Changes in appearance of cortical formation abnormalities in the foetus detected on sequential in utero MR imaging
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MAGNETIC RESONANCE
Changes in appearance of cortical formation abnormalities in the foetus detected on sequential in utero MR imaging Paul D. Griffiths 1 & Mariasavina Severino 2 & Deborah Jarvis 1 & Laura Mandefield 3 & Cecilia Parazzini 4 & Lorenzo Pinelli 5 & Marco Di Maurizio 6 & Fabio Triulzi 7 & Elisa Scola 7 & Giorgio Conte 7 & Giovanni Palumbo 5 & Maurilio Genovese 4 & Andrea Rossi 2 & Renzo Guerrini 8 & Andrea Righini 4 Received: 3 March 2020 / Revised: 11 May 2020 / Accepted: 30 July 2020 # European Society of Radiology 2020
Abstract Objectives We describe 64 foetuses with cortical formation abnormalities (CFA) who had two in utero magnetic resonance (iuMR) exams, paying particular detail to those in which the original classification of CFA category changed between the two studies. The goal was to attempt to quantify the value of third-trimester follow-up studies in CFA foetuses on second-trimester iuMR imaging. Methods The 64 foetuses reviewed came from a CFA cohort of 374 foetuses reported in an earlier publication, which detailed a classification for foetal CFA. A consensus panel of senior paediatric neuroradiologists reviewed both studies, described any change in the category of CFA between them, and attempted to predict the possible clinical significance of any differences based on the combined clinical experience of the panel. Results In 40/64 (62%) foetuses, the CFA description was the same on both studies. In 24/64 (38%) cases, there was a category change which included three foetuses without CFA on first examination, six foetuses where the difference involved change in laterality/symmetry, and in 15 cases the re-classification involved categorical change within the same group. Brain abnormalities other than CFA were present in 30/64 (47%) foetuses on the first study and in 33/64 (52%) on the second. We predicted that prognosis would have changed on the basis of the second study in 8% of cases, all indicating worse prognosis. Conclusions We have shown that the extra diagnostic and predicted prognostic yield justifies follow-up studies in the third trimester if a CFA is shown on the second-trimester iuMR imaging. Key Points • Sixty-four foetuses with cortical formation abnormalities had two iuMR studies, for the vast majority the baseline in the second trimester and the sequential in the third. • In three foetuses, the cortical formation abnormality (CFA) was not visible on the first study. In a further 21 foetuses, the categorical description of the CFA changed between the two studies. Prognosis changed in 8% of the cases following the second iuMR study, and in all cases, the prognosis was worse. • Multiple iuMR studies provide information about the natural history of CFA; the extra diagnostic and predicted prognostic yield justifies follow-up studies.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07125-9) contains supplementary material, which is available to authorized users. * Giovanni Palumbo [email protected] 1
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