Abstract

BACKGROUND AND PURPOSE

Prenatal and postnatal imaging examples of cases in which an indeterminate prognosis was associated with a poor outcome. A, Coronal single-shot fast spin-echo at 33 weeks with extensive bilateral polymicrogyria (peri-Sylvian, frontal, and parietal). Coronal T2 at 2 days of age confirms diffuse polymicrogyria. B, Axial single-shot fast spin-echo at 30 weeks shows a small right cerebral hemisphere with associated abnormal sulcation. There is right-sided polymicrogyria, a left subependymal nodule, and a large middle cystic structure (not shown) inferior to the corpus callosum and extending to the posterior fossa. Axial T2 at 2 days of age confirmed the fetal MR imaging findings. C, Axial FIESTA at 23 weeks demonstrates left unilateral VM. Axial T2 at 3 weeks of age confirms the left VM. The patient later required ventriculoperitoneal shunt due to complications of hydrocephalus and further disconnection surgery without resolution of seizures.

The superior diagnostic accuracy of fetal MR imaging in detecting fetal brain abnormalities has been previously demonstrated; however, the ability of fetal MR imaging to prognosticate postnatal outcome is not well-studied. We performed a retrospective analysis to determine the prognostic accuracy of fetal MR imaging in predicting postnatal neurodevelopmental outcome.

MATERIALS AND METHODS

We identified all fetal MR imaging performed at the Children’s Hospital of Eastern Ontario during a 10-year period and assessed agreement between prenatal prognosis and postnatal outcome. Prenatal prognosis was determined by a pediatric neurologist who reviewed the fetal MR imaging report and categorized each pregnancy as having a favorable, indeterminate, or poor prognosis. Assessment of postnatal neurodevelopmental outcome was made solely on the basis of the child’s Gross Motor Function Classification System score and whether the child developed epilepsy. Postnatal outcome was categorized as favorable, intermediate, or poor. We also assessed the diagnostic accuracy of fetal MR imaging by comparing prenatal and postnatal imaging diagnoses.

RESULTS

We reviewed 145 fetal MR images: 114 were included in the assessment of diagnostic accuracy, and 104 were included in the assessment of prognostic accuracy. There was 93.0% agreement between prenatal and postnatal imaging diagnoses. Prognosis was favorable in 44.2%, indeterminate in 50.0%, and poor in 5.8% of pregnancies. There was 93.5% agreement between a favorable prenatal prognosis and a favorable postnatal outcome.

CONCLUSIONS

A favorable prenatal prognosis is highly predictive of a favorable postnatal outcome. Further studies are required to better understand the role of fetal MR imaging in prognosticating postnatal development, particularly in pregnancies with indeterminate and poor prognoses.

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jross

Jeffrey Ross

• Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.



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