From the Department of Radiology and Medical Imaging (U.D.N., B.Z., B.M.K.-F.)
Department of Pediatric Neurosurgery (K.S.B., C.B.S.).
AJNR Am J Neuroradiol. 2018 Oct;39(10):1947-1952. doi: 10.3174/ajnr.A5760. Epub 2018 Sep 20.
Fetal MRI has become a valuable tool in the evaluation of open spinal dysraphisms making studies comparing prenatal and postnatal MRI findings increasingly important. Our aim was to determine the accuracy of predicting the level of the spinal dysraphic defect of open spinal dysraphisms on fetal MR imaging and to report additional findings observed when comparing fetal and postnatal MR imaging of the spine in this population.
A single-center retrospective analysis was performed of fetal MRIs with open spinal dysraphisms from 2004 through 2016 with available diagnostic postnatal spine MR imaging. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Corresponding clinical/operative reports were reviewed.
One hundred nineteen fetal MRIs of open spinal dysraphisms were included. The level of the osseous defect between fetal and postnatal MR imaging was concordant in 42.9% (51/119) of cases and was 1 level different in 39% (47/119) of cases. On postnatal MR imaging, type II split cord malformation was seen in 8.4% (10/119) of cases, with only 50% (5/10) of these cases identified prospectively on fetal MR imaging. Syrinx was noted in 3% (4/119) of prenatal studies, all cervical, all confirmed on postnatal MR imaging.
Fetal MR imaging is accurate in detecting the level of the spinal dysraphic defect, which has an impact on prenatal counseling, neurologic outcomes, and eligibility for fetal surgery. In addition, fetal MR imaging is limited in its ability to detect split cord malformations in patients with open spinal dysraphisms. Although rare, fetal MR imaging has a high specificity for detection of cervical spinal cord syrinx.
胎儿 MRI 已成为评估开放性脊柱脊膜裂的有价值工具，因此比较产前和产后 MRI 结果的研究变得越来越重要。我们的目的是确定胎儿 MRI 预测开放性脊柱脊膜裂脊柱脊膜裂缺陷水平的准确性，并报告在该人群中比较胎儿和产后脊柱 MRI 时观察到的其他发现。
对 2004 年至 2016 年期间具有开放性脊柱脊膜裂的胎儿 MRI 进行了单中心回顾性分析，这些 MRI 均具有可获得的诊断性产后脊柱 MRI。由 2 位经过委员会认证的神经放射学研究员对图像进行了回顾。同时回顾了相应的临床/手术报告。
共纳入 119 例开放性脊柱脊膜裂的胎儿 MRI。在 42.9%（51/119）的病例中，胎儿和产后 MRI 之间的骨性缺损水平是一致的，在 39%（47/119）的病例中相差 1 个水平。在产后 MRI 上，8.4%（10/119）的病例可见 II 型脊髓纵裂畸形，其中只有 50%（5/10）的病例在胎儿 MRI 上能够前瞻性地识别。产前研究中注意到 3%（4/119）的病例存在脊髓空洞，所有均为颈段，均在产后 MRI 上得到证实。
胎儿 MRI 能够准确检测脊柱脊膜裂缺陷的水平，这对产前咨询、神经结局和胎儿手术的资格有影响。此外，胎儿 MRI 在检测开放性脊柱脊膜裂患者的脊髓纵裂畸形方面存在局限性。尽管罕见，但胎儿 MRI 对检测颈段脊髓空洞具有很高的特异性。
