OP08.03: Diffusion weighted imaging of the spinal cord in infants with prenatally repaired spina bifida and its association with neurological outcomes

To assess spinal cord microstructure using MRI-diffusion weighted imaging (DWI) analysis at 12 months of age in infants who underwent a prenatal spina bifida (SB) repair and explore its association with neurological outcomes. Retrospective study of 36 children who underwent a prenatal SB repair (23 Fetoscopic/13 open-hysterotomy). MRI DWI scan of the spinal cord was performed at 12 months of age. Apparent Diffusion Coefficient (ADC) values were obtained in the spinal cord at the level of the anatomical lesion. ADC values were compared between patients with favourable versus unfavourable neurological outcomes. At 12 months of life, motor function (MF) and sensory levels were assessed and categorised as “Sacral one” (S1) or “not S1” level based on the lowest myotomes involved. Urological outcomes (need for anticholinergics and clean intermittent catheterisation [CIC]) were evaluated at 12 months and ambulation status was documented at 30 months of life. ADC values were expressed as 10-6mm2/s. S1 MF was observed in 72.2% of the infants, S1 sensory level in 67.7%, 30.5% needed anticholinergics and 22.2% CIC. At 30 months of life, 63.9% infants were independent ambulators. At the level of the spinal cord lesion, ADC values were consistently higher in cases with favourable neurological outcomes: S1 MF infants (1.25[1.00-1.89]) vs. not-S1 MF (1.19[1.00-1.30],p = 0.01); S1 sensory level (1.36[1.12-1.74]) vs. not-S1 sensory level (1.21[1.04-1.38],p = 0.02]); no anticholinergic therapy (1.31[1.13-1.70]) vs. need for anticholinergic therapy (1.18[1.04-1.46], p = 0.02); no CIC needed (1.35 [1.22-1.47]) vs. CIC needed (1.21[1.16-1.27],p = 0.04) and independent ambulators [1.36[1.04-1.89]] vs. not-independent ambulators [1.19[1.00-1.4],p = 0.02]. Infants with favourable neurological outcomes after in utero spina bifida repair (independent ambulators, favourable motor and sensorial function and better bladder control) present with significant differences in spinal microstructure when compared to those with unfavourable outcomes.