Isolated ventriculomegaly on prenatal ultrasound: What does fetal <scp>MRI</scp> add?

Kandula, Tejaswi; Fahey, Michael; Chalmers, Rebecca; Edwards, Andrew; Shekleton, Paul A; Teoh, Mark; Clark, Jenni; Goergen, Stacy

doi:10.1111/1754-9485.12287

Cited by 27 publications

(21 citation statements)

References 17 publications

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“…Sixteen studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] fetuses) in cases diagnosed on standard assessment of the fetal brain in the axial plane ( Figure 2). When stratifying the analysis according to the type of anomaly detected on MRI, the incidence of a callosal anomaly undetected on ultrasound was 0.7% (95% CI, 0.2-1.5%) in fetuses that underwent neurosonography and 2.9% (95% CI, 1.1-5.7%) in those that had standard assessment of the fetal brain, while the corresponding figures for a posterior fossa anomaly were 0.4% (95% CI, 0.1-1.1%) and 0.9% (95% CI, 0.2-2.1%) ( Table 3).…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Six hundred and twenty articles were identified, of which 66 were assessed with respect to their eligibility for inclusion (Table S2) and 16 were included in the systematic review (Tables 1 and S3 and Figure 1) [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . These sixteen studies included 1159 fetuses diagnosed with isolated mild or moderate VM.…”

Section: General Characteristicsmentioning

confidence: 99%

“…The main weaknesses of the studies were their retrospective design, small sample size, different gestational ages at examination and lack of stratification of the results according to laterality and degree of ventricular dilatation in most of the included studies. Furthermore, stratification of the analysis according to gestational age at MRI was possible only by adopting a single cut-off (of 24 weeks' gestation), and we could not perform 19 Lavongtheung (2018) 20 Mehlhorn (2017) 21 Gezer (2016) 22 Tonni (2016) 23 Baffero (2015) 24 Kandula (2015) 25 Paladini (2014) 26 Pasquini (2014) 27 Parazzini (2012) 28 Miguelote (2012) 29 Han Huang (2013) 30 Griffiths (2010) 31 Yin (2010) 32 Benacerraf (2007) 33 Morris (2007) 34 Only first author of each study is given. A study can be awarded a maximum of one star for each numbered item within the selection and outcome categories.…”

Section: General Characteristicsmentioning

confidence: 99%

“…Furthermore, the risk of detecting associated anomalies is higher in fetuses with moderate, compared to those with mild, VM, while there was no difference between cases with unilateral, compared to those with bilateral, VM. Tonni (2016) 23 (a) Paladini (2014) 26 Baffero (2015) 24 Pasquini (2014) 27 Parazzini (2012) 28 Miguelote (2012) 29 Study Study Yin (2010) 32 Benacerraf (2007) 20 Mehlhorn (2017) 21 Gezer (2016) 22 Kandula (2015) 25 Han Huang (2013) 30 Griffiths (2010) 31 Morris (2007)…”

Section: Main Findingsmentioning

confidence: 99%

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Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta‐analysis

Mascio

Sileo

Khalil

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To report the rate of additional central nervous system (CNS) anomalies detected exclusively on prenatal magnetic resonance imaging (MRI) in fetuses diagnosed with isolated mild or moderate ventriculomegaly (VM) on ultrasound, according to the type of ultrasound protocol adopted (dedicated neurosonography vs standard assessment of the fetal brain), and to explore whether the diagnostic performance of fetal MRI in detecting such anomalies is affected by gestational age at examination and laterality and degree of ventricular dilatation. Methods MEDLINE,EMBASE, CINAHL and Clinicaltrials.gov were searched for studies reporting on the prenatal MRI assessment of fetuses diagnosed with isolated mild or moderate VM (ventricular dilatation of 10-15 mm) on ultrasound. Additional anomalies detected only on MRI were classified as callosal, septal, posterior fossa, white matter, intraventricular hemorrhage, cortical, periventricular heterotopia, periventricular cysts or complex malformations. The rate of additional anomalies was compared between fetuses diagnosed on dedicated neurosonography, defined as a detailed assessment of the fetal brain, according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines, and those diagnosed on standard fetal brain assessment. The rate of additional CNS anomalies missed on prenatal MRI and detected only at birth was calculated and compared between fetuses that had early (at or before 24 weeks' gestation) and those that had late (after 24 weeks) MRI. Subanalysis was performed according to the laterality (uni-vs bilateral) and degree (mild vs moderate, defined as ventricular dilatation of 10-12 and 13-15 mm, respectively) of ventricular dilatation. Whether MRI assessment led to a significant change in prenatal management was explored. Random-effects meta-analysis of proportions was used.Results Sixteen studies (1159 fetuses) were included in the systematic review. Overall, MRI detected an anomaly not identified on ultrasound in 10.0% (95% CI, 6.2-14.5%) of fetuses. However, when stratifying the analysis according to the type of ultrasound assessment, the rate of associated anomalies detected only on MRI was 5.0% (95% CI, 3.0-7.0%) when dedicated neurosonography was performed compared with 16.8% (95% CI, in cases that underwent a standard assessment of the fetal brain in the axial plane. The overall rate of an additional anomaly detected only at birth and missed on prenatal MRI was 0.9% (95% CI, 0.04-1.5%) (I 2 , 0%). There was no difference in the rate of an associated anomaly detected only after birth when fetal MRI was carried out before, compared with after, 24 weeks of gestation (P = 0.265). The risk of detecting an associated CNS abnormality on MRI was higher in fetuses with moderate than in those with mild VM (odds ratio, 8.1 (95% CI,; P = 0.001), while Conclusions In fetuses undergoing dedicated neurosonography, the rate of a CNS anomaly detected exclusively on MRI is lower than that reported previously. Early MRI has an excellent diagnostic pe...

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Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: General Characteristicsmentioning

confidence: 99%

Section: General Characteristicsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta‐analysis

Mascio

Sileo

Khalil

et al. 2019

Ultrasound in Obstet & Gyne

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“…It has been demonstrated that fetal MRI can detect more anomalies in cases of seemingly isolated ventriculomegaly or ventricular asymmetry, and allows improved resolution and direct visualization of both sides of the fetal brain [8][9][10][11][12][13] . It has been used increasingly as an integral part of prenatal assessment for diverse indications 14 .…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental outcome of fetal isolated ventricular asymmetry without dilation: a cohort study

Meyer

Bar‐Yosef

Hoffman

et al. 2018

Ultrasound in Obstet & Gyne

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Current Controversies in Prenatal Diagnosis 1: Should MRI be performed on all fetuses with mild ventriculomegaly?

2019

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A ventricular diameter of 10 mm correlates with more than two standard deviations of the normal and hence is qualified as ventriculomegaly. The relevance of this is dependent on whether there are associated infectious, genetic, or structural problems. The chance for neurodevelopmental delay in isolated ventriculomegaly less than 15 mm is 7.9% (4.7‐11.1), and less if it is unilateral. It can be further divided in mild (10‐12) or moderate (13‐15), though this is not widely accepted. As part of the workup, structural assessment today may include ultrasound or magnetic resonance imaging, or both. Discussants agreed that the diagnostic performance of both methods is as good as the expertise with which the images are acquired and interpreted. Discussants agreed that when the initial neurosonogram is normal, the likelihood of finding significant findings on MRI is low. Nevertheless, some anomalies may only be picked up or better worked out by fetal MRI. In utero follow‐up is advocated, as progression may indicate a poorer outcome, and some conditions are only obvious late in pregnancy. Most benefit for future patients is expected from appropriate training in prenatal neuroimaging.

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Isolated ventriculomegaly on prenatal ultrasound: What does fetal MRI add?

Abstract: This study helps to inform referral of pregnant women with a fetus who has IVM for prenatal MRI.

Cited by 27 publications

References 17 publications

Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta‐analysis

Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta‐analysis

Neurodevelopmental outcome of fetal isolated ventricular asymmetry without dilation: a cohort study

Current Controversies in Prenatal Diagnosis 1: Should MRI be performed on all fetuses with mild ventriculomegaly?

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