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OP09.03: Prevalence of severe CNS abnormalities assessed by fetal MR among candidates for spina bifida prenatal surgery

2019; Wiley; Volume: 54; Issue: S1 Linguagem: Inglês

10.1002/uog.20732

1469-0705

Lucas Trigo, E. Eixarch, Michaël Aertsen, Isabela Bottura, Mariana Dalaqua, Alcino Alves Barbosa, Luc De Catte, Philippe Demaerel, Steven Dymarkowski, D. A. L. Pedreira, Jan Deprest, E. Gratacós,

Prenatal Screening and Diagnostics

To evaluate the prevalence and type of severe structural central nervous system(CNS) abnormalities in fetuses candidates for spina bifida aperta(SBA) prenatal surgery diagnosed by means of fetal magnetic resonance(MR) and correlate these findings with other prenatal parameters. Multicentric cross-section cohort study of 103 fetuses diagnosed with SBA, prenatally and pre-surgically scanned by MR in the last ten years in three different centres (Barcelona, Leuven and Sao Paulo). Inclusion criteria were identical to MOMs trial, except there was no upper limit of gestational age(GA). Cases with poor imaging quality were excluded. MRs were read by an expert to evaluate the presence of CNS abnormalities. Type of defect(TD), GA, upper lesion level(ULL) and several biometric parameters were also obtained. 38.8% of the fetuses were < 24 weeks and 61.2% 24-28 weeks. The ULL was in 6.8% thoracic, in 23.3% L1-L3, in 42.7% L4-L5 and in 27.2% sacral. 78% of defects were myelomeningocele(MMC) and 22% myeloschisis(MSS). In 48.5% of cases the corpus callosum was abnormal(ACC) and in 14.6% there was heterotopia(HT). Both abnormalities were more frequent in fetuses > 24 weeks (82% vs. 40.3% p < .001 and 86.6% vs. 55.9% p = .003, respectively). ACC was also more frequent when the ULL was higher (thoracic 44% vs. below L3 17.3% p < .001), when the lesion was longer (21.6mm vs. 17.9mm p < .001) and when there was kyphosis (12% vs. 0% p = 0.012). HT was more frequent in MSS (60% vs. 14.2% p < .001). Logistic regression showed four independent predictors for the described CNS abnormalities: ULL (OR 0.57 CI 0.35-0.92 p = .022), ventriculomegaly (OR 1.79 CI 1.30-2.49 p < .001), GA (OR 4.93 CI 1.13-21.35 p = .033) and TD (OR 16.53, CI 2.24-121.68 p = .006). Spina bifida aperta is associated to severe brain abnormalities in 51.4%. In this cross-sectional cohort these were more likely later in gestation, supporting the progressive nature of the condition. Other parameters such as type and length of the defect, ULL and ventriculomegaly were also independent predictors. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.