Prenatal Brain Imaging in Isolated vs. Complicated Club Foot: A Cohort Study

Abstract

Purpose: Talipes equinovarus (TEV) is a common birth defect. Differentiation between isolated and complex TEV is fundamental due to its effect on prognosis. Association between TEV and poor neurological outcome is more prominent in complex cases and highlights the significance of brain evaluation. The aim of the current study was to evaluate the contribution of fetal brain MRI to sonographic evaluation.

Materials and Methods: In this retrospective study we evaluated charts of all pregnant patients referred for fetal brain MRI due to fetal TEV between 1/1/2011 and 12/31/14 in a single tertiary referral center. Isolated and complex TEV were differentiated according to associated anomalies. Brain US and MRI results were compared.

Results: 28 pregnant patients were included with an average gestation and parity of 2.5 and 1.5, respectively. Both isolated and complicated TEV groups included 14 fetuses after initial TEV diagnosis on anatomical survey. Brain sonography and MRI were normal among 12/14 patients with isolated TEV while two patients were later diagnosed with mild ventriculomegaly. US brain evaluation has revealed pathologic findings in 4 (28.6 %) cases in the complicated TEV group, while MRI demonstrated abnormal findings in 8 (57.1 %) fetuses with notable severity diversity. In 6 cases, MRI diagnosed additional pathologies which were not demonstrated by US.

Conclusion: Brain fetal MRI is an efficient tool during antenatal evaluation of complicated TEV with a high percentage of additional findings not demonstrated songraphically while its efficacy in isolated cases is in doubt. The current study expands the relevance of fetal brain MRI in cases of non-CNS anomalies.

Zusammenfassung

Ziel: Pes equinovarus („telipes equinovarus“ TEV) ist eine häufige Geburtsfehlbildung. Die Unterscheidung zwischen isoliertem und komplexem Klumpfuß ist grundlegend, da es Auswirkung auf die Prognose hat. Ein Zusammenhang zwischen TEV und neurologischen Folgeerkrankungen tritt bei komplexen Fällen häufiger auf und unterstreicht den Stellenwert der Untersuchung des Gehirns. Das Ziel der gegenwärtigen Studie ist es, den Beitrag der fetalen Schädel-MRT im Vergleich zur Sonografie zu bewerten.

Material und Methoden: In dieser retrospektiven Studie untersuchten wir die Berichte aller Schwangeren eines einzigen Tertiärzentrum bei denen im Zeitraum vom 1.1.2001 – 31.12.2014 aufgrund eines fetalen TEV ein Schädel-MRT durchgeführt wurde. Die Unterscheidung zwischen isolierten und komplexen TEVs erfolgte aufgrund der assoziierten Anomalien. Die Ergebnisse von US und MRT des Schädels wurden verglichen.

Ergebnisse: Eingeschlossen wurden 28 Patienten mit durchschnittlich 2,5 Schwangerschaften und 1,5 Entbindungen. Beide Gruppen, isolierte und komplexe TEV, bestanden aus jeweils 14 Feten mit Erstdiagnose TEV bei der anatomischen Untersuchung. Ultraschall und MRT des Schädels waren bei 12/14 Patienten mit isoliertem TEV normal während bei zwei Patienten später die Diagnose milde Ventrikulomegalie gestellt wurde. In der Gruppe mit komplexen TEV entdeckte die Schädelsonografie pathologische Befunde bei 4 Fällen (28,6 %) und die MRT zeigte Abnormitäten bei 8 Feten (57,1 %) mit bemerkenswerter Erkrankungsvielfalt. In sechs Fällen diagnostizierte die MRT zusätzliche Erkrankungen, die nicht im US zu sehen waren.

Schlussfolgerung: Das fetale MRT des Gehirns ist eine effektive Methode zur vorgeburtlichen Bewertung eines komplexen TEV mit einem hohen Prozentsatz an sonografisch nicht gezeigten Zusatzbefunden; allerdings ist der Nutzen der MRT bei isolierten Fällen fraglich. Mit dieser Studie wird die Relevanz der fetalen MRT im Hinblick auf extrakranielle Anomalien erweitert.

Key words

club foot - talipes equinovarus - prenatal imaging - fetal brain MRI - neurosonogram

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