Anatomical subgroup analysis of the MERIDIAN cohort: failed commissuration

Objective: To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with either agenesis of the corpus callosum or hypogenesis of the corpus callosum (grouped as failed commissuration) on antenatal ultrasonography (USS) from the MERIDIAN cohort. Methods: We report a sub-group analysis of fetuses with failed commissuration diagnosed on USS (with or without ventriculomegaly) from the MERIDIAN study who had iuMR imaging within 2 weeks of USS and outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported as well as indicators of diagnostic confidence and effects on prognosis/clinical management. Results: 79 fetuses with failed commissuration are reported (55 with agenesis and 24 with hypogenesis as the USS diagnoses). The diagnostic accuracy for detecting ‘failed commissuration’ as a group label was 34.2% for USS and 94.9% for iuMR (difference = 60.7%, 95% confidence interval 47.6% to 73.9%, p < 0.0001). The diagnostic accuracy for detecting hypogenesis of the corpus callosum as a discrete entity was 8.3% for USS and 87.5% for iuMR whilst the diagnostic accuracy for detecting agenesis of the corpus callosum as a distinct entity was 40.0% for USS and 92.7% for iuMR. There was a statistically significant improvement in ‘appropriate’ diagnostic confidence when using iuMR imaging as assessed by a score-based weighted average’ method (p < 0.0001). Prognostic information given to the women changed in 36/79 (45.6%) cases after iuMR imaging and its overall effect on clinical management was ‘significant’, ‘major’ or ‘decisive’ in 35/79 cases (44.3%). Conclusions: Our data suggests that any woman whose fetus has failed commissuration as the only intracranial finding detected on USS should have iuMR imaging for further evaluation

Indices of apoptosis and proliferation as potential prognostic markers in non-functioning pituitary adenomas

OBJECTIVE: Non-functioning pituitary adenomas (NFAs) are a distinct group of pituitary adenomas, which comprise approximately 20% of pituitary adenomas. Although most pituitary adenomas are benign, there is a subset of adenomas that behaves in an aggressive fashion, with either invasion of the surrounding structures or recurrence. The aim of this study was to investigate whether the behaviour of NFAs can be predicted using immunohistochemical markers that label proliferating and apoptotic cells, including a new marker for apoptosis (M30 CytoDEATH). This is the first study to analyse both the proliferation labelling index (LI) and the apoptotic index (AI) in NFAs and to correlate the labelling indices of these histological markers with tumor growth rate as measured by 2 postoperative MRI scans. MATERIAL AND METHODS: 40 patients in total were included in the study. 20 patients with high growth rate and percentage change in the pituitary adenoma volume as assessed on 2 postoperative MRI scans were age/sex matched to 20 patients with low growth rate or percentage change.RESULTS: There is no significant statistical difference of the histological and immunohistochemical indices assessed between cases and controls.CONCLUSION: The routine assessment of the proliferation and the apoptotic markers used in this study in NFAs has no prognostic value

Anatomical subgroup analysis of the MERIDIAN cohort: Ventriculomegaly

Objective To assess the contribution of in utero magnetic resonance (iuMR) imaging in fetuses diagnosed with ventriculomegaly as the only abnormal intracranial finding on antenatal ultrasonography (USS) in the MERIDIAN cohort. Methods We report a sub-group analysis from the MERIDIAN study, of cases of fetal ventriculomegaly diagnosed on USS who then had iuMR imaging within 2 weeks of USS and for whom outcome reference data were available. The diagnostic accuracy of USS and iuMR are reported in relation to the severity of ventriculomegaly. We also study the difference in measurements of trigone size on the two imaging methods and present the clinical impact of adding iuMR to the diagnostic pathway. Results USS failed to detect 31 additional brain abnormalities other than ‘ventriculomegaly’ in the subgroup of 306 fetuses, giving an overall diagnostic accuracy of 89.9% for USS, whilst iuMR correctly detected 27 giving a diagnostic accuracy of 98.4% (statistically significant p < 0.0001). There were other brain abnormalities in 14/244 of fetuses with mild ventriculomegaly on USS (diagnostic accuracy 94.3%), and iuMR correctly diagnosed 12 of those (diagnostic accuracy 98.8%). All of those results reached statistical significance in favour of iuMR. There was a close agreement between the size of trigones measured on USS and on iuMR, with categorical differences in only 16% of cases. iuMR did not systematically over-estimate trigone size, as suspected before the study commenced. Complete prognosis data were available in 295/306 fetuses and the prognosis category changed after iuMR in 69/295 (23.4%) cases. The overall effect of iuMR on clinical management was considered to be either ‘significant’, ‘major’ or ‘decisive’ in 76/295 (25.8%) cases. Conclusion Our data suggest that any woman whose fetus has ventriculomegaly as the only intracranial finding on USS should be offered an adjuvant investigation of iuMR for further evaluation