TY - JOUR
T1 - What brain abnormalities can magnetic resonance imaging detect in foetal and early neonatal spina bifida
T2 - a systematic review
AU - Mufti, Nada
AU - Sacco, Adalina
AU - Aertsen, Michael
AU - Ushakov, Fred
AU - Ourselin, Sebastian
AU - Thomson, Dominic
AU - Deprest, Jan
AU - Melbourne, Andrew
AU - David, Anna L
N1 - Funding Information:
This study was funded 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]. SO is the principal investigator on this grant, and ALD, JD, and AM are co-investigators. NM is funded with support of the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS). ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.
Funding Information:
This work is funded by the Wellcome Trust [203148/Z/16/Z;203145Z/16/Z; WT101957] and Engineering and Physical Sciences Research Council [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. The funders had no direction in the study design, data collection, data analysis, manuscript preparation, or publication decision.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/11/18
Y1 - 2021/11/18
N2 - PURPOSE: Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound.METHODS: Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible.RESULTS: Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse.CONCLUSION: MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.
AB - PURPOSE: Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound.METHODS: Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible.RESULTS: Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse.CONCLUSION: MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.
UR - http://www.scopus.com/inward/record.url?scp=85119291000&partnerID=8YFLogxK
U2 - 10.1007/s00234-021-02853-1
DO - 10.1007/s00234-021-02853-1
M3 - Article
C2 - 34792623
SN - 0028-3940
JO - Neuroradiology
JF - Neuroradiology
ER -