Miraç ÖZALP, Ömer DEMİR, Gülseren DİNÇ, Hidayet ŞAL, Turhan ARAN, Mehmet Armağan OSMANAĞAOĞLU, Sibel KUL

Prenatal Tanıda Fetal Manyetik Rezonans Görüntülemenin Rolü

ÖZET Amaç Üçüncü basamak merkezimizde klinisyenler tarafından tercih edilen fetal MRG endikasyonlarının incelenmesi ve MRG’nin ultrason bulgularına olan ek tanısal katkısının ortaya konmasıdır. Gereç ve Yöntem 2016-2018 yılları arasında fetal MRG yapılan 322 olgu retrospektif olarak incelendi. Fetal lezyonlar organ sistemlerine göre sınıflandırıldı ve klinisyenlerin endikasyonları belirlendi. Prenatal dönemde yapılan fetal ultrason ve MRG sonuçları değerlendirildi. Bulgular MRG çekilen 322 fetüsün endikasyonlarının dağılımı; 138’inde (%42.8) santral sinir sistemi anomalileri, 99’unda (%30.7) plasental anomaliler, 36’sında (%11.2) genitoüriner sistem anomalileri, 18’inde (%5.6) solunum sistemi anomalileri, 17’sinde (%5.3) maternal faktör, 13’ünde (%4) baş, boyun, yüz anomalileri ve 1’inde (%0.4) fetal faktör olarak belirlendi.Tüm endikasyonlar incelendiğinde MRG ile ek bulgu saptanan olgu sayısı 13’tür (%4.03). Santral sinir sistemi anomalileri 7 olgu ile en sık ek bulgu saptanan gruptur, bu grup içerisinde fetal MRG %5.07 oranında ek katkı sunmuştur. Sırasıyla genitoüriner sistem anomalileri olan grupta 3 ek bulgu (%8.33 oranında ek katkı), maternal endikasyonlar grubunda 2 ek bulgu (%11.7 oranında ek katkı) ve solunum sistemi anomalileri olan grupta 1 ek bulgu (%5.55 oranında ek katkı) olduğu görüldü. Sonuç Ultrasonografinin yetersiz kaldığı hallerde uygun perinatal yönetim ve danışmanlık için fetal MRG giderek artan sıklıkta kullanılmaktadır. MR cihazlarının daha ulaşılabilir olması, bu alandaki uzmanlığın artması ve MRG teknolojisindeki ileri gelişmeler, bu modalitenin perinatoloji alanında daha yaygın kullanımı ile sonuçlanacaktır.

Anahtar Kelimeler:

Prenatal tanı, fetal manyetik rezonans görüntüleme, fetal ultrasonografi

The Role of Fetal Magnetic Resonance Imaging in Prenatal Diagnosis

ABSTRACT Objective The aim of this study is to investigate the fetal MRI indications preferred by clinicians in our tertiary care center and to reveal the additional diagnostic contribution of MRI to ultrasound findings. Material and Method Between 2016-2018, 322 cases who underwent fetal MRI were evaluated retrospectively. Fetal lesions were classified according to organ systems and indications of clinicians were determined. Prenatal fetal ultrasound and MRI results were evaluated. Results Distribution of indications of 322 fetuses with fetal MRI; Central nervous system anomalies in 138 (42.8%), placental anomalies in 99 (30.7%), genitourinary system anomalies in 36 (11.2%), respiratory system anomalies in 18 (5.6%), 17 (5.3%) maternal factor, 13 (4.0%) head, neck, face anomalies and 1 (0.4%) fetal factor.When all indications were examined, 13 (4.03%) patients had additional findings with MRI. Central nervous system anomalies were the most common additional finding with 7 cases, fetal MRI contributed 5.07% in this group. There were 3 additional findings (8.33% additional contribution) in the group with genitourinary system abnormalities, 2 additional findings (11.7% additional contribution) in the maternal indications group and 1 additional finding (5.55% additional contribution) in the group with respiratory system anomalies, respectively. Conclusion Fetal MRI is increasingly used for proper perinatal management and counseling in cases where ultrasonography is inadequate. The availability of MRI devices, the increase in expertise in this field and the advancements in MRI technology will result in the more widespread use of this modality in the field of Perinatology.

Keywords:

Prenatal diagnosis, fetal magnetic resonance imaging, fetal ultrasonography,

PDF

___

Patenaude Y, Pugash D, Lim K, Morin L, Lim K, Bly S, et al.; Diagnostic Imaging Committee, The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can. 2014;36(4):349-63.
Palladini D, Volpe P. Anatomic survey of the fetus and early diagnosis of fetal anomaly. In: Ville edit. Ultrasound of Congenital Fetal Anomalies- Differential Diagnosis and Prognostic Indicators. CRC Press 2014;1:20-21.
Hedrick HL, Flake AW, Crombleholme TM, Howell LJ, Johnson MP, Wilson RD, et al. History of fetal diagnosis and therapy: Children’s Hospital of Philadelphia experience. Fetal Diagn Ther 2003;18: 65–82.
Hubbard AM. Ultrafast fetal MRI and prenatal diagnosis. Prenat Diagn. 2003;23: 927–931.
Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37: 116–126.
Jakab A, Pogledic I, Schwartz E, Gruber G, Mitter C, Brugger PC, et al. Fetal cerebral magnetic resonance imaging beyond morphology. Semin Ultrasound CT MR 2015;36: 465–475.
Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016; 316: 952–961.
Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: Executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014; 210: 387–397.
Bekiesinska-Figatowska M, Romaniuk-Doroszewska A, Duczkowska A, Duczkowski M, Iwanowska B, Szkudlińska-Pawlak S. Fetal MRI versus postnatal imaging in the MR-compatible incubator. Radiol Med. 2016;121(9):719-28.
P. Trompoukis, N. Papantoniou, C. Chlapoutaki, S. Mesogitis , A. Antsaklis Fetal MRI: is it really helpful? The Journal of Maternal-Fetal & Neonatal Medicine Volume 2012;25:2363-68.
Cardoen L, De Catte L, Demaerel P, Devlieger R, Lewi L, Deprest J, et al. The role of magnetic resonance imaging in the diagnostic work-up of fetal ventriculomegaly. Facts Views Vis ObGyn 2011;3:159–163.
Arroyo MS, Hopkin RJ, Nagaraj UD, Kline-Fath B, Venkatesan C. Fetal brain MRI findings and neonatal outcome of common diagnosis at a tertiary care center. JPerinatol. 2019; 39(8):1072-1077.
Yalçın SE, Yalçın Y, Tola EN, Yavuz A, Akkurt MO, Sezik M, et al. Fetal manyetik rezonans görüntüleme endikasyonlarının incelenmesi. Perinatoloji Dergisi 2018;26:18-24.
Rossi AC, Prefumo F. Additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies: a systematic review of the literature. Ultrasound Obstet Gynecol 2014;44:388–93.
Griffiths PD, Reeves MJ, Morris JE, Mason G, Russell SA, Poley MN et al. A prospective study of fetuses with isolated ventriculomegaly investigated by antenatal sonography and in utero MR imaging. AJNR Am J Neuroradiol 2010;31:106–111.
Glenn OA. MR imaging of the fetal brain. Pediatr Radiol 2010;40:68–81.
Palacios Jaraquemada JM, Bruno CH. Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings Acta Obstet Gynecol Scand 2005;84:716–724.
Pico H, Dabadie A, Bourliere-Najean B, Philip N, Capelle M, Aschero A, et al. Contribution of the foetal uro-MRI in the prenatal diagnosis of uronephropathies. Diagn Interv Imaging. 2014;95(6):573-8.
Lee TC, Lim FY, Keswani SG, Frischer JS, Haberman B, Kingma PS, et al. Late gestation fetal magnetic resonance imaging-derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia. J Pediatr Surg 2011;46:1165–71.
Kastenholz KE, Weis M, Hagelstein C, Weiss C, Kehl S, Schaible T et al. Correlation of Observed-to-Expected MRI Fetal Lung Volume and Ultrasound Lung-to-Head Ratio at Different Gestational Times in Fetuses With Congenital Diaphragmatic Hernia . American Journal of Roentgenology. 2016;206:856-866.
Espinoza J. Fetal MRI and prenatal diagnosis of congenital heart defects. Lancet. 2019;20;393(10181):1574-1576.