Scientific and clinical background Ultrasonography and fetal screening For many years, fetal imaging with ultrasonography has been the mainstay of antenatal screening programmes in the UK. However, no imaging method is perfect and various technical factors bd3 escort physical limitations of ultrasonography may result in suboptimal images of the fetus being obtained.
Suboptimal images may lead to incorrect diagnoses of structural abnormalities and inaccurate counselling and prognostic information being given to parents. Development of magnetic resonance imaging Magnetic resonance imaging MRI technology has advanced over the years and because of ificant improvements in spatial and contrast resolution, highly reliable and accurate diagnoses of comparable pathology can now be made for children.
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In the s, MRI became a realistic clinical possibility because of mwridian in hardware and software. Magnetic resonance imaging in the literature: diagnostic accuracy Much of the early literature focused on describing the techniques required to perform iuMRI and relied on anecdotal cases to compare the additional information provided with ultrasonography alone.
Doing so inevitably le to bias in favour of iuMRI, and fetal fro experts have criticised nigerian escort baltimore studies for the artificially high detection rates for iuMRI that resulted from biased patient selection, 910 although the extent of this bias is unknown.
One such study was published by meridkan group; 11 it was a study of singleton pregnancies in which a fetal brain abnormality was suspected on loneoy but for which optimal diagnostic information had not been obtained. Although these findings are clearly prone to the aforementioned bias, they nevertheless demonstrate the potential for a ificant improvement in diagnoses based on ultrasonography and provide an upper limit on the improvement attributable to the introduction of milfs looking for fun. Ventriculomegaly VM has been the focus of much research fir the field of fetal neuroimaging with iuMRI because of the high prevalence of the finding 1 or 2 out of pregnancies following a screening ultrasonography.
In our more recent study, fetuses were diagnosed with isolated VM on ultrasonography, with high confidence and no technical limitations.
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Magnetic resonance imaging in the literature: clinical management The literature on the clinical impact of iuMRI on the counselling and management of pregnancies complicated by fetal brain abnormalities is limited. Changes in management more frequently happened between the gestational ages of 20 and 24 weeks.
These 11 studies 1121 — 30 comprised fetuses and changes were observed in 78 Our review concluded that the clinical impact of iuMRI through changes to the counselling and management escorts in woodland pregnancies remains unclear owing to being reported in only a medidian proportion of studies. It is important to recognise that iuMRI is unlikely to be incorporated as a routinely used diagnostic tool for pregnancies.
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Constraints on resources, both financial and human, mean that eros la escorts is likely merjdian be used selectively, in combination with ultrasonography and other tests, for fetuses that are considered to be at a high risk of severe developmental abnormalities. Therefore, the project set out to determine whether or not adding iuMRI to the usual diagnostic pathway helps to improve the diagnosis and appropriate management of fetuses with a suspected brain abnormality based on ultrasonography.
Rationale for the MERIDIAN study In the light of the uncertainties surrounding the extent of improvement in loneely accuracy associated with iuMRI as an adjunct to ultrasonography and its impact on clinical management and counselling, a large prospective study with a representative population of fetal brain abnormalities was required to inform clinical practice in the UK.
For a full evaluation of the use of iuMRI in clinical practice, it was essential that patient acceptability was assessed. New technologies in fetal medicine can raise ethical and social dilemmas for the patients involved and, therefore, the views of patients and their partners are important when considering the implementation of iuMRI.
Study aims and objectives The aim of the research was to assess iuMRI as a technology to aid the PND of fetal developmental brain abnormalities. The objectives were to: assess diagnostic accuracy of iuMRI compared with antenatal ultrasonography through the — measurement of the diagnostic accuracy of antenatal ultrasonography alone i. This work was produced by Griffiths et al. This issue may be freely reproduced for the purposes of private research and study and extracts or indeed, the full report may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.