title: Additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies: a systematic review of the literature.
abstract: OBJECTIVE
  To analyze literature on the additional value of fetal magnetic resonance imaging (MRI) in assessing central nervous system (CNS) anomalies suspected by ultrasound.
  
  
  METHODS
  A search was performed of PubMed, EMBASE, Cochrane library and the reference lists of identified articles. Inclusion criteria were CNS anomalies suspected/diagnosed by ultrasound, MRI performed after ultrasound, and postmortem examination by autopsy or postnatal assessment. MOOSE guidelines were followed. Outcomes assessed were positive/negative agreement between ultrasound and MRI, additional information provided by MRI, and discordance between ultrasound and MRI. Pooled sensitivity and specificity of MRI were calculated using the DerSimonian-Laird method. Postnatal/postmortem examinations were used as the reference standard.
  
  
  RESULTS
  We identified thirteen articles which included 710 fetuses undergoing both ultrasound and MRI. MRI confirmed ultrasound-positive findings in 65.4% of fetuses and provided additional information in 22.1%. MRI disclosed CNS anomalies in 18.4% of fetuses. In 2.0% of cases, ultrasound was more accurate than MRI. In 30% of fetuses, MRI was so different from ultrasound that the clinical management changed. Agreement was observed mainly for ventriculomegaly (51.3%). Disagreement was noted mainly for midline anomalies (48.6%). Pooled sensitivity of MRI was 97% (95% CI, 95-98%) and pooled specificity was 70% (95% CI, 58-81%).
  
  
  CONCLUSIONS
  MRI supplements the information provided by ultrasound. It should be considered in selected fetuses with CNS anomalies suspected on ultrasound.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Bari, Bari, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Rossi
authors.forename: F
authors.initials: F
authors.lastname: Prefumo
mesh_terms: D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009421:Nervous System Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D011859:Radiography; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: central nervous system; fetal malformations; fetal ultrasound; magnetic resonance imaging; prenatal diagnosis