Anatomical subgroup analysis of the MERIDIAN cohort: Posterior fossa abnormalities
Anatomical subgroup analysis of the MERIDIAN cohort: Posterior fossa abnormalities
Objective
To assess the diagnostic and clinical contribution of
fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort
diagnosed with abnormalities of the posterior fossa as the only
intracranial abnormality recognized on antenatal ultrasound.
Methods
This was a subgroup analysis of the MERIDIAN study of
fetuses with abnormalities of the posterior fossa (with or without
ventriculomegaly) diagnosed on antenatal ultrasound in women who had MRI
within 2 weeks of ultrasound and for whom outcome reference data were
available. The diagnostic accuracy of ultrasound and MRI is reported, as
well as indicators of diagnostic confidence and effects on prognosis
and clinical management. Appropriate diagnostic confidence was assessed
by the score‐based weighted average method, which combines diagnostic
accuracy with diagnostic confidence data.
Results
Abnormalities confined to the posterior fossa
according to ultrasound were found in 81 fetuses (67 with parenchymal
and 14 with cerebrospinal fluid‐containing lesions). The overall
diagnostic accuracy for detecting an isolated posterior fossa
abnormality was 65.4% for ultrasound and 87.7% for MRI (difference,
22.3% (95% CI, 14.0–30.5%); P < 0.0001). There was an
improvement in ‘appropriate’ diagnostic confidence, as assessed by the
score‐based weighted average method (P < 0.0001), and a
three‐fold reduction in ‘high confidence but incorrect diagnosis’ was
achieved using MRI. Prognostic information given to the women changed
after MRI in 44% of cases, and the overall effect of MRI on clinical
management was considered to be ‘significant’, ‘major’ or ‘decisive’ in
35% of cases.
Conclusions
Our data suggest that any woman whose fetus has a
posterior fossa abnormality as the only intracranial finding on
ultrasound should have MRI for further evaluation. This is on the basis
of improved diagnostic accuracy and confidence, which impacts
substantially on the prognostic information given to women as well as
their clinical management.
745-752
Griffiths, Paul D.
903ae433-8711-4693-95e0-612a86fed710
Brackley, Karen
0a4c7155-8300-44cd-b463-c629faafdecf
Bradburn, Michael
02085bb8-0d49-4713-8c27-4b6d6c1cdf08
Connolly, Daniel J.A.
90242ec0-504f-4e22-be64-9d210a9dd0d7
Gawne-Cain, Mary L.
965db1c3-79ca-455a-82e0-1cdc9b8042c4
Kilby, Mark D.
dc85a6f2-acb0-4a0b-afbc-2aed41cb9ad5
Mandefield, Laura
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Mooney, Cara
d2fae4c9-e6c7-45e1-b8fe-4878ca1087a8
Robson, Stephen C.
a8c77714-2b9b-4e47-a98d-b37f993f73b0
Vollmer, Brigitte
044f8b55-ba36-4fb2-8e7e-756ab77653ba
Mason, Gerald
a3297c38-d36c-4ce7-865a-ebd5ccbf2244
December 2017
Griffiths, Paul D.
903ae433-8711-4693-95e0-612a86fed710
Brackley, Karen
0a4c7155-8300-44cd-b463-c629faafdecf
Bradburn, Michael
02085bb8-0d49-4713-8c27-4b6d6c1cdf08
Connolly, Daniel J.A.
90242ec0-504f-4e22-be64-9d210a9dd0d7
Gawne-Cain, Mary L.
965db1c3-79ca-455a-82e0-1cdc9b8042c4
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
044f8b55-ba36-4fb2-8e7e-756ab77653ba
Mason, Gerald
a3297c38-d36c-4ce7-865a-ebd5ccbf2244
Griffiths, Paul D., Brackley, Karen, Bradburn, Michael, Connolly, Daniel J.A., Gawne-Cain, Mary L., Kilby, Mark D., Mandefield, Laura, Mooney, Cara, Robson, Stephen C., Vollmer, Brigitte and Mason, Gerald
(2017)
Anatomical subgroup analysis of the MERIDIAN cohort: Posterior fossa abnormalities.
Ultrasound in Obstetrics & Gynecology, 50 (6), .
(doi:10.1002/uog.17485).
Abstract
Objective
To assess the diagnostic and clinical contribution of
fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort
diagnosed with abnormalities of the posterior fossa as the only
intracranial abnormality recognized on antenatal ultrasound.
Methods
This was a subgroup analysis of the MERIDIAN study of
fetuses with abnormalities of the posterior fossa (with or without
ventriculomegaly) diagnosed on antenatal ultrasound in women who had MRI
within 2 weeks of ultrasound and for whom outcome reference data were
available. The diagnostic accuracy of ultrasound and MRI is reported, as
well as indicators of diagnostic confidence and effects on prognosis
and clinical management. Appropriate diagnostic confidence was assessed
by the score‐based weighted average method, which combines diagnostic
accuracy with diagnostic confidence data.
Results
Abnormalities confined to the posterior fossa
according to ultrasound were found in 81 fetuses (67 with parenchymal
and 14 with cerebrospinal fluid‐containing lesions). The overall
diagnostic accuracy for detecting an isolated posterior fossa
abnormality was 65.4% for ultrasound and 87.7% for MRI (difference,
22.3% (95% CI, 14.0–30.5%); P < 0.0001). There was an
improvement in ‘appropriate’ diagnostic confidence, as assessed by the
score‐based weighted average method (P < 0.0001), and a
three‐fold reduction in ‘high confidence but incorrect diagnosis’ was
achieved using MRI. Prognostic information given to the women changed
after MRI in 44% of cases, and the overall effect of MRI on clinical
management was considered to be ‘significant’, ‘major’ or ‘decisive’ in
35% of cases.
Conclusions
Our data suggest that any woman whose fetus has a
posterior fossa abnormality as the only intracranial finding on
ultrasound should have MRI for further evaluation. This is on the basis
of improved diagnostic accuracy and confidence, which impacts
substantially on the prognostic information given to women as well as
their clinical management.
Text
Griffiths_et_al-2017-Ultrasound_in_Obstetrics_&_Gynecology
- Accepted Manuscript
More information
Accepted/In Press date: 31 March 2017
e-pub ahead of print date: 11 April 2017
Published date: December 2017
Organisations:
Clinical & Experimental Sciences
Identifiers
Local EPrints ID: 410651
URI: http://eprints.soton.ac.uk/id/eprint/410651
PURE UUID: cfe139e3-fe27-4b3a-9566-10223c65dbac
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Date deposited: 09 Jun 2017 09:18
Last modified: 16 Mar 2024 05:18
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Contributors
Author:
Paul D. Griffiths
Author:
Karen Brackley
Author:
Michael Bradburn
Author:
Daniel J.A. Connolly
Author:
Mary L. Gawne-Cain
Author:
Mark D. Kilby
Author:
Laura Mandefield
Author:
Cara Mooney
Author:
Stephen C. Robson
Author:
Gerald Mason
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