نقش تصویربرداری رزونانس مغناطیسی جنینی در تشخیص ونتریکولومگالی
Abstract
Introduction
Materials and methods
Results
Conclusion
References
Abstract
Objective
Ventriculomegaly is one of the most common anomalies encountered at obstetric ultrasound and it necessitates follow up. Fetal magnetic resonance imaging (MRI) can be used to confirm the ultrasound diagnose or to detect additional anomalies. Aim of this study is to assess follow up and management of fetal ventriculomegaly shown by ultrasound, and to evaluate additional diagnostic contribution of MRI. Study Design
This study was conducted retrospectively including 89 patients who had fetal MRI subsequent to ultrasound diagnose of ventriculomegaly in between 2011-2017. Medical records of patients were investigated and accompanying anomalies, congenital infection, chromosomal examination, degree and progression of ventriculomegaly, neonatal imaging and diagnose, and neurodevelopmental findings on follow up were evaluated. Patients were classified in two groups as isolated and nonisolated ventriculomegaly, and subgroups mild, moderate, severe were formed according to their findings. SPSS 23.0 programme was used for statistical analysis.
Results
Ultrasound and following MRI was performed in a range of 18-35th gestational weeks, diagnoses were isolated ventriculomegaly for 56 patients and nonisolated ventriculomegaly for 33 patients. Progression and neurodevelopmental delay was higher in severe nonisolated ventriculomegaly group. There was not significant contribution of MRI in the follow up of isolated ventriculomegaly (p < 0.001), and diagnostic imaging findings declined in neonatal period with proceeding normal neurodevelopment in 92.7% of patients followed with diagnosis of isolated ventriculomegaly.
Conclusion
When isolated ventriculomegaly is detected, ultrasound performed by an experienced team is mostly sufficient. MRI can be used in suspicious cases or when ventriculomegaly progresses.
Introduction
In obstetric follow up, ultrasound is the main imaging tool to monitor fetal growth and development. Technologic development and increased experience in ultrasound practice in recent years has allowed ultrasound imaging for both routin purposes and detailed fetal investigation to provide better information in management of the patient [1]. However, beyond major anomalies that can be exactly shown by detailed obstetric ultrasound including fetal neurosonogram, suspicious findings that necessitate to be clarified in the proceeding visits can also be encountered. One suchlike finding involves lateral ventricle measurement which is an important part of central nervous system evaluation. According to ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) guidelines, measurement of atrial width at the level of glomus of the choroid plexus, perpendicular to the long axis of ventricle, using the inner edges of the lateral walls is recommended for ventricular measurement, and 10 mm is described as ventriculomegaly [2]. Ventriculomegaly, prevalance of which is reported to be 0.3–2%, may be unilateral or bilateral [3]. Furthermore, mild, moderate or severe forms which are defined due to measured width of lateral ventricle may be seen, although the exact definition concerning cut-off values varies at different studies [4,5]. Ventriculomegaly may regress or progress during follow up, it may also accompany other cranial or extracranial anomalies. Whether serious fetal anomalia is doubted, fetal magnetic resonance imaging (MRI), which is especially helpful for assessment of central nervous system anomalies, can be used to confirm the ultrasound diagnose or to detect additional anomalies [6]. Aim of this study is to assess follow up and management of fetal ventriculomegaly shown by detailed obstetric ultrasound, and to evaluate additional diagnostic contribution of MRI on this process.