MRI Can Better Diagnose Fetal Brain Abnormalities in-Utero

MedicalResearch.com Interview with:
Prof Paul D Griffiths, FRCR and

Cara Mooney, Study Manager: MERIDIAN
Clinical Trials Research Unit
The University of Sheffield 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Around three in every 1000 pregnancies is complicated by a fetal abnormality. In the UK Ultrasonography (USS) has, for many years, been the mainstay of antenatal screening and detailed anomaly scanning to detect such abnormalities.  However previous studies have suggested that in utero Magnetic Resonance (iuMR) imaging may be a useful adjunct to USS for detecting these brain abnormalities in the developing fetus.

This study was designed to test the diagnostic accuracy and clinical impact of introducing fetal MR in to the diagnostic pathway.

Our results show that iuMR has an overall diagnostic accuracy of 93% compared to ultrasound at 68%, this is an increase in diagnostic accuracy of 25%. When divided into gestational age group the improvement in diagnostic accuracy ranged from 23% in the 18-23 week group, and 29% in the 24 week and over group.

IuMR provided additional diagnostic information in 49% of cases, changed prognostic information in at least 20% and the contribution to clinical management was felt to be at least ‘significant’ in 35% of cases. IuMR also had high patient acceptability with at least 95% of women stating that they would have an iuMR if a future pregnancy were complicated by a fetal brain abnormality.

MedicalResearch.com: What should readers take away from your report?

Response: Based on our findings we recommend that that any pregnancy with a suspected fetal brain abnormality should be offered an iuMR to better inform the counselling and management decisions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We believe that the diagnostic impact data from our study is generalisble, however further research may be required to assess the clinical impact of the improved diagnostic accuracy and information provided by iuMR in other countries.

The MERIDIAN research team are now following up the children born from the MERIDIAN cohort when they are aged 2-3 years old. This follow up study will allow us to update our diagnostic accuracy data based on longer term follow up. We are also completing developmental assessments on the children to understand the effect that brain abnormalities detected antenatally mean for the child’s prognosis and future development.

We are also running the MERIDIAN Add-on study in which we are recruiting women with a normal ultrasound scan to test the false negative rate of ultrasound compared to iuMR (i.e. the rate at which ultrasound missed a brain abnormality).   

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Citation:

Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): a multicentre, prospective cohort study
Griffiths, Paul D et al.
The Lancet , Volume 0 , Issue 0 ,
DOI: http://dx.doi.org/10.1016/S0140-6736(16)31723-8
Published  14 December 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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