Affiliation:
1. Elizabeth Garrett Anderson Institute for Women's Health University College London London UK
2. School of Biomedical Engineering and Imaging Sciences (BMEIS) King's College London London UK
3. Department of Radiology University Hospitals Katholieke Universiteit (KU) Leuven Belgium
4. Pediatric Neurosurgery Department Great Ormond Street Hospital for Children London UK
5. Department of Neurosurgery University Hospitals Katholieke Universiteit (KU) Leuven Belgium
6. Department of Obstetrics and Gynecology University Hospitals Katholieke Universiteit (KU) Leuven Belgium
7. Medical Physics and Biomedical Engineering University College London London UK
Abstract
AbstractIntroductionFetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.Material and methodsWe surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.ResultsMRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0–10), the average scan time available was 37 ± 16 min (range, 20–80 min), with 15 ± 11 min (range, 0–30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2‐weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post‐surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1‐weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre‐ and post‐surgery (p < 0.001).ConclusionsThere was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.
Funder
Engineering and Physical Sciences Research Council
Wellcome Trust
Subject
Obstetrics and Gynecology,General Medicine