Prenatal Brain Imaging in Isolated vs. Complicated Club Foot: A Cohort Study

Abstract

Talipes equinovarus (TEV) is a common birth defect. Differentiation between isolated and complex TEV is fundamental due to its effect on prognosis. Association between TEV and poor neurological outcome is more prominent in complex cases and highlights the significance of brain evaluation. The aim of the current study was to evaluate the contribution of fetal brain MRI to sonographic evaluation. In this retrospective study we evaluated charts of all pregnant patients referred for fetal brain MRI due to fetal TEV between 1/1/2011 and 12/31/14 in a single tertiary referral center. Isolated and complex TEV were differentiated according to associated anomalies. Brain US and MRI results were compared. 28 pregnant patients were included with an average gestation and parity of 2.5 and 1.5, respectively. Both isolated and complicated TEV groups included 14 fetuses after initial TEV diagnosis on anatomical survey. Brain sonography and MRI were normal among 12/14 patients with isolated TEV while two patients were later diagnosed with mild ventriculomegaly. US brain evaluation has revealed pathologic findings in 4 (28.6 %) cases in the complicated TEV group, while MRI demonstrated abnormal findings in 8 (57.1 %) fetuses with notable severity diversity. In 6 cases, MRI diagnosed additional pathologies which were not demonstrated by US. Brain fetal MRI is an efficient tool during antenatal evaluation of complicated TEV with a high percentage of additional findings not demonstrated songraphically while its efficacy in isolated cases is in doubt. The current study expands the relevance of fetal brain MRI in cases of non-CNS anomalies.

Outcome of isolated fetal talipes: A systematic review and meta‐analysis

“…In all, 778 articles were identified; 46 were assessed for eligibility for inclusion and 25 studies were included in the systematic review (Table , Figure , see Supplementary material, Table , Figure ) . These 25 studies included 1567 fetuses affected by isolated talipes on ultrasound, defined as the presence of talipes with no associated anomalies at the time of diagnosis.…”

“…Three studies (118 fetuses) explored the occurrence of associated anomalies detected only at a follow‐up examination in fetuses with a prenatal diagnosis of isolated talipes. Overall, associated anomalies not detected on ultrasound were detected in 7.8% (95% CI 0.1%‐29.3%) of cases at follow‐up ultrasound, whereas in 4.0% (95% CI 0.1%‐13.2%) of cases, fetal MRI detected anomalies that were not detected at ultrasound assessment.…”

Prenatal Diagnosis of Clubfoot: Where Are We Now? Systematic Review and Meta-Analysis

“…The final studies selected by the reviewers included the following levels of evidence: 19 level III retrospective studies [ 1 , 2 , 7 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 25 , 26 , 27 ], 3 level II prospective comparative studies [ 8 , 11 , 20 ], 1 descriptive study of level III [ 19 ] ( Table 1 ).…”

“…Six of the studies identified reported associated pathologies [ 9 , 14 , 21 , 24 , 25 , 27 ]. The following were mentioned in at least 1 of the studies included; Trisomies: 13, 18, 21, Neural Tube Defect, Skeletal Dysplasia, Cardiac anomalies, Sex Chromosome Abnormalities, Submicroscopic CNVs, Developmental Delay, Symptomatic Epilepsy, Thin corpus callosum, Visual inattentiveness, Peroneal Nerve Palsy, Low weight gain, Mild facial asymmetry, Delayed bone age, Cleft Palate, Finger Camptodactyly, Unusual facies, Cerebral Palsy, Rett Syndrome, Hypotonia, Coarse facial features, Torticollis, Hydramnios, Spina Bifida ( Table 2 ).…”

“…In all of the selected studies US was used as the primary diagnostic instrument. Thirteen of the studies [ 1 , 7 , 8 , 10 , 11 , 12 , 15 , 16 , 17 , 19 , 21 , 23 , 26 ] used the US exclusively, while in the rest of the studies [ 2 , 9 , 13 , 14 , 18 , 20 , 22 , 24 , 25 , 27 ] US was used in combination with other procedures such as MRI [ 2 , 9 , 20 ] or karyotyping [ 13 , 14 , 18 , 22 , 24 , 25 , 27 ] ( Table 1 ). Based on the data available and on the studies in which this item was present, the accuracy of this test averaged 80.9%.…”