Abstract
Magnetic resonance imaging (MRI) has become an essential diagnostic modality for congenital disorders of the central nervous system. Recent advancements have transformed foetal MRI into a clinically feasible tool, and in an effort to find predictors of clinical outcomes in spinal dysraphism, foetal MRI began to unveil its potential. The purpose of our review is to introduce MRI techniques to experts with diverse backgrounds, who are involved in the management of spina bifida. We introduce advanced foetal MRI postprocessing potentially improving the diagnostic work-up. Importantly, we discuss how postprocessing can lead to a more efficient utilisation of foetal or neonatal MRI data to depict relevant anatomical characteristics. We provide a critical perspective on how structural, diffusion and metabolic MRI are utilised in an endeavour to shed light on the correlates of impaired development. We found that the literature is consistent about the value of MRI in providing morphological cues about hydrocephalus development, hindbrain herniation or outcomes related to shunting and motor functioning. MRI techniques, such as foetal diffusion MRI or diffusion tractography, are still far from clinical use; however, postnatal studies using these methods revealed findings that may reflect early neural correlates of upstream neuronal damage in spinal dysraphism.
Highlights
Open spinal dysraphism, termed spina bifida aperta, or myelomeningocele or myeloschisis, is one of the most complex and devastating nonlethal congenital malformations. It is characterised by a posteriorly open spine, an open dura mater fused with the dermis of the surrounding skin, an open pia mater fused with the epidermis of the adjacent skin, and a non-neurulated spinal cord residing on top of the pia mater, directly facing the amniotic cavity and fluid [1]
We aimed to provide a critical perspective on how diagnostic and follow-up imaging in spinal dysraphism can be improved by emerging Magnetic resonance imaging (MRI) acquisition, image reconstruction and quantification methods
Diagnostic imaging by means of prenatal MRI is currently undergoing a notable paradigm shift from being a qualitative, second-line option to becoming a quantitative method in the realm of precision medicine
Summary
Magnetic resonance imaging provides morphological cues about hydrocephalus development, hindbrain herniation or outcomes related to shunting and motor functioning. Advanced image processing, such as superresolution reconstruction, enables a better depiction of anatomy in spina bifida. Diffusion tensor imaging may provide early markers of upstream neuronal damage; the method is still in its infancy prenatally
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