SlideShare une entreprise Scribd logo
1  sur  11
Télécharger pour lire hors ligne
UOG Journal Club: November 2012
    Callosal dysgenesis in fetuses with ventriculomegaly: levels
 of agreement between imaging modalities and postnatal outcome

 Li Y, Estroff JA, Khwaja O, Mehta TS, Poussaint TY, Robson CD, Feldman HA,
                                Ware J, Levine D
            Volume 40, Issue 5, Date: November 2012, pages 522–529




                      Journal Club slides prepared by Dr Aly Youssef
                      (UOG Editor for Trainees)
•   Ventriculomegaly (lateral ventricles ≥ 10 mm) is often the first
    ultrasonographic sign of corpus callosum (CC) abnormalities

•   Corpus callosum abnormalities are often associated with central
    nervous system (CNS), chromosomal, syndromic and other structural
    abnormalities

•   Main limitations of the existing studies on CC abnormalities are:
    o the limited prenatal and/or postnatal assessment
    o attrition is common due to termination of pregnancy or loss to
      follow-up

•   The actual data on the outcome of fetuses with callosal abnormalities
    is limited and varies widely in the literature
Callosal dysgenesis in fetuses with ventriculomegaly: levels
of agreement between imaging modalities and postnatal outcome
                        Li et al., UOG 2012




   The aim of the present study was to assess
neurodevelopmental outcome in fetuses diagnosed
with isolated and non-isolated callosal abnormalities
       following referral for ventriculomegaly
Callosal dysgenesis in fetuses with ventriculomegaly: levels
       of agreement between imaging modalities and postnatal outcome
                                     Li et al., UOG 2012

                                       Methods I
Sub-analysis of a prospective study including 430 fetuses referred for ventriculomegaly.
Ultrasound (transabdominal and/or transvaginal) and MRI performed in all cases in the axial
(A), coronal (B) and sagittal planes (C). Sub-analysis included fetuses with a diagnosis of
corpus callosal abnormalities after recruitment into the main study.
                      A                 B                  C
         Ultrasound




                                                                    Complete agenesis of
                                                                    the corpus callosum at
                                                                    26 weeks’ gestation in a
                                                                    fetus     with    lateral
                                                                    ventricular
                                                                    measurement of 10 mm
         MRI
Callosal dysgenesis in fetuses with ventriculomegaly: levels
       of agreement between imaging modalities and postnatal outcome
                                   Li et al., UOG 2012

                                     Methods II
•   Between 3–6 radiologists independently reviewed ultrasound and MR images
    and final diagnoses decided by consensus
•   All callosal abnormalities (hypoplasia, complete agenesis, partial agenesis) were
    combined into a single group
•   Patients with callosal abnormalities were further subdivided into two groups:
     o Isolated (no additional abnormalities)
     o Non-isolated (associated CNS, karyotypic, syndromic or other major
         abnormalities)
•   Pregnancy and postnatal outcomes in fetuses with callosal abnormalities
    (including neurodevelopment at 6 months, 1, 2, and 3 years) were compared
    between those with (non-isolated) and those without (isolated) other
    abnormalities
Callosal dysgenesis in fetuses with ventriculomegaly: levels
       of agreement between imaging modalities and postnatal outcome
                                       Li et al., UOG 2012

                                  Results I
                                      430      women referred for ventriculomegaly



                                       58        prenatal diagnosis of callosal abnormalities
                                     (13%)



             Isolated                                        Non-isolated

                14                                                44
              (24%)                                             (76%)
• The kappa statistic for preconference agreement was 0.76 for ultrasound readers and 0.78
for MRI readers, indicating that both investigations had a similar level of operator dependence
• There were more true positives and false positives by MRI readers than by ultrasound
readers
Callosal dysgenesis in fetuses with ventriculomegaly: levels
         of agreement between imaging modalities and postnatal outcome
                                                       Li et al., UOG 2012

                                                          Results II
                                                          Prenatal consensus diagnosis
           Characteristic                             Isolated callosal                 Non-isolated callosal              P-value ‡
                                                       abnormalities                      abnormalities
                                                           (n = 14)                           (n = 44)
Prenatal assessment
 Gestational age at imaging (weeks)                    30.7 ± 4.8 (20–38)                   26.2 ± 6.3 (19–38)                 0.02

 Abnormal karyotype                                             0                                    17                       0.008
 Ventricular diameter (mm)                             15.8 ± 3.3 (11–21)                    13.9 ± 5.6 (8–42)                 0.02

Pregnancy outcome
 Termination                                                    2                                    12                        0.48

 Neonatal demise                                               0/12                                 1/31†                     > 0.99

 Gestational age at birth (weeks)                      39.6 ± 0.8 (39–41)                   37.8 ± 1.6 (34–41)                0.003

Data shown as mean ± SD (range), n or n/total.
†One patient lost to birth outcome follow-up. ‡ Mann–Whitney test (continuous variables) or Fisher’s exact test (discrete variables).
Callosal dysgenesis in fetuses with ventriculomegaly: levels
           of agreement between imaging modalities and postnatal outcome
                                                        Li et al., UOG 2012

                                                           Results III
                                                                    Prenatal consensus diagnosis
                  Characteristic                              Isolated callosal           Non-isolated   P-value *
                                                               abnormalities                callosal
                                                                   (n = 14)              abnormalities
                                                                                            (n = 44)

Neurodevelopmental outcome                                                                                 0.003
  Number with neurodevelopmental follow-up                              12                    27
  Normal or mild delays that resolved                            67% (8/12)§               7% (2/27)
  Mild delays that persisted                                      8% (1/12)§              22% (6/27)
  Moderate to severe delays/abnormalities                        25% (3/12)§              70% (19/27)


Data shown as n or % (n/total).
§ Includes children with postnatal CNS abnormalities that were not detected prenatally
* Fisher’s exact test (discrete variables)
Callosal dysgenesis in fetuses with ventriculomegaly: levels
      of agreement between imaging modalities and postnatal outcome
                                Li et al., UOG 2012

                               Discussion
• Callosal abnormalities are present in a significant proportion of fetuses with
  ventriculomegaly (13% in the present study)
• Normal neurodevelopment was observed in approximately two-thirds of fetuses
  with isolated callosal abnormalities, and less than 10% of non-isolated cases
• Both ultrasound and MRI have substantial interrater agreement in the prenatal
  diagnosis of CC anomalies, while MRI showed more true-positive and false-
  positive diagnoses than did ultrasound
• Many associated anomalies in prenatally diagnosed isolated and non-isolated
  callosal anomalies became apparent only later in gestation or postnatally.
  This should be considered in counseling patients at the time of diagnosis of
  callosal abnormalities.
Callosal dysgenesis in fetuses with ventriculomegaly: levels
       of agreement between imaging modalities and postnatal outcome
                               Li et al., UOG 2012


                        Strengths of the study
•   Study population embedded within a prospectively enrolled cohort of
    fetuses
•   Large sample size of patients with callosal abnormalities
•   Standardized and specialist evaluations by pediatric neurologists and/or
    pediatric psychologists
•   Long period of postnatal follow-up (up to 5 years of age)

                              Limitations
• Population included is a part of a cohort of fetuses referred for
  ventriculomegaly. Therefore, no data can be provided on prenatally
  diagnosed callosal abnormalities without ventriculomegaly.
Callosal dysgenesis in fetuses with ventriculomegaly: levels
     of agreement between imaging modalities and postnatal outcome
                             Li et al., UOG 2012


                       Discussion points
• Should all women with prenatal diagnosis of callosal abnormalities be
  referred for expert ultrasound assessment?
• Should fetal karyotype determination be routinely offered to these
  women?
• Should MRI be routinely performed in all cases with prenatal diagnosis
  of callosal abnormalities?
• How can the present data guide the clinician in the counseling of women
  with prenatal diagnosis of isolated and non-isolated CC abnormalities?
• Should these women be offered specialist evaluation later in pregnancy?

Contenu connexe

Tendances

Sally's Miraculous Hospital Experience
Sally's Miraculous Hospital ExperienceSally's Miraculous Hospital Experience
Sally's Miraculous Hospital ExperienceZodiac Aerospace
 
Case Review #3: 44 year old male with a subadjacent disc herniation
Case Review #3: 44 year old male with a subadjacent disc herniationCase Review #3: 44 year old male with a subadjacent disc herniation
Case Review #3: 44 year old male with a subadjacent disc herniationRobert Pashman
 
APROP TREATMENT
APROP TREATMENT APROP TREATMENT
APROP TREATMENT AjayDudani1
 
Aberrations After the Treatment of a Corneal Scar
Aberrations After the Treatment of a Corneal ScarAberrations After the Treatment of a Corneal Scar
Aberrations After the Treatment of a Corneal Scarparkavenuelasek
 
Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]
Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]
Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]Lasermed Tic
 
Sling ad incisione singola
Sling ad incisione singolaSling ad incisione singola
Sling ad incisione singolaGLUP2010
 
Resultados preliminares do implante de um novo anel associado ao PRK para pre...
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Resultados preliminares do implante de um novo anel associado ao PRK para pre...
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
 

Tendances (11)

Sally's Miraculous Hospital Experience
Sally's Miraculous Hospital ExperienceSally's Miraculous Hospital Experience
Sally's Miraculous Hospital Experience
 
Case Review #3: 44 year old male with a subadjacent disc herniation
Case Review #3: 44 year old male with a subadjacent disc herniationCase Review #3: 44 year old male with a subadjacent disc herniation
Case Review #3: 44 year old male with a subadjacent disc herniation
 
Percutaneous lumbar nucleoplasty
Percutaneous lumbar nucleoplastyPercutaneous lumbar nucleoplasty
Percutaneous lumbar nucleoplasty
 
Panel of challenging cases
Panel of challenging casesPanel of challenging cases
Panel of challenging cases
 
APROP TREATMENT
APROP TREATMENT APROP TREATMENT
APROP TREATMENT
 
Aberrations After the Treatment of a Corneal Scar
Aberrations After the Treatment of a Corneal ScarAberrations After the Treatment of a Corneal Scar
Aberrations After the Treatment of a Corneal Scar
 
Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]
Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]
Highlights experts meeting_vienna_2011_crst_esup_feb2012[1]
 
Sling ad incisione singola
Sling ad incisione singolaSling ad incisione singola
Sling ad incisione singola
 
12 large case series
12 large case series12 large case series
12 large case series
 
Resultados preliminares do implante de um novo anel associado ao PRK para pre...
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Resultados preliminares do implante de um novo anel associado ao PRK para pre...
Resultados preliminares do implante de um novo anel associado ao PRK para pre...
 
Sponlyloptosis
SponlyloptosisSponlyloptosis
Sponlyloptosis
 

Similaire à UOG Journal Club: Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome

20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...
20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...
20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...Roberto Scarafia
 
Pregnancy of unknown location
Pregnancy of unknown locationPregnancy of unknown location
Pregnancy of unknown locationAhmad Saber
 
Pgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastakiPgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastaki鋒博 蔡
 
Pgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastakiPgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastaki鋒博 蔡
 
Pgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastakiPgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastaki鋒博 蔡
 
Prenatal evaluation and postnatal early outcomes of fetal
Prenatal evaluation and postnatal early outcomes of fetalPrenatal evaluation and postnatal early outcomes of fetal
Prenatal evaluation and postnatal early outcomes of fetalJegon Varakala
 
Chaoui 2016 csp 22q11 giãn khoang vách trong suốt
Chaoui 2016 csp 22q11 giãn khoang vách trong suốtChaoui 2016 csp 22q11 giãn khoang vách trong suốt
Chaoui 2016 csp 22q11 giãn khoang vách trong suốtVõ Tá Sơn
 
Time lapse observations
Time lapse observations Time lapse observations
Time lapse observations Kosmogonia IVF
 
Controversies in prenatal diagnosis 3 should everyone
Controversies in prenatal diagnosis 3 should everyoneControversies in prenatal diagnosis 3 should everyone
Controversies in prenatal diagnosis 3 should everyoneLuis Carlos Murillo Valencia
 
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...Apollo Hospitals
 
Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...
Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...
Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...Walid Ahmed
 
Uterine anomalies and reproductive outcomes
Uterine anomalies and reproductive outcomesUterine anomalies and reproductive outcomes
Uterine anomalies and reproductive outcomesWaled Ayad
 

Similaire à UOG Journal Club: Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome (20)

20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...
20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...
20150918 E. Pompilii - Microarray in diagnosi prenatale: la complessità della...
 
Pregnancy of unknown location
Pregnancy of unknown locationPregnancy of unknown location
Pregnancy of unknown location
 
Pgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastakiPgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastaki
 
Pgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastakiPgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastaki
 
Pgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastakiPgd an overview_dr.laila_bastaki
Pgd an overview_dr.laila_bastaki
 
Prenatal evaluation and postnatal early outcomes of fetal
Prenatal evaluation and postnatal early outcomes of fetalPrenatal evaluation and postnatal early outcomes of fetal
Prenatal evaluation and postnatal early outcomes of fetal
 
UOG Journal Club: Perinatal and long-term outcomes in fetuses diagnosed with ...
UOG Journal Club: Perinatal and long-term outcomes in fetuses diagnosed with ...UOG Journal Club: Perinatal and long-term outcomes in fetuses diagnosed with ...
UOG Journal Club: Perinatal and long-term outcomes in fetuses diagnosed with ...
 
UOG Journal Club: Postmortem examination of human fetal hearts at or below 20...
UOG Journal Club: Postmortem examination of human fetal hearts at or below 20...UOG Journal Club: Postmortem examination of human fetal hearts at or below 20...
UOG Journal Club: Postmortem examination of human fetal hearts at or below 20...
 
Ida vogel nnfm 150415
Ida vogel nnfm 150415Ida vogel nnfm 150415
Ida vogel nnfm 150415
 
UOG Journal Club: Prenatal diagnosis and outcome of fetal posterior fossa flu...
UOG Journal Club: Prenatal diagnosis and outcome of fetal posterior fossa flu...UOG Journal Club: Prenatal diagnosis and outcome of fetal posterior fossa flu...
UOG Journal Club: Prenatal diagnosis and outcome of fetal posterior fossa flu...
 
UOG Journal Club: Relationship of isolated single umbilical artery to fetal g...
UOG Journal Club: Relationship of isolated single umbilical artery to fetal g...UOG Journal Club: Relationship of isolated single umbilical artery to fetal g...
UOG Journal Club: Relationship of isolated single umbilical artery to fetal g...
 
Chaoui 2016 csp 22q11 giãn khoang vách trong suốt
Chaoui 2016 csp 22q11 giãn khoang vách trong suốtChaoui 2016 csp 22q11 giãn khoang vách trong suốt
Chaoui 2016 csp 22q11 giãn khoang vách trong suốt
 
Time lapse observations
Time lapse observations Time lapse observations
Time lapse observations
 
Controversies in prenatal diagnosis 3 should everyone
Controversies in prenatal diagnosis 3 should everyoneControversies in prenatal diagnosis 3 should everyone
Controversies in prenatal diagnosis 3 should everyone
 
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
 
UOG Journal Club: Neurodevelopmental outcome of fetuses with increased nuchal...
UOG Journal Club: Neurodevelopmental outcome of fetuses with increased nuchal...UOG Journal Club: Neurodevelopmental outcome of fetuses with increased nuchal...
UOG Journal Club: Neurodevelopmental outcome of fetuses with increased nuchal...
 
Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...
Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...
Early Pregnancy Loss a Simplified Ultrasound Approche Dr/ Ahmed Walid Anwar M...
 
Unusual ectopic pregnancies
Unusual ectopic pregnanciesUnusual ectopic pregnancies
Unusual ectopic pregnancies
 
Uterine anomalies and reproductive outcomes
Uterine anomalies and reproductive outcomesUterine anomalies and reproductive outcomes
Uterine anomalies and reproductive outcomes
 
UOG Journal Club: Perinatal outcome in women treated with progesterone for th...
UOG Journal Club: Perinatal outcome in women treated with progesterone for th...UOG Journal Club: Perinatal outcome in women treated with progesterone for th...
UOG Journal Club: Perinatal outcome in women treated with progesterone for th...
 

Dernier

Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Forensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentationForensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentationKavitha Krishnan
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 

Dernier (20)

Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Forensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentationForensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentation
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 

UOG Journal Club: Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome

  • 1. UOG Journal Club: November 2012 Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li Y, Estroff JA, Khwaja O, Mehta TS, Poussaint TY, Robson CD, Feldman HA, Ware J, Levine D Volume 40, Issue 5, Date: November 2012, pages 522–529 Journal Club slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
  • 2. Ventriculomegaly (lateral ventricles ≥ 10 mm) is often the first ultrasonographic sign of corpus callosum (CC) abnormalities • Corpus callosum abnormalities are often associated with central nervous system (CNS), chromosomal, syndromic and other structural abnormalities • Main limitations of the existing studies on CC abnormalities are: o the limited prenatal and/or postnatal assessment o attrition is common due to termination of pregnancy or loss to follow-up • The actual data on the outcome of fetuses with callosal abnormalities is limited and varies widely in the literature
  • 3. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 The aim of the present study was to assess neurodevelopmental outcome in fetuses diagnosed with isolated and non-isolated callosal abnormalities following referral for ventriculomegaly
  • 4. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Methods I Sub-analysis of a prospective study including 430 fetuses referred for ventriculomegaly. Ultrasound (transabdominal and/or transvaginal) and MRI performed in all cases in the axial (A), coronal (B) and sagittal planes (C). Sub-analysis included fetuses with a diagnosis of corpus callosal abnormalities after recruitment into the main study. A B C Ultrasound Complete agenesis of the corpus callosum at 26 weeks’ gestation in a fetus with lateral ventricular measurement of 10 mm MRI
  • 5. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Methods II • Between 3–6 radiologists independently reviewed ultrasound and MR images and final diagnoses decided by consensus • All callosal abnormalities (hypoplasia, complete agenesis, partial agenesis) were combined into a single group • Patients with callosal abnormalities were further subdivided into two groups: o Isolated (no additional abnormalities) o Non-isolated (associated CNS, karyotypic, syndromic or other major abnormalities) • Pregnancy and postnatal outcomes in fetuses with callosal abnormalities (including neurodevelopment at 6 months, 1, 2, and 3 years) were compared between those with (non-isolated) and those without (isolated) other abnormalities
  • 6. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Results I 430 women referred for ventriculomegaly 58 prenatal diagnosis of callosal abnormalities (13%) Isolated Non-isolated 14 44 (24%) (76%) • The kappa statistic for preconference agreement was 0.76 for ultrasound readers and 0.78 for MRI readers, indicating that both investigations had a similar level of operator dependence • There were more true positives and false positives by MRI readers than by ultrasound readers
  • 7. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Results II Prenatal consensus diagnosis Characteristic Isolated callosal Non-isolated callosal P-value ‡ abnormalities abnormalities (n = 14) (n = 44) Prenatal assessment Gestational age at imaging (weeks) 30.7 ± 4.8 (20–38) 26.2 ± 6.3 (19–38) 0.02 Abnormal karyotype 0 17 0.008 Ventricular diameter (mm) 15.8 ± 3.3 (11–21) 13.9 ± 5.6 (8–42) 0.02 Pregnancy outcome Termination 2 12 0.48 Neonatal demise 0/12 1/31† > 0.99 Gestational age at birth (weeks) 39.6 ± 0.8 (39–41) 37.8 ± 1.6 (34–41) 0.003 Data shown as mean ± SD (range), n or n/total. †One patient lost to birth outcome follow-up. ‡ Mann–Whitney test (continuous variables) or Fisher’s exact test (discrete variables).
  • 8. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Results III Prenatal consensus diagnosis Characteristic Isolated callosal Non-isolated P-value * abnormalities callosal (n = 14) abnormalities (n = 44) Neurodevelopmental outcome 0.003 Number with neurodevelopmental follow-up 12 27 Normal or mild delays that resolved 67% (8/12)§ 7% (2/27) Mild delays that persisted 8% (1/12)§ 22% (6/27) Moderate to severe delays/abnormalities 25% (3/12)§ 70% (19/27) Data shown as n or % (n/total). § Includes children with postnatal CNS abnormalities that were not detected prenatally * Fisher’s exact test (discrete variables)
  • 9. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Discussion • Callosal abnormalities are present in a significant proportion of fetuses with ventriculomegaly (13% in the present study) • Normal neurodevelopment was observed in approximately two-thirds of fetuses with isolated callosal abnormalities, and less than 10% of non-isolated cases • Both ultrasound and MRI have substantial interrater agreement in the prenatal diagnosis of CC anomalies, while MRI showed more true-positive and false- positive diagnoses than did ultrasound • Many associated anomalies in prenatally diagnosed isolated and non-isolated callosal anomalies became apparent only later in gestation or postnatally. This should be considered in counseling patients at the time of diagnosis of callosal abnormalities.
  • 10. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Strengths of the study • Study population embedded within a prospectively enrolled cohort of fetuses • Large sample size of patients with callosal abnormalities • Standardized and specialist evaluations by pediatric neurologists and/or pediatric psychologists • Long period of postnatal follow-up (up to 5 years of age) Limitations • Population included is a part of a cohort of fetuses referred for ventriculomegaly. Therefore, no data can be provided on prenatally diagnosed callosal abnormalities without ventriculomegaly.
  • 11. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome Li et al., UOG 2012 Discussion points • Should all women with prenatal diagnosis of callosal abnormalities be referred for expert ultrasound assessment? • Should fetal karyotype determination be routinely offered to these women? • Should MRI be routinely performed in all cases with prenatal diagnosis of callosal abnormalities? • How can the present data guide the clinician in the counseling of women with prenatal diagnosis of isolated and non-isolated CC abnormalities? • Should these women be offered specialist evaluation later in pregnancy?