Diagnostic assessment of foetal brain malformations with intra-uterine MRI versus perinatal post-mortem MRI.

PURPOSE: To evaluate differences in diagnostic yield of intra-uterine foetal (iuMR) and post-mortem MRI (PMMR) for complex brain malformations, using autopsy as the reference standard. METHODS: In this retrospective, multicentre study spanning 2 years, we reviewed 13 terminated singleton pregnancies with a prenatal ultrasound finding of complex foetal cerebral abnormalities, referred for both iuMR and PMMR. The iuMR and PMMR studies of the brain were reported independently by two groups of radiologists, blinded to each other's reports. Descriptive statistics were used to compare differences in intracranial abnormalities with autopsy (and genetic testing, where present) as reference standard. RESULTS: The median gestational age at termination was 24.6 weeks (IQR 22-29) with median time between delivery and PMMR of 133 h (IQR 101-165). There was full concordance between iuMR and PMMR findings and autopsy in 2/13 (15.3%) cases. Partial concordance between both imaging modalities was present in 6/13 (46.2%) and total discordance in the remainder (5/13, 38.5%). When compared to autopsy, PMMR missed important key findings specifically for neuronal migration and cerebellar anomalies, whereas iuMR appeared to overcall CSF space abnormalities which were less crucial to reaching the final overall diagnosis. CONCLUSIONS: iuMR should be performed to improve foetal phenotyping where there is a prenatal ultrasound for complex foetal brain abnormalities. Reliance on PMMR alone is likely to result in misdiagnosis in a majority of cases.

Musculoskeletal tuberculosis - imaging using low-end and advanced modalities for developing and developed countries.

Musculoskeletal involvement by TB is rare in comparison to other forms of the disease. It most commonly involves the spine but can also involve large weight-bearing joints, long bones, the skull and the soft tissues. Characteristic appearances of musculoskeletal TB are described for numerous imaging modalities in this paper but it is also highlighted that when based on imaging appearances alone, there is always a differential diagnosis, including other infections and malignancies. Awareness of of TB as a possible cause of vertebral body lesions, arthritis and synovitis, long bone lesions and soft tissue collections will allow clinicians to consider TB based on imaging and will sometimes be characteristic enough to allow for a trial of therapy, thereby avoiding biopsy. This paper specifically describes the imaging appearances on both basic modalities such as plain radiographs and ultrasound for those working in resource-restricted areas, as well as on high-end modalities such as CT and MRI for those with access to these. Tuberculosis is no longer a disease limited to the developing world and radiologists in the developed world must be able to make this diagnosis in both immigrants and the native population.