Fantasia Ilaria, Bussani Rossana, Gregori Massimo, Zennaro Floriana, D'Ottavio Giuseppina, Monasta Lorenzo, Cortivo Caterina, Quadrifoglio Mariachiara, Maso Gianpaolo, Ricci Giuseppe, Ottaviani Chiara, Militello Roberto, Stampalija Tamara
Department of Obstetrics and Gynecology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
Institute of Pathological Anatomy, Trieste University Hospital, Trieste, Italy.
Eur J Obstet Gynecol Reprod Biol. 2020 Jul;250:31-35. doi: 10.1016/j.ejogrb.2020.04.032. Epub 2020 Apr 23.
To evaluate if limiting factors of intrauterine magnetic resonance imaging (iuMRI) performed in the early second trimester of pregnancy (19-23 weeks) affect its accuracy in comparison to post-mortem MRI (pmMRI) in fetuses that underwent termination of pregnancy (TOP) for central nervous system (CNS) defects.
This is a secondary analysis of a 10 years prospective observational study. Cases of TOP < 23 weeks for CNS malformation that had undergone neurosonography (NSG), iuMRI, pmMRI and autopsy were included. The agreement between iuMRI and pmMRI was calculated. The autopsy represented the gold-standard.
Overall, 143 TOPs for fetal congenital anomaly underwent the post-mortem diagnostic protocol. Of these, 31 cases underwent iuMRI and pmMRI for CNS abnormality. Three cases were excluded due to brain autolysis at autopsy. Corpus callosum defects were the most represented (16/28; 57 %). In only one case of posterior fossa defect, pmMRI identified the presence of vermian hypoplasia not diagnosed at iuMRI. In 2 cases (7%), iuMRI added clinically relevant additional findings to NSG, that were posteriorly confirmed by pmMRI.
The study shows that, at 19-23 weeks and for CNS defects, limiting factors that might influence the performance of iuMRI have little influence on iuMRI accuracy. This finding is particularly important for professionals who work in countries with legal bound for TOP in the early second trimester.
评估妊娠中期早期（19 - 23周）进行的宫内磁共振成像（iuMRI）的限制因素，与因中枢神经系统（CNS）缺陷而终止妊娠（TOP）的胎儿的尸检后磁共振成像（pmMRI）相比，是否会影响其准确性。
这是一项对为期10年的前瞻性观察性研究的二次分析。纳入了因CNS畸形在23周前进行了终止妊娠、接受过神经超声检查（NSG）、iuMRI、pmMRI和尸检的病例。计算了iuMRI和pmMRI之间的一致性。尸检为金标准。
总体而言，143例因胎儿先天性异常而进行的终止妊娠接受了尸检诊断方案。其中，31例因CNS异常接受了iuMRI和pmMRI检查。3例因尸检时脑自溶而被排除。胼胝体缺陷最为常见（16/28；57%）。仅1例后颅窝缺陷病例中，pmMRI发现了iuMRI未诊断出的小脑蚓部发育不全。在2例（7%）病例中，iuMRI为NSG增加了临床相关的额外发现，随后被pmMRI证实。
该研究表明，在19 - 23周且针对CNS缺陷时，可能影响iuMRI性能的限制因素对iuMRI准确性影响不大。这一发现对于在妊娠中期早期有TOP法律限制的国家工作的专业人员尤为重要。
