Accuracy of in-utero MRI to detect fetal brain abnormalities and prognosticate developmental outcome: postnatal follow-up of the MERIDIAN cohort

Abstract

Background In utero MRI (iuMRI) detects fetal brain abnormalities more accurately than ultrasonography and provides additional clinical information in around half of pregnancies. We aimed to study whether postnatal neuroimaging after age 6 months changes the diagnostic accuracy of iuMRI and its ability to predict developmental outcome. MethodsFamilies enrolled in the MERIDIAN study whose child survived to age 3 years were invited to have a case note review and assessment of developmental outcome with the Bayley Scales of Infant and Toddler Development, the Ages and Stages Questionnaire, or both. A paediatric neuroradiologist, masked to the iuMRI results, reviewed the postnatal neuroimaging if the clinical report differed from iuMRI findings. Diagnostic accuracy was recalculated. A paediatric neurologist and neonatologist categorised participants' development as normal, at risk, or abnormal, and the ability of iuMRI and ultrasonography to predict developmental outcome were assessed.Findings 210 participants had case note review, of whom 81 (39%) had additional investigations after age 6 months. The diagnostic accuracy of iuMRI remained higher than ultrasonography (proportion of correct cases was 529 [92%] of 574 vs 387 [67%] of 574; absolute difference 25%, 95% CI 21 to 29; p<0·0001). Developmental outcome data were analysed in 156 participants, and 111 (71%) were categorised as normal or at risk. Of these 111 participants, prognosis was normal or favourable for 56 (51%) using ultrasonography and for 76 (69%) using iuMRI (difference in specificity 18%, 95% CI 7 to 29; p=0·0008). No statistically significant difference was seen in infants with abnormal outcome (difference in sensitivity 4%, 95% CI -10 to 19; p=0·73).Interpretation iuMRI remains the optimal tool to identify fetal brain abnormalities. It is less accurate when used to predict developmental outcome, although better than ultrasonography for identifying children with normal outcome. Further work is needed to determine how the prognostic abilities of iuMRI can be improved.

Dural Sinus Arteriovenous Malformation in the Fetus. Case Report and Discussion of the Literature

“…Our case differs from the reported cases by different localization at MRI, with MRI findings that are easily obtainable [9,15,25], but it seemed to have a similar severe prognosis of evolving heart failure and neurological damage, since it occurred at such an early gestational period.…”

“…As for the diagnosis, other authors also agree with the usefulness of MRI imaging in utero [14,15]. Mainly, Hart et al [15] reported a large MERIDIAN study on in utero MRI, considered to be an optimal tool to identify brain anomalies, though without the possibility of predicting developmental outcome.…”

Role of prenatal magnetic resonance imaging in fetuses with isolated anomalies of corpus callosum: multinational study

“…This is a critical issue because the large majority of CNS anomalies cannot be identified using the standard axial plane of the fetal brain during the routine anomaly scan. More recent studies exploring the role of MRI in fetuses with isolated CNS malformation diagnosed on neurosonography showed that the additional value of MRI is tangible, but generally lower than reported previously when neurosonography is performed by expert operators [22][23][24][25][26][27][28] . Despite this, there is still a significant number of cases in which additional anomalies are not detected commonly on ultrasound, such as malformations of cortical development, making MRI a fundamental tool for an accurate prediction of neurodevelopmental outcome [24][25][26][27][28] .…”

“…Despite this, there is still a significant number of cases in which additional anomalies are not detected commonly on ultrasound, such as malformations of cortical development, making MRI a fundamental tool for an accurate prediction of neurodevelopmental outcome [24][25][26][27][28] . In this scenario, integration of MRI and ultrasound for assessment of fetuses at risk of CNS anomalies may help to predict the postnatal outcome [21][22][23][24][25][26][27][28][29] .…”

WAPM-World Association of Perinatal Medicine practice guidelines: fetal central nervous system examination

“…Therefore, all the suspected abnormal cases at the anatomy scan should be referred for a "fetal neurosonography", a dedicated examination of the fetal brain and spine that requires specific expertise and sophisticated ultrasound equipment. The prenatal detection of CNS anomalies allows, not only a specific prenatal management and counseling, but also facilitate appropriate prognostic definition with the support of supplementary diagnostic tests as MRI [7][8][9] and genetic tests. [10] However, it is important to emphasize that a normal CNS assessment in the second-trimester morphology scan does not rule out the emergence of fetal anomalies later in pregnancy.…”