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Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly

Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly
Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly

Objective: To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort.

Methods: We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway.

Results: USS failed to detect 31 additional brain abnormalities other than ‘ventriculomegaly’ in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either ‘significant’, ‘major’ or ‘decisive’ in 76/295 (25.8%) cases.

Conclusion: Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation.

Griffiths, Paul D.
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Brackley, Karen
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Connolly, Daniel J.A.
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Gawne-Cain, Mary L.
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Bradburn, Michael
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Griffiths, Daniel I.
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Kilby, Mark D.
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Mandefield, Laura
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Mooney, Cara
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Robson, Stephen C.
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Vollmer, Brigitte
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Mason, Gerald
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Griffiths, Paul D.
903ae433-8711-4693-95e0-612a86fed710
Brackley, Karen
0a4c7155-8300-44cd-b463-c629faafdecf
Connolly, Daniel J.A.
90242ec0-504f-4e22-be64-9d210a9dd0d7
Gawne-Cain, Mary L.
965db1c3-79ca-455a-82e0-1cdc9b8042c4
Bradburn, Michael
02085bb8-0d49-4713-8c27-4b6d6c1cdf08
Griffiths, Daniel I.
735e61ab-7cae-4965-9c02-68dc2f8ee307
Kilby, Mark D.
dc85a6f2-acb0-4a0b-afbc-2aed41cb9ad5
Mandefield, Laura
50d35200-6d9f-4622-8569-516dcca091c8
Mooney, Cara
d2fae4c9-e6c7-45e1-b8fe-4878ca1087a8
Robson, Stephen C.
a8c77714-2b9b-4e47-a98d-b37f993f73b0
Vollmer, Brigitte
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Mason, Gerald
a3297c38-d36c-4ce7-865a-ebd5ccbf2244

Griffiths, Paul D., Brackley, Karen, Connolly, Daniel J.A., Gawne-Cain, Mary L., Bradburn, Michael, Griffiths, Daniel I., Kilby, Mark D., Mandefield, Laura, Mooney, Cara, Robson, Stephen C., Vollmer, Brigitte and Mason, Gerald (2017) Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly. Ultrasound in Obstetrics & Gynecology. (doi:10.1002/uog.17475).

Record type: Article

Abstract

Objective: To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort.

Methods: We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway.

Results: USS failed to detect 31 additional brain abnormalities other than ‘ventriculomegaly’ in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either ‘significant’, ‘major’ or ‘decisive’ in 76/295 (25.8%) cases.

Conclusion: Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation.

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Griffiths_et_al-2017-Ultrasound_in_Obstetrics_&_Gynecology-1 - Accepted Manuscript
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Accepted/In Press date: 17 March 2017
e-pub ahead of print date: 24 March 2017
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 410650
URI: https://eprints.soton.ac.uk/id/eprint/410650
PURE UUID: 371f45a5-7500-46ca-9b93-7e7d7c8cf953
ORCID for Brigitte Vollmer: ORCID iD orcid.org/0000-0003-4088-5336

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Date deposited: 09 Jun 2017 09:18
Last modified: 03 Dec 2019 06:07

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Contributors

Author: Paul D. Griffiths
Author: Karen Brackley
Author: Daniel J.A. Connolly
Author: Mary L. Gawne-Cain
Author: Michael Bradburn
Author: Daniel I. Griffiths
Author: Mark D. Kilby
Author: Laura Mandefield
Author: Cara Mooney
Author: Stephen C. Robson
Author: Gerald Mason

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