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  • Küçük Resim
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    Can the cell-free DNA test predict placenta accreta spectrum or placenta previa totalis?
    (Georg Thieme Verlag Kg, 2021) Adıyaman, Duygu; Kuyucu, Melda; Atakul, Bahar Konuralp; Can, Dilara; Özeren, Mehmet; Koç, Altuğ; Öztekin, Deniz
    Background Following the discovery that fetal DNA originates from the trophoblastic cells of the placenta, the contribution of the cell-free DNA test in placenta-related obstetric complications has begun to be investigated. Compared to uncomplicated pregnancies, higher fetal fractions were detected in placenta accreta spectrum and placenta previa, which are among placenta-related obstetric complications. However, this data applies only to advanced gestational weeks. Aim To investigate the possible predictive value of fetal fraction in cell-free DNA tests in pregnancies with placenta previa and placenta accreta spectrum in early gestational ages. Materials and Methods This study was conducted in women who were screened via cell-free DNA tests for common aneuploidies in the first and second trimester and subsequently diagnosed with placenta previa or placenta accreta spectrum. After the diagnosis was confirmed with a C-section, fetal fractions were retrospectively compared to a control group with a history of an uncomplicated C-section who were also previously screened by cell-free DNA test. Results The median and interquartile range (IQR) of fetal fractions for placenta previa (n=19), placenta accreta spectrum (n=7), and control groups (n=85) were 8.1 (6-10), 6.8 (6.7-10.7), and 7.1 (4.7-9.65), respectively. No statistically significant difference was observed among the three groups in terms of fetal fractions (p=0.587). Conclusions According to our data, we did not observe any relationship between placental invasion abnormalities vs. control group or placenta previa vs. control group using the fetal fractions of the cell-free DNA test. Furthermore, we could not confirm a predictive role and/or any additional clinical contribution. We believe that future studies focusing on placental mRNA might be more helpful than cell-free fetal DNA testing.
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    The role of fetal MRI-based texture analysis in differentiating congenital pulmonary airway malformation and pulmonary sequestration
    (Galenos Yayincilik, 2022) Sarioilu, Orkun; Sarioilu, Fatma Ceren; Atakul, Bahar Konuralp; Öztekin, Deniz; Oztekin, Ozgur
    Aim: The purpose of our study was to evaluate the diagnostic performance of fetal magnetic resonance imaging (MRI)-based texture analysis (TA) to differentiate the two most common lung malformations, congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS). Materials and Methods: This retrospective single-center study included 24 patients with CPAM and 8 patients with PS who had a fetal MRI examination between January 2015 and December 2020. T2-weighted coronal images were used for TA. One reader designated the malformation borders and drew a region-of-interest for TA. The differences in values of the texture features between the groups were assessed and receiver operating characteristic curves were calculated for each statistically significant feature. P-value<0.05 was considered statistically significant. Results: Forty-eight texture features were calculated for each malformation. Twenty features on T2-weighted images were significantly different between the CPAMSs and PSs. Among these, short-run high gray-level emphasis and long-run emphasis, which are gray-level run length matrix features parameters, had the largest area under the curves: 0.956 (sensitivity 87%, specificity 95%) and 0.943 (sensitivity 87%, specificity 85%), respectively. Conclusion: Our results suggest that fetal MRI-based TA may be used to distinguish CPAMs from PSs in fetuses with uncertain pulmonary findings prior to birth.
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    The role of the fetal MRI to predict the postnatal survival in fetuses with congenital diaphragmatic hernia
    (Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2021) Sarioğlu, Fatma Ceren; Sarıoğlu, Orkun; Yılmaz İnci Turkan; Atakul, Bahar Konuralp; Öztekin, Deniz; Öztekin, Özgür
    Objective: To assess the role of the magnetic resonance imaging (MRI) to predict the postnatal survival in patients with congenital diaphragmatic hernia (CDH). Method: 25 patients with CDH who had fetal MRI between 2015 and 2020 were enrolled in this retrospective study. Patients were divided into two groups according to the postnatal survival at 30 days of age: alive and dead. The fetal MRI images were assessed to calculate the lung-to-liver signal intensity ratio (LLSIR), and the total lung volume (TLV). In addition, the site of the defect (right or left), accompanying liver herniation (present or absent), detectable-ipsilateral lung parenchyma at the apex (present or absent) were also recorded. MRI images were evaluated by two pediatric radiologists. A p value lesser than 0.05 was considered statistically significant. Results: Among 25 fetuses, 6 were alive and 19 were dead within 30 days after birth. The detectable lung parenchyma had a relationship with the alive group (p = 0.023). Observed-to-expected TLV (p = 0.001) and LLSIR (p = 0.023) were significantly lower in the dead group. Using the cutoff values for the observed-to-expected TLV as 0.27 (a sensitivity of 84%, a specificity of 84%) and for the LLSIR as 2.02 (a sensitivity of 89%, a specificity of 67%) were found as predictors for death. Conclusion: The postnatal survival in CDH may be predicted using the observed-to-expected TLV and LLSIR on the fetal MRI. The presence of the detectable-ipsilateral lung parenchyma at the apex may also be associated with the postnatal survival.