Diagnosis Of Fetal CNS Malformations Using Ultrasonography Combined With MRI And The Prognosis Of Prenatally Diagnosed ACC

Part1Study on fetal malformations of cortical development by US and MRI Objective:Cerebral cortical development is a complex process, which can be divided into three overlapping steps:cell proliferation, neuronal migration, and cortical organization. Genetic factor or prenatal injury of diverse etiology, including trauma, infections or exposure to teratogens produce a wide range of malformations of cortical development (MCD). At present there are only a few studies describing prenatal diagnosis of cortical malformations, most of the cases can be diagnosed until symptoms occur in children with development delay and young people with epilepsy.It is necessary to make accurately diagnoses in-utero and offer appropriate counseling and optimization of obstetric management. In this article, we reviewed malformation of cortical development fetuses in our hospital, in order to explore the prenatal imaging findings on ultrasonograph (US) and magnetic resonance imaging(MRI).Materials and methods:Study population:From August2012to December2013three hundred and twenty singleton pregnancy women whose fetus with brain anomalies diagnosed on ultrasound were investigated within this study. All of the fetuses underwent MRI examination in two days. The age ranged from21to44years old. The gestational age ranged from26to40weeks.All the examinations were performed for clinical purposes, with the approval of the hospital ethical committee and informed consent of the mothers.Methods:US was performed transabdominally using iU22(Vision2010; Philips, Seattle, WA, USA) ultrasound system equipped with a3.5MHz probe. The transvaginal approach was used for fetuses with vertex presentation with7.5MHz probe.All fetal MR images were obtained on a1.5Tesla unit (Achieva:Philips Healthcare, Eindhoven, the Netherlands) with phased-array surface coils. Multiplanar T2-weighted single shot fast spin-echo, T1-weighted fast spin-echo and axial diffusion-weighted sections were acquired.Follow up of each pregnancy was documented.Results:1. In320of cases,12cases were diagnosed of malformations of cortical development;2. The US findings leading to the diagnosis of MCD were microcephaly(n=4), heterotopic gray matter (n=3), hemimegalencephaly(n=1); The MR imaging confirmed MCD in4cases which could not show on US, schizencephaly (n=2), tuberous sclerosis(n=1), hypoplasia of temporal lobe (n=1);3. Among of the cases, ten cases underwent termination of pregnancy, while two were liveborn with bad prognosis.Conclusion:US and MRI is powerful tool for diagnosing fetal malformations of cortical development which have typical imaging characteristics. Part2Diagnosis of fetal CNS malformations by US combined with MRI Objective:Fetal CNS malformation is common congenital malformation in our country with high mortality. To diagnose those the fetal CNS abnormalities accurately is critical for both clinical management and the aristogenesis.US has advantage of real-time, readily available, safe, less expensive and easy to use. However US has some limation in diagnosing certain kind of anomalies. MRI with high spatial and tissue resolution has been used routine clinically. But, MRI can not instead of US in prenatal diagnosing and been widely used in reason of too expensive and less real-time. The purpose of the study is to further accumulate experience for application of both US and MRI in diagnosing of the fetus CNS abnormities by reviewing the cases in our hospital.Method:Be the same as part1.Result:In122(38%) of320cases confirmed comparable diagnosis both on US and MRI. MRI provided more information than did US in173(54%)cases; MRI corrected the US diagnosis in16(5%) cases and9(3%)cases that US showed abnormal informations could not show on MRI.Conclusions:US was very useful for diagnosing fetuses CNS abnormities which could be used widely. MRI had advantage over US for detecting fetuses CNS abnormalities. Combining US with MRI could be diagnosed more definitively. Part3Meta-analysis for the prognosis of prenatally diagnosed fetal ACCObjective:Fetal agenesis of the corpus callosum (ACC)can be diagnosed by US and MRI, however, scholars view between different about the prognosis of the ACC, especially the different types. This study was designed to collect literatures of the outcome of ACC, in order to investigate the prognosis of ACC and provide the evidence for prenatal counseling.Methods:Literatures about the prognosis of ACC from1990to2012were analyzed synthetically by meta-analysis.Results:Total of565cases in total15literatures were included. The overall rate of terminations was65%,(95%CI=0.52-0.76). There was a higher incidence of ACC in males than females, with the pooled RR1.29(95%CI=1.04-1.59),p<0.05. The overall rate of prognosis of isolated ACC is favourable in up to70%(95%CI=0.57-0.81), compared with16%(95%CI=0.07-0.32) for ACC associated structural anomalies. There was statistical significant difference in outcome between the isolated ACC and ACC associated structural anomalies, with the pooled OR0.07(95%CI=0.02-0.24), p<0.05.Conclusion:There is a high rate of terminations due to prenatal diagnosis of fetal agenesis of corpus callosum. The incidence of ACC in males is higher than females. The prognosis of isolated ACC might be favourable, while compared with the ACC associated with other anomalies, the outcome is unoptimistic.