Added Value of Fetal MRI in the Evaluation of Fetal Anomalies of the Corpus Callosum: A Retrospective Analysis of 78 Cases

Abstract

Objective To evaluate the added value of fetal MRI to ultrasound in detecting and specifying callosal anomalies, and its impact on clinical decision making.

Methods Fetuses with a sonographic diagnosis of an anomalous corpus callosum (CC) who underwent a subsequent fetal brain MRI between 2010 and 2015 were retrospectively evaluated and classified according to the severity of the findings. The findings detected on ultrasound were compared to those detected on MRI. An analysis was performed to assess whether fetal MRI altered the group classification, and thus the management of these pregnancies.

Results 78 women were recruited following sonographic diagnoses of either complete or partial callosal agenesis, short, thin or thick CC. Normal MRI studies were obtained inµ19 cases (24 %). Among these, all children available for follow-up received an adequate adaptive score in their Vineland II adaptive behavior scale assessment. Analysis of the concordance between US and MRI demonstrated a substantial level of agreement for complete callosal agenesis (kappa: 0.742), moderate agreement for thin CC (kappa: 0.418) and fair agreement for all other callosal anomalies. Comparison between US and MRI-based mild/severe findings classifications revealed that MRI contributed to a change in the management for 28 fetuses (35.9 %), mostly (25 fetuses, 32.1 %) in favor of pregnancy preservation.

Conclusion Fetal MRI effectively detects callosal anomalies and enables satisfactory validation of the presence or absence of callosal anomalies identified by ultrasound and adds valuable data that improves clinical decision making.

Zusammenfassung

Methoden Feten mit sonografischer Diagnose von Corpus callosum (CC) Anomalien und anschließender fetaler Schädel-MRT zwischen 2010 und 2015 wurden retrospektiv evaluiert und nach dem Schweregrad der Befunde klassifiziert. Die im Ultraschall erhobenen Befunde wurden mit denen der MRT verglichen. Um zu beurteilen, ob die fetale MRT die Gruppenklassifikation und somit auch das Management dieser Schwangerschaften ändert, wurde eine Analyse durchgeführt.

Ergebnisse Es wurden 78 Frauen mit sonografischer Diagnose einer kompletten oder partiellen Corpus-callosum-Agenesie rekrutiert, mit kurzem, dünnem oder dickem CC. Normale MRT- Ergebnisse lagen in 9 Fällen (24 %) vor. Von diesen erreichten alle Kinder, die zur Nachuntersuchung zur Verfügung standen, einen zufriedenstellenden Score bezüglich des Anpassungsverhaltens im „Vineland-II-Adaptive Behaviour Scales“. Die Analyse der Konkordanz zwischen US und MRT zeigte, dass der Grad der Übereinstimmung bei kompletter Balkenagenesie erheblich (kappa: 0,742), bei dünnem CC moderat (kappa: 0,418) und für alle anderen Balkenanomalien gut war. Der Vergleich zwischen den Befundklassifikationen basierend auf US und MRT zeigte, dass die MRT zu einer Veränderung im Management von 28 Feten (35,9 %) beigetragen hat, in den meisten Fällen (25 Feten; 32,1 %) zu Gunsten der Fortsetzung der Schwangerschaft.

Schlussfolgerung Die fetale MRT erkennt effektiv Corpus-callosum-Anomalien und ermöglicht eine zufriedenstellende Bewertung bei Verdacht auf Balkenagenesie im Ultraschall und liefert wertvolle Informationen, die zu einer besseren klinische Entscheidungsfindung beitragen.

Key words

pregnancy management - CNS anomalies - fetal ultrasound - fetal MRI - corpus callosum

^* These authors contributed equally to the article.

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