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To evaluate whether fetal magnetic resonance imaging (MRI) provides additional information to that obtained from prenatal ultrasound and does the additional information alter clinical management.
This is a retrospective review of patients presenting for fetal MRI after being referred for an anomaly diagnosed at our prenatal ultrasound unit (2001-2011) between 18-37 weeks gestation. Data was abstracted to compare the ultrasound (US) diagnosis to the MRI diagnosis. We then evaluated if the MRI changed clinical management by chart review and physician survey. There was considered to be a change in management if the MRI diagnosis changed counseling, initiated discussion of comfort care or pregnancy termination, prompted a surgical referral, stopped further imaging, or changed mode of delivery. Statistical analysis included chi-square or Fisher's exact test where appropriate.
Three hundred and twenty-eight patients had both a fetal US and MRI at our institution. The most frequent indication for MRI was for abnormalities of the central nervous system (53%) 174/328. In 109 cases (33.2%), MRI confirmed the US diagnosis, and in 106 cases (32.3%) MRI confirmed the diagnosis but made additional findings. MRI changed the US diagnosis to a different diagnosis in 74 cases (22.6%) and changed the diagnosis to normal in 39 cases (11.9%). Overall MRI provided additional diagnostic information or changed the diagnosis in 65.5% of cases, which lead to a change in clinical management in 203(61.9%) of cases. In 139(68.4%) women, the MRI changed the diagnosis and resulted in a change in counseling, compared to 54( 43.2%) where MRI did not change the diagnosis nor counseling(p=0.03).
Ultrasound is the screening method of choice for evaluation of the fetus. MRI can be a useful adjuvant and can provide useful information that results in a change in clinical management. The most common change in clinical management was a change in parental counseling.