Magnetic resonance imaging to enhance the diagnosis of fetal developmental brain abnormalities in utero

The objective of this research is to assess MRI as a technology to aid in the prenatal diagnosis of fetal developmental brain abnormalities. The study will recruit 750 pregnant women from 18 weeks gestation onwards where the fetus is known or suspected of having some form of developmental brain abnormality based on antenatal ultrasound examination. Study participants will receive their clinical care in one of 15 collaborating fetal medicine units drawing from a large and varied geographic and socio-economic referral area in England and Scotland. The study is designed primarily to assess the diagnostic accuracy of MRI along with the related aspect of diagnostic confidence. The clinical impact of MRI in this context will also be assessed both quantitatively, as changes in clinical management, and qualitatively by assessing the impact of the 'new technique' on the clinicians who interact with the pregnant women. In parallel, the opinions of the women included in the study will be sought in order to assess perceptions of MRI on acceptability and decision making. Finally, health economic modelling will be performed for the specific changes in management attributable to the inclusion of MRI in the diagnostic pathway. The work is centred at the Academic Unit of Radiology, University of Sheffield. The MRI examination itself will be performed either in Sheffield, or a local collaborating centre. The aim is to deliver a programme of research able to inform fetal medicine practice within the United Kingdom in five years from the start of the study. The study will provide evidence relevant to a range of health policy options, for instance service delivery based on gestational age (before and after 24 weeks) or for specific types of suspected brain abnormality. The results should also provide some indication of the clinical and patient acceptability of centralised versus regional MRI services.