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Prenatal Diagnosis of Fetal Aqueductal Stenosis: A Multicenter Prospective Observational Study through the North American Fetal Therapy Network.
Emery, Stephen P; Lopa, Samia; Peterson, Erika; Jelin, Angie C; Treadwell, Marjorie C; Gebb, Juliana; Galan, Henry L; Bergh, Eric; Criebaum, Amanda; McLennan, Amelia; Lillegard, Joseph; Blumenfeld, Yair J.
Afiliação
  • Emery SP; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.
  • Lopa S; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.
  • Peterson E; Department of Obstetrics and Gynecology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
  • Jelin AC; Department of Gynecology and Obstetrics, Johns Hopkins University, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
  • Treadwell MC; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA.
  • Gebb J; Division of Pediatric General, Fetal and Thoracic Surgery, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
  • Galan HL; Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Children's Hospital Colorado, Denver, Colorado, USA.
  • Bergh E; Department of Obstetrics and Gynecology, University of Texas at Houston, Children's Memorial Hermann Hospital, Houston, Texas, USA.
  • Criebaum A; Department of Obstetrics and Gynecology, St. Louis Fetal Care Institute, St. Louis, Missouri, USA.
  • McLennan A; Department of Obstetrics and Gynecology, University of California Davis, UC Davis Medical Center, Sacramento, California, USA.
  • Lillegard J; Department of Surgery, Children's Minnesota, Minneapolis, Minnesota, USA.
  • Blumenfeld YJ; Department of Obstetrics and Gynecology, Stanford University, Stanford Medicine Children's Health Stanford, Palo Alto, California, USA.
Fetal Diagn Ther ; 51(3): 216-224, 2024.
Article em En | MEDLINE | ID: mdl-38320542
ABSTRACT

INTRODUCTION:

A critical component of an evidence-based reassessment of in-utero intervention for fetal aqueductal stenosis (fetal AS) is determining if the prenatal diagnosis can be accurately made at a gestational age amenable to in-utero intervention.

METHODS:

A multicenter, prospective, observational study was conducted through the North American Fetal Therapy Network (NAFTNet). Pregnancies complicated by severe central nervous system (CNS) ventriculomegaly (lateral ventricle diameter >15 mm) not secondary to a primary diagnosis (myelomeningocele, encephalocele, etc.) were recruited at diagnosis. Imaging and laboratory findings were recorded in an online REDCap database. After evaluation, investigators were asked to render their degree of confidence in the diagnosis of fetal AS. The prenatal diagnosis was compared to the postnatal diagnosis obtained through neonatal neuroimaging. Performance characteristics of ultrasound and magnetic resonance imaging (MRI) were calculated, as was the mean gestational age at diagnosis.

RESULTS:

Between April 2015 and October 2022, eleven NAFTNet centers contributed 64 subjects with severe fetal CNS ventriculomegaly. Of these, 56 had both prenatal and postnatal diagnoses recorded. Ultrasound revealed 32 fetal AS true positives, 4 false positives, 7 false negatives, and 13 true negatives, rendering a sensitivity of 0.82, a specificity of 0.76, a positive predictive value of 0.89, and a negative predictive value of 0.65. The mean gestational age at diagnosis by ultrasound was 25.5 weeks (std +/- 4.7 weeks). The proportion of agreement (true positive + true negative/n) was highest at 24 weeks gestation. For fetal MRI (n = 35), the sensitivity for fetal AS was 0.95, specificity was 0.69, positive predictive value was 0.84, and negative predictive value was 0.90. MRI was performed at 25 weeks on average.

CONCLUSION:

The prenatal diagnosis of fetal AS can be made with accuracy at a gestational age potentially amenable to in-utero intervention. Only 7% of subjects were incorrectly diagnosed prenatally with fetal AS by ultrasound and 11% by MRI. Diagnostic accuracy of fetal AS will likely improve with increased experience.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diagnóstico Pré-Natal / Ultrassonografia Pré-Natal / Hidrocefalia Tipo de estudo: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Fetal Diagn Ther Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diagnóstico Pré-Natal / Ultrassonografia Pré-Natal / Hidrocefalia Tipo de estudo: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Fetal Diagn Ther Ano de publicação: 2024 Tipo de documento: Article