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(A-G): Cystic hygroma in a fetus at 31 weeks. T2WI sagittal, (A) and BTFE coronal, (B and C) axial T2WI (D) images showing large multiloculated cystic midline mediastinal mass compressing and displacing the great vessels. Prenatal USG (E and F) revealed multiple cystic lesions in the anterior mediastinum. Postnatal X-ray (G) showed anterior mediastinal widening
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Ultrasonography (USG) is the primary method for antenatal fetal evaluation. However, fetal magnetic resonance imaging (MRI) has now become a valuable adjunct to USG in confirming/excluding suspected abnormalities and in the detection of additional abnormalities, thus changing the outcome of pregnancy and optimizing perinatal management. With the de...
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Citations
... Ultrasonography (USG) is widely recognized as the primary screening tool for fetal imaging due to its safety, cost-effectiveness, wide availability, real-time display, and well-established literature data (1)(2)(3). However, the sensitivity and specificity of USG may be reduced by factors such as fetal position, oligohydramnios, maternal obesity, and fetal ossification (1,2). ...
... Ultrasonography (USG) is widely recognized as the primary screening tool for fetal imaging due to its safety, cost-effectiveness, wide availability, real-time display, and well-established literature data (1)(2)(3). However, the sensitivity and specificity of USG may be reduced by factors such as fetal position, oligohydramnios, maternal obesity, and fetal ossification (1,2). In such cases and specific clinical scenarios with abnormalities detected by USG, Magnetic Resonance Imaging (MRI) may provide important diagnostic information (2). ...
... However, the sensitivity and specificity of USG may be reduced by factors such as fetal position, oligohydramnios, maternal obesity, and fetal ossification (1,2). In such cases and specific clinical scenarios with abnormalities detected by USG, Magnetic Resonance Imaging (MRI) may provide important diagnostic information (2). ...
OBJECTIVES: In this study, we aimed to assess the diagnostic accuracy of prenatal Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in fetal congenital anomalies. STUDY DESIGN: A retrospective cross-sectional analysis was conducted on 148 patients who had previously undergone prenatal MRI between January 2013 and May 2023. A total of 185 anomalies in 148 fetuses were evaluated using USG and MRI. The prenatal diagnoses were compared with definitive diagnoses and were classified as diagnosed, partially correct, questionable, or undiagnosed. In addition, USG and MRI findings were compared in terms of their consistency and consolidation. RESULTS: The postnatal evaluation revealed a total of 185 anomalies in 148 fetuses. USG diagnosed 94% of these anomalies, while MRI diagnosed 95.1% of them. Both USG and fetal MRI were able to diagnose 91.9% (n=170) of anomalies during the prenatal period. Fetal MRI provided an additional contribution to USG in the diagnosis of six anomalies (3.24%). CONCLUSION: In fetuses undergoing detailed ultrasonography and specialized neurosonography by experienced professionals, additional fetal anomalies exclusively detected through MRI are now found to be lower than previously documented. However, fetal MRI is presently employed to offer supplementary information, and advice, and assist in clinical decision-making. In the future, extensive prospective studies with standardized protocols for ultrasound imaging of the fetal brain are necessary to better understand the true role of fetal MRI in cases where fetal neurosonography has already been performed.
... Fetal magnetic resonance imaging (MRI) is a radiationfree and operator-independent imaging method that provides a wider field of view and high soft-tissue contrast resolution. Fetal MRI can provide information additional to US, especially in evaluating fetal brain structures, and is widely used for this purpose [2][3][4]. ...
... Although measurements are often made on axial images, the accuracy of the measurements was also checked on the sagittal and coronal images (Figs. 3,4). The number of pulmonary veins (PVs) was noted in each pregnant woman (Fig. 5). ...
Purpose:
Fetal cardiac magnetic resonance imaging (FCMR) can be used as an imaging modality in fetal cardiovascular evaluation as studied in recent years. We aimed to evaluate cardiovascular morphology using FCMR and to observe the development of cardiovascular structures according to gestational age (GA) in pregnant women.
Method:
In our prospective study, 120 pregnant women between 19 and 37 weeks of gestation in whom absence of cardiac anomaly could not be excluded by ultrasonography (US) or, who were referred to us for magnetic resonance imaging (MRI) for suspected non-cardiovascular system pathology, were included. According to the axis of the fetal heart, axial, coronal, and sagittal multiplanar steady-state free precession (SSFP) and 'real time' untriggered SSFP sequence, respectively, were obtained. The morphology of the cardiovascular structures and their relationships with each other were evaluated, and their sizes were measured.
Results:
Seven cases (6.3%) contained motion artefacts that did not allow the assessment and measurement of cardiovascular morphology, and three (2.9%) cases with cardiac pathology in the analysed images were excluded from the study. The study included a total of 100 cases. Cardiac chamber diameter, heart diameter, heart length, heart area, thoracic diameter, and thoracic area were measured in all fetuses. The diameters of the aorta ascendens (Aa), aortic isthmus (Ai), aorta descendens (Ad), main pulmonary artery (MPA), ductus arteriosus (DA, superior vena cava (SVC), and inferior vena cava (IVC) were measured in all fetuses. The left pulmonary artery (LPA) was visualised in 89 patients (89%). The right PA (RPA) was visualised in 99 (99%) cases. Four pulmonary veins (PVs) were seen in 49 (49%) cases, three in 33 (33%), and two in 18 (18%). High correlation values were found for all diameter measurements performed with GW.
Conclusion:
In cases where US cannot achieve adequate image quality, FCMR can contribute to diagnosis. The very short acquisition time and parallel imaging technique with the SSFP sequence allow for adequate image quality without maternal or fetal sedation.
... Gestational Magnetic Resonance (MRI) began to be performed in 1983 and, during its first years, the method was not consolidated, despite its potential, since the image acquisition sequences were slow and, therefore, very impaired by movement fetal. From the 1990s, with the advent of fast sequences, especially the T2 single shot spin echo, the exam became much less susceptible to motion artifacts, starting to be more widespread [1]. Fetal magnetic resonance imaging (MRI) is increasingly used as a complementary imaging technique during prenatal diagnosis [2]. ...
Over the last few decades, fetal imaging has led to significant improvements in prenatal counseling and postnatal therapy options, as obstetric MRI examination mainly plays a complementary role to the morphological ultrasound study when there is any diagnostic doubt or even to confirm If there is any abnormal finding in the conventional ultrasound exam. It is worth noting that there is no evidence that MRI causes biological effects in the fetus, the exams should be reserved for patients in the second and third trimester of pregnancy. Here, we performed a literature review to point out the importance of the applicability of gestational Magnetic Resonance for the identification of changes in embryonic development, gestational pathologies, maternal diseases, sequelae of infections, fetal malformations, diagnosis of placental deficiency and creation of three-dimensional prototypes for surgical planning and fetal visualization. From this narrative review it was possible to identify that the applicability of gestational MRI is related to the identification of alterations in embryonic development, gestational pathologies in general, maternal diseases, sequelae of infections, fetal malformations, diagnosis of placental deficiency and creation of prototypes three-dimensional (3D) models for surgical planning and fetal visualization.
... Fetal MRI is recommended only in case of ultrasound abnormality that cannot be clearly described, such as hypoxia ischemia, placenta, or brain abnormalities (e.g., ventriculomegaly or failure to split into the right and left hemisphere) ( Figure 3). Additionally, fetal MRI is recommended later in the second or the third trimester of pregnancy (after week 16) when organogenesis is complete and the multilayered structure of the brain is visible [20]. ...
Brain asymmetry is a hallmark of the human brain. Recent studies report a certain degree of abnormal asymmetry of brain lateralization between left and right brain hemispheres can be associated with many neuropsychiatric conditions. In this regard, some questions need answers. First, the accelerated brain asymmetry is programmed during the pre-natal period that can be called “accelerated brain decline clock”. Second, can we find the right biomarkers to predict these changes? Moreover, can we establish the dynamics of these changes in order to identify the right time window for proper interventions that can reverse or limit the neurological decline? To find answers to these questions, we performed a systematic online search for the last 10 years in databases using keywords. Conclusion: we need to establish the right in vitro model that meets human conditions as much as possible. New biomarkers are necessary to establish the “good” or the “bad” borders of brain asymmetry at the epigenetic and functional level as early as possible.
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Summarizing the variety of diagnostic imaging methods in obstetrics, there are next main offensive positions. Urgent indications for CT during pregnancy. Appendicitis – during pregnancy of the first and second trimesters. Ultrasound and/or MRI should be performed before CT. Pulmonary artery thromboembolism – in this case low-dose CT angiography of the lungs (with X-ray protection of the fetus). If suspected – CT should be the primary method of examination. In renal colic, ultrasound is the method of choice. In case of injury, ultrasound may be sufficient for the initial assessment in pregnant women, but CT should be performed if more severe or polytrauma is suspected. All patients who undergo CT of the abdomen or pelvis during pregnancy must sign a written personal consent form. In a study that presents a minimal risk (including CT pelviometry, CT of other areas of the body and MRI), it is advisable to explain to the pregnant woman about the minimal risk. Intravenous gadolinium is contraindicated in pregnancy and should be used only when absolutely necessary. Pelviometry can be performed either by low-dose CT or by MRI. Key words: pregnant women, fetuses, ultrasound (ultrasound diagnostics), MRI (magnetic resonance imaging), CT (X-ray computed tomography).
... The major drawbacks of using CT is the radiation involved, particularly in case of infants and children, whose tissues are more radiosensitive than adults. [14][15][16] Magnetic resonance imaging MRI provides optimal contrast for evaluation of soft tissues. MRI is superior to CT in evaluation of inflammatory and neoplastic processes. ...
... Prenatal ultrasound is the imaging modality of choice for evaluation of fetal congenital anomalies. 15 However, fetal MRI is indicated for further evaluation in suspected chromosomal abnormalities and familiar genetic disorders. 18 Orbital and ocular abnormalities associated with midline anomalies are easily identified and evaluated on MRI. 12 Fetal MRI utilizes ultrafast sequences to overcome artifacts resulting from fetal movement, is useful for long-term follow up, has superior ability for soft tissue characterization without radiation, and for better evaluation of venous and neurological compression. ...
Orbital lesions in the pediatric population vary from adults in terms of their presentation, unique pathology, and imaging characteristics. The prompt and accurate diagnosis of these lesions is imperative to prevent serious consequences in terms of visual impairment and disfigurement. Along with dedicated ophthalmologic examination, imaging is instrumental in characterizing these lesions, both for accurate diagnosis and subsequent management. In our pictorial essay, we provide a basic review of orbital embryology, anatomy, and congenital orbital pathologies, with emphasis on radiological findings.
... MRI diagnostic criteria [6]: Direct signs: The corpus callosum of median sagittal plane was complete absence (complete ACC) (Fig. 1), partial absence and thinning of the corpus callosum (partial ACC) (Fig. 2); radial distribution of gyri, loss or absence of reed ball-shaped contour in the splenium. Complete ACC Ultrasound and MRI Comparison (for the same case); A. Ultrasonogram Cross-section vie; Lateral cerebral ventricle body outward expansion, loss of normal structure drawn towards the midline, the bilateral ventricles were parallel "Teardrop-like"; the posterior horn of the lateral ventricle expanded (≥ 10 mm), the transparent septum disappeared, the 3 rd ventricle showed expansion and upward displacement, and the lateral ventricle was "Teardrop-like"; B. MRI image Axial view; The lateral ventricle anterior horn became smaller, with inverted "A" or crescentshaped separation, the lateral ventricle had near parallel separation, and the 3 rd ventricle showed expansion and upward displacement; C. Ultrasonogram Longitudinal section view; The cerebral sulci appeared less clear, and gyri echo was not clearly seen; D. MRI image Sagittal vie; The corpus callosum was completely absent, and the gyrus showed radial distribution Chi-square test was used to analysis the consistency and difference of the results by SPSS 22.0. ...
Objectives:
To evaluate the diagnostic value and clinical application of prenatal ultrasonography (US) and Magnetic Resonance Imaging (MRI) for different types of fetal Agenesis of the Corpus Callosum (ACC).
Material and methods:
There were 42 cases of fetal ACC discovered by routine US, including complete ACC 18 cases and partial ACC 24 cases, checked by MRI within 1 week. The results were confirmed by head ultrasound after birth or brain biopsy after labor induction.
Results:
From prenatal ultrasonic diagnosis, 18 cases were complete ACC and 24 cases were partial ACC. MRI was able to find complete ACC in 11 cases, partial ACC in 16 cases, and non-ACC in 15 cases. Labor induction or birth confirmed that, 11 cases were complete ACC, 14 cases were partial ACC, and 17 cases were non-ACC.The results of different types of ACC were detected by ultrasound and MRI were statistically significant (p < 0.05).MRI examination was superior to ultrasound in specificity, positive predictive value, negative predictive value, Youden index, and diagnostic index.
Conclusions:
MRI is high specific degrees, diagnostic performance is satisfactory, should be use as a necessary method for prenatal definitive diagnosis of ACC. However, prenatal ultrasound can be tested repeatedly and can be combined with blood flow imaging detection in real time, and it is still the preferred method for screening fetal structural malformation in a comprehensive way, which is suitable for general screening of ACC.
... Perinatal Journal 2018;26 (1): [18][19][20][21][22][23][24] künyeli yaz›n›n Türkçe sürümüdür. ...
... Ultrasonografi (USG), di¤er modalitelere göre daha ucuz oluflu, anne ve fetüs üzerinde zararl› etkilerinin bulunmay›fl› ve gerçek zamanl› görüntülemeye olanak sa¤lamas› dolay›s›yla, fetal anatomiyi de¤erlendirmede tercih edilen primer tarama yöntemidir. [1,2] Bununla birlikte küçük görüfl alan›, fetal pozisyon ba¤›ml›l›¤›, maternal obezite ve oligohidramniyos durumunda görüntü kalitesinde azalma, bunlara ek olarak ileri gebelik haftalar›nda ossifikasyon nedeniyle intrakraniyal ya-p›lar›n görüntülenmesinde zorluk gibi k›s›tl›l›klar› mevcuttur. [1][2][3] Bu nedenle ultrasonografi bulgular› belirsiz veya eksik oldu¤unda ya da yeterli görüntüleme sa¤lanamad›¤›nda manyetik rezonans görüntüleme (MRG) daha iyi perinatal dan›flmanl›k görevi görebilir ve yönetim aç›s›ndan de¤erli bir rol oynayabilir. ...
... [1,2] Bununla birlikte küçük görüfl alan›, fetal pozisyon ba¤›ml›l›¤›, maternal obezite ve oligohidramniyos durumunda görüntü kalitesinde azalma, bunlara ek olarak ileri gebelik haftalar›nda ossifikasyon nedeniyle intrakraniyal ya-p›lar›n görüntülenmesinde zorluk gibi k›s›tl›l›klar› mevcuttur. [1][2][3] Bu nedenle ultrasonografi bulgular› belirsiz veya eksik oldu¤unda ya da yeterli görüntüleme sa¤lanamad›¤›nda manyetik rezonans görüntüleme (MRG) daha iyi perinatal dan›flmanl›k görevi görebilir ve yönetim aç›s›ndan de¤erli bir rol oynayabilir. ...
Amaç: Fetal anatomiyi de¤erlendirmede ultrasonografi tercih edi-len tarama yöntemi olmas›na ra¤men, h›zl› tarama tekniklerinin geliflmesiyle fetal manyetik rezonans görüntüleme (MRG) giderek daha fazla kullan›lmaktad›r. MRG, daha iyi doku kontrast› sa¤lar ve sonografiden farkl› olarak, maternal obezite, fetal pozisyon, oli-gohidramniyos veya kemik artefaktlardan önemli ölçüde etkilen-mez. Fetal MRG genellikle kesin olmayan sonografik bulgular› te-yit etmek veya fetal malformasyonlar›n ileri de¤erlendirilmesinde endikedir. Amac›m›z, üçüncü basamak merkezimizde klinisyenler taraf›ndan tercih edilen fetal MRG endikasyonlar›n› incelemektir. Yöntem: Üç y›ll›k dönemde fetal MRG yap›lan 112 olguyu ret-rospektif olarak inceledik. Fetal lezyonlar› organ sistemlerine göre s›n›fland›rd›k ve klinisyenlerin bu yönteme baflvurma nedenleri ile tercih edilen endikasyonlar› ortaya koyduk. Bulgular: Fetal MRG incelemesine 112 fetüsten; 68'inde intrak-raniyal anomaliler, 23'ünde maternal obezite, sekizinde intraabdo-minal anomali, beflinde intratorasik anomaliler, dördünde spinal kord anomalisi, bir olguda boyun anomalisi, bir olguda genitoüri-ner anomali ve iki fetüste de di¤er anomaliler için baflvurulmufltur. Sonuç: ‹ntrakraniyal patoloji, en s›k saptanan alt grup ventrikülo-megali olmak üzere, fetal MRG de¤erlendirmesi için majör endi-kasyondu. Ventrikülomegali nedeniyle MRG ile ileri de¤erlendir-me yap›lan olgular›n üçünde (%8.3) perinatal yönetimi de¤ifltiren ek bulgular tespit edilmifltir. Abstract: Investigation of fetal magnetic resonance imaging indications Objective: Although ultrasonography is the preferred screening method for examining fetal anatomy, fetal magnetic resonance imaging (MRI) has been used more widely upon the advancements in rapid screening techniques. MRI provides a better tissue contrast , and unlike sonography, it is not affected significantly by maternal obesity, fetal position, oligohydramnios, or bone arti-facts. Fetal MRI is usually indicated for confirming uncertain sonographic findings, or for the further evaluation of fetal malfor-mations. Our purpose is to investigate fetal MRI indications preferred by the clinicians in our tertiary center. Methods: We retrospectively evaluated 112 cases which underwent fetal MRI during a three-year period. We classified fetal lesions according to the organ systems, and determined the reasons why cli-nicians employed this method and the preferred indications. Results: Of 112 fetuses which required fetal MRI examination, 68 had intracranial anomalies, 23 had maternal obesity, 8 had intraab-dominal anomaly, 5 had intrathoracic anomalies, 4 had spinal cord anomaly, 1 had neck anomaly, 1 had genitourinary anomaly and 2 had other anomalies. Conclusion: Intracranial pathology was the major indication for fetal MRI examination, as ventriculomegaly was the most frequently observed subgroup. We found additional findings changing the perinatal management in three (8.3%) of the cases which underwent further examination with MRI due to ventriculomegaly.
... MRI allows a more accurate prenatal diagnosis than US, due to the detailed description of the cerebellum and the posterior fossa and can give a full assessment of the spinal lesion or other complications in Chiari II malformation (fig 4a) [42,[46][47][48][49]. ...
Open spina bifida, also known as spina bifida aperta is a neural tube defect involving the lack of closure of vertebral arches and associated meninges and/or spinal cord abnormalities.Ultrasound examination is the gold standard for the diagnosis of spina bifida aperta. It represents the main imaging tool used to ascertain this diagnosis early in gestation. Three-dimensional ultrasound is necessary to detect the level and the size of the defect. Magnetic resonance imaging (MRI) represents a more sensitive tool, giving specific information of the defect and associated anomalies, playing an important role in ruling out differential diagnosis. Due to the advent of MRI use, it is possible today to achieve in utero treatment of fetuses with this pathology. The aim of the current review is to provide an update of literature regarding the role of ultrasound and MRI in the prenatal diagnosis of spina bifida aperta.
