Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

• Published in: Acta obstetricia et gynecologica Scandinavica 2024-02, Vol.103 (2), p.322-333
• Main Authors: Mufti, Nada, Aertsen, Michael, Thomson, Dominic, De Vloo, Phillippe, Demaerel, Philippe, Deprest, Jan, Melbourne, Andrew, David, Anna L., Atkinson, David, Bredaki, Foteini Emmanouella, Chappell, Joanna, De Catte, Luc, Devlieger, Roland, Ebner, Michael, Fidon, Lucas, Gaunt, Trevor, Kendall, Giles S., Ourselin, Sebastien, Baruteau, Kelly Pegoretti, Sacco, Adalina, Sokolska, Magdalena, Vercauteren, Tom
• Format: Article
• Language: English
• Subjects: accessibility; Brain; Female; Fetal Medicine; fetal surgery; Gestational Age; Humans; Magnetic Resonance Imaging; open spina bifida; Original; Pregnancy; protocols; Retrospective Studies; sequences; Spina bifida; Spina Bifida Cystica - diagnostic imaging; Spina Bifida Cystica - surgery; Surgery
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.14711

Introduction Fetal 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 methods We 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. Results MRI 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