Evelina London Children's Hospital, London, United Kingdom; Paediatric Surgery Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom.
Evelina London Children's Hospital, London, United Kingdom.
J Pediatr Surg. 2022 Feb;57(2):239-244. doi: 10.1016/j.jpedsurg.2021.10.033. Epub 2021 Oct 30.
We sought to assess variability and concordance between fetal MRI and ultrasound (USS) in the evaluation of fetal body abnormalities.
All fetal body anomalies reported on F-MRI within the iFIND database (http://www.ifindproject.com) were included. Differences in findings regarding anomalies on contemporaneous USS were explored. Three clinical specialists evaluated each case independently, and the anomaly severity was graded: as "insignificant" to "lethal". The value of MRI in alteration of either antenatal or postnatal care was established.
Fifty-four cases were identified consisting of 5 healthy controls, 37 with USS-identified body anomalies, and 12 with known CNS or cardiac anomalies. In fetuses with a known body anomaly, information on the MRI was relevant to change the clinical course in 59% of cases. There was also an incidental detection rate of 7% in fetuses with known cardiac or CNS anomalies, or 1.5% of normal control, although these were rarely clinically relevant. Importantly, fetuses undergoing MRI for cardiac concerns did have major anomalies that were missed (one case of oesophageal atresia and two cases of ARM).
In cases where fetal anomalies are suspected, F-MRI is a valuable means of further characterizing anomalies and may detect additional anomalies in fetuses with recognized cardiac or CNS anomalies. In fetuses with a recognized body anomaly, more than half of those scanned by MRI had information available which changed clinical management. Importantly there were also incidental findings in healthy control fetuses, so the management of these needs to be recognized in fetal MRI research.
II, Prospective cohort study.
我们旨在评估胎儿磁共振成像（MRI）与超声（USS）在评估胎儿身体异常方面的变异性和一致性。
本研究纳入了 iFIND 数据库（http://www.ifindproject.com）中报告的所有胎儿身体异常的 F-MRI。探讨了在同期 USS 检查中关于异常发现的差异。三位临床专家独立评估每个病例，并对异常严重程度进行分级：“无意义”至“致死性”。确定 MRI 在改变产前或产后护理方面的价值。
共确定了 54 例病例，包括 5 例健康对照、37 例 USS 识别的身体异常和 12 例已知 CNS 或心脏异常。在已知身体异常的胎儿中，MRI 信息与改变临床过程相关的比例为 59%。在已知心脏或 CNS 异常或正常对照的胎儿中，偶然发现的比例为 7%，尽管这些发现很少具有临床意义。重要的是，接受 MRI 检查心脏问题的胎儿确实存在被遗漏的重大异常（1 例食管闭锁和 2 例上肢异常）。
在怀疑胎儿存在异常的情况下，F-MRI 是进一步描述异常的一种有价值的手段，并且可能在已知存在心脏或 CNS 异常的胎儿中检测到额外的异常。在已知存在身体异常的胎儿中，超过一半接受 MRI 检查的胎儿有可供改变临床管理的信息。重要的是，在健康对照胎儿中也有偶然发现，因此需要认识到这些在胎儿 MRI 研究中的管理问题。
II，前瞻性队列研究。
