1Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital.
2Department of Radiology, Division of Clinical Radiology, University of Utah; and.
Neurosurg Focus. 2019 Oct 1;47(4):E4. doi: 10.3171/2019.7.FOCUS19450.
Prenatal imaging has several critical roles in the diagnosis and management of myelomeningocele, including specific family counseling and the selection of fetal surgery or postnatal repair. In this study, the authors compared the accuracy of fetal MRI and prenatal ultrasonography (US) in predicting the spinal lesion level and assessed the correlation between imaging findings and motor function as independently evaluated by a physical therapist (PT) after birth.
A retrospective review of demographic and clinical data was performed to identify children who had been treated with postnatal myelomeningocele closure at a single institution between March 2013 and December 2018. Patients were eligible for inclusion if they had all of the following: prenatal US identifying the neural tube defect level, fetal MRI identifying the neural tube defect level, and postoperative PT evaluation identifying the motor deficit level. Statistical analysis was performed using Cohen's kappa coefficient to compare the US- and MRI-demonstrated lesion level and correlate these findings with the motor level assigned postnatally by a PT via manual muscle testing.
Thirty-four patients met the inclusion criteria. The mean gestational age at US was 23.0 ± 4.7 weeks, whereas the mean gestational age at MRI was 24.0 ± 4.1 weeks. The mean time from surgery to the PT evaluation was 2.9 ± 1.9 days. Prenatal US and MRI were in agreement within one spinal level in 74% of cases (25/34, k = 0.43). When comparing the US-demonstrated spinal level with the PT-assigned motor level, the two were in agreement within one level in 65% of cases (22/34, k = 0.40). When comparing MRI-demonstrated spinal level with the PT motor level, the two were in agreement within one level in 59% of cases (20/34, k = 0.37). MRI and US were within two spinal levels of the PT evaluation in 79.4% and 85.3% of cases, respectively. MRI and US agreed within two levels in 97.1% of cases. Prenatal US and MRI were equivalent when comparing the difference between the imaged level and the postnatal motor deficit level (mean level difference: 1.12 ± 1.16 vs 1.17 ± 1.11, p = 0.86).
Prenatal US and MRI equivalently predicted the postnatal motor deficit level in children with myelomeningocele. These data may be valuable in prenatal prognostication.
产前影像学在脊髓脊膜膨出的诊断和管理中具有几个关键作用，包括特定的家庭咨询以及胎儿手术或产后修复的选择。在这项研究中，作者比较了胎儿 MRI 和产前超声（US）在预测脊柱病变水平方面的准确性，并评估了成像结果与产后由物理治疗师（PT）独立评估的运动功能之间的相关性。
对 2013 年 3 月至 2018 年 12 月在一家机构接受产后脊髓脊膜膨出闭合治疗的儿童进行了回顾性的人口统计学和临床数据回顾，以确定研究对象。如果患儿满足以下所有条件，则符合纳入标准：产前 US 可识别神经管缺陷水平，胎儿 MRI 可识别神经管缺陷水平，以及产后 PT 评估可识别运动缺陷水平。采用 Cohen's kappa 系数进行统计学分析，以比较 US 和 MRI 显示的病变水平，并将这些发现与产后由 PT 通过徒手肌力测试分配的运动水平相关联。
34 名患儿符合纳入标准。US 的平均胎龄为 23.0±4.7 周，而 MRI 的平均胎龄为 24.0±4.1 周。手术到 PT 评估的平均时间为 2.9±1.9 天。产前 US 和 MRI 在 74%（25/34，k=0.43）的病例中一致在一个脊柱水平内。当将 US 显示的脊柱水平与 PT 分配的运动水平进行比较时，在 65%（22/34，k=0.40）的病例中两者在一个水平内一致。当将 MRI 显示的脊柱水平与 PT 运动水平进行比较时，在 59%（20/34，k=0.37）的病例中两者在一个水平内一致。MRI 和 US 分别在 79.4%和 85.3%的病例中与 PT 评估相差两个脊柱水平内，97.1%的病例中 MRI 和 US 相差两个水平内。产前 US 和 MRI 在比较影像学水平与产后运动缺陷水平的差异时是等效的（平均水平差异：1.12±1.16 与 1.17±1.11，p=0.86）。
产前 US 和 MRI 在预测脊髓脊膜膨出患儿的产后运动缺陷水平方面等效。这些数据可能对产前预后具有重要意义。
