Abstract
Objective: Intrauterine fetal ventriculomegaly (IVM) is one of the most commonly detected fetal anomalies. Prenatal diagnosis in IVM is considered a challenge with a significant impact on management. The current study aims to evaluate the added value of performing fetal MRI to sonographically diagnosed IVM. Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between January 2017 and March 2019. We included pregnant women with a single fetus sonographically diagnosed IVM (symmetrical or asymmetrical). First, a basic obstetric sonographic examination was done, followed by a detailed (2D/3D) fetal CNS anomaly scan for the detection of other associated anomalies. A fetal MRI brain scan was performed for all cases. Results: Sixty women were included in the study. Of the 60 fetuses with IVM, additional findings were seen on MRI in 14 cases (23%), and most of these findings were identified in fetuses with severe IVM (about 50%). No additional abnormalities were identified in fetuses of less than 24 weeks gestation. Callosal and septum pellucidum lesions (29%), along with posterior fossa abnormalities (28%) and cortical malformations (21%) accounted for the most common additional significant fetal MRI findings. Fetal MRI sensitivity, specificity, and positive and negative predictive values in correlation with those of prenatal ultrasound turned out to be notably higher, approaching nearly 100 %. Conclusions: Fetal MRI for sonographically diagnosed moderate or severe IVM is recommended to guide clinical management.
Highlights
Cerebral ventriculomegaly (VM) is one of the most commonly detected fetal anomalies found at the mid-trimester ultrasound.[1]
There is no doubt that VM is one of the most common abnormalities found on prenatal ultrasound, and it is a marker for increased risk of underlying malformations, chromosomal abnormalities, and infection.[11]
Our study found that maternal age was of significance as 80% of the pregnant females in our cases were more than 34 years old, which suggested that advanced maternal age may be associated with higher risk of congenital anomalies, including those of the CNS
Summary
Cerebral ventriculomegaly (VM) is one of the most commonly detected fetal anomalies found at the mid-trimester ultrasound.[1]. Ultrasound (US) is a popular screening modality for fetal CNS abnormalities. Fetal magnetic resonance imaging (MRI) is being used increasingly as a complementary tool to US in fetal CNS abnormalities assessment. This is because MRI is displayed in multiple planes, has better soft-tissue contrast and better depiction of subtle parenchymal abnormalities, and shows maturational stages of gray and white matter development, at a level that is beyond the US capability.[6] In addition, MRI, just like US, causes no exposure to ionizing radiation and appears to have no teratogenic effect on the fetus.[7]
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