[The influence of MRI examination on prenatal guidance and therapeutic decisions in fetuses with central nervous system defects].

PURPOSE

The aim of this study was the evaluation of diagnostic and prognostic value of prenatal US and MRI in fetuses with central nervous system abnormalities, and of the influence of incorporating MRI to diagnostic algorithm on the therapeutic decisions.

MATERIALS AND METHODS

123 pregnant women (16-40 weeks' gestation) underwent MRI due to abnormal appearance of fetal central nervous system in US (using Voluson-Kretz 730PRO). MRI has been performed on a 1.5-T Excite (GE), using a phased-array body coil, with T2-weighted sequences (SSFSET2) and orthogonal scans. The MRI findings have been compared to those from prenatal US. The influence of MRI examination in prenatal diagnostic on decisions concerning termination of pregnancy, method of delivery and neurosurgical intervention after birth was assessed.

RESULTS

Among 123 fetuses with central nervous system abnormalities, 11 neonates died after birth (in 6 cases pathologic examination was performed), in 67 cases the MR findings were correlated with the results of the neonatal evaluation, all other cases have not been verified. Almost in 70% of the cases, MRI findings complemented the US diagnosis, in 22 cases changed it with respect to central nervous system defects, and in 18 cases--with respect to other system/organ abnormalities. In a few cases US failed to provide a correct diagnosis. In 3 cases, the MRI findings have not been confirmed with postnatal evaluation.

CONCLUSIONS

Prenatal MRI in congenital central nervous system defects allows to obtain much more important therapeutic data and complement or correct the fetal sonographic diagnosis. Prenatal MRI allows to plan gynaecological, neonatal, neurosurgical treatment, and to predict neurological defects. It also improves prenatal guidance.