Levine Deborah, Barnes Patrick D, Robertson Richard R, Wong Geoffrey, Mehta Tejas S
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Radiology. 2003 Oct;229(1):51-61. doi: 10.1148/radiol.2291020770. Epub 2003 Aug 14.
To evaluate with respect to gestational age (GA) the effect of magnetic resonance (MR) imaging on changes in diagnosis, patient counseling, and case management regarding fetuses suspected of having central nervous system (CNS) anomalies.
The authors compared images from 242 ultrasonographic (US) studies and 242 MR imaging studies of the CNS in 214 fetuses. Reference standards of postnatal physical examination, imaging, surgical, and autopsy findings were available in 171 (79.9%) fetuses. Referring physicians were surveyed on how MR imaging findings changed patient counseling or case management. Outcomes were compared with respect to GA. Statistical tests used were the Fisher exact test, Student t test, and analysis of variance.
Confirmatory US findings were normal in 69 fetuses. MR imaging findings changed diagnosis in 46 of 145 (31.7%) fetuses with abnormal US findings. The mean GA of 72 of 145 fetuses with changes in maternal counseling (25.9 weeks) was significantly greater than that in 73 of 145 fetuses without changes in maternal counseling (22.6 weeks, P <.01). The mean GA of the 46 fetuses with changes in diagnosis (26.3 weeks) was significantly greater than that of the 99 fetuses with no major change in diagnosis (23.3 weeks, P <.01). There were 27 of 145 changes in case management, with no significant difference in mean GA of fetuses with and those without changes in case management. In fetuses with abnormal US findings, MR images were used to decide to terminate the pregnancy (n = 13; mean GA, 20.1 weeks), continue the pregnancy (n = 4; mean GA, 19.2 weeks), direct the mode and/or location of delivery (n = 5; mean GA, 30.5 weeks), and direct perinatal care (n = 5; mean GA, 30.2 weeks).
When a CNS anomaly is detected or suspected at US, MR imaging may demonstrate additional findings that can alter diagnosis and case management. Changes in management are GA dependent.
针对孕周（GA）评估磁共振（MR）成像对疑似患有中枢神经系统（CNS）异常胎儿的诊断变化、患者咨询及病例管理的影响。
作者比较了214例胎儿的242次中枢神经系统超声（US）检查图像和242次MR成像检查图像。171例（79.9%）胎儿有产后体格检查、影像学、手术及尸检结果等参考标准。就MR成像结果如何改变患者咨询或病例管理对转诊医生进行了调查。根据孕周比较结果。使用的统计检验方法有Fisher精确检验、Student t检验和方差分析。
69例胎儿超声检查结果证实正常。145例超声检查结果异常的胎儿中，46例（31.7%）的MR成像结果改变了诊断。145例孕妇咨询有变化的胎儿中，72例的平均孕周（25.9周）显著大于145例孕妇咨询无变化的胎儿中73例的平均孕周（22.6周，P<.01）。46例诊断有变化的胎儿的平均孕周（26.3周）显著大于99例诊断无重大变化的胎儿的平均孕周（23.3周，P<.01）。145例中有27例病例管理有变化，病例管理有变化和无变化的胎儿平均孕周无显著差异。在超声检查结果异常的胎儿中，MR图像用于决定终止妊娠（n = 13；平均孕周，20.1周）、继续妊娠（n = 4；平均孕周，19.2周）、指导分娩方式和/或地点（n = 5；平均孕周，30.5周）以及指导围产期护理（n = 5；平均孕周，30.2周）。
当超声检查发现或怀疑有中枢神经系统异常时，MR成像可能显示出可改变诊断和病例管理的其他发现。管理的变化取决于孕周。
