Ana Paula Pinho Matos

OP23.04: Cervical lymphangioma: prenatal evaluation by MRI and long-term outcomes: Short oral presentation abstracts

Objectives: At two metropolitan Australian hospitals offering fetal medicine and genetic services 1) Investigate how often referrals for isolated CPC/EIF are made at a local level, comparing 2014-16 referrals with earlier epochs 2) Audit the consequence of CPC/EIF referrals in terms of consultations undergone, further investigations performed, and ultimate pregnancy outcome. Methods: Retrospective audit of women referred to genetic counsellor and/or fetal medicine services at St George Hospital (SGH) and the Royal Hospital for Women (RHW) in metropolitan Australia with CPC and/or EIF from January 1st 2006 to December 31st 2016 inclusive. Data collected included demographics, prior screening, ultrasonic findings, consultations/investigations after CPC/EIF diagnosis, and pregnancy outcome. Findings were compared by hospital and 3 time periods; 2006-2009, 2010-2013, 2014-2016. Low risk women with isolated EIF/CPC were also compared to those at high risk or with multiple signs. Results: Of the 208 women, 118 (57%) were referred to specialist services for isolated CPC and/or EIF, and 102 (49%) were low-risk for aneuploidy prior to morphology ultrasound. Significantly more women had undergone combined first trimester screening in the 2014 to 2016 epoch versus previous years at both SGH (p=0.032) and RHW (p=0.004). However, the number of women referred for CPC and EIF remained constant at SGH (p=0.814) and RHW (p=0.731).Despite no fetus being born with a major structural or chromosomal abnormality in the group of low-risk women with isolated signs, 18% were referred to both genetic counselling and fetal medicine services, 7% had NIPT after morphology, 14% had amniocentesis and 33% had additional ultrasound(s). Conclusions: Despite advances in screening technology, low-risk women are still referred to specialist services for these 2 soft signs and undergoing unnecessary follow up, NIPT and amniocentesis.

EP21.01: Confocal microtomography (micro-CT) analysis and three-dimensional (3D) reconstruction of pathological conditions affecting the human fallopian tube (FT): Electronic Poster Abstracts

Methods: Eight specimens of FT affected by pathological conditions, from elective and emergency surgeries were selected, three Ectopic pregnancies (EP) from emergency surgeries and five remnants of FT (RFT) from surgical sterilization. The specimens were fixed in formalin for 24h and stained in Lugol solution for 72h. The micro-CT studies were conducted using protocols adapted from biological studies and the specimens were evaluated by traditional microscopy. Conclusion: Micro-CT is able to demonstrate many previously described characteristics of pathological FT in 3D, with good tissue contrast and can help guiding traditional histopathological sectioning of specimens.

OC22.05: Semi-automatic analysis of vascular volume along the fallopian tube and impact of the ovarian fimbria on fallopian tube vascularisation using confocal microtomography

Methods: Eight healthy women, with a natural regular cycle, underwent 4-minute TVUS during the menses (M), late follicular (LF), early luteal (EL) and late luteal (LL) phase of the cycle. Strain mapping based on optical flow was applied to calculate and visualise strain variations. The obtained strain maps were rendered with suitable colour maps; red for relaxation (negative strain) and blue for contraction (positive strain). Statistical analysis based on Kruskal–Wallis test and Dunn’s test were applied to evaluate the differences in contraction frequency between the phases. Results: 2D-strain maps were created for all phases in transversal direction (figure1). Statistical analysis showed significant differences in contraction frequency between M-LF (P=0.002), M-EL (P=0.003), LF-LL (P=0.034) and EL-LL (P=0.048) phase. Conclusions: The results show that we can accurately strain-map the non-pregnant uterus, and that we can objectively classify contraction frequency in different phases of the menstrual cycle. Future work will focus on three-dimensional strain analysis to provide more accurate results in multiple directions.

Avaliação do abdome fetal por ressonância magnética. Parte 2: malformações da parede abdominal e tumores

Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.

Avaliação do abdome fetal por ressonância magnética. Parte 1: malformações da cavidade abdominal

Although ultrasound continues to be the mainstay modality for the evaluation of fetal disorders, fetal magnetic resonance imaging (MRI) has often been used as a valuable adjunct in recent years. The exponential growth of the use of fetal MRI has been facilitated by technological advancements such as ultrafast T2-weighted sequences and diffusion-weighted imaging. Fetal MRI can achieve results that are comparable to or better than those of ultrasound, particularly in cases of maternal obesity, severe oligohydramnios, or abnormal fetal position. Because of its superior soft tissue contrast, wide field of view, and multiplanar imaging, fetal MRI is able to evaluate the large fetal organs, such as the lungs, liver, bowel, and kidneys. In addition, fetal MRI allows large or complex malformations to be examined, facilitating the understanding of the malformation within the context of the body as a whole. Initial fetal MRI studies were focused on the central nervous system. With advances in software and hardware, fetal MRI gained importance in the evaluation of the fetal abdomen. The purpose of this article is to review the recent literature and developments in MRI evaluation of the fetal abdomen, with an emphasis on imaging aspects, protocols, and common clinical indications.

Tuboperitoneal fistula, ectopic pregnancy, and remnants of fallopian tube: a confocal microtomography analysis and 3D reconstruction of human fallopian tube pathologies

Abstract Objective: The aim of this study was to provide a three-dimensional (3D) microscopic reconstruction of morphological modifications of the fallopian tube (FT) following surgical sterilization (including tuboperitoneal fistula) and ectopic pregnancy (EP) using confocal microtomography (micro-CT). Methods: Six specimens of FT from elective and emergency surgeries were selected: three remnants of the FT (RFT) from surgical sterilization, including one presenting tuboperitoneal fistula, and three FTs with EP. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies. Results: Three RFTs from surgical sterilization and three FTs affected by EPs were successfully scanned using micro-CT. There was good contrast impregnation, allowing tissue segmentation and analysis of different sections of the FTs. Three FT specimens from EP exhibited considerable distortion of the tubal anatomy, mainly from the blood clot in the tubal abortion. Three RFT specimens exhibited some features observed in traditional microscopy, such as tubal distension and loss of normal anatomical characteristics of a normal FT, and indicated the presence of a tuboperitoneal fistula in one of the three specimens. Conclusion: Micro-CT can identify morphological characteristics of FT pathologies previously described in a microscopic scale, with tissue contrast and the possibility of 3D reconstruction. Micro-CT is also useful in guiding traditional sectioning of specimens for histopathological studies.

Prenatal diagnosis of suprarenal mass by magnetic resonance imaging: a case series

Abstract Objective: The aim of this study was to evaluate the perinatal outcomes and postnatal follow-up of prenatally diagnosed suprarenal masses (SRMs) evaluated by magnetic resonance imaging (MRI). Methods: Thirteen fetuses with SRMs detected during routine prenatal ultrasound screening were evaluated by MRI between February 2007 and May 2015. The prenatal characteristics of the masses, complications of the pregnancies, and related malformations were collected as the postnatal clinical, radiological, and pathological data. Results: The median gestational age at MRI was 30 weeks (18–41), and birth weight was 3285 (1700–3750) g. The mean follow-up period was 6 years (1.3–10). We observed 69.2% of the masses, which were predominantly cystic (69.2%), located on the left side. Associated malformations were found in 23% of the fetuses, with congenital heart defects being more prevalent. During the pregnancy, 15.4% of the fetuses had involution of the SRM, and one fetus had surgical treatment and different ultrasound and MRI diagnoses. Of the 69.2% of the cases, spontaneous resolution occurred in 30.7% during the first year of life and 38.4% the masses presented without modifications or signs of regression since the neonatal period. Conclusions: Prenatal SRMs were associated with congenital heart defects. Spontaneous regression and absence of modifications in the masses were commonly observed in the long-term follow-up of the SRMs.

Prenatal Diagnosis of Caroli Disease Associated With Autosomal Recessive Polycystic Kidney Disease by 3-D Ultrasound and Magnetic Resonance Imaging

BACKGROUNDnCaroli disease is a very rare congenital anomaly characterized by non-obstructive saccular or fusiform dilatation of the intrahepatic bile ducts. It is associated with bile stagnation and hepatolithiasis, which explain the recurrent cholangitis and portal hypertension as a consequence of congenital liver fibrosis. Although there are several reports of diagnosis in childhood and adult life, the prenatal diagnosis using conventional 2-D ultrasound is rare, with few reports in the literature.nnnCASEnWe present a case of a 26-year-old primigravid woman at 24xa0weeks of gestation which 3-D ultrasound in the rendering mode clearly revealed the enlarged fetal kidneys and the increased abdominal volume, confirming the diagnosis of autosomal recessive polycystic kidney disease. The MRI was essential to the prenatal diagnosis of Caroli disease, identifying the congenital saccular dilations of intrahepatic bile ducts.