Fetal Skeletal Deformities - the Diagnostic Accuracy of Prenatal Ultrasonography and Fetal Magnetic Resonance Imaging

 

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Abstract

Objective: To evaluate the diagnostic accuracy of prenatal ultrasonography and fetal magnetic resonance imaging (MRI) in fetuses with skeletal deformities (SD). Methods: Fourteen pregnant women of 21 - 34 weeks of gestation whose fetuses had SD on prenatal ultrasound (seven fetuses with spina bifida, four with complex malformation syndrome, two with scoliosis, and one with chondrodysplasia) were additionally investigated by fetal MRI using a 1.5T superconducting system with T1-and T2-weighted sequences in three section-planes. Main outcome measures were diagnostic accuracy, potential effect on parental counselling and influence on perinatal management of the additional investigation with fetal MRI. Results: In 10 cases ultrasound had a better diagnostic accuracy than MRI concerning the diagnosis of SD. In four cases with spina bifida MRI provided additional information towards preoperative evaluation for neurosurgery. In five cases parental counselling was improved. There was no influence on perinatal management. Conclusion: MRI may provide additional information to ultrasound scan in fetuses with spina bifida and consecutive neurosurgery; in fetuses with other skeletal deformities additional information may be expected only in rare cases.

Zusammenfassung

Ziel: Die Evaluierung der diagnostischen Wertigkeit des pränatalen Ultraschalls im Vergleich zur fetalen Magnetresonanztomographie (MRT) bei Feten mit Skelettfehlbildungen. Methode: Vierzehn schwangere Frauen zwischen der SSW 21 - 34 mit sonographisch diagnostizierten Skelettfehlbildungen (sieben Feten mit Spina bifida, vier mit komplexem Malformationssyndrom, zwei mit Skoliose und ein Fetus mit Chondrodysplasie) wurden zusätzlich mittels fetaler MRT untersucht. Ergebnisse: In 10 Fällen wurde die diagnostische Wertigkeit der Sonographie höher als die der MRT eingestuft. In vier Fällen mit Spina bifida konnte durch die zusätzliche Untersuchung mittels MRT Information zur präoperativen Evaluierung der geplanten neurochirurgischen Intervention gewonnen werden. In fünf Fällen wurden die Eltern kompetenter beraten. Das perinatale Management wurde nicht beeinflusst. Schlussfolgerung: Die fetale MRT als Ergänzung zur Sonographie stellt bei Feten mit Spina bifida und geplanter postpartaler neurochirurgischer Intervention eine sinnvolle Zusatzuntersuchung dar; bei Feten mit anderen Skelettfehlbildungen ist nur in seltenen Fällen mit einer Befunderweiterung zu rechnen.

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Wibke Blaicher

Department of Gynecology and Obstetrics

Division of Prenatal Diagnosis and Therapy

University Hospital Vienna

Währinger Gürtel 18 - 20

1090 Vienna

Austria

Phone: +43/1-4 04 00-29 94

Fax: +43/1-4 04 00-29 95

Email: wibke.blaicher@univie.ac.at