Fetal brain abnormalities have a relatively high incidence and can be accompanied by significant clinical morbidities and complications. A recently published prospective study called the MERIDIAN study demonstrated that in utero MRI (iuMRI), as an adjunct to ultrasound imaging, may improve the accuracy of clinical diagnoses, prognoses, and overall management strategies.
Fetal brain abnormalities are concerning because of their high incidence (approximately 3 in 1,000 pregnancies) and the risk of accompanying morbidities and complications. In the United Kingdom, ultrasonography (ultrasound imaging) is the primary diagnostic and prognostic tool used for detecting fetal brain abnormalities. Clinicians and researchers around the world agree, however, that ultrasound imaging alone may be insufficient for accurate diagnoses. It has been proposed that in utero MRI (iuMRI) imaging may be a useful adjunct, to ultrasonography, and could yield more accurate and reliable diagnoses and treatment strategies.
A recently published study, called the MERIDIAN, is a multicenter, prospective study that investigated whether iuMRI can be a valuable adjunct to ultrasound imaging for fetal brain abnormalities. The MERIDIAN study included a total of 570 fetuses who showed fetal brain abnormalities with ultrasonography. Health care providers were asked to record how certain they were of their diagnoses after ultrasonography alone, and subsequently after iuMRI. The study revealed that overall diagnostic accuracy was higher using iuMRI (93%), in comparison to ultrasonography (68%). It was also demonstrated that the proportion of high confidence diagnoses increased by nearly 13% after iuMRI. This suggests that iuMRI imaging allowed clinicians to make more confident decisions in regards to diagnoses and prognoses.
Furthermore, in 26% of the cases, iuMRI brought about significant clinical changes including how mothers were counseled and managed. It also significantly influenced important decision making in an additional 9% of cases. It is important to note that iuMRI is a relatively safe procedure that was readily acceptable by mothers. In fact, more than 80% of the mothers noted that iuMRI information significantly helped them understand their baby’s condition. In addition, 70% also agreed that the iuMRI information helped them understand how the pathology could affect the child’s quality of life. Overall, the study demonstrates that iuMRI, in adjunct to ultrasonography, can improve diagnostic, prognostic, and management decisions.
The MERIDIAN study showed that iuMRI, in conjunction with ultrasound imaging, can improve diagnostic accuracy, help clinicians make more confident decisions, and assist in making appropriate management and counseling strategies. The technique is completely safe, readily acceptable, and provides the mother with further insight into understanding the baby’s condition. The authors propose that fetuses with suspected brain abnormalities on ultrasound should have iuMRI before clinicians and health care providers make any decision on diagnoses, prognosis, and counseling.
Written By: Haisam Shah, BSc