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Radiological Imaging of Teratological Fetuses: What Can We Learn?

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Radiological Imaging of Teratological Fetuses: What Can We Learn? Insights Imaging (2017) 8:301–310 DOI 10.1007/s13244-017-0551-8 PICTORIAL REVIEW Radiological imaging of teratological fetuses: what can we learn? Lucas L. Boer1 & A. N. Schepens-Franke1 & J. J. A. van Asten2 & D. G. H. Bosboom2 & K. Kamphuis-van Ulzen2 & T. L. Kozicz1 & D. J. Ruiter1 & R-J. Oostra3 & W. M. Klein2 Received: 23 January 2017 /Revised: 22 February 2017 /Accepted: 8 March 2017 /Published online: 24 April 2017 # The Author(s) 2017. This article is an open access publication Abstract Conclusions Full-term teratological fetuses have become Objectives To determine the advantages of radiological imag- increasingly rare and deserve a prominent place in every ing of a collection of full-term teratological fetuses in order to anatomical museum; they are suitable for contemporary increase their scientific and educational value. teratological research and education. Modern radiological Background Anatomical museums around the world exhibit techniques markedly enhance their scientific and didactic full-term teratological fetuses. Unfortunately, these museums value. are regularly considered as Bmorbid cabinets^. Detailed Teaching Points dysmorphological information concerning the exhibited spec- • To explore the scientific and educational potential of imens is often lacking. Moreover, fetuses with severe and institutionalised teratological collections complex congenital anomalies are frequently diagnosed in- • To understand the additional value of radiological imaging completely, incorrectly or not at all. in diagnosing teratological specimens Methods In order to verify diagnoses and to enrich their • To learn about the specific settings of MRI parameters when educational and scientific value, we imaged 41 out of the scanning fixed specimens 72 teratological specimens present in the collection of our • To recognise specific internal dysmorphology in several con- Anatomy and Pathology Museum in Nijmegen genital anomalies (The Netherlands) by means of magnetic resonance imag- ing (MRI) and computed tomography (CT). Additionally, Keywords Education . Magnetic resonance imaging . contemporary dysmorphological insights and 3D models Computed tomography . Teratology . Congenital anomaly are implemented in the teratology education of medical students and residents. Introduction Many anatomical museums around the world exhibit terato- logical specimens of third trimester fetuses. Among the * Lucas L. Boer institutionalised collections, especially noteworthy are the [email protected] eighteenth century collection of the Federal Pathological Anatomy Museum in Vienna (Austria) [1, 2], the eighteenth century collection of the Hunterian Museum of the Royal 1 Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Centre, Geert Grooteplein Noord 21, College of Surgeons in London [3] and the nineteenth century 6525 EZ Nijmegen, The Netherlands Vrolik collection residing in the Vrolik Museum at the 2 Department of Radiology and Nuclear Medicine, Radboud University Medical Centre of Amsterdam [4]. They all contain University Medical Centre, Nijmegen, The Netherlands a rich trove of teratological specimens. Although some aca- 3 Department of Anatomy, Embryology and Physiology, Academic demic institutions have abandoned their anatomical collec- Medical Centre, University of Amsterdam, tions because of apparent legal issues, safety reasons, financial Amsterdam, The Netherlands cuts or newly defined priorities, these museums are much 302 Insights Imaging (2017) 8:301–310 more than time capsules with accumulations of curiosities [5]. They can be regarded as vibrant, inspirational, instructive and interdisciplinary academic working environments with scien- tific and educational potentials that can be exploited in (bio)medical curricula or in resident training programs [6]. However, one might wonder if anatomical museums should still exhibit full-grown dysmorphic fetuses as these types of anomalies are rarely occurring events in modern times. Moreover, one could question whether historical teratological specimens still have a contemporary value in a period of daily evolving medical innovations and molecular technology. These are issues anatomical museums have to deal with on a daily basis [7, 8]. Congenital anomalies have intrigued mankind since the Fig. 1 Photograph of the teratological collection in the Museum for Anatomy and Pathology of the Radboud University Medical Centre in earliest times. Already in ancient cultures terracotta ornaments Nijmegen, The Netherlands. The exhibit displays 35 teratological fetuses, were fabricated depicting congenital anomalies. These were 10 specimens of animal teratology, historical books on teratology, 3D clearly based upon existing cases, indicating that they were models and plaster casts perceived as divinities, omens or even punishments of super- natural origin [9, 10]. Nowadays, people with very diverse the most educational specimens found a permanent expository backgrounds visit teratological collections residing in medical position (Fig. 1). museums. Knowledge of both the normal and abnormal em- In order to increase the scientific and educational value of bryological development is important for both teachers and the specimens of this unique teratological collection, we physicians while medical students and patients have a con- wanted to elucidate the internal (dys)morphological character- stantly growing medical knowledge and ask more sophisticat- istics. Instead of invasive exploration, computed tomography ed questions [6]. This implies that a teratological collection (CT) and magnetic resonance imaging (MRI) techniques were can be of great value to educate people about human devel- used to generate detailed images of the internal opment. Although several anatomical museums expose tera- (dys)morphology of the teratological fetuses. Radiological im- tological specimens, most institutions lack detailed external aging proved to be an excellent method to investigate these and internal (dys)morphological descriptions or imaging. delicate specimens in a non-invasive manner [11]. Recently, Because of this, collections are often stigmatised as Bmorbid the museum opened an innovative exhibition of specimens cabinets^. documented with these images. This exhibition is accessible The teratological collection of the Museum for Anatomy for both medical students and the general public. Radiological and Pathology in Nijmegen, The Netherlands, currently pos- imaging and information about normal development and path- sesses 72 specimens. It was collected by Albert Verhofstad ogenesis can be obtained by consulting a touchscreen in which (deceased 2008), who was affiliated to the Radboud all specimens are described in full detail (Fig. 2). Common University Medical Centre in Nijmegen, between the 1950s information is given on physical billboards throughout the and 1970s. The collection originates from before the ubiqui- exposition. tous availability and utilisation of (high-resolution) ultrasound Here we report on the radiological imaging results and we for prenatal screening and therefore most specimens are full- describe four fetuses (cases 1–4), in which new diagnoses or grown fetuses or newborns. Nowadays full-grown fetuses interesting morphological characteristics were established. with severe congenital anomalies are rarely born in well- Furthermore, we discuss the scientific and educational bene- developed countries. This implies that teratological collec- fits that can be gained from radiological imaging of dysmor- tions become more valuable with time. phic fetuses. The purpose of this paper is to present an ap- In the past, our collection of teratological fetuses too was proach to create an innovative teratological exposition in order often seen as a Bmorbid cabinet^ by both students and the to de-stigmatise and to more profoundly educate the general public. In the exhibition, there was neither a clear (bio)medical student and professional. choice of the exhibited fetuses nor was there any systematic approach recognisable; questions about the nature and patho- genesis of several congenital anomalies could not be an- Materials and methods swered. Therefore, in order to systematically expose the tera- tological collection of our museum, we defined nine anomaly The entire collection of 72 teratological fetuses was visu- groups, into which all 72 specimens could be categorised. ally inspected and re-described according to contemporary This categorisation led to an new exhibition, in which 35 of syndromological views by a panel of experts in 2012 Insights Imaging (2017) 8:301–310 303 Fig. 2 Screenshot of the interactive information of neural tube defects using radiological imaging: vertebrae of a fetus with rachischisis can be compared to vertebrae of a normal fetus and a fetus with spina bifida (R.J.O., A.N.S.F. and L.L.B.). Verification of the identi- MRI protocol fied syndromes and sequences was obtained by consulting peer groups and contemporary handbooks on clinical Specimens were scanned on a TIM TRIO 3-T MRI scanner syndromology [12, 13]. Several anomaly groups were de- (Siemens, Erlangen, Germany). Specimens smaller than fined according to the classification of congenital anoma- 30 cm in length were placed in a standard circular head and lies described by the European Surveillance of Congenital neck coil, specimens over 30 cm in length were measured with Anomalies [14]. Radiological imaging was used to gener- an additional body coil. MRI scan parameters of the clinical
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