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Myelomeningocele Versus Myelocele on Fetal MR Images: Are There Differences in Brain Findings?
Usha D Nagaraj1, Karin S Bierbrauer2, Charles B Stevenson2
11 Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3026.
Objective:
The purpose of this study was to examine differences between patients with myelomeningocele and those with myelocele with respect to brain imaging findings at fetal MRI.
Materials And Methods:
A single-center retrospective analysis was performed of fetal MRI examinations revealing open spinal dysraphism from 2004 through 2016 with available diagnostic postnatal spinal MR images in conjunction with neurosurgical follow-up findings. Images were reviewed by two board-certified fellowship-trained pediatric neuroradiologists. Relevant clinical data were recorded.
Results:
The study included 119 fetal MRI examinations of patients with open spinal dysraphism. Myeloceles were found in 29.4% (35/119) of these examinations and myelomeningoceles in the others. All (35/35) myeloceles showed grade 3 (severe) Chiari II malformations. Only 73.8% (62/84) of myelomeningoceles showed grade 3 Chiari II malformation. Clinically significant spinal kyphosis was found in 5.0% (6/119) of fetuses, and all of these fetuses had grade 3 Chiari II malformations. The size of the spinal dysraphic defect had significant positive correlation with lateral (p < 0.0001) and third (p = 0.006) ventricular size. Mean volume of the myelomeningocele sac was significantly different among Chiari II grades and inversely proportional to Chiari II grade (p = 0.0009).
Conclusion:
Larger spinal dysraphic defects correlated with increased ventricular size at fetal MRI. All of the fetuses with myelocele or kyphosis had severe Chiari II malformations. Larger myelomeningocele sac size was associated with lower grade of Chiari II malformation, suggesting that myelomeningocele sac formation may be protective against hindbrain herniation.
Insights
Myelocele is associated with severe Chiari II malformations, unlike myelomeningocele. Larger spinal defects correlate with increased ventricular size in fetal MRI brain imaging.
Area of Science:
- Neuroscience
- Radiology
- Developmental Biology
Background:
- Open spinal dysraphism is a spectrum of congenital anomalies.
- Myelocele and myelomeningocele are distinct types of open spinal dysraphism.
- Chiari II malformation is a common finding in patients with open spinal dysraphism.
Purpose of the Study:
- To investigate the differences in fetal brain imaging findings between patients with myelocele and myelomeningocele using fetal MRI.
- To correlate spinal defect characteristics with brain abnormalities.
Main Methods:
- Retrospective analysis of fetal MRI examinations (2004-2016) of patients with open spinal dysraphism.
- Review of MRI images by two pediatric neuroradiologists.
- Correlation of imaging findings with postnatal spinal MRI and neurosurgical follow-up.
Main Results:
- Myelocele was identified in 29.4% of cases; all showed severe (grade 3) Chiari II malformations.
- Only 73.8% of myelomeningoceles showed grade 3 Chiari II malformations.
- Larger spinal defects correlated with increased lateral and third ventricular size. Spinal kyphosis was associated with grade 3 Chiari II malformations.
Conclusions:
- Myelocele is consistently associated with severe Chiari II malformations, whereas myelomeningocele shows variable severity.
- Larger myelomeningocele sac size may be protective against hindbrain herniation.
- Spinal defect size is a significant predictor of ventricular enlargement in fetal MRI.
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