Research Presentation Session: Paediatrics

RPS 1312 - Neuro- and skeletal-paediatric radiology

March 1, 09:30 - 11:00 CET

7 min
Evaluating AI and human-derived tumour volume estimations in paediatric osteosarcoma: association with histological response and survival predictions
Lisa C. Adams, München / Germany
    Author Block: L. C. Adams1, K. K. Bressem1, W. Morakote2, V. Suryadevara2, A. Pribnow2, S. Spunt2, L. Baratto2, J. Rosenberg2, H. E. Daldrup-Link2; 1Berlin/DE, 2Palo Alto, CA/USPurpose: The study aimed to assess the potential of using human- and AI-assessed tumour volume changes as markers for treatment response in paediatric osteosarcoma, in comparison to histological necrosis, and to evaluate their association with patient survival.Methods or Background: In paediatric osteosarcoma, the extent of tumour necrosis post-surgery is used to estimate treatment response. This single-centre retrospective study involved examining pre- and post-chemotherapy MRI scans of 57 paediatric and young adult patients with histologically confirmed osteosarcoma. A subset of these patients also underwent 18F-FDG PET. We correlated human- and AI-assessed tumour volume changes with overall (OS) and recurrence-free survival (RFS) metrics using concordance correlation (CC). Additionally, quantitative measures such as tumour volume/size changes and histological necrosis (%) were assessed for their impact on OS/RFS through logrank tests and Cox regression. We further compared tumour ADC and SUV between responders (≥90% histological necrosis) and non-responders.Results or Findings: AI-assessed tumour volume change measurements were a stronger predictor of OS than histological necrosis (Harrell's C=
  1. 88 versus C=0.70). Human assessments did not outpace necrosis in predicting survival outcomes. When examining histological necrosis ≥90% and AI-driven volume change of <25% post-chemotherapy, both were linked to improved OS (p=0.021 and p<0.0001 respectively). There was high agreement between human and AI measurements (CC coefficient >0.95). Furthermore, patients with a histological necrosis of ≥90% had higher ADC values both pre- and post-chemotherapy (both p=0.004), and displayed lower pre-therapy SUV values when compared to non-responders (p=0.001).
    2. Conclusion: Both human and AI-derived tumour volume changes showed a correlation with histological necrosis, indicating their potential as markers for treatment response and OS in paediatric osteosarcoma. AI-driven volume change measurements demonstrated stronger predictive capabilities for OS than histological necrosis.Limitations: Our research was based in a single centre, potentially limiting wider applicability.Funding for this study: Funding was received from the National Cancer Institute (grant R01CA269231).Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the IRB, with approval number
7 min
Intracranial haemorrhage detected with prenatal MRI in foetuses with Chiari II malformation: indication or contraindication for foetal surgery
Marlene Stuempflen, Vienna / Austria
    Author Block: S. Hui1, D. Prayer2, P. Kienast2, J. Binder2, K. Goeral2, C. Mitter2, T. Dorittke2, G. Kasprian2, M. Stuempflen2; 1Guangzhou/CN, 2Vienna/ATPurpose: Intracranial haemorrhages (ICH) have emerged as a notable association in Chiari II malformation (CM II), yet their origins and clinical implications remain elusive. This study aims to validate the prevalence of ICH in CM II, investigate contributing factors to ICH, and delineate the phenotypic attributes associated with CM II and ICH.Methods or Background: A retrospective review of foetal MRI scans obtained in foetuses with CM II presenting (January 2007 to December 2022) at Vienna General Hospital was performed for ICH utilising EPI-T2* blood-sensitive sequence. Foetuses with aqueduct stenosis (AS) were also included as a control group. The incidence of ICH and corresponding gestational ages were compared between CM II and AS cases, and morphometric measurements (inner/outer CSF spaces, posterior fossa, venous structure) were compared among the three 1:1 age-matched groups: CM II+ICH, CM II-ICH, and AS+ICH. Additionally, a co-occurrence network was constructed to visualise associations between diagnostic features in ICH cases.Results or Findings: A total of 101 foetuses with CM II and 90 controls with AS were included. The prevalence of ICH in foetuses with CM II was higher compared to the AS cases (
  1. 7% vs 18.9%), accompanied by congested veins (deep vein congestion mainly in young foetuses, and cortical veins also affected in older foetuses). ICH was correlated with more distal vermis ectopia, reduced outer CSF spaces, and clivus-supraocciput angle. The co-occurrence network analysis underscored venous congestion and venous sinus stenosis as pivotal components within the network.
    2. Conclusion: The prevalence of ICH among foetuses with CM II accentuates the interplay of venous congestion, ICH, and vasogenic oedema, hinting at potential anatomical attributes underlying the vicious cycle. Prenatal repair surgery should be applied to these cases as soon as possible.Limitations: The retrospective nature of this study was an identified limitation.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the Ethics Committee with approval code: 1716/
7 min
Using 'fast' MRI head scan to improve paediatric patient experience for investigation of headaches
Laura Christine Walker, Pathhead / United Kingdom
    Author Block: L. C. Walker, A. Quigley, S. Choi, L. Armstrong, D. Evans, R. Kirkbride; Edinburgh/UKPurpose: There are numerous requests, per year, for Magnetic Resonance Imaging (MRI) head scans for paediatric patients who present with headaches, usually returning a normal resultant MRI scan. A fast head (FH) imaging protocol (IP) was developed, reducing scan length from 12 minutes 51 seconds (Standard Head (SH) IP) to four minutes 22 seconds, a 66% time reduction in scan-time, potentially improving patient experience.Methods or Background: 50 retrospective paediatric patients (mean age, 10 years ±
  1. 215 Standard Deviation (SD), referred for headaches, who had both FH and SH IP, at the same appointment, were included. Imaging was split on a picture archiving and communication system, randomised, then each folder blindly reported twice, separately, by two consultant neuro-radiologists. The original report was used as gold standard and compared with all imaging. Scores on a pre-determined ranking system were recorded by the radiologists using a four-point Likert scale (LS) for all scans. Intra-observer agreement was reviewed and SD was used as the statistical evaluation.
    2. Results or Findings: The FH IP showed adequate overall image quality and, on three sequences, less motion artefact with a score of two or more points on the LS. In two cases on the T1 and fluid attenuation inversion recovery sequences the average score was less than two (
  2. 95; 1.98) when visualising the basal ganglia. Although these scores were less than the SH imaging, the overall image quality was deemed to be sufficiently diagnostic across all points with a sensitivity of 82.7%, specificity of 76.5% and accuracy of 79.4%.
    3. Conclusion: FH imaging shows pathology can confidently be identified despite a reduction in image quality and offers sufficient diagnostic clinical information. FH IP imaging can become the new SH IP when investigating headaches in paediatric patients.Limitations: No limitations were identified.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? Not applicableEthics committee - additional information: The study is retrospective.
7 min
Reference values for knee ultrasound in children and adolescents: thickness of intercondylar cartilage, and length of ossified patella
Sílvia Costa Dias, Porto / Portugal
    Author Block: S. C. Dias1, D. C. Carvalho1, M. Castro1, C. C. Dias1, I. M. Ramos1, I. Brito1, K. Rosendahl2; 1Porto/PT, 2Tromsø/NOPurpose: The study aimed to establish ultrasound-based reference values for intercondylar cartilage thickness and patellar length by age and sex.Methods or Background: This was a prospective, cross-sectional study on healthy volunteers aged 3–17 years. Exclusion criteria were those of chronic medicated diseases that affect the skeletal system or a recent trauma. Bilateral knee ultrasound was performed by one of two experienced examiners, with the child supine, knee 90° flexed for measurement of intercondylar cartilage thickness and extended for the patellar length. Interobserver variation on 27 participants was assessed.Results or Findings: A total of 127 volunteers (67 females) with a median age of
  1. 9 years were included. Median thickness of the intercondylar cartilage was 3.1 mm (percentiles 2.5th – 97.5th: 2.1- 4.2 mm) for females and 3.4 mm (percentiles 2.5th – 97.5th: 2.3-4.7 mm) for males (p=0.005). There were no differences according to right or left side (p=0.757). The cartilage thickness decreased with age, with a median of 3.6 mm for 3–6-year-olds and 2.9 mm in 14-17 year-olds (p < 0.001). Median length of the ossified patella was 33.6 mm (percentiles 2.5th – 97.5th: 0.0 – 44.2 mm) on the right side versus 32.4 mm (percentiles 2.5th – 97.5th: 0.8 – 42.2 mm) on the left side (p < 0.001). No differences were seen according to sex (p=0.259 for the right and p=0.233 for the left side). The reproducibility between the two readers was high (intraclass correlation coefficient values > 0.9).
    2. Conclusion: The intercondylar cartilage thickness decreased with increasing age, with females having thinner cartilage than males. The length of the ossified right patella was significantly longer than the left. The presented reference values can help discriminate between normality and pathology.Limitations: No limitations were identified.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: The study registration number is: CE 191/
7 min
The diagnostic performance of magnetic resonance imaging in the categorisation of paediatric neck lymph nodes: radiological and pathological correlations
Naz Paytoncu, Istanbul / Turkey
    Author Block: N. Paytoncu, E. Çalışkan, H. G. Düzkalır, M. Arifoğlu, N. Fıstıkçıoğlu, H. P. Günbey; Istanbul/TRPurpose: In literature, there isn't a compact magnetic resonance imaging (MRI) study of the neck in the paediatric population covering both numerical data and morphological criteria. Therefore, the aim of this study was to present certain MRI features of neck lymph nodes in benign and malignant conditions in children.Methods or Background: Contrast-enhanced MRI of the neck of 51 paediatric patients aged 1-18 years (40 boys, 11 girls [
  1. 08±4.73]) who underwent neck lymph node biopsy were retrospectively analysed. They were grouped as benign, including reactive (27 [52.9%]), lymphadenitis (11 [21.6%]), and malignant (13 [25.5%]). The groups were evaluated multiparametrically in terms of quantitative and qualitative variables.
    2. Results or Findings: Medians and ranges (25-75th percentile) of long axis, short axis, area and apparent diffusion coefficient (ADC) values of the largest lymph node were 21 (17-24) mm, 14 (12-18) mm,
  2. 60 (144.79-351.82) mm2, 2531 (2457-2714) mm2/s for reactive, 24 (19-27) mm, 15 (11-20) mm, 271.80 (231.43-412.20) mm2, 2534 (2425-2594) mm2/s for lymphadenitis, 27 (23.50-31.50) mm, 20 (15-22) mm, 377.08 (260.47-530.94) mm2, 2337 (2254-2466) mm2/s for malignant, respectively. The lymph nodes with a long axis greater than 22 mm, a short axis greater than 16 mm, an area greater than 319 cm2, and an ADC value less than 2367 mm2/s may be malignant. Those with an atypical location (especially supraclavicular) have a higher rate of malignancy (p=0.003). Perinodal signal changes, nodal heterogeneity with cystic/necrotic areas and posterior cervical triangle location are common in lymphadenitis (p<0.001). Reactive lymph nodes are distributed symmetrically in both neck halves (p<0.001).
    3. Conclusion: In an MRI-based approach to reactive, lymphadenitis and malignant lymph nodes for the paediatric era, not only numerical data such as long axis, short axis, surface area and ADC, but also morphological criteria such as location, distribution, internal structure and perinodal heterogeneity should be used.Limitations: The study cohort could be expanded to include a greater number of participants. ADC measurements result from the solid millimetric section of mostly necrotic lymph nodes, which might not be optimal.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: The ethics review board at our institution approved this study (decision number: 2023/514/244/16) which is performed in accordance with the principles of the Declaration of Helsinki.
7 min
Glymphatic system dysfunction and white matter connectivity alterations for diagnosing autism spectrum disorder in children
Miaoyan Wang, Wuxi / China
    Author Block: M. Wang1, K. He2, D. Xu1, L. Wang1, G. Zhang3, B. Peng4, Y. Dai4, L. Zhang1, H. Jiang1; 1Wuxi/CN, 2Changchun/CN, 3Shenzhen/CN, 4Suzhou/CNPurpose: Multiparametric MRI analysis can help elucidate the pathogenesis of autism spectrum disorder (ASD). This study aimed to analyse the glymphatic system and alterations of white matter connectivity for diagnosing ASD.Methods or Background: In this retrospective case-control study, the data of children aged 3–6 years with ASD, and typically developing (TD) children from two tertiary medical centres were collected. Patients with ASD were assigned to the mild-moderate, and severe groups using the Childhood Autism Rating Scale. Automated diffusion tensor imaging along the perivascular space (aDTI-ALPS) index and fractional anisotropy values were obtained on DTI. Node efficiency values were derived from the construction of structural brain networks. A general linear model was used to evaluate the group differences in aDTI-ALPS index, fractional anisotropy values, and brain network properties. Multiple MRI parameter features were evaluated for diagnostic efficacy using a machine learning framework.Results or Findings: Seventy children with ASD (mean age,
  1. 25 years; 51 male patients) and 45 TD children (mean age, 4.54 years; 25 male patients) were included in the study. The aDTI-ALPS index was lesser in the mild-moderate ASD group than that in the control group (1.43 versus 1.58, p<.001). A further reduction in the aDTI-ALPS index was observed in the severe ASD group compared with that in the mild-moderate ASD group (1.43 versus 1.33, p<.001). The accuracies of diagnosing ASD and distinguishing severe ASD using aDTI-ALPS combined with extra-axial cerebrospinal fluid volume, white matter fractional anisotropy, and node efficiency were 82.50% and 85.00% respectively, and area under the curve were 0.88 and 0.89, respectively.
    2. Conclusion: The multiparametric predictive model based on glymphatic system dysfunction and alterations in white matter connectivity enables the effective diagnosis and stratification of severity levels in autism spectrum disorder.Limitations: No limitations were identified.Funding for this study: Funding was provided by the Precision Medicine Key Project of Wuxi Health Commission (grant number: J202107); Sanming Project of Medicine in Shenzhen (SZSM202011005); and Wuxi Science and Technology Development Project (CN) (grant number: N20192005).Has your study been approved by an ethics committee? YesEthics committee - additional information: The study received institutional review board approval and written informed consent was obtained from all participants.
7 min
Microstructural white matter change, emotional dysfunction and visual working memory in adolescents with borderline personality disorder
Xiaoping Yi, Changsha / China
    Author Block: X. Yi1, B. T. Chen2; 1Changsha/CN, 2Duarte, CA/USPurpose: Emotional dysfunction is one of the core symptoms in adolescent borderline personality disorder (BPD), with the underlying mechanisms remaining unclear. The aim of this study was to assess the alteration of microstructural white matter fibres and its association with visual working memory and emotional dysfunction in adolescent BPD.Methods or Background: A total of 53 adolescents with BPD aged 12–17 years and 39 age- and gender-matched healthy controls (HCs) were enrolled into this study. Based on diffusion tensor imaging (DTI) data, radial diffusivity (RD) and axial diffusivity (AD) were generated using Tract-Based Spatial Statistics (TBSS) method. Correlative analysis of microstructural alterations with visual working memory, non-suicidal self-injurious behaviours (NSSI) and childhood trauma were performed.Results or Findings: Compared with HCs, adolescents with BPD showed lower AD values in the splenium of the corpus callosum, left anterior corona radiata, and left external capsule. In adolescents with BPD, higher RD values were observed in the genu of the corpus callosum, body of the corpus callosum, right anterior corona radiata, and right uncinate fasciculus. There were significant correlations between increased RD of genu and body of corpus callosum was negatively correlated with visual working memory (visual reproduction), NSSI (Ottawa Self-Injury Inventory-4C), and childhood trauma (Childhood Trauma Questionnaire-E) (P<
  1. 05).
    2. Conclusion: There were brain microstructural alterations within the cortical-limbic system in adolescents with BPD, and these changes were found to be associated with visual working memory, NSSI and childhood trauma in BPD. These results implicate that the microstructural alterations may serve as a potential neuroimaging biomarker for underlying pathological mechanisms in adolescents with BPD.Limitations: The sample size was relatively small, and this was a cross-sectional study.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: The present study was approved by the ethics committee of our institute (IRB: 2022020227), and all participants and their legal guardians provided written informed consent.
7 min
Lesion volume and spike frequency impact perfusion in focal cortical dysplasia: a paediatric arterial spin labelling study
Antonio Giulio Gennari, Zurich / Switzerland
    Author Block: A. G. Gennari, G. Bicciato, S. Lo Biundo, R. Kottke, I. Yakoub, D. Cserpan, R. Tuura O’Gorman, G. Ramantani; Zurich/CHPurpose: Arterial spin labelling (ASL) has yielded promising results in the presurgical workup of children with FCD-related epilepsy. Despite the increased utilisation of ASL, the interpretation of perfusion patterns and their correlations with other patient characteristics remains unclear. Our study evaluated the perfusion changes captured by ASL in this vulnerable subgroup and investigated their clinical, EEG, and MRI determinants.Methods or Background: We included children with an MRI-detectable FCD, who underwent ASL. We assessed ASL perfusion changes qualitatively by visual inspection and quantitatively by estimating the asymmetry index (AI). We correlated perfusion patterns and their extent, as well as the AI values, with clinical, EEG, and MRI features.Results or Findings: We considered 18 scans from 15 children with FCD-related epilepsy; seven underwent resective epilepsy surgery. A total of 16 of 18 (89%) scans showed FCD-related perfusion changes: 10 FCDs were hypoperfused, whereas six were hyperperfused. Nine scans had perfusion changes larger than, and seven equal to, the FCD extent on anatomical images. Hyperperfusion in ASL was determined by frequent EEG spikes (p=
  1. 047, Chi-square test). Perfusion changes in ASL larger than the FCD corresponded to larger lesion volumes (p=0.017, Wilcoxon-Mann-Whitney test). Higher AI values were determined by frequent EEG spikes (p=0.004, Welch t-test) and smaller lesion volumes (after controlling for age at MRI) in univariate analysis, but only frequent EEG spikes retained their significance in multivariate analysis.
    2. Conclusion: ASL showed FCD-related perfusion changes in most cases, including smaller volume lesions, which may escape detection in anatomical MRI. Higher spike frequency may increase ASL yield in affected children. These observations may facilitate the interpretation of ASL findings, improving treatment management, counselling, and prognostication in children with FCD-related epilepsy.Limitations: The main limitations are the retrospective design and the small sample size.Funding for this study: We thank the Anna Mueller Grocholski Foundation and the Swiss National Science Foundation (SNSF: 208184) (to G.R.) and the Swiss Government Excellence Scholarship (to A.G.G.) for funding. The funders had no role in the design or analysis of the study. None of the authors has any conflict of interest to disclose.Has your study been approved by an ethics committee? YesEthics committee - additional information: The study was approved by and performed according to the guidelines and regulations of the local ethics committee (KEK-ZH 2019-01854). All parents gave written informed general consent to reuse clinical data for research.
7 min
Assessing the validity of MR imaging severity score for predicting the clinical outcome in acute necrotising encephalopathy of childhood
Kumail Khandwala, Karachi / Pakistan
    Author Block: K. Khandwala, K. Hilal, S. Kaleem, M. Mufarrih; Karachi/PKPurpose: Acute necrotising encephalopathy of childhood (ANEC) is a unique entity with bilateral grey and white matter involvement. The purpose of this study is to determine whether severity of MR imaging findings can predict the prognosis and the clinical outcome of patients with ANEC.Methods or Background: A retrospective cross-sectional study was conducted on 42 patients diagnosed with ANEC. An MR imaging severity score was devised for each patient according to a point system derived from the presence of haemorrhage, cavitation, enhancement, diffusion restriction and location of lesions. The scoring was categorised into mild, moderate, and severe. Clinical outcomes were determined at the time of discharge and at one-yearly follow-ups as mild disability, moderate disability, severe disability, and death.Results or Findings: The study included 21 boys and 21 girls with a mean age of
  1. 5 months. No statistically positive correlation (r 0.1198) was found between the MR grading and the clinical outcome. A statistically significant correlation of diffusion restriction (p 0.03) and cerebellar involvement (p 0.05) with worse clinical outcome was seen. Those with presence of shock also correlated with worse outcomes (p 0.01).
    2. Conclusion: Cerebellar involvement and presence of diffusion restriction on imaging, and presence of shock on presentation were associated with a worse clinical outcome in our study. The MR imaging severity score overall, however, did not correlate significantly with clinical outcome. Therefore, our results suggest the importance of combined clinical, laboratory, and neuroimaging findings in determining the prognostic outcome of patients with ANEC rather than imaging severity alone.Limitations: This was a single centre study with limited resources to conduct extensive virological studies, follow-up MRI or assess RANBP2 target mutation for determining a genetic analysis. Our follow-ups were also limited because not all patients could be clinically examined.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: The study was approved with approval number: 2020-5529-
7 min
Bone involvement in children with lymphoma: results of a PET/MR study
Lucia Pilati, Teolo / Italy
    Author Block: L. Pilati1, G. Fichera1, S. Bertin1, M. Pillon1, D. Cecchin1, P. Zucchetta2, C. Giraudo1; 1Padua/IT, 2Treviso/ITPurpose: The objective of this study was to assess the diagnostic value of 18F-FDG-PET/MR for bone involvement in pediatric patients with lymphomaMethods or Background: Children and adolescents (i.e., <21 years-old) with lymphoma who underwent a 18F-FDG-PET/MR at diagnosis, from January 2017 to December 2022 were included. For each PET/MR site (skull, upper and lower extremities, and axial skeleton) and number of skeletal lesions (up to five) were recorded with a separate evaluation of T1w, TIRM and PET datasets. PET/MR was considered positive when a lesion was visible on T1W and/or TIRM and had high metabolic activity (higher than the mediastinal blood pool). Biopsy or a combined reference standard, including other radiological techniques and follow-up were used. The diagnostic value of T1W, TIRM, PET, and PET/MR was assessed by computing per-patient sensitivity (Se) and specificity (Sp).Results or Findings: 59 patients (mean age
  1. 8±3.1years old; 32 females) matched the inclusion criteria. Overall, 11 (18.6%) patients, eight with Hodgkin-lymphoma, had bone involvement. Overall, 60 lesions were detected with the lower extremities being mostly affected (30 lesions), followed by the axial skeleton (16 lesions). The average size of the largest lesions was 26.5±16 mm. On T1w images were identified five false positive and four false negative patients (Se=63.6%, Sp=89.6%) while with TIRM six patients turned out to be false positive (Se=100%, Sp=87.5%). With PET and PET/MR occurred only one false negative (Se=90.91%, Sp=100%).
    2. Conclusion: PET/MR including TIRM allows an accurate characterization of bone involvement in children and adolescents with lymphoma.Limitations: No limitations were identified.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? Not applicableEthics committee - additional information: Not applicable.
7 min
Pre- and postoperative foetal MRI for the evaluation of foetoscopic hybrid surgery in foetuses with spina bifida aperta
Maximilian Schulze, Marburg / Germany
    Author Block: M. Schulze1, C. Keil1, I. Bedei2, V. Hohmann1, B. Saß1, S. Köhler1, R. Axt-Fliedner2, A. Kemmling1; 1Marburg/DE, 2Giessen/DEPurpose: Foetal MRI is important for the preoperative evaluation of spina bifida aperta (SBA) and its intracranial findings and is therefore relevant for treatment decisions. Postoperative MRI enables intrauterine evaluation of the surgical result, also with regard to the regression of ACM and possible further postpartum therapy requirements.Methods or Background: SBA is a congenital malformation of multifactorial aetiology. The sensorimotor impairment of function depends on the level of the spinal lesion. In addition, intracranial malformations such as Arnold Chiari malformation (ACM), hydrocephalus, callosal disorders, and heterotopias are found. The MOMS trial demonstrated the superiority of intrauterine therapy over postpartum therapy of SBA. The aim of the study is to evaluate the prenatal hybrid surgery (laparotomy with foetoscopic closure of the SBA) performed at the centre.From 2021- 2023, fifteen foetuses were operated on. Preoperative MRIs were performed in the 19th- 26th periods. SSW and postoperative MRIs were performed in the 30th-32nd week of pregnancy according to standard protocol, T2 HASTE, DWI.Results or Findings: The ratio of boys to girls was 6:
  1. 10 foetuses (66%) showed a meningomyelocele, 5 (33%) had rachischisis, and lesion length was median of five segments (range 48). Motor levels were 4/15 foetuses (27%) at L5 and 11/15 foetuses (73%) at S1. 100% had an ACM; 4 showed heterotopias, 3 had CC dysgenesis and 2 had syringomyelia.
    2. Postop MRI showed complete closure of the SBA and regression of the ACM in all foetuses. 4/15 foetuses (27%) had a hydrocephalus, which was treated postnatally by means of a VP shunt. The postop foetal MRI findings were confirmed by postpartum clinical examination and postpartum MRI control.Conclusion: Foetal MRI provides important morphological and functional information for the pre- and postoperative evaluation of intrauterine hybrid surgery.Limitations: The study is retrospective.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? Not applicableEthics committee - additional information: Not applicable.

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