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Anatomical subgroup analysis of the MERIDIAN cohort: Posterior fossa abnormalities

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 in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with abnormalities of the posterior fossa as the only intracranial abnormality recognised on antenatal ultrasonography (USS).Methods: We report a sub-group analysis of fetuses with abnormalities of the posterior fossa diagnosed on antenatal USS (with or without ventriculomegaly) from the MERIDIAN cohort who had iuMR imaging within 2 weeks of USS and outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported as well as indicators of diagnostic confidence and effects on prognosis and clinical management.Results: Abnormalities confined to the posterior fossa according to USS were found in 81 fetuses (67 with parenchymal and 14 with CSF-containing lesions). The overall diagnostic accuracy for detecting an isolated posterior fossa abnormality was 65% for USS and 88% for iuMR (difference = 22%, 95% CI: 14.0 to 30.5%, p < 0.0001). There was an improvement in ‘appropriate’ diagnostic confidence as assessed by a score-based weighted average’ method (p < 0.0001) and a three-fold reduction in ‘high confidence but incorrect diagnoses’ was achieved by using iuMR imaging. The prognostic information given to the women after iuMR imaging changed in 44% of cases and the overall effect of iuMR on clinical management was considered to be ‘significant’, ‘major’ or ‘decisive’ in 35% of cases.Conclusions: Our data suggests that any woman whose fetus has a posterior fossa abnormality as the only intracranial finding on USS should have iuMR imaging for further evaluation. This is on the basis of improved diagnostic accuracy and confidence which has substantial effects on the prognostic information given to women and changes in clinical management.
Griffiths, Paul D.
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Brackley, Karen
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Bradburn, Michael
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Connolly, Daniel J.A.
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Gawne-Cain, Mary L.
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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
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
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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., 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. (doi:10.1002/uog.17485).

Record type: Article

Abstract

Objective: To assess the diagnostic and clinical contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with abnormalities of the posterior fossa as the only intracranial abnormality recognised on antenatal ultrasonography (USS).Methods: We report a sub-group analysis of fetuses with abnormalities of the posterior fossa diagnosed on antenatal USS (with or without ventriculomegaly) from the MERIDIAN cohort who had iuMR imaging within 2 weeks of USS and outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported as well as indicators of diagnostic confidence and effects on prognosis and clinical management.Results: Abnormalities confined to the posterior fossa according to USS were found in 81 fetuses (67 with parenchymal and 14 with CSF-containing lesions). The overall diagnostic accuracy for detecting an isolated posterior fossa abnormality was 65% for USS and 88% for iuMR (difference = 22%, 95% CI: 14.0 to 30.5%, p < 0.0001). There was an improvement in ‘appropriate’ diagnostic confidence as assessed by a score-based weighted average’ method (p < 0.0001) and a three-fold reduction in ‘high confidence but incorrect diagnoses’ was achieved by using iuMR imaging. The prognostic information given to the women after iuMR imaging changed in 44% of cases and the overall effect of iuMR on clinical management was considered to be ‘significant’, ‘major’ or ‘decisive’ in 35% of cases.Conclusions: Our data suggests that any woman whose fetus has a posterior fossa abnormality as the only intracranial finding on USS should have iuMR imaging for further evaluation. This is on the basis of improved diagnostic accuracy and confidence which has substantial effects on the prognostic information given to women and changes in clinical management.

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Griffiths_et_al-2017-Ultrasound_in_Obstetrics_&_Gynecology - Accepted Manuscript
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Accepted/In Press date: 31 March 2017
e-pub ahead of print date: 11 April 2017
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 410651
URI: https://eprints.soton.ac.uk/id/eprint/410651
PURE UUID: cfe139e3-fe27-4b3a-9566-10223c65dbac
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: 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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