in prenatal diagnosis of fetal anomalies. Eur J Obstet Gynecol Reprod Biol 2001;96:173-8.
  • Huisman TA. Fetal magnetic resonance imaging of the brain: is ventriculomegaly the tip of the syndromal iceberg? Semin Ultrasound CT MR 2011;32:491-509.
  • Griffiths PD, Reeves MJ, Morris JE, et al. A prospective study of fetuses with isolated ventriculomegaly investigated by antenatal sonography and in utero MR imaging. AJNR Am J Neuroradiol 2010;31:106-11.
  • Levine D, Barnes PD, Robertson RR, Wong G, Mehta TS. Fast MR imaging of fetal central nervous system abnormalities. Radiology 2003;229:51-61.
  • Twickler DM, Magee KP, Caire J, Zaretsky M, Fleckenstein JL, Ramus RM. Second-opinion magnetic resonance imaging for suspected fetal central nervous system abnormalities. Am J Obstet Gynecol 2003;188:492-6.
  • Santo S, D'Antonio F, Homfray T, et al. Counseling in fetal medicine: agenesis of the corpus callosum. Ultrasound Obstet Gynecol 2012;40:513-21.
  • Ghi T, Pilu G, Falco P, et al. Prenatal diagnosis of open and closed spina bifida. Ultrasound Obstet Gynecol 2006;28:899-903.
  • Rossi A, Biancheri R, Cama A, Piatelli G, Ravegnani M, Tortori-Donati P. Imaging in spine and spinal cord malformations. Eur J Radiol 2004;50:177-200.
  • Kul S, Korkmaz HA, Cansu A, et al. Contribution of MRI to ultrasound in the diagnosis of fetal anomalies. J Magn Reson Imaging 2012;35:882-90.
  • Yalçın SE, Yalçın Y, Tola EN, et al. Fetal Manyetik Rezonans görüntüleme endikasyonlarının incelenmesi. Perinatoloji Dergisi 2018;26:18-24.

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

Yıl 2019, Cilt: 33 Sayı: 1, 33 - 43, 26.04.2019
https://doi.org/10.5505/deutfd.2019.68552

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. 

Kaynakça

  • Levine D. Obstetric MRI. J Magn Reson Imaging 2006;24:1-15.
  • Weston MJ. Magnetic resonance imaging in fetal medicine: a pictorial review of current and developing indications. Postgrad Med J 2010;86:42-51.
  • Chung R, Kasprian G, Brugger PC, Prayer D. The current state and future of fetal imaging. Clin Perinatol 2009;36:685-99.
  • 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;38:186-94.
  • Smith FW, Adam AH, Phillips WD. NMR imaging in pregnancy. Lancet 1983;1:61-2.
  • Levine D, Barnes PD, Sher S, et al. Fetal fast MR imaging: reproducibility, technical quality, and conspicuity of anatomy. Radiology 1998;206:549-54.
  • 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;44:388-93.
  • Saleem SN. Fetal MRI: An approach to practice: A review. J Adv Res 2014;5:507-23.
  • Bahado-Singh RO, Goncalves LF. Techniques, terminology, and indications for MRI in pregnancy. Semin Perinatol 2013;37:334-9.
  • International Society of Ultrasound in Obstetrics & Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the 'basic examination' and the 'fetal neurosonogram'. Ultrasound Obstet Gynecol 2007;29:109-16.
  • Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Clinical Standards Committee. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011;37:116-26.
  • Prayer D, Malinger G, Brugger PC, et al. ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 2017;49:671-680.
  • Bekker MN, van Vugt JM. The role of magnetic resonance imaging in prenatal diagnosis of fetal anomalies. Eur J Obstet Gynecol Reprod Biol 2001;96:173-8.
  • Huisman TA. Fetal magnetic resonance imaging of the brain: is ventriculomegaly the tip of the syndromal iceberg? Semin Ultrasound CT MR 2011;32:491-509.
  • Griffiths PD, Reeves MJ, Morris JE, et al. A prospective study of fetuses with isolated ventriculomegaly investigated by antenatal sonography and in utero MR imaging. AJNR Am J Neuroradiol 2010;31:106-11.
  • Levine D, Barnes PD, Robertson RR, Wong G, Mehta TS. Fast MR imaging of fetal central nervous system abnormalities. Radiology 2003;229:51-61.
  • Twickler DM, Magee KP, Caire J, Zaretsky M, Fleckenstein JL, Ramus RM. Second-opinion magnetic resonance imaging for suspected fetal central nervous system abnormalities. Am J Obstet Gynecol 2003;188:492-6.
  • Santo S, D'Antonio F, Homfray T, et al. Counseling in fetal medicine: agenesis of the corpus callosum. Ultrasound Obstet Gynecol 2012;40:513-21.
  • Ghi T, Pilu G, Falco P, et al. Prenatal diagnosis of open and closed spina bifida. Ultrasound Obstet Gynecol 2006;28:899-903.
  • Rossi A, Biancheri R, Cama A, Piatelli G, Ravegnani M, Tortori-Donati P. Imaging in spine and spinal cord malformations. Eur J Radiol 2004;50:177-200.
  • Kul S, Korkmaz HA, Cansu A, et al. Contribution of MRI to ultrasound in the diagnosis of fetal anomalies. J Magn Reson Imaging 2012;35:882-90.
  • Yalçın SE, Yalçın Y, Tola EN, et al. Fetal Manyetik Rezonans görüntüleme endikasyonlarının incelenmesi. Perinatoloji Dergisi 2018;26:18-24.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Semir Köse Bu kişi benim 0000-0001-7621-7503

Fatma Ceren Sarıoğlu 0000-0002-6714-2367

Dilay Gökdeniz Bu kişi benim 0000-0001-7066-8346

Handan Güleryüz 0000-0003-1691-1362

Sabahattin Altunyurt Bu kişi benim 0000-0002-8887-3097

Yayımlanma Tarihi 26 Nisan 2019
Gönderilme Tarihi 17 Ağustos 2018
Yayımlandığı Sayı Yıl 2019 Cilt: 33 Sayı: 1

Kaynak Göster

Vancouver Köse S, Sarıoğlu FC, Gökdeniz D, Güleryüz H, Altunyurt S. Manyetik rezonans görüntülemenin fetal anomalilerin tanı ve yönetimine katkısının retrospektif bir kohortta analizi. DEU Tıp Derg. 2019;33(1):33-4.