Biometric analysis of the foetal meconium pattern using T1 weighted 2D gradient echo MRI.

Georgia Hyde,Ashok Raghavan,Andrew Fry,Elspeth Whitby

doi:10.1259/bjro.20200032

Georgia Hyde, Ashok Raghavan + Show 2 more

Open Access

https://doi.org/10.1259/bjro.20200032

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Abstract

Objectives:Foetal MRI is used to assess abnormalities after ultrasonography. Bowel anomalies are a significant cause of neonatal morbidity, however there are little data concerning its normal appearance on antenatal MRI. This study aims to investigate the pattern of meconium accumulation throughout gestation using its hyperintense appearance on T1 weighted scans and add to the current published data.Methods:This was a retrospective cohort study in a tertiary referral clinical MRI centre. Foetal body MRI scans of varying gestational ages were obtained dating between October 2011 and March 2018. The bowel was visualised on T1 weighted images. The length of the meconium and the width of the meconium at the rectum, sigmoid colon, splenic flexure and hepatic flexure was measured. Presence or absence of meconium in the small bowel was noted. Inter- and intrarater reliability was assessed.Results:181 foetal body scans were reviewed. 52 were excluded and 129 analysed. Visualisation of the meconium in the large bowel became increasingly proximal with later gestations, and small bowel visualisation was greater at earlier gestations. There was statistically significant strong (r = 0.6–0.8) or very strong (r = 0.8–1.0) positive correlation of length and width with increasing gestation. Interrater reliability was moderate to excellent (r = 0.4–1.0).Conclusion:This study provides new information regarding the pattern of meconium accumulation throughout gestation. With care, the results can be used in clinical practice to aid diagnosis of bowel pathology.Advances in knowledge:The findings of this study provide further information concerning the normal accumulation of foetal meconium on MR imaging, an area where current research is limited.

Highlights

Foetal structural abnormalities are primarily identiied by ultrasound scan (USS) as part of routine antenatal care.[1]
Its use as a diagnostic technique for foetal body abnormalities is useful, especially in terms of using meconium to observe the anatomy of the bowel due to its hyperintense appearance on T1 weighted (T1W) imaging.[5]
Outcome data were collected for all 129 cases

Summary

Introduction

Foetal structural abnormalities are primarily identiied by ultrasound scan (USS) as part of routine antenatal care.[1] cost-efective and widely used, screening ultrasonography is sometimes limited in the amount of information it can provide.[2] In the last decade, MRI has become more widely available and is used to image a foetus ater ultrasound, when the results are inconclusive or require further investigation.[3] he majority of research in foetal MRI has far been concerned with neurological imaging.[4] its use as a diagnostic technique for foetal body abnormalities is useful, especially in terms of using meconium to observe the anatomy of the bowel due to its hyperintense appearance on T1 weighted (T1W) imaging.[5] several studies have demonstrated the eicacy of foetal MRI in identifying and conirming conditions such as colonic obstruction and atresia.[6,7,8,9] Even virtual colonography has been reported in foetal imaging.[10]

Objectives

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