Use of Magnetic Resonance Imaging in the Diagnosis of Fetal Vertebral Abnormalities in Utero: a Single-center Retrospective Cohort Study

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2022 Jun 3

PMID 35655821

Authors

Xianyun Cai

Xin Chen

Xinhong Wei

Wen Liu

Ximan Hou

Tao Gong

Jinxia Zhu

Ewart Mark Haacke

Guangbin Wang

Affiliations

Soon will be listed here.

Abstract

Background: Magnetic resonance imaging (MRI) has been used increasingly as an adjunct examination to ultrasound (US) for the evaluation of fetal anomalies. The purpose of this study was to determine whether the accuracy and confidence of diagnosing fetal vertebral anomalies are improved with MRI. We also assessed whether fetal MRI provides additional information when diagnosing fetal vertebral anomalies.

Methods: We performed a single-center, retrospective study of 127 pregnant women with fetuses suspected of having vertebral anomalies on US examination; women also underwent fetal MRI scanning. Comparisons of diagnostic accuracy and confidence were made between MRI and US for the identification of fetal vertebral anomalies. We also assessed any additional information provided by MRI. McNemar's paired binomial test, chi-square test, or Fisher's exact test were used to compare the diagnostic ability between MRI and US. In all cases, postnatal or postmortem imaging findings were used as reference standards.

Results: A total of 127 participants were recruited between December 2015 and January 2021. Fetal vertebral anomalies were detected in 63.8% (81/127) cases and found to be negative in 36.2% (46/127) of cases at follow up. The diagnostic accuracy of vertebral anomalies was 46.9% (38/81) for US and 84.0% (68/81) for MRI [difference, 37.1%; 95% confidence interval (CI): 27% to 48%; P<0.001]. Both MRI and US were concordant and correct in 36.2% (46/127) of fetuses; MRI provided additional information for 16.5% (21/127) of fetuses, and corrected US diagnoses of 36.2% (46/127) of fetuses; both MRI and US were not consistent with postnatal findings in 10.2% (13/127) of fetuses, and the remaining fetus (0.8%, 1/127) was diagnosed correctly using US but failed to be diagnosed by MRI. Diagnoses were reported with high confidence using MRI in 95.3% (121/127) of cases and 73.2% (93/127) using US.

Conclusions: Fetal vertebral MRI improves the accuracy and confidence of diagnosing fetal vertebral anomalies. This finding indicates that fetal MRI supplements the information provided by US and that MRI may be a good complement in selected fetuses, when US can either not achieve a definite diagnosis or there is doubt regarding its reliability. Thus, MRI may be used to inform prenatal counseling and management decisions.

References

Whyte M, Greenberg C, Salman N, Bober M, McAlister W, Wenkert D . Enzyme-replacement therapy in life-threatening hypophosphatasia. N Engl J Med. 2012; 366(10):904-13. DOI: 10.1056/NEJMoa1106173. View

Blaicher W, Mittermayer C, Messerschmidt A, Deutinger J, Bernaschek G, Prayer D . Fetal skeletal deformities - the diagnostic accuracy of prenatal ultrasonography and fetal magnetic resonance imaging. Ultraschall Med. 2004; 25(3):195-9. DOI: 10.1055/s-2004-812946. View

Griffiths P, Widjaja E, Paley M, Whitby E . Imaging the fetal spine using in utero MR: diagnostic accuracy and impact on management. Pediatr Radiol. 2006; 36(9):927-33. DOI: 10.1007/s00247-006-0234-y. View

Prayer D, Brugger P . Investigation of normal organ development with fetal MRI. Eur Radiol. 2007; 17(10):2458-71. DOI: 10.1007/s00330-007-0604-3. View

Nemec S, Kasprian G, Brugger P, Bettelheim D, Amann G, Nemec U . Abnormalities of the upper extremities on fetal magnetic resonance imaging. Ultrasound Obstet Gynecol. 2011; 38(5):559-67. DOI: 10.1002/uog.8949. View

Sherrod B, Ho W, Hedlund A, Kennedy A, Ostrander B, Bollo R . A comparison of the accuracy of fetal MRI and prenatal ultrasonography at predicting lesion level and perinatal motor outcome in patients with myelomeningocele. Neurosurg Focus. 2019; 47(4):E4. DOI: 10.3171/2019.7.FOCUS19450. View

Jian N, Lin N, Tian M, Zhang S, Li G, Zhao H . Normal development of costal element ossification centers of sacral vertebrae in the fetal spine: a postmortem magnetic resonance imaging study. Neuroradiology. 2019; 61(2):183-193. DOI: 10.1007/s00234-018-2147-5. View

Egloff A, Bulas D . Magnetic Resonance Imaging Evaluation of Fetal Neural Tube Defects. Semin Ultrasound CT MR. 2015; 36(6):487-500. DOI: 10.1053/j.sult.2015.06.004. View

Jian N, Tian M, Xiao L, Zhao H, Shi Y, Li G . Normal development of sacrococcygeal centrum ossification centers in the fetal spine: a postmortem magnetic resonance imaging study. Neuroradiology. 2018; 60(8):821-833. DOI: 10.1007/s00234-018-2050-0. View

10.

Robinson A, Blaser S, Vladimirov A, Drossman D, Chitayat D, Ryan G . Foetal "black bone" MRI: utility in assessment of the foetal spine. Br J Radiol. 2014; 88(1046):20140496. PMC: 4614248. DOI: 10.1259/bjr.20140496. View

11.

Filly R, Golbus M . Ultrasonography of the normal and pathologic fetal skeleton. Radiol Clin North Am. 1982; 20(2):311-23. View

12.

Yanagihara T, Hata T . Three-dimensional sonographic visualization of fetal skeleton in the second trimester of pregnancy. Gynecol Obstet Invest. 2000; 49(1):12-6. DOI: 10.1159/000010205. View

13.

Glenn O, Barkovich J . Magnetic resonance imaging of the fetal brain and spine: an increasingly important tool in prenatal diagnosis: part 2. AJNR Am J Neuroradiol. 2006; 27(9):1807-14. PMC: 7977903. View

14.

Ng C, Palmer C . Analysis of diagnostic confidence and diagnostic accuracy: a unified framework. Br J Radiol. 2007; 80(951):152-60. DOI: 10.1259/bjr/64096611. View

15.

Tanaka T, Uhthoff H . Coronal cleft of vertebrae, a variant of normal enchondral ossification. Acta Orthop Scand. 1983; 54(3):389-95. DOI: 10.3109/17453678308996590. View

16.

Chauvin N, Victoria T, Khwaja A, Dahmoush H, Jaramillo D . Magnetic resonance imaging of the fetal musculoskeletal system. Pediatr Radiol. 2020; 50(13):2009-2027. DOI: 10.1007/s00247-020-04769-z. View

17.

Westvik J, Lachman R . Coronal and sagittal clefts in skeletal dysplasias. Pediatr Radiol. 1998; 28(10):764-70. DOI: 10.1007/s002470050462. View

18.

Hedequist D, Emans J . Congenital scoliosis: a review and update. J Pediatr Orthop. 2007; 27(1):106-16. DOI: 10.1097/BPO.0b013e31802b4993. View

19.

Abrams S, Filly R . Congenital vertebral malformations: prenatal diagnosis using ultrasonography. Radiology. 1985; 155(3):762. DOI: 10.1148/radiology.155.3.3890005. View

20.

Goldstein I, Makhoul I, Weissman A, Drugan A . Hemivertebra: prenatal diagnosis, incidence and characteristics. Fetal Diagn Ther. 2005; 20(2):121-6. DOI: 10.1159/000082435. View