Prevalence and timing of pregnancy termination for brain malformations.

OBJECTIVE: To determine the prevalence and the timing of pregnancy termination relative to the type of central nervous system (CNS) malformations. Design Retrospective cohort study. SETTING: Multidisciplinary centre for prenatal diagnosis in the Languedoc-Roussillon region, France. POPULATION: A cohort of 481 pregnancy terminations performed between 2005 and 2009. METHODS: Detailed post-termination fetal and neuropathological analyses were carried out to identify the CNS malformations. Then, the prevalence and timing of pregnancy termination were assessed relative to the identified malformations. RESULTS: About one-third of pregnancy terminations (143/481) were performed for severe CNS malformations. Up to 24 weeks of gestation (WG), pregnancy terminations (56.6%) were carried out mainly for defects occurring during the two major first steps of CNS development (neurulation and differentiation of cerebral vesicles). After 24 WG, pregnancy terminations (43.3%) were mainly performed for corpus callosum agenesis (16/17), vermian agenesis (10/12) and gyral anomalies (13/15). For hindbrain malformations and gyral anomalies, there was a significant relationship between the timing of pregnancy termination and the presence of a severe ventriculomegaly at prenatal diagnosis (p=0.002 and p=0.02, respectively). CONCLUSION: By classifying CNS malformations according to the neuropathological analysis, the authors show that the timing and prevalence of pregnancy termination are distributed in a manner that is consistent with what is currently known on the development of brain. They are also influenced by the French prenatal screening policy and the variable expressivity of the brain malformations and associated lesions.

Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR images.

OBJECTIVES: To determine the value of postcontrast MR imaging (MRI) in cases of suspected pelvic endometriosis by assessing interobserver variability of MR imaging according to the endometriotic locations. METHODS: This retrospective study included 158 patients with clinical suspicion of endometriosis who had undergone surgery after MRI between January 2004 and April 2009. Three radiologists with different degrees of experience were independently asked to determine the presence of rectosigmoid colon, vaginal, and bladder endometriosis using both conventional and a combination of conventional and postcontrast MRI. Descriptive analysis, ROC analysis and interobserver agreements (kappa values) were calculated. RESULTS: Rectosigmoid colon, vaginal, and bladder endometriosis was present in 65, 39 and eight patients, respectively. The accuracy of conventional assessment for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.2%, 74.1% and 96.8%, and 73.4%, 76.6% and 98.7%, and 86.1%, 88.6% and 99.4%, respectively. The accuracy of conventional and postcontrast MR images for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.8%, 78.5% and 98.1%, and 83.5%, 83.5% and 99.4%, and 87.3%, 89.2% and 99.4%, respectively. CONCLUSIONS: Interobserver variability of MRI using conventional MRI alone is excellent for the diagnosis of DPE. No significant benefit of intravenous gadolinium, rectal or vaginal administration has been demonstrated.

Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis.

BACKGROUND: Thin-section oblique axial magnetic resonance imaging (MRI) is useful in staging endometrial and cervical carcinomas but there are no data on its contribution to assessing deep endometriosis. We evaluated the contribution of this MRI technique to diagnosis of uterosacral ligament (USL) endometriosis. METHODS: In this retrospective study, two radiologists, who were blinded to the surgical and histological results, compared the results from conventional sagittal and axial MRI with those from conventional plus thin-section (3 mm) oblique axial MRI in 100 symptomatic patients. Descriptive statistical analyses including sensitivity, specificity, positive and negative predictive values, accuracy and positive and negative likelihood ratios were performed. Kappa for inter-observer agreement was calculated. RESULTS: Conventional MR images for the diagnosis of left/right USL endometriosis revealed accuracies of 69/76 and 59/75%, sensitivities of 66/71 and 52/71% and specificities of 76/86 and 76/82% for senior and junior readers, respectively. The combination of conventional and thin-section oblique axial MR images revealed accuracies of 82/87 and 74/81%, sensitivities of 89/93 and 73/81% and specificities of 61/72 and 76/79%, for senior and junior readers, respectively. When conventional MRI combined with oblique axial T2-weighted MRI was compared with conventional MRI use only, significant differences in diagnostic accuracies were observed for right (P = 0.04) and left (P = 0.01) USL endometriosis. CONCLUSIONS: Thin-section oblique axial T2-weighted imaging can improve the success of conventional MRI for assessment of USL endometriosis. Further prospective studies are required before this new MR protocol is performed routinely for suspected pelvic endometriosis.