OP05.02: The importance of specialized, international internet consultations for diagnosis of brain anomalies

Objectives: To evaluate the importance of specialized, international internet consultations of fetuses with suspected brain anomalies. To propose a method to optimize the diagnostic capabilities of the referral centers. Methods: We retrospectively retrieved clinical and imaging data of internet consultations performed between the years 2008 and 2010 on fetuses with suspected brain anomalies at two large referral centers. The original, consultation and postnatal diagnoses were compared. We also evaluated the technical characteristics of the original examinations and of the e-mailed material. Results: The study included 88 consultations originating from 45 centers in 29 countries. The mean gestational age was 25 weeks (12–38), the mean number of images analyzed was 9 (1–24). Image quality was considered appropriate in 77. In 52 cases the diagnoses were concordant and discordant in 36. The consultation significantly modified prognosis in 24 patients and management in 13. The addition of video clips, TVS, 3D-volumes and MRI improved the diagnostic certainty of the consultations. Conclusions: Internet consultations in patients with suspected brain pathologies are fast and easy to perform without the need of complicated technical facilities. In clear cut cases they provide the referring physician reassurance of his diagnosis; in more complicated cases or when the imaging provided is not optimal, the referral center provides a differential diagnosis and recommendations regarding management.