title: Diagnostic accuracy of ultrasonography and magnetic resonance imaging for the detection of fetal anomalies: a blinded case-control study.
abstract: OBJECTIVE
  To compare the accuracy of two-dimensional ultrasound (2D-US), three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) for the diagnosis of congenital anomalies without prior knowledge of indications and previous imaging findings.
  
  
  METHODS
  This was a prospective, blinded case-control study comprising women with a singleton pregnancy with fetal congenital abnormalities identified on clinical ultrasound and those with an uncomplicated pregnancy. All women volunteered to undergo 2D-US, 3D-US and MRI, which were performed at one institution. Different examiners at a collaborating institution performed image interpretation. Sensitivity and specificity of the three imaging methods were calculated for individual anomalies, based on postnatal imaging and/or autopsy as the definitive diagnosis. Diagnostic confidence was graded on a four-point Likert scale.
  
  
  RESULTS
  A total of 157 singleton pregnancies were enrolled, however nine cases were excluded owing to incomplete outcome, resulting in 148 fetuses (58 cases and 90 controls) included in the final analysis. Among cases, 13 (22.4%) had central nervous system (CNS) anomalies, 40 (69.0%) had non-CNS anomalies and five (8.6%) had both CNS and non-CNS anomalies. The main findings were: (1) MRI was more sensitive than 3D-US for diagnosing CNS anomalies (MRI, 88.9% (16/18) vs 3D-US, 66.7% (12/18) vs 2D-US, 72.2% (13/18); McNemar's test for MRI vs 3D-US: P = 0.046); (2) MRI provided additional information affecting prognosis and/or counseling in 22.2% (4/18) of fetuses with CNS anomalies; (3) 2D-US, 3D-US and MRI had similar sensitivity for diagnosing non-CNS anomalies; (4) specificity for all anomalies was highest for 3D-US (MRI, 85.6% (77/90) vs 3D-US, 94.4% (85/90) vs 2D-US, 92.2% (83/90); McNemar's test for MRI vs 3D-US: P = 0.03); and (5) the confidence of MRI for ruling out certain CNS abnormalities (usually questionable for cortical dysplasias or hemorrhage) that were not confirmed after delivery was lower than it was for 2D-US and 3D-US.
  
  
  CONCLUSIONS
  MRI was more sensitive than ultrasonography and provided additional information that changed prognosis, counseling or management in 22.2% of fetuses with CNS anomalies. False-positive diagnoses for subtle CNS findings were higher with MRI than with ultrasonography. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Fetal Imaging, Oakland University William Beaumont Hospital School of Medicine, Rochester, MI, USA.|Department of Radiology, Division of Pediatric Radiology, Oakland University William Beaumont Hospital School of Medicine, Rochester, MI, USA.
authors.forename: L F
authors.initials: LF
authors.lastname: Gonçalves
authors.affiliation: Department of Obstetrics and Gynecology, Division of Women's and Fetal Imaging, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mody
authors.affiliation: Department of Obstetrics and Gynecology, Division of Women's and Fetal Imaging, Baylor College of Medicine, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Shetty
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: H
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.affiliation: Perinatology Research Branch, Eunice Kennedy Shriver NICHD/NIH/DHHS, Detroit, MI, USA.|Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.|Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
authors.forename: R
authors.initials: R
authors.lastname: Romero
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D011897:Random Allocation; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: 3D; accuracy; fetal MRI; prenatal diagnosis; sensitivity; specificity; ultrasound