A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero

Abstract

ObjectivesThis systematic review was undertaken to define the diagnostic performance of in utero MR (iuMR) imaging when attempting to confirm, exclude or provide additional information compared with the information provided by prenatal ultrasound scans (USS) when there is a suspicion of foetal brain abnormality.MethodsElectronic databases were searched as well as relevant journals and conference proceedings. Reference lists of applicable studies were also explored. Data extraction was conducted by two reviewers independently to identify relevant studies for inclusion in the review. Inclusion criteria were original research that reported the findings of prenatal USS and iuMR imaging and findings in terms of accuracy as judged by an outcome reference diagnosis for foetal brain abnormalities.Results34 studies met the inclusion criteria which allowed diagnostic accuracy to be calculated in 959 cases, all of which had an outcome reference diagnosis determined by postnatal imaging, surgery or autopsy. iuMR imaging gave the correct diagnosis in 91 % which was an increase of 16 % above that achieved by USS alone.ConclusioniuMR imaging makes a significant contribution to the diagnosis of foetal brain abnormalities, increasing the diagnostic accuracy achievable by USS alone.Key points • Ultrasound is the primary modality for monitoring foetal brain development during pregnancy • iuMRI used together with ultrasound is more accurate for detecting foetal brain abnormalities • iuMR imaging is most helpful for detecting midline brain abnormalities • The moderate heterogeneity of reviewed studies may compromise findings

The prevalence and the adding value of fetal MRI imaging in midline cerebral anomalies

“…There are great controversies regarding the prenatal US versus MRI, as Wagenvoort et al [10] stated that foetal brain MRI added more information and is more accurate than foetal US. Additionally, Jarvis et al [11] concluded that when foetal brain abnormalities are suspected on US, MR imaging can significantly contribute to the diagnostic pathway by clarifying findings and significantly increasing the detection rate of abnormalities, particularly in the midline and posterior fossa anomalies. However, dedicated neuro-sonography studies concluded that MRI is for the confirmation of diagnosis and that each modality provided additional/different information only in a minority of cases [12].…”

Anatomical subgroup analysis of the MERIDIAN cohort: ventriculomegaly

“…There is now considerable evidence supporting the value of fetal MRI in diagnosing fetal brain abnormalities, based on systematic reviews and our prospective study. Whilst designing the MERIDIAN study, fetal medicine focus groups were formed with the purpose of identifying important issues that should be addressed by the study in order to improve clinical practice.…”

Anatomical subgroup analysis of the MERIDIAN cohort: failed commissuration

“…There was, however, accumulating evidence from MRI studies before the start of the MERIDIAN study suggesting that the diagnosis of agenesis of the CC on ultrasound may not be straightforward. Most publications comparing ultrasound and MRI of the fetal brain from that period described CC pathology as the greatest source of discrepancy between ultrasound and MRI reports and this has been highlighted in systematic reviews and meta‐analyses. In addition, a recent publication from our group based on the experience of 7 years of MRI studies immediately before the start of the MERIDIAN study raised serious questions about the ability of ultrasound to diagnose failed commissuration.…”