Myelomeningocele–Chiari II malformation–Neurological predictability based on fetal and postnatal magnetic resonance imaging. (19th June 2021)

• Record Type: Journal Article
• Authors: Khalaveh, Farjad; Seidl, Rainer; Czech, Thomas; Reinprecht, Andrea; Gruber, Gerlinde Maria; Berger, Angelika; Kiss, Herbert; Prayer, Daniela; Kasprian, Gregor
• Is Part Of: Prenatal diagnosis. Volume 41:Number 8(2021)
• Page Start: 922
• Page End: 932
• Publication Date: 2021-06-19
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5987
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: This systematic comparison between pre‐ and postnatal imaging findings and postnatal motor outcome assesses the reliability of MRI accuracy in the prognostication of the future long‐term (mean, 11.4 years) ambulatory status in a historic group of postnatally repaired myelomeningocele (MMC) cases. Methods: A retrospective, single‐center study of 34 postnatally repaired MMC patients was performed. We used fetal and postnatal magnetic resonance imaging (MRI) to compare the fetal and postnatal radiological lesion level to each other and to the postnatal ambulatory level as a standard of reference and analyzed Chiari II malformation characteristics. Results: In 13/15 (87%) and 29/31 (94%) cases, the functional level was equal to or better than the prenatal and postnatal radiological lesion level. A radiological lesion level agreement within two segments could be achieved in 13/15 (87%) patients. A worse than expected functional level occurred in cases with Myelocele (2/3 patients), coexistent crowding of the posterior fossa (2/3 patients) and/or abnormal white matter architecture, represented by callosal dysgenesis (1/3 patients). In all patients (2/2) with a radiological disagreement of more than two segments, segmentation disorders and scoliosis were observed. Conclusion: Fetal and postnatal MRI are predictive of the long‐term ambulatory status in postnatally repaired MMC patients. Key points: What's already known about this topic? Fetal and postnatal magnetic resonance imaging (MRI) show a good correlation in identifying the level of the myelomeningocele (MMC) lesion. Prenatal ultrasound (US) and fetal MRI show a comparable agreement, within two segments, in predicting the short‐term ambulatory status. What does this study add? Fetal and postnatal MRI have a good predictive value for the long‐term ambulatory status in patients with postnatal MMC closure. MMC patients with worse than expected ambulatory status showed signs of vermian displacement and corpus callosum dysgenesis. In MMC patients with spinal segmentation disorders and scoliosis, there was a major disagreement between fetal and postnatal MRI, specifically with regard to the MMC lesion level.