Objective: To evaluate the prevalence on magnetic resonance imaging (MRI) of ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) in adolescents presenting with severe dysmenorrhea.Design: Prospective study.Setting: Clinic.Patient(s): A total of 345 adolescents aged 12-20 years referred to the radiologic MRI department unit between September 2019 and June 2020. Intervention(s): Multiplanar pelvic MRI with cine MRI was performed. Data on the medical history with systematic questioning were collected for each patient before the scan.Main Outcome Measure(s): Data on the endometriosis phenotypes (OMA and/or DIE), distribution of anatomical lesions, and adenomyo-sis were evaluated and recorded using a dedicated MRI spreadsheet. Myometrial contractions were systematically reported for each case. The data were correlated with the characteristics of the patients and severity of painful symptoms evaluated using a visual analog scale. Result(s): The prevalence rates of endometriosis and adenomyosis were 39.3% (121 patients) and 11.4% (35 patients), respectively. Among the adolescents with endometriosis, 25 (20.7%) presented with OMA, and 107 (88.4%) presented with DIE. The odds ratios (con-fidence intervals) for each pairwise comparison between the age distributions were 2.3 (1.4-3.8) for 15-18 vs. <15 years of age and 3.3 (1.2-8.5) for 18-20 vs. <15 years of age, highlighting a predominance of cases after 18 years of age. Uterine contractions were visu-alized in 34.4% of cases, with no particular association with endometriosis. No clinical risk factor was identified as being particularly associated with endometriosis. Notably, the visual analog scale score was the same for cases with and without endometriosis.Conclusion(s): Severe endometriosis phenotypes (OMA and/or DIE) can be observed in adolescents with intense dysmenorrhea, with a linear increase in prevalence over time resulting in a clear predominance after 18 years of age. Endometriosis in adolescents is a chal-lenging clinical problem with a long delay in diagnosis. Imaging can help reduce this delay in young patients with suggestive symptoms.Clinical Trial Registration Number: NCT05153512. (Fertil Sterile 2023;119:626-33. (c) 2023 by American Society for Reproductive Medicine.) El resumen esta disponible en Espanol al final del articulo.

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG ([email protected]). These guidelines are based on consensus reached between participants following a survey of current practices, conducted by ISUOG in 2014 (Appendix S1). Fetal magnetic resonance imaging (MRI) is an important diagnostic imaging adjunct to ultrasonography1, particularly for the assessment of fetal brain development2. A survey conducted by ISUOG in 2014 (Appendix S1), in which 60 international perinatal centers participated, showed that fetal MRI is being performed in one or more centers in at least 27 countries worldwide. However, the quality of imaging, sequences used and operator experience appear to differ widely between centers3. The impact of such differences should be reduced by development of guidelines to define better the role of fetal MRI in relation to prenatal diagnostic ultrasound. The aim of this document is to provide information on state-of-the-art fetal MRI for those performing the examination, as well as for clinicians interpreting the results. The purpose of fetal MRI is to complement an expert ultrasound examination4, 5, either by confirmation of the ultrasound findings or through the acquisition of additional information6. MRI is not currently used as a primary screening tool in prenatal care, although standardized and complete assessment of the fetal anatomy is probably feasible. Figure 1 presents the survey participants' opinions regarding indications for which MRI can provide useful information. MRI is not associated with known adverse fetal effects at any point in pregnancy, when performed without administration of contrast media7. There are no reported adverse effects of MRI performed at 1.5 Tesla (1.5 T)8. However, there have been no human studies of possible adverse effects at higher field strength, such as 3.0 T7, 9, 10, although recent data show that it may be safe in a porcine model11. There is general consensus that fetal MRI is indicated following an expert ultrasound examination in which the diagnostic information about an abnormality is incomplete. Under these circumstances, MRI may provide important information that may confirm or complement the ultrasound findings and alter or modify patient management. Presently, factors influencing the decision to perform fetal MRI include, but are not limited to: experience/equipment of the ultrasound and MRI facilities, accessibility to MRI, maternal conditions, gestational age, safety concerns, legal consideration regarding termination of pregnancy (TOP) and parental wishes after appropriate counseling3, 10, 12, 13. The ISUOG survey addressed the necessity of MRI for selected indications and used a 7-point rating scale to weight the responses from 0 (not at all indicated) to 7 (definitely indicated) (Figure 1). The variety of responses is likely to reflect the divergence seen between various specialties and the spectrum of pathologies seen at each center. The opinions may also reflect different levels of experience when performing fetal ultrasound and MRI. In general, performance of an ultrasound examination following only the minimum recommendations for second-trimester ultrasound/basic brain examination, as proposed by ISUOG5, is insufficient prior to requesting MRI. Additional views, such as orthogonal views, higher frequency probes and/or transvaginal imaging are required to detail the specific abnormality14, 15. The practice of TOP and associated medicolegal implications may influence the use of fetal MRI at local institutions. In countries in which the decision about TOP has to be made before 24 weeks, the performance of MRI prior to this time may help an individual couple decide on the future of their pregnancy; however, in general, MRI is better reserved for later in the second or third trimester13. Although available data are still inconclusive, MRI for parental reassurance regarding the absence of associated pathologies in fetuses with apparently isolated conditions may be recommended in fetuses with isolated ventriculomegaly16, agenesis of the corpus callosum17, absent septum pellucidum and cerebellar or vermian anomalies18. In addition, fetal MRI has been found to be helpful in monochorionic twin pregnancies after iatrogenic or natural demise of a cotwin to find pathological changes in the surviving twin19, 20. Fetal MRI performed before 18 weeks does not usually provide information additional to that obtained on ultrasound examination. In some cases, additional information can be obtained before 22 weeks13 but MRI becomes increasingly helpful thereafter. Specific examples of pathologies that can be evaluated in the third trimester include, but are not limited to, those of cortical development and neck masses that may cause airway compromise21. Most organs can be visualized in detail between 26 and 32 weeks of pregnancy, when pathologies related to abnormal development are more fully evolved, but each pregnancy and each fetus will differ. It may become more difficult for the woman to stay comfortable in the scanner with advancing gestation and consideration of left-lateral offset is recommended. When indicated, performed properly and interpreted correctly, MRI not only contributes to diagnosis but may be an important component of treatment choice, delivery planning and counseling. Practitioners who interpret fetal MRI should be familiar with fetal diagnosis, as it differs from diagnosis in other patient populations. Choice of appropriate protocols and techniques requires extensive training; thus, the performance of fetal MRI should be limited to individuals with specific training and expertise. The same applies to interpretation of the examination. In many centers this will require a multispecialty collaborative approach, including experts in the field of prenatal diagnosis, perinatology, neonatology, pediatric neurology and neuroradiology, genetics and other related specialties (Table 1), in order to integrate the clinical and family histories and the ultrasound and MRI findings, to optimize patient care. Consultation with a geneticist and other pediatric subspecialists may be required in order to provide the patient with the best counseling and management options. Although at present we are unaware of the existence of a recognized fetal MRI specialization, individuals who perform fetal MRI should have undergone specialized training in collaboration with a teaching center, enabling them to perform a state-of-the-art fetal MRI examination after a sufficient amount of cases (GOOD PRACTICE POINT; i.e. recommended best practice based on the clinical experience of the guideline development group). Performance of fetal MRI according to standardized criteria (Table 2) will improve the management of pregnancies complicated by a fetal malformation or acquired condition (GOOD PRACTICE POINT). At present, 1.5 T is the most commonly used field strength, providing acceptable resolution even as early as 18 weeks22. 3 T has the potential to provide images with higher resolution and better signal-to-noise ratio than does 1.5 T, while maintaining a comparable or lower energy deposition22. Nonetheless, higher field strength is currently not recommended for in-vivo fetal imaging10. In all cases, the field-of-view should be adjusted to the region of interest. A slice thickness of 3–5 mm with a 10–15% intersection gap will be appropriate in most cases. The examination should include at least T2 information in three orthogonal planes of the fetal brain and body, and T1- and GRE-EP sequences in one or two planes, preferably frontal and sagittal. This ‘minimum’ protocol should be executable in less than 30 min, even allowing for fetal movement and sequence repetition. Only examinations that are performed following this protocol should be regarded as ‘state of the art’ (GOOD PRACTICE POINT). Although usually measurements will already have been made with ultrasound, measuring certain structures at the MRI examination may be of benefit in particular cases12. When measuring fluid-containing structures, it is important to remember that MRI measurements are usually around 10% greater than the corresponding ultrasound measurements. In lung volumetry, normal gestational-age related MRI measurements correlate with fetal body volume29 and are considered predictive of outcome in cases of lung pathology30. The whole examination should be stored according to local practice, preferably in electronic format. CDs of the examinations can be produced for the patient to enable second-opinion assessment (GOOD PRACTICE POINT). Fetal situs, stomach and gallbladder (fluid filling), fluid and meconium signals of bowels (Figure 7c,d), kidneys, urinary bladder (fluid filling); on request: female/male external genitals (in case of latter: descent of testes) (Figure 8) Standardized reports should follow the suggested structure outlined in Table 3 (GOOD PRACTICE POINT). As MRI is usually not a first-line examination, but a complementary examination following an ultrasound examination performed in the second trimester31, the emphasis of the examination and report should be on structures that are more difficult to assess with ultrasound. A detailed anatomical assessment may be performed on demand. D. Prayer*, Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria G. Malinger*, Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel P. C. Brugger, Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria C. Cassady, Texas Children's Hospital and Fetal Center, Houston, TX, USA L. De Catte, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium B. De Keersmaecker, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium G. L. Fernandes, Fetal Medicine Unit, Department of Obstetrics, ABC Medicine University, Santo Andre, Brazil P. Glanc, Departments of Radiology and Obstetrics & Gynecology, University of Toronto and Sunnybrook Research Institute, Obstetrical Ultrasound Center, Department of Medical Imaging, Body Division, Sunnybrook Health Sciences Centre, Toronto, Canada L. F. Gonçalves, Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA G. M. Gruber, Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria S. Laifer-Narin, Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA W. Lee, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA A.-E. Millischer, Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France M. Molho, Diagnostique Ante Natal, Service de Neuroradiologie, CHU Sud Réunion, St Pierre, La Réunion, France J. Neelavalli, Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA L. Platt, Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA D. Pugash, Department of Radiology, University of British Columbia and Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada P. Ramaekers, Prenatal Diagnosis, Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium L. J. Salomon, Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France M. Sanz, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA I. E. Timor-Tritsch, Division of Obstetrical & Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA B. Tutschek, Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany and Prenatal Zurich, Zürich, Switzerland D. Twickler, University of Texas Southwestern Medical Center, Dallas, TX, USA M. Weber, Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria R. Ximenes, Fetal Medicine Foundation Latin America, Centrus, Campinas, Brazil N. Raine-Fenning, Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham and Nurture Fertility, The Fertility Partnership, Nottingham, UK *D. P. and G. M. contributed equally to this article. These Guidelines should be cited as: ‘Prayer D, Malinger G, Brugger PC, Cassady C, De Catte L, De Keersmaecker B, Fernandes GL, Glanc P, Gonçalves LF, Gruber GM, Laifer-Narin S, Lee W, Millischer A-E, Molho M, Neelavalli J, Platt L, Pugash D, Ramaekers P, Salomon LJ, Sanz M, Timor-Tritsch IE, Tutschek B, Twickler D, Weber M, Ximenes R, Raine-Fenning N. ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 2017; 49: 671–680.’ Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Research question: Is there a change in magnetic resonance imaging (MRI) criteria of diffuse and focal phenotypes of adenomyosis before and after pregnancy? Design: A retrospective, monocentric, observational study in a single academic tertiary referral centre for endometriosis diagnosis and management. Women were followed for symptomatic adenomyosis, and without a prior history of surgery who give birth after 24+0 weeks. For each patient, pelvic MRI pre- and post-pregnancy was performed by two experienced radiologists with the same image acquisition protocol. Diffuse and focal adenomyosis MRI presentation were analysed before and after pregnancy. Results: Between January 2010 and September 2020, of the 139 patients analysed, 96 (69.1%) had adenomyosis at MRI distributed as follow: 22 (15.8%) presented diffuse adenomyosis, 55 (39.6%) focal adenomyosis and 19 (13.7%) both phenotypes. The frequency of isolated diffuse adenomyosis on MRI was significantly lower before versus after pregnancy (n = 22 [15.8%] versus n = 41 [29.5%], P = 0.01). The frequency of isolated focal adenomyosis was significantly higher before pregnancy than after pregnancy (n = 55 [39.6%] versus n = 34 [24.5%], P = 0.01). The mean volume of all focal adenomyosis lesions on MRI decreased significantly after pregnancy, from 6.7 2.5 mm(3) to 6.4 2.3 mm(3), P = 0.01. Conclusion: The current data indicate that, based on MRI, there is an increase in diffuse adenomyosis and a decrease in focal adenomyosis after pregnancy.

Objectives It has been suggested previously that the presence of Probst bundles (PB) in cases with a short corpus callosum (SCC) on diffusion tensor imaging (DTI) may help to differentiate between corpus callosal (CC) dysplasia and a variant of normal CC development. The objectives of this study were to compare DTI parameters between cases of SCC vs normal CC and between cases of SCC with PB (SCC-PB+) vs SCC without PB (SCC-PB-). Methods This was a retrospective study of patients referred to the Necker Hospital in Paris, France, for magnetic resonance imaging (MRI) evaluation of an apparently isolated SCC detected by sonography between November 2016 and December 2022 (IRB: 00011928). MRI was performed using a 1.5-Tesla Signa system. T2-weighted axial and sagittal sequences of the fetal brain were used to measure the length and thickness of the CC. 16-direction DTI axial brain sequences were performed to identify the presence of PB and to generate quantitative imaging parameters (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) of the entire CC, genu, body and splenium. Cases in which other associated brain abnormalities were detected on MRI were excluded. Cases were matched for fetal gender and gestational age with controls in a 1:3 ratio. Control cases were normal fetuses included in the LUMIERE on the FETUS trial (NCT04142606) that underwent the same DTI evaluation of the brain. Comparisons between SCC and normal CC cases, and between SCC-PB+ and SCC-PB- cases were performed using ANOVA and adjusted for potential confounders using ANCOVA. Results Twenty-two SCC cases were included and compared with 66 fetuses with a normal CC. In 10/22 (45.5%) cases of SCC, PB were identified. As expected, dimensions of the CC were significantly smaller in SCC compared with normal CC cases (all P < 0.01). In SCC-PB+ vs SCC-PB- cases, FA values were significantly lower in the entire CC (median, 0.21 (range, 0.19-0.24) vs 0.24 (range, 0.22-0.28); P < 0.01), genu (median, 0.21 (range, 0.15-0.29) vs 0.24 (range, 0.17-0.29); P = 0.04), body (median, 0.21 (range, 0.18-0.23) vs 0.23 (range, 0.21-0.27); P = 0.04) and splenium (median, 0.22 (range, 0.16-0.30) vs 0.25 (range, 0.20-0.29); P = 0.03). ADC values were significantly higher in the entire CC, genu and body in SCC-PB+ vs SCC-PB- cases (all P < 0.05). In SCC-PB+ cases, all FA values were significantly lower, and ADC values in the CC body were significantly higher compared with normal CC cases (all P < 0.05). In SCC-PB- cases, there was no significant difference in FA and ADC compared with normal CC cases (all P > 0.05). Conclusions Fetal DTI evaluation of the CC showed that FA values were significantly lower and ADC values tended to be significantly higher in SCC-PB+ compared with normal CC cases. This may highlight alterations of the white matter microstructure in SCC-PB+. In contrast, isolated SCC-PB- does not demonstrate significant changes in DTI parameters, strengthening the possibility that this is a normal CC variant. (c) 2023 International Society of Ultrasound in Obstetrics and Gynecology.

To compare the diffusion tensor imaging (DTI) metrics in the corpus callous (CC) in fetuses with “short” CC (SCC) with normal CC and between SCC with and without Probst bundles (PB). Retrospective study of fetuses with an apparently isolated SCC. MRI scans were performed on a 1.5T General Electric Sigma system (GE Healthcare, USA). 16-directions DTI axial brain sequences were performed to identify PB and to generate quantitative DTI metrics (Fractional Anisotropy [FA], Apparent Diffusion Coefficient [ADC]). All cases were matched for GA with controls included in the LUMIERE on the FETUS trial (NCT0414206) at a 1:3 ratio. 22 fetuses with SCC were compared to 66 normal CC. PB were identified in 10/22(45.4%) SCC. Dimensions of the SCC were significantly lower compared to normal CC (all p < 0.01). In all SCC, FA values were significantly lower compared to normal CC in the entire CC (0.22[0.19-0.28] vs 0.26[0.22-0.32], p < 0.01), the genu (0.22[0.15-0.29] vs 0.27[0.22-0.33], p < 0.01), the body (0.22[0.18-0.27] vs 0.26[0.22-0.34], p < 0.01) and the splenium (0.23[0.16-0.30] vs 0.29[0.22-0.38], p < 0.01). In SCC with PB, FA values were significantly lower compared to SCC without PB in the entire CC, the genu, the body and the splenium (all p < 0.05). Also, the ADC values were significantly higher in the SCC with PB compared to SCC without PB (all p < 0.05). In SCC with PB, all FA values were significantly lower and the ADC was significantly higher compared to normal CC (all p < 0.05). In SCC without PB, there was no difference in FA and ADC compared to normal CC (all p > 0.05). Fetal DTI evaluation of the SCC with PB showed significant differences in DTI metrics compared to normal CC. These differences may highlight alterations of the white matter microstructure in SCC with PB. Isolated SCC without PB does not demonstrate significant changes in diffusion parameter and may only represent normal variant.

(Abstracted from Fertil Steril 2024;121(3)) Adenomyosis is a benign uterine disorder characterized by the presence of endometrial glands and stroma within the myometrium associated with smooth muscle hyperplasia. Its presentation is heterogeneous, involving hypermenorrhea, dysmenorrhea, and infertility, with variations in phenotype based on the location of the lesions.

RESEARCH QUESTION:In women with radiologically diagnosed adenomyosis, is the presence of endometriosis associated with a higher rate of miscarriage?DESIGN:An observational cohort study of women who received medical care for benign gynaecological conditions between May 2005 and May 2018. Women who had adenomyosis lesions visualized by uterine magnetic resonance imaging (MRI) were included. Women who had never been pregnant were excluded. Women with adenomyosis identified by MRI but who did not have endometriosis lesions (control group) were compared with women with adenomyosis and endometriosis lesions (study group). Primary outcome was rate of a previous history of early miscarriage.RESULTS:A total of 214 pregnancies in the study group and 53 pregnancies in the control group were analysed. The rate of a previous miscarriage was significantly higher among women with adenomyosis and endometriosis lesions compared with women in the control group (61/214 [28.5%] versus 6/53 [11.3%], respectively, P = 0.009). A multivariable generalized estimating equation logistic regression model, adjusted for adenomyosis and endometriosis phenotypes, found that the association between endometriosis and adenomyosis significantly increased the risk of miscarriage (OR 3.2, 95% CI 1.1 to 9.65). The risk was significantly higher with deep infiltrating endometriosis (OR 4.37, 95% CI 1.32 to 14.53).CONCLUSIONS:Women affected by endometriosis had a significantly higher rate of previous spontaneous miscarriage than women without endometriosis with adenomyosis lesions identified by MRI. Mechanistic studies are needed to establish the complex link between the presence of endometriosis and adenomyosis and the rate of spontaneous miscarriage.

ABSTRACT Objectives To compare the ability of detailed routine ultrasound examination, performed without knowledge of maternal serology and fetal status, with that of targeted prenatal imaging performed in prenatal diagnostic units in cases of known fetal infection to identify cytomegalovirus (CMV)‐infected fetuses that will develop long‐term sequelae. Methods All prenatal imaging reports were collected for 255 children with congenital CMV in a registered cohort between 2013 and 2017 (NCT01923636). All women had undergone detailed routine fetal ultrasound examination at 20–24 and 30–34 weeks as part of routine antenatal care. All cases of known fetal CMV infection had also undergone targeted prenatal ultrasound examination. Postnatal structured follow‐up for up to 48 months of age involved clinical, audiological and neurological assessment, including Brunet–Lezine scoring. Long‐term sequelae (> 12 months) were considered to be mild in cases with isolated unilateral hearing loss and/or vestibular disorders, and severe in cases with bilateral hearing loss and/or neurological sequelae. All imaging reports were analyzed retrospectively with the knowledge of congenital CMV infection, searching for reference to findings that were, or could have been, related to fetal infection. Findings were analyzed in relation to whether the cases were diagnosed with CMV in utero or only postnatally. Results There were 237 children with complete follow‐up data (> 12 months), for a median of 24 (range, 12–48) months. Of these, 30% (71/237) were diagnosed with CMV prenatally and 70% (166/237) were diagnosed within 3 weeks after birth. 72.5% (29/40) of children with long‐term sequelae, including 74% (14/19) with severe long‐term sequelae, were not identified in the prenatal period. Among those diagnosed prenatally, the sensitivity of prenatal imaging for predicting long‐term sequelae and severe long‐term sequelae was 91% and 100%, respectively, while, in the group diagnosed only postnatally, non‐specific infection‐related ultrasound findings had been reported without raising suspicion in 48% of cases with long‐term sequelae and 64% of those with severe long‐term sequelae. Conclusions Routine detailed ultrasound examination in pregnancy is not an appropriate screening tool for congenital CMV infection that leads to long‐term sequelae, in contrast with the high performance of targeted prenatal imaging in known cases of fetal infection. The non‐specific nature of ultrasound features of CMV and their evolution, and a lack of awareness of caregivers about congenital CMV, are likely explanations. Awareness of the sonologist regarding congenital CMV and knowledge of the maternal serological status in the first trimester seem key to the performance of prenatal ultrasound. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Abstract Study question How to assess the different adenomyosis phenotype before and after pregnancy on magnetic resonance imaging according to stringent validated criteria ? Summary answer Diffuse adenomyosis increases significantly after pregnancy while the rate of focal adenomyosis and the mean volume of focal adenomyosis lesions decrease significantly after pregnancy. What is known already Adenomyosis and endometriosis are benign hormone-dependent disorders associated with pelvic pain, dysmenorrhea and/or infertility. The natural course of adenomyosis and endometriosis is still unclear, particularly during pregnancy. Pregnancy is considered to have a positive impact on endometriosis. Several studies regarding the impact of adenomyosis on pregnancy are available. Adenomyosis can cause fertility disorders, miscarriage, preterm birth. However, available data evaluating the effect of pregnancy on adenomyosis are lacking. Study design, size, duration Between January 1st 2010 and September 30th 2020, 139 patients were followed in our referral care center (Gynecology department of Port-Royal Hospital, Paris) for symptomatic adenomyosis and or endometriosis. For each of them, a magnetic resonance imaging were performed before and after pregnancy. The data based on magnetic resonance imaging, pre- and post-pregnancy, were analyzed in a single retrospective study. Participants/materials, setting, methods Patients had to be over 18 years old, to be pregnant and to be followed for symptomatic adenomyosis or endometriosis without any previous surgery. Each pelvic magnetic resonance imaging were performed by a single experienced radiologist. The protocol was identical on a 1.5 T magnetic resonance imaging machine based on validated criteria. The rate of diffuse and focal adenomyosis, the volume of focal adenomyosis lesions and the thickness of maximal junctional zone were reported. Main results and the role of chance The mean age of patients was 34.6 ± 3.4 years old, 83 (59.7%) of patients underwent assisted reproductive technology to be pregnant. The mean time interval between the MRI and the delivery was 55.2 months and the mean time interval between the delivery and the MRI was 32.2 months. Before pregnancy, there was 96 (69.1%) patients with adenomyosis, all phenotype combined versus 111 (79.9%) after pregnancy (p = 0.04) on magnetic resonance imaging. The rate of diffuse adenomyosis increased significantly on magnetic resonance imaging after pregnancy compared to before pregnancy (n = 22 (15.8%) vs n = 41 (29.5%), p = 0.01). The thickness of junctional zone maximal was significantly higher after pregnancy (8.0 mm ± 5.1 vs 12.0 mm ± 4.8, p < 0.01). The rate of focal adenomyosis (n = 55 (39.6) vs n = 34 (24.5), p = 0.01) as well as the volume of focal adenomyosis lesions (6.7 mm3 2.5± vs 6.4 mm3 ± 2.3, p < 0.01) decreased significantly after pregnancy on magnetic resonance imaging. Limitations, reasons for caution This single-center study was conducted in a referral center whom patients presented more severe forms of adenomyosis, which could have affected the external validity of this study. The mean time interval between delivery and MRI was 32.2 month which implies a short follow up period to observe long term outcomes. Wider implications of the findings The hypothesis that a specific hormonal environment during pregnancy may imply a positively impact of the evolution of focal adenomyosis is raised by this study. The evolution of focal adenomyosis after pregnancy is similar to the evolution of endometriosis lesions volume that support shared etiopathogenic mechanisms between the two entities. Trial registration number ‘not applicable’

OBJECTIVE:Bowel obstructions beyond the duodenum represent a heterogeneous group of congenital anomalies with a highly variable prognosis, the main issue being postnatal short bowel syndrome (SBS). The objective of our study was to evaluate the contributions of fetal MRI in cases of bowel obstruction.MATERIALS AND METHODS:A retrospective analysis of all newborns, for whom both ante-natal ultrasound and fetal MRI were available, referred to our center for suspected bowel obstruction was performed. Examinations were reviewed blinded to the postnatal outcome. Key outcome measures included exact diagnosis and the existence of postoperative SBS. We evaluated the contribution of MRI in determining precise location and etiology of the bowel obstruction, dilatation of the proximal bowel loops, and assessment of the quality of the remaining distal bowel loops.RESULTS:Twenty-five newborns were included. There were 19 single obstructions and 6 complex forms (4 apple peel syndromes and 2 multiple atresias). MRI correctly identified the affected segment of the small bowel in 59.1% of the cases. MRI identified the mechanism of obstruction in 72% of cases. MRI reliably predicted an abnormal appearance of the bowel distal to the obstruction in 100% of the severe cases (3/3) and in 66.7% of complex forms (4/6).CONCLUSION:Our study suggests that fetal MRI, when done in addition to prenatal ultrasound, is contributory in the management of fetuses with suspected bowel obstruction. MRI may be particularly useful in determining the location and origin of the bowel obstruction and in assessing the quality of the bowel distal to the obstruction, which might assist in the prediction of SBS and more detailed prenatal counseling.

ABSTRACT Objective Fetal anomalies of the corpus callosum (CC) have been reported in the prenatal imaging literature since 1985, and, especially when isolated, pose challenges for both the patient and fetal medicine specialist. The purpose of this study was to review systematically the literature on prenatally diagnosed abnormalities of the CC, focusing on the terminology used to describe abnormalities other than complete agenesis of the CC, and to assess the heterogeneity of the nomenclature and definitions used. Methods This study was conducted in accordance with the PRISMA statement for reporting systematic reviews. A literature search was performed to identify prospective or retrospective case series or cohort studies, published in English, French, Italian, German or Spanish, reporting fetal imaging findings and describing anomalies of the CC. Quality and risk of bias of the studies were evaluated using the Newcastle–Ottawa scale and a modification of the scale developed by Conde‐Agudelo et al. for other fetal imaging studies. The data extracted included the number of patients, the number of different anomalies identified, the descriptive names of the anomalies, and, where applicable, the definitions of the anomalies, the number of cases of each type of anomaly and the biometric charts used. Secondary tests used to confirm the diagnosis, as well as the postnatal or post‐termination tests used to ascertain the diagnosis, were also recorded. Results The search identified 998 records, and, after review of titles and abstracts and full review of 45 papers, 27 studies were included initially in the review, of which 24 were included in the final analysis. These 24 studies had a broad range of quality and risk of bias and represented 1135 cases of CC anomalies, of which 49% were complete agenesis and the remainder were described using the term partial agenesis or nine other terms, of which five had more than one definition. Conclusions In comparison to the postnatal literature, in the prenatal literature there is much greater heterogeneity in the nomenclature and definition of CC anomalies other than complete agenesis. This heterogeneity and lack of standard definitions in the prenatal literature make it difficult to develop large multicenter pooled cohorts of patients who can be followed in order to develop a better understanding of the genetic associations and neurodevelopmental and psychological outcomes of patients with CC anomalies. As this information is important to improve counseling of these patients, a good first step towards this goal would be to develop a simpler categorization of prenatal CC anomalies that matches better the postnatal literature. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

BACKGROUND AND PURPOSE: Prognosis of isolated short corpus callosum is challenging. Our aim was to assess whether fetal DTI tractography can distinguish callosal dysplasia from variants of normal callosal development in fetuses with an isolated short corpus callosum. MATERIALS AND METHODS: This was a retrospective study of 37 cases referred for fetal DTI at 30.4?weeks (range, 25?34 weeks) because of an isolated short corpus callosum? less than the 5th percentile by sonography at 26?weeks (range, 22?31 weeks). Tractography quality, the presence of Probst bundles, dysmorphic frontal horns, callosal length (internal cranial occipitofrontal dimension/length of the corpus callosum ratio), and callosal thickness were assessed. Cytogenetic data and neurodevelopmental follow-up were systematically reviewed. RESULTS: Thirty-three of 37 fetal DTIs distinguished the 2 groups: those with Probst bundles (Probst bundles+) in 13/33 cases (40%) and without Probst bundles (Probst bundles?) in 20/33 cases (60%). Internal cranial occipitofrontal dimension/length of the corpus callosum was significantly higher in Probst bundles+ than in Probst bundles?, with a threshold value determined at 3.75 for a sensitivity of 92% (95% CI, 77%?100%) and specificity of 85% (95% CI, 63%?100%). Callosal lipomas (4/4) were all in the Probst bundles? group. More genetic anomalies were found in the Probst bundles+ than in Probst bundles? group (23% versus 10%, P?=?.08). CONCLUSIONS: Fetal DTI, combined with anatomic, cytogenetic, and clinical characteristics could suggest the possibility of classifying an isolated short corpus callosum as callosal dysplasia and a variant of normal callosal development.

Objective To evaluate the postnatal outcome of children with a prenatal diagnosis of apparently isolated agenesis of the septum pellucidum (ASP). Methods A retrospective cohort study of cases of prenatally diagnosed ASP followed in two tertiary centers and a meta-analysis combining data from the cohort study with data from published studies identified in a systematic review were carried out. Only cases with apparently isolated ASP on antenatal ultrasound and/or magnetic resonance imaging and with available postnatal follow-up data were considered eligible for inclusion. The following outcomes were analyzed: incidence of chromosomal anomalies, agreement between antenatal and postnatal findings, overall incidence of septo-optic dysplasia (SOD) and incidence of major neurological disability (motor, language, coordination or behavioral disorder or epilepsy) in non-SOD children. The incidence of SOD in infants with apparently normal optic pathways on antenatal imaging was also evaluated. Results Fifteen cases of isolated ASP, with median postnatal follow-up of 36 months (range, 12-60 months), were selected from the two centers. Six previously published studies met the inclusion criteria for the systematic review and a total of 78 cases were eligible for the analysis, including the 15 cases from our series. Genetic tests were carried out antenatally in 30 fetuses, of which two had an abnormal result (pooled proportion, 9.0% (95% CI, 1.8-20.7%); I-2 = 0%). Additional or discordant imaging findings were noted postnatally in 9/70 (pooled proportion, 13.7% (95% CI, 3.5-29.0%); I-2 = 63.9%) cases. Of all 78 neonates with available follow-up, SOD was diagnosed postnatally in 14 (pooled proportion, 19.4% (95% CI, 8.6-33.2%); I-2 = 51.2%). In 60 cases, the optic pathways were considered to be normal on antenatal imaging, and six of these (pooled proportion, 9.1% (95% CI, 1.1-24.0%); I-2 = 62.0%) were diagnosed postnatally with SOD. Of the 46 infants with available neurological follow-up who were not affected by SOD, a major neurological disability was diagnosed in three (pooled proportion, 6.5% (95% CI, 0.5-18.6%); I-2 = 40.1%). Conclusions In the vast majority of cases with a prenatal diagnosis of apparently isolated ASP, the prognosis is favorable. However, an additional anomaly is detected after birth in about 14% of cases and has a negative impact on clinical outcome. Detailed antenatal assessment of the brain and optic pathways is strongly recommended in order to identify the presence of associated anomalies. Antenatal visualization of apparently normal optic pathways does not rule out SOD. (c) 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Objectives To evaluate the feasibility of dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and measure values of in vivo placental perfusion in women. Methods This study was part of the Placentimage trial (NCT01092949). Gadolinium-chelate (Gd) enhanced dynamic MRI was performed two days before termination of pregnancies at 16 to 34 weeks gestational age (GA). Quantitative analysis was performed using one-compartment intravascular modeling. DCE perfusion parameters were analyzed across GA and were compared in IUGR and AGA fetuses. Results 134 patients were enrolled. After quality control check, 62 DCE MRI were analyzed including 48 and 14 pregnancies with normal and abnormal karyotypes, respectively. Mean placental blood flow was 129±61 mL/min/100ml in cases with normal karyotypes. Fetuses affected by IUGR (n = 13) showed significantly lower total placental blood flow values than AGA fetuses (n = 35) (F total = 122±88 mL/min versus 259±34 mL/min, p = 0.002). DCE perfusion parameters showed a linear correlation with GA. Conclusions Measuring placental perfusion in vivo is possible using DCE MRI. Although this study has many limitations it gives us the first DCE MRI values that provide a potential standard for future research into placental perfusion methods and suggests that placental functional parameters are altered in IUGR pregnancies.

Ultrasound is widely used as the initial diagnostic imaging modality during pregnancy with both high spatial and temporal resolution. Although MRI in pregnancy has long focused on the fetus, its use in placental imaging has greatly increased over recent years. In addition to the possibilities of evaluating function, MRI with a wide field of view and high contrast resolution allows characterization of placental anatomy, particularly in situations that are difficult to specify with ultrasound, especially for suspected placenta accreta. MRI also appears to be a particularly useful examination for the anatomical evaluation of the placenta independent of maternal body habitus or fetal position. Indeed, surprisingly little attention is paid to the placenta in MRI when the indication for the examination is fetal. Thus, some aspects of the placenta seem to us to be important to be recognized by the radiologist and to be described on the MRI report. In this review, we will describe MRI sequences used for, and common features seen in, imaging of i) the normal placenta, ii) abnormal aspects of the placenta that should be identified on MRI performed for fetal reason, and iii) placental anomalies for which placental MRI may be indicated.

Objective Fetal anomalies of the corpus callosum (CC) have been reported in the prenatal imaging literature since 1985, and, especially when isolated, pose challenges for both the patient and fetal medicine specialist. The purpose of this study was to review systematically the literature on prenatally diagnosed abnormalities of the CC, focusing on the terminology used to describe abnormalities other than complete agenesis of the CC, and to assess the heterogeneity of the nomenclature and definitions used.Methods This study was conducted in accordance with the PRISMA statement for reporting systematic reviews. A literature search was performed to identify prospective or retrospective case series or cohort studies, published in English, French, Italian, German or Spanish, reporting fetal imaging findings and describing anomalies of the CC. Quality and risk of bias of the studies were evaluated using the Newcastle-Ottawa scale and a modification of the scale developed by Conde-Agudelo et al. for other fetal imaging studies. The data extracted included the number of patients, the number of different anomalies identified, the descriptive names of the anomalies, and, where applicable, the definitions of the anomalies, the number of cases of each type of anomaly and the biometric charts used. Secondary tests used to confirm the diagnosis, as well as the postnatal or post-termination tests used to ascertain the diagnosis, were also recorded.Results The search identified 998 records, and, after review of titles and abstracts and full review of 45 papers, 27 studies were included initially in the review, of which 24 were included in the final analysis. These 24 studies had a broad range of quality and risk of bias and represented 1135 cases of CC anomalies, of which 49% were complete agenesis and the remainder were described using the term partial agenesis or nine other terms, of which five had more than one definition.Conclusions In comparison to the postnatal literature, in the prenatal literature there is much greater heterogeneity in the nomenclature and definition of CC anomalies other than complete agenesis. This heterogeneity and lack of standard definitions in the prenatal literature make it difficult to develop large multicenter pooled cohorts of patients who can be followed in order to develop a better understanding of the genetic associations and neurodevelopmental and psychological outcomes of patients with CC anomalies. As this information is important to improve counseling of these patients, a good first step towards this goal would be to develop a simpler categorization of prenatal CC anomalies that matches better the postnatal literature. (c) 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Background Screening ultrasound (US) has increased the detection of congenital vascular anomalies in utero. Complementary magnetic resonance imaging (MRI) may improve the diagnosis, but its real utility is still not well established. Objectives We aimed to describe the imaging findings on prenatal US and MRI of the most frequent congenital vascular anomalies (lymphatic malformations and congenital hemangiomas) to assess the accuracy of prenatal US and MRI exams for diagnosis and to evaluate the relevance of the additional information obtained by complementary fetal MRI. Materials and methods All confirmed postnatal congenital vascular anomalies detected in the last 10 years at 3 university hospitals were retrospectively identified. The prenatal diagnosis was compared with the final diagnosis for both methods and the clinical relevance of additional MRI information was evaluated. A second MRI in advanced pregnancy was performed in fetuses with lesions in a sensitive anatomical location and the clinical relevance of the additional information was evaluated. Results Twenty-four cases were included in the study, 20 lymphatic malformations and 4 hemangiomas. MRI slightly improved the diagnosis of lymphatic malformation, 85% vs. 80% at US, especially for abdominal lesions. Both methods had a low identification rate (25%) for tumors. MRI performed late in five fetuses with lymphatic malformation allowed optimized management at birth. Conclusion MRI improves the diagnosis of congenital lymphatic malformations whereas hemangiomas remain difficult to identify in utero. The main role of MRI is to provide high-defined anatomical data to guide management at birth.

Background Neuronal ceroid lipofuscinoses (NCLs) form a clinically and genetically heterogeneous group of inherited neurodegenerative disorders that share common neuropathological features. Although they are the first cause of neurodegenerative disorders in children, their congenital forms are rarely documented. They are classically due to mutations in the CTSD gene (the CLN10 disease). Affected newborns usually present severe microcephaly, seizures and respiratory failure leading to death within the first postnatal days or weeks. Cases We report on two siblings, in which exome sequencing identified a novel homozygous CTSD variant. The first sib presented at birth with seizures, rapidly progressive postnatal microcephaly and visual deficiency related to retinal dysfunction. Progressive neurological deterioration leads to death at the age of 24 months. Cathepsin D activity was reduced in the cultured fibroblasts of this patient. The second sib, a fetus of 36 weeks of gestation, was delivered after pregnancy termination for brain abnormalities (in accordance with French Legislation) suggesting a recurrence of the disease. Fetal postmortem examination disclosed neuropathological features consistent with NCL. Conclusions Congenital NCL related to CTSD mutations is a neuronal storage disorder that produces in the developing brain diffuse neurodegeneration and white matter atrophy resulting in a progressive and rapidly lethal microcephaly.