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

of 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 outcomes in prenatal diagnosis

Steps of our research

Reevaluation of 40 embryos with abnormal findings

on MRI in the posterior fossa, using the percentile

curves we established last year, comparison to

original diagnoses, postnatal diagnoses and

neurodevelopmental assessment of the children.

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Step 1.

Measurements. A lot of them…

We made nearly thousand of 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. 8

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Midsagittal plane measurements

Midbrain

Pons

Medulla oblangata

Brainstem

Tentorium

Cerebelli

4th Ventricle

Torcular

Vermis

Cisterna Magna

(CM) 10

Axial plane measurmentsAxial 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 hasan “objective” neurological assessment.

Now what? 20

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 Ber21

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 unit22

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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