Comparison of Fetal Ultrasonography and Fetal Magnetic Resonance Imaging for the Detection of Additional Anomalies in Cases of Fetal Ventricolumegaly

Yıl 2018, Cilt: 49 Sayı: 2, 192 - 195, 27.06.2018

Vuslat Lale Bakır , A. Aktuğ Ertekin Zeki Şahinoğlu , Nebiye Serra Sencer

https://doi.org/10.16948/zktipb.417284

Öz

Objective: To compare fetal US and fetal MRI techniques for the detection of
additional findings in cases of fetal venticulomegaly diagnosed by antenatal
US.

 

Material
and Method: 46 Patients diagnosed with
ventriculomegaly by ultrasonography between May 2009 – April 2010 have been
included in the study. Gestational (FETAL age mi demek gerek, tam terimi
bilmiyorum?) age (GA) was between 21 and 35 weeks. MRI examination couldn’t be
performed in 4 patients due to clostrophoby and 2 patients didn’t give consent
for the procedure. Those 6 patients have been excluded from the study and the
examination was carried in 40 patients. The ventriculomegaly was graded in 2
groups as mild (10-14 mm) or as severe (15 mm or higher). MRI has been
performed in maximum 4 days following ultrasonography with a  1,5 T MRI unit (Sympony, Siemens, Erlangen,
Germany), using a “phased array” body coil. The fetal anatomy was evaluated
by  the 
“Half-Fourier acquisition single-shot turbo spin-echo" (HASTE)
sequence (TR: 4.4, TE: 64, flip angle: 150°, slice thickness: 6 mm, gap: 0.1
mm, matriks: 160x256, FOV: 350 mm) in three planes adjusted to the fetal
position. The frequency of the patients 
where MRI and US results were in concordance and teh frequency of the
patients where MRI provided additional diagnostic information were given  by a confidence interval of 95%. Chi-square
test (Yates) was used to compare the groups. The significance was evaluated at
p<0.05.

 

Findings: Mild ventirculomegaly (10-14 mm) was detected in 28 patients (Group
1), and severe ventriculomegaly (>15 mm) was detected in 12 patients
(Group II). MRI detected additional findings compared to ultrasonography in 7
of the 28 patients in Group I (25% [CI 95%; 0.11-0.45]) and 5 of the 12
patients in Group II (%42 [CI 95%; 0.15-0.72]), a total of 12 patients (30% [CI
95%; 0.16-0.46]). When 2 groups were compared for the additional findings
provided by MRI, MRI detected more abnormalities in severe ventriculomegaly
group (42%), however the difference with mild ventriculomegaly group (25%) was
not statistically significant ( x² yates: 0.459, p:0.498). MRI changed patient
management in 4 patients in Group I (14% [95% CI; 0.09-0.34]) and 3 patients in
Group II (25% [95% CI; 0.14-0.94]). In total, MRI changed patient management in
17% [95% CI; 0.13-0.41] of the patients.

 

Conclusion:
Our study demonstrated that, while US has a high
accuracy in diagnosing ventriculomegaly, fetal MRI examination can provide
additional findings to US, especially in detecting co-existing CNS
abnormalities.

Anahtar Kelimeler

Fetal Ventriculomegaly, Magnetic Resonance Imaging

Fetal Ventrikülomegali Olgularında Ek Anomali Tanısında Fetal Ultrasonografiiel Manyetik Rezonans Görüntüleme Tetkiklerinin Değerlendirilmesi

Öz

Amaç: Antenatal dönemde yapılan USG’de fetal
ventrikülomegali saptanan olgularda, ek bulgular açısından, fetal USG ile fetal
MRG  tetkiklerini karşılaştırmaktır.

 

Materyal ve Metod: Mayıs 2009 - Nisan 2010
tarihleri arasında USG’de ventrikülomegali tanısı konan 46
hasta dahil edildi. Fetal yaş 21-35 gebelik haftası (GH), arasındaydı. 4
hastada klostrofobi nedeniyle, 2 hastada da onay vermedikleri için MRG tetkiki
yapılamadı. 40 hastaya MRG tetkiki yapıldı, diğer 6 hasta çalışmadan çıkarıldı. Ventrikülomegali
derecesi hafif  (10-14 mm) ve belirgin
(15 mm ve üzeri) olarak 2’ye ayrılarak değerlendirildi. USG
tetkiki sonrası en geç 4 gün içerisinde hastalara MRG tetkiki yapıldı. MR
görüntüleme, 1.5 T MR cihazında (Sympony, Siemens, Erlangen, Almanya),
"phased array" vücut sarmalı kullanılarak yapıldı. Fetal anatomiyi
belirlemek için fetal pozisyona uygun başlıca 3 planda "Half-Fourier
acquisition single-shot turbo spin-echo" (HASTE) sekansı (TR: 4.4, TE: 64,
sapma açısı: 150°, kesit kalınlığı: 6 mm, kesitler arası boşluk: 0.1 mm,
matriks: 160x256, FOV: 350 mm) kullanıldı. MRG ve USG tetkiklerinde tanısal
uyumu olan hasta sıklıkları ve MRG tetkiki ile ek tanısal bilgi elde edilen
hastaların sıklıkları, % 95 güven aralığı ile birlikte verildi. Grupların
karşılaştırılmasında ki-kare (yates) testi kullanıldı. Anlamlılık p<0.05
düzeyinde değerlendirildi.     

                                                                       
               

Bulgular:  28 hastada (Grup I) hafif
ventrikülümegali (10-14mm), 12 hastada (Grup II) belirgin ventrikülomegali
(>15 mm)  saptandı. I.gruptaki 28
hastanın 7’sinde (% 25 [% 95 GA; 0.11-0.45]) , II.gruptaki 12 hastanın 5’inde
(% 42 [% 95 GA; 0.15-0.72]) ve tüm olgular göz önüne alındığında toplam 12
hastada (% 30 [% 95 GA; 0.16-0.46])  MRG
tetkiki USG’ye ek bulgu saptadı. MRG tetkikinin sağladığı ek bulgular açısından
her iki grup karşılaştırıldığında, belirgin ventrikülomegali olan grupta MRG
tetkiki  daha fazla oranla ek bulgu (%
42) saptamasına rağmen istatistiksel olarak hafif ventrikülomegali olan grupla
( % 25) arasında anlamlı fark saptanmadı ( x² yates: 0.459, p:0.498). MRG
tetkiki I. grupta 4 olguda (% 14  [% 95
GA; 0.09-0.34]) II.Grupta ise 3 olguda (% 25 [% 95 GA; 0.14-0.94])  hasta yönetimini değiştirdi. Tüm hasta grubu
göz önüne alındığında  olguların %
17’sinde  [% 95 GA; 0.13-0.41] hasta
yönetimini değiştirdi.

 

 

Sonuç:  Çalışmamız, her ne kadar USG tetkikinin ventrikülomegali olgularında
yüksek oranda doğru tanı koyabilsede, fetal MRG tetkikinin özellikle eşlik
edebilecek diğer SSS anomalilerini ortaya koymakta USG’ye ek bulgular
saptayabileceğini ortaya koymuştur.

Anahtar Kelimeler

Fetal Ventrikülomegali, Manyetik Rezonans Görüntüleme

Kaynakça

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