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• W1995315261 abstract "L’IRM fœtale est une imagerie spécialisée toujours effectuée après une échographie « de référence ». L’indication de l’IRM doit prendre en compte l’anxiété générée par l’annonce de cet examen à caractère exceptionnel. Aucune conséquence fœtale n’est connue à ce jour, pour des champs magnétiques jusqu’à 1,5 tesla. Par rapport à l’échographie, l’IRM cérébrale fœtale permet d’obtenir un meilleur contraste entre cortex et substance blanche et une meilleure visibilité du cervelet et du tronc cérébral. L’évaluation du pronostic des anomalies cérébrales reste souvent un problème difficile et il est important de connaître les éléments qui sont constamment associés à un mauvais pronostic neurologique tels qu’une absence de courbure pontique ou une anomalie corticale bilatérale. La date de réalisation de l’IRM dépend de son indication : la période 29–32 semaines d’aménorrhée (SA) est un bon compromis entre l’âge gestationnel et la progression de la giration. Les principaux points d’appel échographiques sont les ventriculomégalies et les anomalies de la fosse postérieure. Parfois, l’indication fait suite à un contexte familial particulier, alors que l’échographie est normale (sclérose tubéreuse de Bourneville, lissencéphalies…). Outre son intérêt diagnostique, l’IRM fœtale peut être utilisée dans les cas de refus ou de difficulté prévisible d’autopsie. Fetal MRI is a specific imaging modality, always performed after a reference ultrasound examination. The decision to perform an MRI-scan must take into account the anxiety constantly generated by the need for this unusual examination during pregnancy. To date, no side-effect associated with 1.5 tesla magnets has been described. Compared to ultrasonography, fetal brain MRI provides better contrast between grey and white matter, as well as better delineation of the brainstem (pontic curvature) and the cerebellum (lobules and fissures). However, it often remains difficult to inform parents about prognosis. Thereby, it is of utmost importance to be familiar with the definite criteria associated with a poor neurological prognosis such as lack of pontic curvature or as diffuse or bilateral cortical malformations. This has to be considered within the framework of French regulations which allow pregnancy termination with no time limit. The optimal timing to perform a fetal MRI-scan depends on the context. The period between 27 and 30 weeks of gestation is a good balance between gestational age and gyration or sulcation development. The main ultrasonographic findings requiring MRI are ventriculomegalies and posterior fossa abnormalities. MRI exploration can sometimes be performed despite a normal ultrasonography in case of genetic disorders such as tuberous sclerosis and lissencephalies. In addition to its diagnostic value towards decision to terminate pregnancy, fetal MRI can be used as “in vivo autopsy”, in case of expected technical difficulties or refusal of post-abortion examinations by relatives. Technical advances (real time and specific sequences like diffusion tensor and spectroscopy) and prospective clinical studies will probably improve the efficiency of this method to assess neurological prognosis." @default.
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• W1995315261 date "2009-11-01" @default.
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• W1995315261 title "Imagerie par résonance magnétique (IRM) fœtale cérébrale : indications, aspects normaux et pathologiques" @default.
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• W1995315261 doi "https://doi.org/10.1016/j.neurol.2009.01.036" @default.
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