Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
AJNR Am J Neuroradiol. 2012 Feb;33(2):359-65. doi: 10.3174/ajnr.A2762. Epub 2011 Nov 17.
iuMR has been shown to increase the detection rate of developmental abnormalities of the CNS, though most reports are limited to singleton pregnancies. The hypothesis tested in this study was that iuMR performed in multifetal pregnancies will show additional information about fetal CNS abnormalities in a similar proportion of cases when compared with singleton pregnancies.
Fifty women with multifetal pregnancies were recruited consecutively carrying at least 1 fetus with a suspected developmental fetal CNS abnormality on sonography. All had iuMR at the same center by using the same MR imaging protocol. When the sonography and MR imaging reports were discrepant, 1 fetomaternal expert assessed the reports independently to predict in what percentage a change in prognosis/counseling would have occurred if iuMR was included in the diagnostic pathway.
There was agreement between the sonography and iuMR reports in 66% and disagreement in 34% of cases. The major cause for discrepancy was the presence or absence of the corpus callosum, which accounted for 10/17 of the disagreements. In 12/17 of the discrepant cases, the effect on management was judged to be significant.
We conclude that iuMR has a similar rate of discrepancy to sonography in multifetal pregnancies compared with the published data concerning singleton pregnancies. Our analysis of the effect on management shows that changes in the decision to consider termination of pregnancy would have occurred in 12/17 of the discrepant cases (ie, in 24% of our cases overall).
iuMR 已被证明可以提高中枢神经系统发育异常的检出率，尽管大多数报告仅限于单胎妊娠。本研究检验的假设是，在多胎妊娠中进行 iuMR 将以与单胎妊娠相似的比例为胎儿中枢神经系统异常提供更多信息。
连续招募了 50 名多胎妊娠妇女，这些妇女至少有 1 名胎儿在超声检查中被怀疑有发育性胎儿中枢神经系统异常。所有患者均在同一中心进行 iuMR 检查，使用相同的磁共振成像方案。当超声和磁共振成像报告存在差异时，1 名胎儿-母体专家独立评估报告，以预测如果将 iuMR 纳入诊断路径，预后/咨询的变化百分比。
超声和 iuMR 报告的结果在 66%的病例中一致，在 34%的病例中不一致。差异的主要原因是胼胝体的存在或缺失，这占了 17 个差异中的 10 个。在 17 个有差异的病例中，有 12 个病例的处理效果被认为是显著的。
我们得出结论，iuMR 在多胎妊娠中的不一致率与单胎妊娠的已发表数据相似。我们对管理影响的分析表明，在 17 个有差异的病例中（即我们所有病例的 24%），会发生终止妊娠的决策变化。
