Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida
Por:
Trigo L, Eixarch E, Bottura I, Dalaqua M, Barbosa AA Jr, De Catte L, Demaerel P, Dymarkowski S, Deprest J, Lapa DA, Aertsen M and Gratacós E
Publicada:
1 jun 2022
Ahead of Print:
15 ago 2021
Resumen:
Objectives To determine the prevalence of brain anomalies at the time of preoperative magnetic resonance imaging (MRI) assessment in fetuses eligible for prenatal open spina bifida (OSB) repair, and to explore the relationship between brain abnormalities and features of the spinal defect. Methods This was a retrospective cross-sectional study, conducted in three fetal medicine centers, of fetuses eligible for OSB fetal surgery repair between January 2009 and December 2019. MRI images obtained as part of the presurgical assessment were re-evaluated by two independent observers, blinded to perinatal results, to assess: (1) the type and area of the defect and its anatomical level; (2) the presence of any structural central nervous system (CNS) anomaly and abnormal ventricular wall; and (3) fetal head and brain biometry. Binary regression analyses were performed and data were adjusted for type of defect, upper level of the lesion (ULL), gestational age (GA) at MRI and fetal medicine center. Multiple logistic regression analysis was performed in order to identify lesion characteristics and brain anomalies associated with a higher risk of presence of abnormal corpus callosum (CC) and/or heterotopia. Results Of 115 fetuses included, 91 had myelomeningocele and 24 had myeloschisis. Anatomical level of the lesion was thoracic in seven fetuses, L1-L2 in 13, L3-L5 in 68 and sacral in 27. Median GA at MRI was 24.7 (interquartile range, 23.0-25.7) weeks. Overall, 52.7% of cases had at least one additional brain anomaly. Specifically, abnormal CC was observed in 50.4% of cases and abnormality of the ventricular wall in 19.1%, of which 4.3% had nodular heterotopia. Factors associated independently with higher risk of abnormal CC and/or heterotopia were non-sacral ULL (odds ratio (OR), 0.51 (95% CI, 0.26-0.97); P = 0.043), larger ventricular width (per mm) (OR, 1.23 (95% CI, 1.07-1.43); P = 0.005) and presence of abnormal cavum septi pellucidi (OR, 3.76 (95% CI, 1.13-12.48); P = 0.031). Conclusions Half of the fetuses assessed for OSB repair had an abnormal CC and/or an abnormal ventricular wall prior to prenatal repair. The likelihood of brain abnormalities was increased in cases with a non-sacral lesion and wider lateral ventricles. These findings highlight the importance of a detailed preoperative CNS evaluation of fetuses with OSB. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Filiaciones:
:
University of Barcelona, Barcelona, Spain and KU Leuven, Leuven, Belgium, member of BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Eixarch E:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
Bottura I:
Hospital Israelita Albert Einsten, São Paulo, Brazil
Dalaqua M:
Department of Radiology, Hospital Israelita Albert Einsten, Sao Paulo, The School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE)., Brazil
Barbosa AA Jr:
The School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Imaging Diagnosis Department, Hospital Israelita Albert Einsten, Sao Paulo, Brazil
De Catte L:
Department of Radiology and Department of Obstetrics and Gynecology, UZ KU Leuven, Leuven, Belgium
Demaerel P:
Department of Radiology, UZ KU Leuven, Leuven, Belgium
Dymarkowski S:
Department of Radiology, UZ KU Leuven, Leuven, Belgium
Deprest J:
Department of Obstetrics and Gynaecology, UZ KU Leuven, Leuven, Belgium, Belgium and the Institute of Women's Health, University College London, London, United Kingdom
Lapa DA:
head of department, Department of Hospital Infantil Sabará, Fetal Therapy Program, Hospital Israelita Albert Einsten, Sao Paulo, Brazil, Sao Paulo, Brazil
Aertsen M:
Department of Radiology, UZ KU Leuven, Leuven, Belgium
Gratacós E:
Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
hybrid
|