Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

GIFT-Surg Imaging Working Group; Nada Mufti; Michael Aertsen; Dominic Thomson; Phillippe De Vloo; Philippe Demaerel; Jan Deprest; Andrew Melbourne; Anna L David

doi:10.1111/aogs.14711

Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

GIFT-Surg Imaging Working Group, Nada Mufti^*, Michael Aertsen, Dominic Thomson, Phillippe De Vloo, Philippe Demaerel, Jan Deprest, Andrew Melbourne, Anna L David

^*Corresponding author for this work

Biomedical Engineering Department

Univ London, Birkbeck University London, University College London, University of London Royal Veterinary College, University of London, St Georges University London, Imperial College London, Kings College London, Royal Holloway University London, Queen Mary University London, Div Populat Hlth Sci & Educ
KU Leuven
Great Ormond Street Hospital for Children, London, United Kingdom.
School of Biomedical Engineering and Imaging Sciences (BMEIS)
1Department of Hepatology, Imperial College London, London, UK. 2Institute of Liver Studies at King's College School of Medicine at King's College Hospital, London, UK. 3Institute of Human Health and Performance, University College London, London, UK. 4Department of Asthma Allergy and Lung Biology, King's College London, London, UK. 5Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Dep. of Medical Physics and Biomedical Engineering

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

INTRODUCTION: Fetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.

MATERIAL AND METHODS: We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.

RESULTS: MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001).

CONCLUSIONS: There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.

Original language	English
Pages (from-to)	322-333
Number of pages	12
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	103
Issue number	2
Early online date	20 Nov 2023
DOIs	https://doi.org/10.1111/aogs.14711
Publication status	Published - Feb 2024

Keywords

Pregnancy
Female
Humans
Spina Bifida Cystica/diagnostic imaging
Retrospective Studies
Gestational Age
Brain
Magnetic Resonance Imaging

Access to Document

10.1111/aogs.14711Licence: CC BY-NC-ND

Cite this

@article{944e06d7d8c54602b1469ac4f068ac1e,

title = "Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study",

abstract = "INTRODUCTION: Fetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.MATERIAL AND METHODS: We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.RESULTS: MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001).CONCLUSIONS: There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.",

keywords = "Pregnancy, Female, Humans, Spina Bifida Cystica/diagnostic imaging, Retrospective Studies, Gestational Age, Brain, Magnetic Resonance Imaging",

author = "{GIFT-Surg Imaging Working Group} and Nada Mufti and Michael Aertsen and Dominic Thomson and {De Vloo}, Phillippe and Philippe Demaerel and Jan Deprest and Andrew Melbourne and David, {Anna L}",

note = "Funding Information: This study was supported by the Guided Instrumentation of Fetal Therapy and Surgery (GIFT‐Surg) project, funded by the Wellcome Trust (203148/Z/16/Z; 203145Z/16/Z; WT101957) and Engineering and Physical Sciences Research Council (EPSRC) (NS/A000049/1; NS/A000050/1; NS/A000027/1; EP/L016478/1). This grant included external peer review for scientific quality with a patient and public involvement panel. SO is the principal investigator on this grant, and ALD, JD, TV and AM are coinvestigators. LF is funded by the European Union's Horizon 2020 research and innovation program under the Marie‐Sklodowska‐Curie grant agreement TRABIT no. 765148. NM is funded with support of the Wellcome/EPSRC center for Interventional and Surgical Sciences (WEISS) (203145Z/16/Z). PDV is a senior clinical investigator of Research Fund Flanders (FWO 18B2322N). ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Center. The funders had no direction in the study design, data collection, data analysis, manuscript preparation or publication decision. Funding Information: The authors would like to thank Dr Fernando Perez Garcia for writing the Python script for the automatic extraction of relevant MRI acquisition parameters. The GIFT-Surg Imaging Working Group: David Atkinson, Center for Medical Imaging, University College London, London, UK; Foteini Emmanouella Bredaki, Women's Health Division, University College London Hospitals, London, UK; Joanna Chappell, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK; Luc De Catte, Department of Obstetrics and Gynecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium; Roland Devlieger, Department of Obstetrics and Gynecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium; Michael Ebner, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK; Lucas Fidon, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK; Trevor Gaunt, Radiology Department, Great Ormond Street Hospital for Children, London, UK; Giles S. Kendall, Women's Health Division, University College London Hospitals, London, UK, Elizabeth Garrett Anderson Institute for Women's Health, University College London, UK; Sebastien Ourselin, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK, Medical Physics and Biomedical Engineering, University College London, UK; Kelly Pegoretti Baruteau, Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, UK; Adalina Sacco, Women's Health Division, University College London Hospitals, London, UK, Elizabeth Garrett Anderson Institute for Women's Health, University College London, UK; Magdalena Sokolska, Department of Medical Physics and Biomedical Engineering, University College London Hospitals, UK; Tom Vercauteren, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK, Medical Physics and Biomedical Engineering, University College London, UK. Collaborator contributions: Magdalena Sokolska, David Atkinson, Trevor Gaunt and Kelly Pegoretti Baruteau guided MRI acquisitions and protocols in UCLH, London, UK. Trevor Gaunt and Kelly Pegoretti Baruteau also reported the acquired MRI images. Luc De Catte performed and supervised the acquisition of ultrasound imaging. Roland Devlieger provided advice on fetal surgery content in this manuscript. Giles S. Kendall provided advice on neuro-neonatal content. Foteini Emmanouella Bredaki and Adalina Sacco helped in case collection as fetal surgery coordinators. Michael Ebner developed and optimized the SRR algorithm. Lucas Fidon developed the automated atlas-based segmentation methods. Joanna Chappell carried out technical analysis on reconstructed images. Tom Vercauteren and Sebastien Ourselin supervised the development and optimisation of the super resolution reconstruction algorithm. Publisher Copyright: {\textcopyright} 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).",

year = "2024",

month = feb,

doi = "10.1111/aogs.14711",

language = "English",

volume = "103",

pages = "322--333",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley-Blackwell",

number = "2",

}

TY - JOUR

T1 - Longitudinal MRI in the context of in utero surgery for open spina bifida

T2 - A descriptive study

AU - GIFT-Surg Imaging Working Group

AU - Mufti, Nada

AU - Aertsen, Michael

AU - Thomson, Dominic

AU - De Vloo, Phillippe

AU - Demaerel, Philippe

AU - Deprest, Jan

AU - Melbourne, Andrew

AU - David, Anna L

N1 - Funding Information: This study was supported by the Guided Instrumentation of Fetal Therapy and Surgery (GIFT‐Surg) project, funded by the Wellcome Trust (203148/Z/16/Z; 203145Z/16/Z; WT101957) and Engineering and Physical Sciences Research Council (EPSRC) (NS/A000049/1; NS/A000050/1; NS/A000027/1; EP/L016478/1). This grant included external peer review for scientific quality with a patient and public involvement panel. SO is the principal investigator on this grant, and ALD, JD, TV and AM are coinvestigators. LF is funded by the European Union's Horizon 2020 research and innovation program under the Marie‐Sklodowska‐Curie grant agreement TRABIT no. 765148. NM is funded with support of the Wellcome/EPSRC center for Interventional and Surgical Sciences (WEISS) (203145Z/16/Z). PDV is a senior clinical investigator of Research Fund Flanders (FWO 18B2322N). ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Center. The funders had no direction in the study design, data collection, data analysis, manuscript preparation or publication decision. Funding Information: The authors would like to thank Dr Fernando Perez Garcia for writing the Python script for the automatic extraction of relevant MRI acquisition parameters. The GIFT-Surg Imaging Working Group: David Atkinson, Center for Medical Imaging, University College London, London, UK; Foteini Emmanouella Bredaki, Women's Health Division, University College London Hospitals, London, UK; Joanna Chappell, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK; Luc De Catte, Department of Obstetrics and Gynecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium; Roland Devlieger, Department of Obstetrics and Gynecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium; Michael Ebner, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK; Lucas Fidon, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK; Trevor Gaunt, Radiology Department, Great Ormond Street Hospital for Children, London, UK; Giles S. Kendall, Women's Health Division, University College London Hospitals, London, UK, Elizabeth Garrett Anderson Institute for Women's Health, University College London, UK; Sebastien Ourselin, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK, Medical Physics and Biomedical Engineering, University College London, UK; Kelly Pegoretti Baruteau, Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, UK; Adalina Sacco, Women's Health Division, University College London Hospitals, London, UK, Elizabeth Garrett Anderson Institute for Women's Health, University College London, UK; Magdalena Sokolska, Department of Medical Physics and Biomedical Engineering, University College London Hospitals, UK; Tom Vercauteren, School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK, Medical Physics and Biomedical Engineering, University College London, UK. Collaborator contributions: Magdalena Sokolska, David Atkinson, Trevor Gaunt and Kelly Pegoretti Baruteau guided MRI acquisitions and protocols in UCLH, London, UK. Trevor Gaunt and Kelly Pegoretti Baruteau also reported the acquired MRI images. Luc De Catte performed and supervised the acquisition of ultrasound imaging. Roland Devlieger provided advice on fetal surgery content in this manuscript. Giles S. Kendall provided advice on neuro-neonatal content. Foteini Emmanouella Bredaki and Adalina Sacco helped in case collection as fetal surgery coordinators. Michael Ebner developed and optimized the SRR algorithm. Lucas Fidon developed the automated atlas-based segmentation methods. Joanna Chappell carried out technical analysis on reconstructed images. Tom Vercauteren and Sebastien Ourselin supervised the development and optimisation of the super resolution reconstruction algorithm. Publisher Copyright: © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

PY - 2024/2

Y1 - 2024/2

N2 - INTRODUCTION: Fetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.MATERIAL AND METHODS: We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.RESULTS: MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001).CONCLUSIONS: There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.

AB - INTRODUCTION: Fetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.MATERIAL AND METHODS: We surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.RESULTS: MRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0-10), the average scan time available was 37 ± 16 min (range, 20-80 min), with 15 ± 11 min (range, 0-30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2-weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post-surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1-weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre- and post-surgery (p < 0.001).CONCLUSIONS: There was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.

KW - Pregnancy

KW - Female

KW - Humans

KW - Spina Bifida Cystica/diagnostic imaging

KW - Retrospective Studies

KW - Gestational Age

KW - Brain

KW - Magnetic Resonance Imaging

UR - http://www.scopus.com/inward/record.url?scp=85177235455&partnerID=8YFLogxK

U2 - 10.1111/aogs.14711

DO - 10.1111/aogs.14711

M3 - Article

C2 - 37984808

AN - SCOPUS:85177235455

SN - 0001-6349

VL - 103

SP - 322

EP - 333

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 2

ER -

Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this