fetal and placenta mr
TRANSCRIPT
![Page 1: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/1.jpg)
Fetal and Placenta MRLloyd Stambaugh, MD
Radia
![Page 2: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/2.jpg)
Fetal MR Indications
• Fetal MR is most commonly used to assess the brain after an abnormal fetal sonogram• Absent CSP
• Ventriculomegaly
• Abnormal posterior fossa
• Most common Fetal MR abnormal findings• Absent corpus callosum
• Ventriculomegaly
• Dandy Walker variant
![Page 3: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/3.jpg)
Less common indications
• Chest mass
• Abdomen/pelvic mass
• Spinal abnormality
![Page 4: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/4.jpg)
MRI Safety and Pregnancy
• FDA requires MRI devices indicate the safety of MRI with respect to the fetus “has not been established.”
• 2007 ACR states all pregnant patients can receive MRI as long as the “risk-benefit ratio to the patient warrants that the study be performed.”
![Page 5: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/5.jpg)
MRI Safety and Pregnancy
• Canadian study, all births > 20 gestation between 2003-2015
• 1.4M deliveries
• MRI rate 3.97 per 1000 pregnancies
• 1st trimester MRI stillbirth RR 1.68 (CI 0.97 to 2.9); adjust risk difference 4.7 per 1000 person-years
• No significant higher risk of congenital anomalies, neoplasm, vision or hearing loss.
• Conclusion – 1st trimester MRI exposure was not associated with increased risk of harm to the fetus or in early childhood.
JAMA. 2016 Sep 6;316(9):952-61
![Page 6: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/6.jpg)
25 y.o. pregnant patient. Absent CSP and ventriculomegaly on ultrasound.
![Page 7: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/7.jpg)
31 y.o. pregnant patient. Mild asymmetric ventriculomegaly.
![Page 8: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/8.jpg)
Fetal Brain MR added value
• Meta-analysis of 27 articles, 1184 patients – compared US and MR of fetal brain
• US and MR agreed 65%
• MR showed additional/different pathology in 23%
• Compared with post-natal dx • MR agreed 80%
• US agreed 54%
• Fetal brain MR in addition to US improves diagnostic accuracy
J Matern Fetal Neonatal Med, 2016; 29(18): 2949-2961
![Page 9: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/9.jpg)
Fetal MR additional value
• Systemic review of literature
• 13 articles, 710 fetuses
• MR confirmed US-positive findings in 65%
• Provided additional information in 22%
• MR additional findings changed management in 30%
• US/MR primarily agreed for ventriculomegaly, but more often disagreed for midline anomalies.
Ultrasound Obstet Gynecol 2014; 44: 388-393
![Page 10: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/10.jpg)
Fetal MR additional value
• MERIDIAN Study -- Multicenter, prospective, cohort study with brain abnormality on US (16 fetal medicine centers, 570 patients)
• Diagnostic accuracy improved• 23% in 18-24 wk EGA group
• 29% in >24 week EGA group
• Overall accuracy• US 68%
• MR 93%
• MR provided additional information in 49% and changed prognosis in 20%
![Page 11: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/11.jpg)
• MR influence on counseling• None 22%
• Minor 63%
• Major 15%
• MR contribution to management• None 12%
• Minor 53%
• Significant 26%
• Major 6%
• Decisive 3%35%
![Page 12: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/12.jpg)
28 y.o. pregnant patient with abnormal ventricle on US
![Page 13: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/13.jpg)
32 y.o. pregnant patient with abnormal posterior fossa on US, concerning for Dandy Walker
![Page 14: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/14.jpg)
MR Placenta
![Page 15: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/15.jpg)
Placenta Accreta Spectrum
• Risk factors• Previous cesarean section, particularly multiple
• Placent previa
• AMA
• Additional – multiparity/IVF/uterine surgery/fibroids/smoking/etc
• Placenta previa + 3 prior C-sections = 40% PAS
• No previa + 3 prior C-sections = <1% PAS
![Page 16: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/16.jpg)
31 y.o. female at 28w2d with prior C-section, previa, and pain under C-section scar
![Page 17: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/17.jpg)
![Page 18: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/18.jpg)
34 y.o. pregnant female with prior C-section. Peripheral location of gestation sac in LUS
![Page 19: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/19.jpg)
![Page 20: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/20.jpg)
42 yo pregnant patient with abdominal pain & vomiting
Placenta percreta through right lower uterine segment. Large RLQ hematoma and hemoperitoneum.
![Page 21: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/21.jpg)
36 y.o. pregnant female with prior C-section and probable placenta accreta/percreta by US
![Page 22: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/22.jpg)
Placenta Accreta Spectrum – US vs MR
• US• Sensitivity 77% to 87%• Specificity 96% to 98%
• MR• Sensitivity 80% to 85%• Specificity 65% to 100%
• MR and US have similar sensitivity, but US is generally more specific
• MR is helpful• Posterior or lateral placenta• Extra-uterine organ involvement with percreta
Clinical Ob Gyn; vol 61, No4, 755-765
![Page 23: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/23.jpg)
• Assessed 28 cases of suspected placenta accreta spectrum in third trimester; all cases received US & MR; surgical confirmation of diagnosis
• US• Sensitivity 0.96
• Specificity 0.6
• MR• Sensitivity 0.83
• Specificity 0.4
• Post-hoc MR structured scoring system improved sens 0.96/spec 0.6
J Matern Fetal Neonatal Med. 2020 Nov 12:1-4
![Page 24: Fetal and Placenta MR](https://reader030.vdocument.in/reader030/viewer/2022012418/6172d485df4e3d61b8019400/html5/thumbnails/24.jpg)
Thank You