Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Feb;64(2):233-245.
doi: 10.1007/s00234-021-02853-1. Epub 2021 Nov 18.

What brain abnormalities can magnetic resonance imaging detect in foetal and early neonatal spina bifida: a systematic review

Nada Mufti  1   2 , Adalina Sacco  1   3 , Michael Aertsen  4 , Fred Ushakov  3 , Sebastian Ourselin  2 , Dominic Thomson  5 , Jan Deprest  1   6 , Andrew Melbourne  2 , Anna L David  1   6
Affiliations
Meta-Analysis

What brain abnormalities can magnetic resonance imaging detect in foetal and early neonatal spina bifida: a systematic review

Nada Mufti et al. Neuroradiology. 2022 Feb.

Abstract

Purpose: Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound.

Methods: Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible.

Results: Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse.

Conclusion: MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.

Keywords: Foetal surgery; Intracranial anomaly; MRI; Spina bifida; Systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flow diagram for study selection of systematic review comparing MRI to ultrasound in detection of additional brain abnormalities in foetal and early neonatal spina bifida. Adapted from PRISMA 2008 [25]
Fig. 2
Fig. 2
Flow diagram for study selection of systematic review on detection of brain abnormalities by MRI in foetuses diagnosed with OSB by ultrasound. Adapted from PRISMA 2008 [25]
Fig. 3
Fig. 3
Graphical timeline display of all studies in both systematic reviews according to spina bifida surgery type
Fig. 4
Fig. 4
Types of postnatal confirmation in systematic review (SR) 1 (left) and SR2 (right)
See this image and copyright information in PMC

References

    1. Scott Adzick N, Thom EA, Spong CY, Brock JW, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D’Alton ME, Farmer DL. A randomised trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011;364:993–1004. doi: 10.1056/NEJMoa1014379. - DOI - PMC - PubMed
    1. Araujo Junior E, Nakano ML, Nardozza LM, Haratz KK, Oliveira PS, Martins WP, Ajzen SA, Moron AF. Comparison between 2D ultrasonography and magnetic resonance imaging for assessing brain and spine parameters in fetuses with spina bifida. Arch Gynecol Obstet. 2013;287(5):845–849. doi: 10.1007/s00404-012-2656-0. - DOI - PubMed
    1. Calle S, Bonfante E, Simmons G, Rogers J, Sitton C, Hughes K, Papanna RM, Riascos R, Patel R. Postnatal intracranial findings following fetal repair of spinal dysraphisms. J Comput Assist Tomogr. 2020;44(1):65–69. doi: 10.1097/RCT.0000000000000962. - DOI - PubMed
    1. Geerdink N, van der Vliet T, Rotteveel JJ, Feuth T, Roeleveld N, Mullaart RA. Essential features of Chiari II malformation in MR imaging: an interobserver reliability study–part 1. Childs Nerv Syst. 2012;28(7):977–985. doi: 10.1007/s00381-012-1761-5. - DOI - PMC - PubMed
    1. Geerdink N, van der Vliet T, Rotteveel JJ, Feuth T, Roeleveld N, Mullaart RA. Interobserver reliability and diagnostic performance of Chiari II malformation measures in MR imaging–part 2. Childs Nerv Syst. 2012;28(7):987–995. doi: 10.1007/s00381-012-1763-3. - DOI - PMC - PubMed