Natan Argaman , 3 rd year medical student (4 year program), Sackler - - PowerPoint PPT Presentation

Natan Argaman, 3rd year medical student (4 year program), Sackler School of Medicine, Tel Aviv University

Supervised by:

• Dr. Katorza Eldad, Antenatal Diagnostic Unit, The Chaim Sheba Medical Center,

Tel Hashomer, and Sackler School of Medicine, Tel Aviv University

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Outline

A short reminder What we have done so far Current results Next step

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What was missing in the first step…?

R Ber, O Bar-Yosef, C Hoffmann et al. Normal Fetal Posterior Fossa in MR Imaging: New Biometric Data and Possible Clinical Significance. AJNR 2015; 36: 795-802

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Aims of the study

The current methods of prenatal diagnosis are very limited.

Furthermore, the current biometric data is old and maybe lack

• f updated evidence.

Hence, we have 2 objectives to our current research:

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Validate the curves which Katorza’s group established in the first step Reduce false positive rate of pathological

• utcomes in prenatal diagnosis

Steps of our research

Reevaluation of 40 embryos with abnormal findings

• n MRI in the posterior fossa, using the percentile

curves we established last year, comparison to

• riginal

diagnoses, postnatal diagnoses and neurodevelopmental assessment of the children.

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Step 1.

• Measurements. A lot of them…

We made nearly thousand

• f

measurements

• 23 structures in MRI scans of 40 fetuses.

In this step we gathered radiological data and defined normal and abnormal fetuses by the current accepted medical curves.

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Midsagittal plane measurements

Midbrain Pons Medulla oblangata

Brainstem Tentorium Cerebelli 4th Ventricle Torcular Vermis Cisterna Magna (CM)

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Axial plane measurments

Axial plane

Cerebellum 4th Ventricle Vermis Cisterna Magna Pons

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Our data

Step 2.

 Collecting postnatal “subjective” neurological development information.  We have called 37 mothers in order to collect data about the neurological

development of their child. Couple of drawbacks:

• 1. Only few mothers agreed to fully cooperate.
• 2. We feel that the test is not reliable enough,

though it’s a validated telephone questionnaire.

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Step 3.

 Collecting postnatal “objective” neurological development information.

We have collected medical data of children who came to the pediatric neurological clinic in Sheba Medical Center. Drawback – apparently, only few children were under follow-up of a pediatric neurologist.

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Case no. 1 (an example)

A 41-year-old woman is in her second pregnancy. On routine ultrasound screening test there were suspicious findings. The women referred to fetal MRI scan.

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MRI findings:

• 1. Enlarged cisterna magna (22mm)
• 2. A cystic finding (20x15x25mm), Posterior to the vermis.

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Out of the initial sample group, only small subgroup underwent a “subjective” neurological evaluation (via telephone questionnaire) and even smaller minority has an “objective” neurological assessment.

Now what?

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Initial sample (Total) Quality measurements Full questionnaire (Vineland) Neurological assessment 44 40 (~91%) 10 (~22%) 5 (~11%)

Step 4.

Currently we are establishing different prenatal diagnoses, based on the new biometric data of our group.

Special thanks to Roee Ber

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Step 5.

After much thought and consultation, we are now debating whether to try making a more reliable objective assessment to the other children in the initial sample group or to process our current results only.

Special thanks to Dr. Omer Bar-Yosef, pediatric neurological clinic and Prof. Reuven Achiron, head of diagnostic ultrasound unit

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I want to thank few people for this unique opportunity:

 Prof. Anat Achiron for leading this great project.  Mrs. Yaffit Rot for the great help throughout the year.  Dr. Eldad Katorza for the guidance and support!

And I will thank you again next year…

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