Agreement between prenatal ultrasound and 3.0T magnetic resonance imaging in the assessment of anomalies of the central nervous system: A single-center experience in Slovakia.

OBJECTIVE: To assess the concordance of in-utero magnetic resonance imaging (MRI) findings at 3.0T in fetuses with suspect abnormalities of the central nervous system (CNS) on ultrasonography. METHODS: A retrospective study was done on 222 pregnant women indicated for fetal MRI, with the examination performed within 2 weeks from indication. The inclusion criteria for patients were age 18 years or older with the fetus at 18 weeks of gestation or more. Fetal CNS pathologies were divided into six categories: ventriculomegaly; supratentorial midline abnormalities (ACC); supratentorial space-occupying lesions; abnormalities of the posterior fossa; destructive cerebral lesions; and cortical formation abnormalities (CFA). Chance-adjusted agreement was assessed using unweighted Cohen's kappa (κ). RESULTS: The best agreement between ultrasound and MRI was observed in ventriculomegaly (κ=0.817; 95% confidence interval [CI] 0.76-0.88). There was only a moderate agreement in ACC (κ=0.483; 95% CI 0.35-0.61). CFA pathologies had a poor agreement between the modalities (κ=0.140; 95% CI -0.03 to 0.31). CONCLUSION: Ultrasonography has good overall agreement with MRI in diagnosing fetal CNS anomalies. CFA had the most disagreement between ultrasound and MRI. The prognostic implication of these findings can be used for parental neuro-counseling but should be investigated further.

Prenatal Diagnosis of Torcular Dural Sinus Malformation: A Case Study.

Torcular dural sinus malformations (tDSMs) are rare congenital defects representing a complex of vascular anomalies that have been grouped in one single unit. Although the current literature suggests a generally favourable prognosis for prenatally diagnosed tDSMs, there are still only limited data and published papers on the subject. Factors resulting in an adverse outcome of the fetuses and children have to be taken into consideration to determine precisely the nature of the consultation and management. A 33-year-old primipara at 21 weeks, 5 days of gestation was referred to our clinic with the suspicion of a central nervous system (CNS) malformation of the fetus, and the diagnosis of tDSM with thrombus was made. No factors contributing to an adverse outcome such as arterialization of the lesion, ventriculomegaly or neuroparenchymal damage were present. The pregnant woman was scheduled for regular sonographic and magnetic resonance imaging (MRI) controls. In the third trimester the lesion decreased in size, which is a key imaging marker for a favourable prognosis. The child was born in term, and the latest neurological examination at the age of six weeks is without pathological findings. This case study demonstrates a prenatally diagnosed tDSM with a favourable outcome with a regression in the size of the lesion during the prenatal period.

Fetal adrenal gland enlargement - prenatal and postnatal management.

BACKGROUND: The enlargement of suprarenal gland is related to preterm birth and the birth weight. The ultrasound measurement of fetal adrenal gland volume may identify women at risk for impending preterm birth. The aim of our study was to investigate the newborns in the region of western Slovakia followed up due to suprarenal gland enlargement. To set the ratio of prenatally diagnosed suprarenal gland enlargment, postnatal managment and treatment and interventions. The newborns with congenital adrenal hyperplasia were excluded. METHODS: We have analyzed 6 years of medical records of all cases from the western Slovakia region of suprarenal gland enlargement encountered to 1st Pediatric Department, Children's University Hospital Bratislava Republic in the time period of January 2010 to Janurary 2016. The diagnosis of suprarenal gland enlargement was set by ultrasound examination performed on the 4th postnatal day as an overall screening test. Newborns with positive laboratory screening on congenital adrenal hyperplasia (CAH) were excluded from our study. We analyzed the origin of surarenal gland enlargement, gestation week on the due date, the birth weight and other comorbidities and genetic pathologies in newborns with the enlarged suprarenal glands. RESULTS: There were 6 newborns followed up due to suprarenal gland enlargement. All of the patients had diagnosed the adrenal haemorrhage. Adrenal lesions like adrenal cysts or neuroblastomas were not confirmed. All of the adrenal enlargements were benign with no need of other medical or surgical intervention. None of the newborn patients had other genetic abnormalities, mineral or hormonal imbalances, problems with arterial pressure or haemodynamic instability. All of the patients underwent at least 5 prenatal ultrasound tests and at least 2 postnatal ultrasound measurements. The avarage birth weight was 3030 grams (2700 grams - to 3750 grams). The avarage birth lenght was 50 cm (47 centimeter to 53 cm).The average gestation week (gw) on due date was 39 gw. 85% from the patients were born on 40 gw, 15% on 39 gw. CONCLUSION: We didn't confirm the relation between the suprarenal gland enlargement and the preterm birth (≤ 34 weeks' gestation). In the period of 6 years we didn't find a newborn patient with the prenatal diagnosis of suprarenal gland enlargement. The adrenal gland enlargement didn't have a relation with the low gestation birth, weight, length or the preterm birth.