Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly: iuMR for Ventriculomegaly

Paul D Griffiths; Karen Brackley; Michael Bradburn; Daniel Ja Connolly; Mary L Gawne-cain; Daniel I Griffiths; Mark D Kilby; Laura Mandefield; Cara Mooney; Stephen C Robson; Brigitte Vollmer; Gerald Mason

doi:10.1002/uog.17475

Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly: iuMR for Ventriculomegaly

Paul D Griffiths, Karen Brackley, Michael Bradburn, Daniel Ja Connolly, Mary L Gawne-cain, Daniel I Griffiths, Mark D Kilby, Laura Mandefield, Cara Mooney, Stephen C Robson, Brigitte Vollmer, Gerald Mason

Metabolism and Systems Science

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Abstract

Objective To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort. Methods We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway. Results USS failed to detect 31 additional brain abnormalities other than ‘ventriculomegaly’ in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either ‘significant’, ‘major’ or ‘decisive’ in 76/295 (25.8%) cases. Conclusion Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation.

Original language	English
Journal	Ultrasound in Obstetrics and Gynecology
Early online date	24 Mar 2017
DOIs	https://doi.org/10.1002/uog.17475
Publication status	E-pub ahead of print - 24 Mar 2017

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Griffiths_et_al_Anatomical_subgroup_analysis_Ventriculomegaly_Ultrasound
This is the peer reviewed version of the article published as above, which has been published in final form at http://dx.doi.org/10.1002/uog.17475. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Checked 11/5/2017
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Griffiths, P. D., Brackley, K., Bradburn, M., Connolly, D. J., Gawne-cain, M. L., Griffiths, D. I., Kilby, M. D., Mandefield, L., Mooney, C., Robson, S. C., Vollmer, B., & Mason, G. (2017). Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly: iuMR for Ventriculomegaly. Ultrasound in Obstetrics and Gynecology. Advance online publication. https://doi.org/10.1002/uog.17475

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title = "Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly: iuMR for Ventriculomegaly",

abstract = "Objective To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort. Methods We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway. Results USS failed to detect 31 additional brain abnormalities other than {\textquoteleft}ventriculomegaly{\textquoteright} in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either {\textquoteleft}significant{\textquoteright}, {\textquoteleft}major{\textquoteright} or {\textquoteleft}decisive{\textquoteright} in 76/295 (25.8%) cases. Conclusion Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation.",

author = "Griffiths, {Paul D} and Karen Brackley and Michael Bradburn and Connolly, {Daniel Ja} and Gawne-cain, {Mary L} and Griffiths, {Daniel I} and Kilby, {Mark D} and Laura Mandefield and Cara Mooney and Robson, {Stephen C} and Brigitte Vollmer and Gerald Mason",

year = "2017",

month = mar,

day = "24",

doi = "10.1002/uog.17475",

language = "English",

journal = "Ultrasound in Obstetrics and Gynecology",

issn = "09607692",

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T1 - Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly

T2 - iuMR for Ventriculomegaly

AU - Griffiths, Paul D

AU - Brackley, Karen

AU - Bradburn, Michael

AU - Connolly, Daniel Ja

AU - Gawne-cain, Mary L

AU - Griffiths, Daniel I

AU - Kilby, Mark D

AU - Mandefield, Laura

AU - Mooney, Cara

AU - Robson, Stephen C

AU - Vollmer, Brigitte

AU - Mason, Gerald

PY - 2017/3/24

Y1 - 2017/3/24

N2 - Objective To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort. Methods We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway. Results USS failed to detect 31 additional brain abnormalities other than ‘ventriculomegaly’ in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either ‘significant’, ‘major’ or ‘decisive’ in 76/295 (25.8%) cases. Conclusion Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation.

AB - Objective To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort. Methods We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway. Results USS failed to detect 31 additional brain abnormalities other than ‘ventriculomegaly’ in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either ‘significant’, ‘major’ or ‘decisive’ in 76/295 (25.8%) cases. Conclusion Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation.

U2 - 10.1002/uog.17475

DO - 10.1002/uog.17475

M3 - Article

SN - 09607692

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

ER -

Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly: iuMR for Ventriculomegaly

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