How Accurately Does Current Fetal Imaging Identify Posterior Fossa Anomalies?

Fetal-Neonatal Neurology Research Program, Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 07/2008; 190(6):1637-43. DOI: 10.2214/AJR.07.3036
Source: PubMed


The first objective of our study was to describe the prevalence and spectrum of posterior fossa anomalies over 5 years in a major fetal care center where the referral diagnosis (by fetal sonography) was investigated by fetal MRI and, if confirmed, by postnatal MRI if possible. The second objective was to assess the accuracy with which fetal MRI predicts postnatal MRI findings in this population.
We retrospectively identified all cases of suspected fetal posterior fossa anomalies referred to our center from 2002 through 2006. We reviewed maternal, fetal, neonatal, and follow-up records of all cases and fetal and early postnatal imaging studies.
Of the 90 cases of suspected fetal posterior fossa anomalies (by fetal sonography) referred over the study period, 60 (67%) were confirmed by fetal MRI. Of 42 live-born infants, 39 (93%) underwent postnatal MRI. There was complete agreement in fetal and postnatal MRI diagnoses in 23 infants (59%). In 16 cases (41%), fetal and postnatal MRI diagnoses disagreed; postnatal MRI excluded fetal MRI diagnoses in six cases (15%) and revealed additional anomalies in 10 cases (26%).
Although a valuable adjunct to fetal sonography in cases of suspected posterior fossa anomaly, current fetal MRI, particularly in early gestation, has limitations in accurately predicting postnatal MRI abnormalities. Advancing the accuracy of MRI for the diagnosis of posterior fossa anomalies will require greater understanding of normal brain development and improved tissue resolution of fetal MRI. During the interim, our findings strongly support the need for postnatal MRI follow-up in cases with suspected posterior fossa anomalies by fetal MRI.

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Available from: Judy Estroff, Oct 07, 2015
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    • "Rosen et al., MRI OF BRAIN ABNORMALITIES IN FETUSES WITH CLEFTS 621 fetal cerebral cortex has begun to mature and is in a period of rapid growth (Limperopoulos et al., 2008). Two patients in this study who did not have brain anomalies on fetal MRI were diagnosed with brain anomalies postnatally. "
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    ABSTRACT: Objective : To determine the prevalence of brain abnormalities identified by prenatal imaging of fetuses with cleft lip with or without cleft palate (CL/P) or cleft palate only (CP) and to compare with postnatal imaging and neurologic evaluation. Design : This was a retrospective review of radiologic images (magnetic resonance imaging [MRI] and sonography) of fetuses diagnosed with CL/P or CP at the Advanced Fetal Care Center at Children's Hospital Boston between 2002 and 2008. Images were reviewed for possible brain abnormalities by a pediatric radiologist who specializes in this field. Postnatal imaging was also assessed whenever available and correlated with clinical findings. Setting : A large, tertiary-care, academic pediatric hospital. Population : One hundred twenty-six fetuses and 105 corresponding infants. Results : Brain abnormalities were found in 8 of 126 fetuses (6.3%) by prenatal MRI. The malformations were corpus callosal dysgenesis (n  =  3), encephalocele (n  =  1), hypoplasia of the cerebellar hemispheres or vermis (n  =  3), and white matter neuronal migration anomaly (n  =  1). An additional 2 patients were diagnosed with brain abnormalities postnatally that had not been detected on prenatal imaging. Conclusions : The possibility of brain anomalies should be assessed in a fetus found to have CL/P or CP by sonography and/or MRI. Central nervous system imaging and careful neurodevelopmental follow-up is indicated in these infants.
    The Cleft Palate-Craniofacial Journal 09/2011; 48(5):619-22. DOI:10.1597/09-262 · 1.20 Impact Factor
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    • "Because many posterior fossa abnormalities are associated with supratentorial abnormalities, fetal MRI is also used to evaluate the supratentorial brain when an infratentorial abnormality is identified. Although fetal MRI can provide additional information about suspected posterior fossa anomalies, it is important to be aware of its limitations, particularly when performed early in gestation [57]. "
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    Pediatric Radiology 11/2009; 40(1):68-81. DOI:10.1007/s00247-009-1459-3 · 1.57 Impact Factor
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