Ultraschall Med 2016; 37(06): 591-597
DOI: 10.1055/s-0035-1553359
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Prenatal Brain Imaging in Isolated vs. Complicated Club Foot: A Cohort Study

Pränatale Darstellung des Gehirns bei isoliertem und komplexem Klumpfuß: eine Kohortenstudie
I. Gat
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
2   Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
O. Bar Yosef
3   Pediatric Neurology Unit, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
C. Hoffmann
4   Department of Radiology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
O. Lebovitz
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
D. Shashar
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
Y. Gilboa
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
I. Yagel
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
R. Achiron
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
,
E. Katorza
1   Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
› Author Affiliations
Further Information

Publication History

10 January 2015

03 May 2015

Publication Date:
11 September 2015 (online)

Abstract

Purpose: Talipes equinovarus (TEV) is a common birth defect. Differentiation between isolated and complex TEV is fundamental due to its effect on prognosis. Association between TEV and poor neurological outcome is more prominent in complex cases and highlights the significance of brain evaluation. The aim of the current study was to evaluate the contribution of fetal brain MRI to sonographic evaluation.

Materials and Methods: In this retrospective study we evaluated charts of all pregnant patients referred for fetal brain MRI due to fetal TEV between 1/1/2011 and 12/31/14 in a single tertiary referral center. Isolated and complex TEV were differentiated according to associated anomalies. Brain US and MRI results were compared.

Results: 28 pregnant patients were included with an average gestation and parity of 2.5 and 1.5, respectively. Both isolated and complicated TEV groups included 14 fetuses after initial TEV diagnosis on anatomical survey. Brain sonography and MRI were normal among 12/14 patients with isolated TEV while two patients were later diagnosed with mild ventriculomegaly. US brain evaluation has revealed pathologic findings in 4 (28.6 %) cases in the complicated TEV group, while MRI demonstrated abnormal findings in 8 (57.1 %) fetuses with notable severity diversity. In 6 cases, MRI diagnosed additional pathologies which were not demonstrated by US.

Conclusion: Brain fetal MRI is an efficient tool during antenatal evaluation of complicated TEV with a high percentage of additional findings not demonstrated songraphically while its efficacy in isolated cases is in doubt. The current study expands the relevance of fetal brain MRI in cases of non-CNS anomalies.

Zusammenfassung

Ziel: Pes equinovarus („telipes equinovarus“ TEV) ist eine häufige Geburtsfehlbildung. Die Unterscheidung zwischen isoliertem und komplexem Klumpfuß ist grundlegend, da es Auswirkung auf die Prognose hat. Ein Zusammenhang zwischen TEV und neurologischen Folgeerkrankungen tritt bei komplexen Fällen häufiger auf und unterstreicht den Stellenwert der Untersuchung des Gehirns. Das Ziel der gegenwärtigen Studie ist es, den Beitrag der fetalen Schädel-MRT im Vergleich zur Sonografie zu bewerten.

Material und Methoden: In dieser retrospektiven Studie untersuchten wir die Berichte aller Schwangeren eines einzigen Tertiärzentrum bei denen im Zeitraum vom 1.1.2001 – 31.12.2014 aufgrund eines fetalen TEV ein Schädel-MRT durchgeführt wurde. Die Unterscheidung zwischen isolierten und komplexen TEVs erfolgte aufgrund der assoziierten Anomalien. Die Ergebnisse von US und MRT des Schädels wurden verglichen.

Ergebnisse: Eingeschlossen wurden 28 Patienten mit durchschnittlich 2,5 Schwangerschaften und 1,5 Entbindungen. Beide Gruppen, isolierte und komplexe TEV, bestanden aus jeweils 14 Feten mit Erstdiagnose TEV bei der anatomischen Untersuchung. Ultraschall und MRT des Schädels waren bei 12/14 Patienten mit isoliertem TEV normal während bei zwei Patienten später die Diagnose milde Ventrikulomegalie gestellt wurde. In der Gruppe mit komplexen TEV entdeckte die Schädelsonografie pathologische Befunde bei 4 Fällen (28,6 %) und die MRT zeigte Abnormitäten bei 8 Feten (57,1 %) mit bemerkenswerter Erkrankungsvielfalt. In sechs Fällen diagnostizierte die MRT zusätzliche Erkrankungen, die nicht im US zu sehen waren.

Schlussfolgerung: Das fetale MRT des Gehirns ist eine effektive Methode zur vorgeburtlichen Bewertung eines komplexen TEV mit einem hohen Prozentsatz an sonografisch nicht gezeigten Zusatzbefunden; allerdings ist der Nutzen der MRT bei isolierten Fällen fraglich. Mit dieser Studie wird die Relevanz der fetalen MRT im Hinblick auf extrakranielle Anomalien erweitert.

 
  • References

  • 1 Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clinical orthopaedics and related research 2009; 467: 1146-1153 Epub 2009/02/19
  • 2 Colaco HB, Patel S, Lee MH et al. Congenital clubfoot: a review. British journal of hospital medicine 2010; 71: 200-205 Epub 2010/04/16
  • 3 Drvaric DM, Kuivila TE, Roberts JM. Congenital clubfoot. Etiology, pathoanatomy, pathogenesis, and the changing spectrum of early management. The Orthopedic clinics of North America 1989; 20: 641-647
  • 4 Barry M. Prenatal assessment of foot deformity. Early human development 2005; 81: 793-796
  • 5 Offerdal K, Jebens N, Blaas HG et al. Prenatal ultrasound detection of talipes equinovarus in a non-selected population of 49 314 deliveries in Norway. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2007; 30: 838-844
  • 6 Malone FD, Marino T, Bianchi DW et al. Isolated clubfoot diagnosed prenatally: is karyotyping indicated?. Obstetrics and gynecology 2000; 95: 437-440 Epub 2000/03/11
  • 7 Nemec U, Nemec SF, Kasprian G et al. Clubfeet and associated abnormalities on fetal magnetic resonance imaging. Prenatal diagnosis 2012; 32: 822-828 Epub 2012/06/09
  • 8 Sharma R, Stone S, Alzouebi A et al. Perinatal outcome of prenatally diagnosed congenital talipes equinovarus. Prenatal diagnosis 2011; 31: 142-145 Epub 2011/01/27
  • 9 Bakalis S, Sairam S, Homfray T et al. Outcome of antenatally diagnosed talipes equinovarus in an unselected obstetric population. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2002; 20: 226-229 Epub 2002/09/17
  • 10 Mammen L, Benson CB. Outcome of fetuses with clubfeet diagnosed by prenatal sonography. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 2004; 23: 497-500 Epub 2004/04/22
  • 11 Lauson S, Alvarez C, Patel MS et al. Outcome of prenatally diagnosed isolated clubfoot. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2010; 35: 708-714
  • 12 Carroll SG, Lockyer H, Andrews H et al. Outcome of fetal talipes following in utero sonographic diagnosis. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2001; 18: 437-440
  • 13 Rijhsinghani A, Yankowitz J, Kanis AB et al. Antenatal sonographic diagnosis of club foot with particular attention to the implications and outcomes of isolated club foot. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 1998; 12: 103-106
  • 14 Pharoah PO. Prevalence and pathogenesis of congenital anomalies in cerebral palsy. Archives of disease in childhood Fetal and neonatal edition 2007; 92: F489-F493
  • 15 Weston MJ. Magnetic resonance imaging in fetal medicine: a pictorial review of current and developing indications. Postgraduate medical journal 2010; 86: 42-51 quiz 0
  • 16 Breysem L, Bosmans H, Dymarkowski S et al. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. European radiology 2003; 13: 1538-1548
  • 17 Quinn TM, Hubbard AM, Adzick NS. Prenatal magnetic resonance imaging enhances fetal diagnosis. Journal of pediatric surgery 1998; 33: 553-558
  • 18 Gat I, Hoffmann C, Shashar D et al. Fetal Brain MRI: Novel Classification and Contribution to Sonography. Ultraschall in Med 2014; DOI: 10.1055/s-0034-1384935. Epub 2014/12/24. MRT des fetalen Gehirns: Neuklassifizierung und Unterstützung der Sonografie.
  • 19 Servaes S, Hernandez A, Gonzalez L et al. Fetal MRI of clubfoot associated with myelomeningocele. Pediatric radiology 2010; 40: 1874-1879
  • 20 Cohen-Overbeek TE, Grijseels EW, Lammerink EA et al. Congenital talipes equinovarus: comparison of outcome between a prenatal diagnosis and a diagnosis after delivery. Prenatal diagnosis 2006; 26: 1248-1253
  • 21 International Society of Ultrasound in O, Gynecology Education C. Sonographic examination of the fetal central nervous system: guidelines for performing the “basic examination” and the “fetal neurosonogram”. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2007; 29: 109-116 Epub 2007/01/04
  • 22 Salomon LJ, Garel C. Magnetic resonance imaging examination of the fetal brain. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2007; 30: 1019-1032
  • 23 Vazquez E, Mayolas N, Delgado I et al. Fetal neuroimaging: US and MRI. Pediatric radiology 2009; 39: 422-435
  • 24 Hoffmann C, Weisz B, Yinon Y et al. Diffusion MRI findings in monochorionic twin pregnancies after intrauterine fetal death. AJNR American journal of neuroradiology 2013; 34: 212-216
  • 25 Barker S, Chesney D, Miedzybrodzka Z et al. Genetics and epidemiology of idiopathic congenital talipes equinovarus. Journal of pediatric orthopedics 2003; 23: 265-272
  • 26 Canto MJ, Cano S, Palau J et al. Prenatal diagnosis of clubfoot in low-risk population: associated anomalies and long-term outcome. Prenatal diagnosis 2008; 28: 343-346 Epub 2008/04/03
  • 27 Garel C. Fetal MRI: what is the future?. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2008; 31: 123-128
  • 28 Glenn OA. MR imaging of the fetal brain. Pediatric radiology 2010; 40: 68-81
  • 29 Bar-On E, Mashiach R, Inbar O et al. Prenatal ultrasound diagnosis of club foot: outcome and recommendations for counselling and follow-up. The Journal of bone and joint surgery British volume 2005; 87: 990-993 Epub 2005/06/24
  • 30 Glenn OA, Barkovich AJ. Magnetic resonance imaging of the fetal brain and spine: an increasingly important tool in prenatal diagnosis, part 1. AJNR American journal of neuroradiology 2006; 27: 1604-1611
  • 31 Glenn OA, Barkovich J. Magnetic resonance imaging of the fetal brain and spine: an increasingly important tool in prenatal diagnosis: part 2. AJNR American journal of neuroradiology 2006; 27: 1807-1814
  • 32 Werler MM, Yazdy MM, Mitchell AA et al. Descriptive epidemiology of idiopathic clubfoot. American journal of medical genetics Part A 2013; 161A: 1569-1578