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Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage

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Abstract

Background and purpose

Fetal postmortem MR Imaging (pmMRI) has been recently used as an adjuvant tool to conventional brain autopsy after termination of pregnancy (TOP). Our purpose was to compare the diagnostic performance of intrauterine MRI (iuMRI) and pmMRI in the detection of brain anomalies in fetuses at early gestational age (GA).

Material and methods

We retrospectively collected 53 fetuses who had undergone iuMRI and pmMRI for suspected brain anomalies. Two pediatric neuroradiologists reviewed iuMRI and pmMRI examinations separately and then together. We used Cohen’s K to assess the agreement between pmMRI and iuMRI. Using the combined evaluation iuMRI+pMRI as the reference standard, we calculated the “correctness ratio.” We used Somers’ D to assess the cograduation between postmortem image quality and time elapsed after fetus expulsion.

Results

Our data showed high agreement between iuMRI and pmMRI considering all the categories together, for both observers (K1 0.84; K2 0.86). The correctness ratio of iuMRI and pmMRI was 79% and 45% respectively. The major disagreements between iuMRI and pmMRI were related to postmortem changes as the collapse of liquoral structures and distorting phenomena. We also found a significant cograduation between the time elapsed from expulsion and pmMRI contrast resolution and distortive phenomena (both p < 0.001).

Conclusions

Our study demonstrates an overall high concordance between iuMRI and pmMRI in detecting fetal brain abnormalities at early GA. Nevertheless, for the correct interpretation of pmMRI, the revision of fetal examination seems to be crucial, in particular when time elapsed from expulsion is longer than 24 h.

Key Points

• IuMRI and pmMRI showed overall high concordance in detecting fetal brain abnormalities at early GA.

• PmMRI corroborated the antemortem diagnosis and it could be a valid alternative to conventional brain autopsy, only when the latter cannot be performed.

• Some caution should be taken in interpreting pmMR images when performed after 24 h from fetal death.

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Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

GA:

Gestational age

iuMRI:

Intrauterine magnetic resonance imaging

PCF:

Posterior cranial fossa

pmMRI:

Postmortem magnetic resonance imaging

TOP:

Termination of pregnancy

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Acknowledgments

We are grateful to Professor Paul D. Griffiths for his advice in preparing the manuscript.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Pediatric Radiology and Neuroradiology Department, Children’s Hospital V. Buzzi – ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy

    Giana Izzo, Chiara Doneda, Cecilia Parazzini & Andrea Righini

  2. Neuroradiology Unit, Verona University Hospital, Verona, Italy

    Giacomo Talenti

  3. Department of Neuroradiology, Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy

    Giorgia Falanga

  4. Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy

    Marco Moscatelli

  5. Neuroradiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Giorgio Conte, Elisa Scola & Fabio Triulzi

  6. Obstetrics and Gynecology Department, Children’s Hospital V. Buzzi – ASST Fatebenefratelli-Sacco, Milan, Italy

    Mariangela Rustico

Authors
  1. Giana Izzo
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  2. Giacomo Talenti
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  3. Giorgia Falanga
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  4. Marco Moscatelli
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  5. Giorgio Conte
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  6. Elisa Scola
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  7. Chiara Doneda
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  8. Cecilia Parazzini
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  9. Mariangela Rustico
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  10. Fabio Triulzi
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  11. Andrea Righini
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Corresponding author

Correspondence to Giana Izzo.

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Guarantor

The scientific guarantor of this publication is Andrea Righini, chief of the Neuroradiology Department.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper. One of the authors has statistical expertise.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

One study case has been previously reported in Prenatal Magnetic Resonance Imaging of Atypical Partial Rhombencephalosynapsis with involvement of the Anterior Vermis: Two Case Reports. Izzo G, Conte G, Cesaretti C, Parazzini C, Bulfamante G, Righini A. Neuropediatrics. 2015 Dec;46(6):416–9.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Izzo, G., Talenti, G., Falanga, G. et al. Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage. Eur Radiol 29, 2740–2750 (2019). https://doi.org/10.1007/s00330-018-5878-0

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  • DOI: https://doi.org/10.1007/s00330-018-5878-0

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