Prognostic Accuracy of Fetal MRI in Predicting Postnatal Neurodevelopmental Outcome

Abstract

BACKGROUND AND PURPOSE:The superior diagnostic accuracy of fetal MR imaging in detecting fetal brain abnormalities has been previously demonstrated; however, the ability of fetal MR imaging to prognosticate postnatal outcome is not well-studied. We performed a retrospective analysis to determine the prognostic accuracy of fetal MR imaging in predicting postnatal neurodevelopmental outcome. MATERIALS AND METHODS:We identified all fetal MR imaging performed at the Children's Hospital of Eastern Ontario during a 10-year period and assessed agreement between prenatal prognosis and postnatal outcome. Prenatal prognosis was determined by a pediatric neurologist who reviewed the fetal MR imaging report and categorized each pregnancy as having a favorable, indeterminate, or poor prognosis. Assessment of postnatal neurodevelopmental outcome was made solely on the basis of the child's Gross Motor Function Classification System score and whether the child developed epilepsy. Postnatal outcome was categorized as favorable, intermediate, or poor. We also assessed the diagnostic accuracy of fetal MR imaging by comparing prenatal and postnatal imaging diagnoses. RESULTS:We reviewed 145 fetal MR images: 114 were included in the assessment of diagnostic accuracy, and 104 were included in the assessment of prognostic accuracy. There was 93.0% agreement between prenatal and postnatal imaging diagnoses. Prognosis was favorable in 44.2%, indeterminate in 50.0%, and poor in 5.8% of pregnancies. There was 93.5% agreement between a favorable prenatal prognosis and a favorable postnatal outcome. CONCLUSIONS:A favorable prenatal prognosis is highly predictive of a favorable postnatal outcome. Further studies are required to better understand the role of fetal MR imaging in prognosticating postnatal development, particularly in pregnancies with indeterminate and poor prognoses.

Fetal MRI assessment of posterior fossa anomalies: A review

“…In recent decades, the use of fetal MRI has improved accurate diagnosis of in-utero abnormalities. 4 In a fetal imaging study in the United Kingdom, 5 the overall diagnostic accuracy for detecting an isolated posterior fossa abnormality by US was only 65.4% compared with an accuracy of 87.7% for fetal MRI. Furthermore, prognostic information changed after fetal MRI in 44% of the cases, illustrating the importance of fetal MRI in making an accurate diagnosis for posterior fossa abnormalities.…”

“…Ultrafast fetal MRI is a widely available secondary technique used to confirm, correct, or complement questionable US findings. In recent decades, the use of fetal MRI has improved accurate diagnosis of in‐utero abnormalities 4 . In a fetal imaging study in the United Kingdom, 5 the overall diagnostic accuracy for detecting an isolated posterior fossa abnormality by US was only 65.4% compared with an accuracy of 87.7% for fetal MRI.…”

Role of prenatal magnetic resonance imaging in fetuses with isolated anomalies of corpus callosum: multinational study

“…More recent studies exploring the role of MRI in fetuses with isolated CNS malformation diagnosed on neurosonography showed that the additional value of MRI is tangible, but generally lower than reported previously when neurosonography is performed by expert operators [22][23][24][25][26][27][28] . Despite this, there is still a significant number of cases in which additional anomalies are not detected commonly on ultrasound, such as malformations of cortical development, making MRI a fundamental tool for an accurate prediction of neurodevelopmental outcome [24][25][26][27][28] . In this scenario, integration of MRI and ultrasound for assessment of fetuses at risk of CNS anomalies may help to predict the postnatal outcome [21][22][23][24][25][26][27][28][29] .…”

“…Despite this, there is still a significant number of cases in which additional anomalies are not detected commonly on ultrasound, such as malformations of cortical development, making MRI a fundamental tool for an accurate prediction of neurodevelopmental outcome [24][25][26][27][28] . In this scenario, integration of MRI and ultrasound for assessment of fetuses at risk of CNS anomalies may help to predict the postnatal outcome [21][22][23][24][25][26][27][28][29] .…”

“…This is a critical issue because the large majority of CNS anomalies cannot be identified using the standard axial plane of the fetal brain during the routine anomaly scan. More recent studies exploring the role of MRI in fetuses with isolated CNS malformation diagnosed on neurosonography showed that the additional value of MRI is tangible, but generally lower than reported previously when neurosonography is performed by expert operators [22][23][24][25][26][27][28] . Despite this, there is still a significant number of cases in which additional anomalies are not detected commonly on ultrasound, such as malformations of cortical development, making MRI a fundamental tool for an accurate prediction of neurodevelopmental outcome [24][25][26][27][28] .…”