Congenital Thoracic Abnormalities: Contribution of Prenatal Magnetic Resonance İmaging to Ultrasound Diagnosis

Amaç: Çalışmada konjenital torasik anomalikleri olan fetüslerde prenatal manyetik rezonans görüntüleme (MRG)’nin prenatal ultrason (US)'na olan katkısını ortaya koymayı amaçladık. Gereç ve Yöntemler: Prenatal dönemde ultrason (US) de fetal torasik anomaliler tespit edilen ve ardından fetal Amaç: Çalışmada konjenital torasik anomalikleri olan fetüslerde prenatal manyetik rezonans görüntüleme (MRG)’nin prenatal ultrason (US)'na olan katkısını ortaya koymayı amaçladık. Gereç ve Yöntemler: Prenatal dönemde ultrason (US) de fetal torasik anomaliler tespit edilen ve ardından fetal MRG yapılan 984 gebenin 33'ü retrospektif olarak analiz edildi. Metadolojik çalışmada, prenatal MR görüntüleme ve US bulguları doğum sonrası görüntüleme, otopsi, cerrahi patolojik inceleme, fizik muayene veya klinik takip ile karşılaştırıldı. US, MRG ve her iki yöntemin kombinasyonları için tanısal duyarlılıklar, US ve MR sonuçları, doğum sonrası kesin tanılarla karşılaştırılarak hesaplandı. Sonuçlar: US ve MRG'nin torasik anomalileri saptamadaki duyarlılıkları sırasıyla % 53.3 ve % 66.7 bulundu. Prenatal görüntülemede olguların %82’sinde hem MR hem de US bulguları birbiriyle uyumluydu. Olguların %48’inde hem MR hem de US doğru tanıyı koydu. MRG, %3 olguda şüpheli US tanısını doğruladı. Prenatal MRG, %30 vakada primer tanıya ek olarak pulmoner hipoplazi ve mediastinal şift gibi ek bulguları ortaya çıkararak US’ye ilave katkıda bulunmuştur. MRG’nin US'ye en fazla katkısı (% 90) konjenital diyafram hernilerinde (KDH) oldu. KDH’li olguların tümünde pulmoner hipoplazi ile uyumlu olarak T2 ağırlıklı MRG’de sinyal azalması saptandı. MRG, %9 olguda US tanısını tamamen değiştirdi. Prenatal MRG’nin US’ye toplam katkı oranı %42 idi. Doğum öncesi kistik adenomatoid malformasyon (CCAM) veya doğumsal lober sıvı yüklenmesi (CLFO) tanısı konan fetüslerin %67’sinde doğum sonrasında spontan rezolüsyon saptandı. Sonuç: US'ye tamamlayıcı yöntem olarak MRG görüntüleme doğumsal toraks patolojilerinin prenatal tanısında başarıyla kullanılabilir. MRG prenatal dönemde US’ye ek bulgular sağlayabilir, şüpheli tanıyı doğrulayabilir veya tanıyı tamamen değiştirebilir. Çalışmada MRG’nin US’ye en fazla (%90) katkı sağladığı patoloji konjenital diyafram hernileri bulundu.

Anahtar Kelimeler:

prenatal tanı, manyetik rezonans görüntüleme, , ultrason, fetüs

Congenital Thoracic Abnormalities: Contribution of Prenatal Magnetic Resonance İmaging to Ultrasound Diagnosis

Objective: We aimed to evaluate the contribution of prenatal magnetic resonance (MR) imaging to ultrasound (US) in the diagnosis of congenital thoracic abnormalities. Materials and Methods: Thirty-three out of 984 pregnant women, with fetal thoracic anomalies detected at US and subsequently underwent fetal MR imaging were analyzed retrospectively. In the present methodological study, prenatal MR imaging and US findings are compared with postnatal imaging, autopsy, surgical pathologic examination, physical examination or clinical follow-up. Diagnostic sensitivities were calculated for US, MR imaging and combinations of both methods by comparing US and MR results with postnatal definite diagnoses. Results: The sensitivities of US and MR imaging in detecting thoracic anomalies were 53.3% and 66.7%, respectively. Both US and MRI findings were consistent in prenatal imaging in a total 27 (82%) of cases. Both US and MR imaging made correct diagnosis in 48% of cases. MR imaging confirmed the suspected US diagnosis in 3%. Prenatal MR imaging positively contributed to US with revealing additional findings such as pulmonary hypoplasia and mediastinal shift in 30% cases. Main contribution (90%) of MR imaging to US was in congenital diaphragmatic hernia (CDH) cases. In all cases with CDH, MRI showed reduction in T2 signal consistent with pulmonary hypoplasia. MR imaging completely altered the diagnosis in 9% of cases. Total contribution rate of prenatal MR imaging to US was 42%. Sixty-seven percent of prenatally detected congenital cystic adenomatoid malformation (CCAM) and congenital lobar fluid overload (CLFO) cases exhibited spontaneous resolution before birth. Conclusion: MR imaging as a complementary to US can be used successfully in the prenatal diagnosis of congenital thoracic pathologies. It can provide additional findings, confirm the suspected diagnosis or completely alter the prenatal US diagnosis. The most additional contribution of MRI to US was provided in cases of CDH.

Keywords:

prenatal diagnosis, magnetic resonance imaging, ultrasound, thorax abnormalities,

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