Abstract
BackgroundFetal MRI is increasingly used in congenital abdominal wall defects. In gastroschisis, the role of fetal MRI in surgical therapy is poorly understood. Currently, the type of repair is determined primarily by clinical presentation and institutional preference.ObjectiveTo evaluate the feasibility of fetal MRI volumetry in gastroschisis treatment.Materials and methodsWe included 22 cases of gastroschisis in this retrospective single-center study. Routine fetal MRI scans were acquired between Jan. 1, 2006, and July 1, 2018, at gestational ages of 19–34 postmenstrual weeks. Fetal-MRI-based manual segmentation and volumetry were performed utilizing steady-state free precision and T2-weighted sequences. Acquired parameters included intraabdominal volume, eventrated organ volume and total fetal body volume, and we calculated a volume ratio between eventrated organ volume and intraabdominal volume (E/I ratio).ResultsPrimary closure was conducted in 13 cases and silo bag treatment with delayed closure in 9 cases. Prenatal MRI volumetry showed a significantly higher E/I ratio in patients with silo bag treatment with delayed closure (mean [M]=0.34; 95% confidence interval [CI] 0.30, 0.40) than in primary closure (M=0.23, 95% CI 0.19, 0.27; P=0.004). We propose a volume ratio cutoff value of 0.27 for predicting silo bag treatment.ConclusionFetal MRI predicted silo bag treatment in patients with gastroschisis in 90% of the cases in our cohort and might facilitate prenatal counseling and treatment planning.
Highlights
Gastroschisis describes a congenital abdominal wall defect allowing organ protrusion into the amniotic cavity
Routine fetal MRI was performed according to International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines [17] and included steady-state free precision sequences in three orthogonal planes, and standard T2-W turbo spin-echo sequences (TSE), T1-W sequences acquired during maternal breathhold, and T2*-weighted sequences in coronal planes
The group treated with silo bag featured significantly more male subjects and less female subjects than the group treated with primary closure
Summary
Gastroschisis describes a congenital abdominal wall defect allowing organ protrusion into the amniotic cavity. While the aetiology is poorly understood [1], theories regarding the development of gastroschisis involve vascular abnormalities [2], amniotic membrane rupture [3], teratogenic factors leading to abnormal mesenchymal differentiation [4] as well as failure of umbilical ring/umbilical cord attachment [5]. Surgical treatment usually consists either of primary closure or initial silo bag placement with delayed closure. In a meta-analysis of randomized studies, silo bag treatment with delayed closure showed better outcome [6]. MRI is increasingly used in congenital abdominal wall defects. The role of fetal MRI in surgical therapy is poorly understood. The type of repair is determined primarily by clinical presentation and institutional preference
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