T. Cos

Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: A prospective study

To compare prospectively maternal acceptance of fetal and neonatal virtuopsy with that of conventional autopsy and to determine the confidence with which magnetic resonance (MR) virtuopsy can be used to diagnose normality/abnormality of various fetal anatomical structures.

Safety of MR Imaging at 1.5 T in Fetuses: A Retrospective Case-Control Study of Birth Weights and the Effects of Acoustic Noise

PURPOSE To evaluate the effects of exposure to routine magnetic resonance (MR) imaging at 1.5 T during pregnancy on fetal growth and neonatal hearing function in relation to the dose and timing of in utero exposure in a group of newborns at low risk for congenital hearing impairment or deafness. MATERIALS AND METHODS This retrospective case-control study was approved by the local ethics committee, and written informed consent was waived. Between January 2008 and December 2012, a group of 751 neonates exposed to MR imaging in utero and a group of control subjects comprising 10 042 nonexposed neonates, both groups with no risk factors for hearing impairment at birth, were included. Neonatal hearing screening was performed by means of otoacoustic emission testing and auditory brain stem response according to national guidelines, and the prevalence of hearing impairment in the two groups was compared by using a noninferiority test with Wilson score confidence intervals. The effect of MR exposure on birth weight percentile was examined between the singleton neonates in the exposed group and a randomly chosen subset of 1805 singleton newborns of the nonexposed group by performing an analysis of variance. RESULTS The rate of hearing impairment or deafness was found to be 0% (0 of 751) in the neonates in the exposed group and was not inferior to that in the nonexposed group (34 of 10 042 [0.34%], P < .05). There was no between-group difference in birth weight percentiles (50.6% for exposed vs 48.4% for nonexposed; P = .22). CONCLUSION This study showed no adverse effects of exposure to 1.5-T MR imaging in utero on neonatal hearing function or birth weight percentiles.

Magnetic resonance imaging in the normal fetal heart and in congenital heart disease

To evaluate prospectively the feasibility of magnetic resonance imaging (MRI) for assessment of the fetal heart for congenital heart disease (CHD).

Post-mortem high-field magnetic resonance imaging: Effect or various factors

Abstract Purpose: To evaluate image quality and diagnostic accuracy of high-field post-mortem (PM) magnetic resonance imaging (MRI) on fetuses below 20 weeks of gestation before and after the freeze-thaw process. Materials and methods: Nine fetuses were scanned with three different scanning procedures: “fresh”, just after termination of pregnancy (TOP), “non-fresh short scan” and “non-fresh long scan” after being kept at −20 °C, followed by a conventional autopsy. The brain, thorax except the heart, heart and abdomen were studied. The qualities of the images for the four different fetal regions and for the three different scanning procedures were reported. Regression analysis was used to investigate the effect on image quality of different factors. Additionally, the diagnostic accuracy was also evaluated. Results: Fetuses at 12.0–19.6 weeks were included. Regression analysis showed that better image quality was correlated to advanced gestation at TOP and scan on fresh fetuses. PM-MRI on fresh fetuses was always diagnostic for the brain and in more than half of cases on non-fresh fetuses and was nearly equally diagnostic for thoracic and abdominal structures. Conclusion: High-field PM-MRI seems to offer a quite reliable alternative to the parents declining conventional PM for fetuses before 20 weeks whether these fetuses are freshly scanned or after being frozen.

OP26.01: Post-mortem examination of fetal heart in the first half of the pregnancy: a comparison of high-field MRI at 9.4 T to lower-field MRI and to autopsy

Methods: We reviewed all deliveries at Duke University from 2002–2011 to identify parturients receiving treatment for malignancy. All pregnant women exposed to doxorubicin were selected for analysis. Maternal cardiac function of the cohort was compared to historic controls based on doxorubicin exposure level (5% incidence at 400 mg/m2). Cardiac dysfunction was defined as an abnormal left ventricular fractional shortening (FS%) or ejection fraction (EF). The Fischer’s exact test was used for analysis. Results: Twenty-four parturients underwent treatment for malignancy; fourteen of these utilized doxorubicin-based regimens. Malignancies were divided between solid tumors (62%) and hematologic (38%). Eight women had maternal echocardiograms performed in the peripartum period after exposure to doxorubicin. Cumulative dose exposure varied from 25 mg/m2 to 375 mg/m2. Four patients demonstrated evidence of mild (FS%) or pronounced (EF) cardiac dysfunction (OR 19, P = 0.001, 2-tailed Fisher Exact) when compared to historic controls. No maternal deaths occurred, however, one patient remains on a left ventricular assist device (LVAD) due to severe postpartum cardiomyopathy. Conclusions: Pregnancy should be considered a high risk factor for doxorubicin-induced cardiomyopathy. Maternal echocardiography should be considered for all parturients, exposed to doxorubicin, regardless of the exposure dosage.